Social Justice, Health Inequities, and Access to New Age-Related Interventions

Abstract

New interventions into the aging process have already prolonged the life span of nematodes, fruit flies, mice, and most recently even of primates. What has been successful in laboratory animals may be applied to human aging in the long run as well. At the same time, the almost universal trend of population aging raises concerns that health care costs will rise significantly and that this trend will threaten universal and equal access to health-related services. Therefore, it is crucial to assess the potential impact of new age-related biomedical interventions on health care systems in order to predict who will have access to these interventions and how this will affect existing health inequities in old age. This would at first require data on the cost-effectiveness of new age-related interventions. However, such data are not yet available. Nevertheless, a discussion on the potential impact of this technological development in such an early stage has one big advantage: possible undesirable outcomes may still be prevented by timely regulatory action. Therefore, instead of trying to answer the question of the possible consequences for publicly and privately financed health care based on data concerning cost-effectiveness, we will try to anticipate which groups will presumably have access to these interventions into the aging process. We will also suggest a social justice framework to evaluate unequal access, based on a conception of health-related equality of opportunity. As a starting point for this projection, we will compare different biodemographic scenarios. According to our analysis, access to age-related interventions will be limited to certain population groups and this will further increase already existing health inequities among the elderly, which should be avoided from a social justice perspective. We suggest that the most promising strategy to prevent such a development would be to set priorities in publicly funded age-related research. An analysis of the development of NIA-funding and the current NIA strategy will examine to which extent starting points for such an ethically justified priority setting already exist and how it could basically be conceived.

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Notes

  1. 1.

    Following the terminology of the WHO commission on social determinants of health, by health inequities we mean “avoidable health inequalities” (Commission on Social Determinants of Health 2008: 25-35).

  2. 2.

    Cf. http://www.who.int/whosis/database/life_tables/life_tables.cfm (accessed 28.2.09). In the EU nevertheless substantial inequalities in healthy life years exist: See Jagger et al. 2008.

  3. 3.

    Source: WHO Life Tables for member states, http://apps.who.int/whosis/database/life_tables/life_tables.cfm, accessed 18.7.2009.

  4. 4.

    Statistics available at: www.statistics.gov.uk/statbase/Product.asp?vlnk=14466, accessed 18.7.2009.

  5. 5.

    see: http://www.nia.nih.gov/

  6. 6.

    The following information if not available directly from the NIA as indicated is based on an informative article by Robert Binstock (Binstock 2004).

  7. 7.

    http://www.nia.nih.gov/NR/rdonlyres/169BAC4D-FDF9-4FB4-8CB9-1D323F0F83F9/8872/CJ2009012808PDF.pdf.

  8. 8.

    National Institute on Aging 2007: 12. Of course the NIA outlines all age-related health problems as a general target of its work. This is not only Alzheimer’s disease, but also CVD, cancer and diabetes, decline in sensory functions, age-related problems of the musculoskeletal system and psychological disorders.

  9. 9.

    See http://www.share-project.org/ (accessed 28.2.2009).

  10. 10.

    See ERA-AGE Newsletter 11, available at http://era-age.group.shef.ac.uk/newsletters/25/eraage-newsletter-issue-11 (accessed 6.3.2009).

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Correspondence to Hans-Jörg Ehni.

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Ehni, HJ., Marckmann, G. Social Justice, Health Inequities, and Access to New Age-Related Interventions. Medicine Studies 1, 281–295 (2009). https://doi.org/10.1007/s12376-009-0027-3

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Keywords

  • Biodemographic scenarios
  • Life span extension
  • Priority setting in research
  • Biomedical aging research