Ageing populations and care ecosystems: Policy complementarity, substitution and disconnect


Global ageing is a phenomenon that created considerable opportunities as well as significant challenges. Longevity and increases in healthy years generate a range of societal and individual benefits. However, not all extra years of life are spent in good health, thus placing increased demands on care ecosystems encompassing formal and informal health and care services and support mechanisms. Furthermore, the dynamics of population ageing itself entail changes in the population structures, such as the availability of working-age groups as well as the family unit itself, thus posing challenges to the availability and ability of the different actors within the care ecosystems to play their part in meeting the escalating demands. Thinking globally, the fastest transformations in ageing structures are currently taking place in low- and middle-income countries (LMICs).

Many LMICs will experience such transformations within as little as 20 years compared to over a hundred years in some European countries such as France and England. The World Health Organisation estimates that by 2050, 80 per cent of the world older people will be living in LMICs, calling for an urgent reassessment and development of existing and new health and care policies to encompass formal/informal and individual/state support mechanisms. In this seminar, I provide an overview of global ageing followed by an interpretation of the care ecosystems drawing examples from high-income and LMI countries.

In this presentation, Professor Hussein explores the dynamic relationship between formal and informal care spheres as two vital interactive components of an overall ecosystem. Some of these roles are based on assumed preferences and availability of informal support and are guided by fiscal and infrastructure challenges, among other factors. I will discuss the increased policy narratives in Europe of the importance of informal networks such as ‘intergenerational support’, ‘care communities’, individual self-support as complements, and potentially substitutes to more formal LTC services.

She constructs and compares these remerging interests to current LTC support in LMICs, using the Middle East as a regional example, which relies almost solely on these informal support mechanisms. These spheres of formal and informal care are viewed with different lenses within the policy landscape yet can connect or disconnect from their assumed roles and ability to achieve the desired outcomes. Such roles also exist within a framework of shifting responsibilities across substitution and complementarity across various actors: the state, community, family and the individual. Professor Hussein argues for developing a dynamic care ecosystem approach acknowledging inequalities and gender bias when assuming roles to various actors yet is adaptive to changes across the life course and external factors, such as technology and migration.


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Professor of Health and Social Care Policy, the London School of Hygiene and Tropical Medicine, UK

Shereen Hussein is a Professor of Health and Social Care Policy at the Department of Health Services Research and Policy (HSRP) at the LSHTM. She is a Co-Director of the PRUComm policy research unit. She is also an Honorary Professor at the University of Kent and King’s College London in the UK and the University of Southern Queensland in Australia.

Shereen is a demographer with expertise in labour-migration, sociology and economics. Her primary research revolves around ageing, family dynamics, migration and long-term care. Shereen has previously worked with the United Nations, the Population Council, the World Bank, and the League of Arab States. Her current research focuses on ageing demographics, long term care demand and migration within the UK and Europe and the implications on policy and practice.

Shereen has conducted extensive research on population ageing and its impact on long term care and health policy and practices in the UK, internationally and in the Middle East and North Africa (MENA) region. She has contributed to recent United Nations’ policy response to ageing in the region through collaboration with UN-ESCWA and directly providing expert consultations to several countries in the region including Turkey, Oman and Egypt. Shereen leads many large research projects on ageing and long-term care in the UK and contributes to a large project addressing responses to dementia in developing countries STRiDE. Shereen is the founder and lead of the MENARAH network.