Ageing people, ageing workers Health surveillance of Italian health care workers Lucia Isolani, M.D. Public Health Service, ASUR Marche Macerata - Italy Professor of Occupational Medicine at Faculty of Law, University of Urbino - Italy 1
A Transforming World: the longevity revolution Ageing is becoming a virtually universal phenomenon during the 21 st century It s the triumph of public health (declining mortality, growing life expectancy at birth), medical advancement and economic development 2
Young Children and Older People as a Percentage of Global Population: 1950-2050 United Nations, 2013 3
Mortality is declining 4
In 2000, A Fairly Young World... Under 5% 5% to 12.4% 12.5% to 20% Above 20% Percent of Population Age 60+ in 2000 Source: U.S. Census Bureau 5
... Rapidly Aging by 2025 Under 5% 5% to 12.4% 12.5% to 20% Above 20% Percent of Population Age 60+ in 2025 Source: U.S. Census Bureau 6
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Increasing age, increasing health risks and the associated medical costs 9
Life expectancy gains mean a shift in the cause of mortality: from infectious diseases and acute illness to chronic diseases and degenerative illnesses (diabetes, cardiovascular disease, cancer, Alzheimer) 10
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Italy s population has been continuously ageing since 1960 The median age in 2015 was 3 years older than the median age of the EU overall population (45 compared with 42) 14
The ageing of the Italian population is predicted to continue and although the country will experience a very moderate pattern of ageing from 2040, the old-age dependency ratio will increase from 33.7 % (the highest in the EU) in 2015 to 53 % in 2060 (above the predicted EU average of 50) EUROSTAT, 2014 15
The share of the oldest age group (65 years and above) has increased since 1990 from 15% to 21% in 2012 The group of 55 to 64-year-old remained at 12% between 1990 and 2012 16
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The age group 65+ will almost double between 2015 and 2065, from 21,7% in 2015 to 32,6% of the total population in 2065 18
Aging people, aging workers 19
World s workforce is ageing and many States are increasing their official retirement ages Increasing employment levels and prolonging people s working lives have been important objectives of national and European policies since the late 1990s 20
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In many EU countries, only a minority of workers continues to work after 55-60 and these are healthier of those who retire (healthy worker effect) 22
26% of workers think work affects their health negatively 22% of workers 50+ think they would not be able to do their current job at the age of 60 OSHA UE, 2013 23
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No official definition of the elderly population and the older labour force exists in Italy 25
Conventionally, the older labour force is composed of people aged either over 50, or between 55 and 64, while individuals over 65 (sometimes over 60 in the case of women) belong to the elderly general population 26
Employment rate per age groups in Italy, 2000-2013 27
The employment rate of those aged 55-64 is relatively low in Italy, around 48 % compared with the EU average of more than 53 % in 2015 28
The employment rate of the oldest age group (65 years and above) in Italy has been around 1 to 2% lower than the EU average throughout the past decade. In 2012, it was 3.4%, compared to an EU average of 5% 29
Why healthcare sector 30
Healthcare is the fastest-growing sector of the EU economy, employing 10% of EU workers Women represent nearly 77% of the healthcare work force (13.1 million) 31
There has been a rapid ageing of the healthcare workforce in the EU as the baby-boom generation started to reach retirement age 32
This is reflected in the share of physicians who were aged 55 or over, which rose from 24 % in 2004 to 37 % in 2014 The share of physicians aged 55 or over in the total number of physicians was within the range of 40 46 % in Bulgaria, Cyprus, Germany, Hungary, Belgium, Latvia, Estonia and France, peaking at 52 % in Italy. By contrast, the relative importance of this age group was less than one fifth in Malta (17 %) and the UK (13 %) in 2013 EUROSTAT, 2013 33
The Italian health-care sector workforce correspond to the 7.2% of the total workforce ISTAT, 2015 646.236 health workers: 107.448 Physicians, 263.803 Nurses Ministry of Health, 2010 Italy has the highest share of physicians aged 55 or over RGS, 2015 34
The health workforce is ageing like the rest of the population Eurostat Evaluation Report AHM 2007 35
Old workers in Italy (> 50 yrs) answer: 32%: carry heavy loads at work (32% UE) 21% tiring or painful working positions (16% UE) 13% shift work (14% UE) 11.4 work at night at least once a month (16% EU) 76% reconciliation between working and private time (85% UE) 29% three or more external constraints on their work pace (27% UE) 16% on-the-job training (26% UE) 24% work did affect their health negatively (27% UE) 78% satisfaction with working conditions (84% UE) 65% able to do their current job at the age of 60 (71% UE) 34% measures to adapt the workplace for older people had been put in place at their workplace (31% UE) 36 Fifth European Working Conditions Survey (5th EWCS), carried out by the European Foundation for the Improvement of Living and Working Conditions (Eurofound) in 2010
Health care workers face a wide range of hazards on the job: sharps injuries, harmful exposures to chemicals and hazardous drugs, back injuries, latex allergy, violence and stress 37
Cases of nonfatal occupational injury and illness with healthcare workers are among the highest of any industry sector EU-OSHA, 2003 Eurostat, 2010 38
Although the risk assessment and the possibility to prevent or reduce healthcare worker exposure to these hazards, healthcare workers continue to experience injuries and illnesses in the workplace
Is healthcare sector an healthy and safety workplace for old workers too? 40
The healthcare work is changing rapidly as well: workloads are increasing faster than the number of personnel, and general/family practice is developing, though specialization remains strong. Ambulatory and home care are expanding too. Teamwork is becoming the main organizational arrangement, and there is now a great deal of pressure to be simultaneously more effective and more efficient 41
There are forecasts of significant reductions in certain categories of personnel, such as nurses and general practitioners 42
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ESTIMATED SHORTAGE IN HEALTH CARE SECTOR IN ITALY BY 2020 Health Professionals or other health workers Estimated shortage by 2020 Estimated percentage of care not covered Physicians 230.000 13,5% Dentists, pharmacists and physiotherapists 150.000 13,5% Nurse 590.000 14,0% Total 970.000 13,8% European Commission, 2014 44
In this panorama there is an international recruitment of young health personnel 45
Changing supply of health services Changing demand for health services Changing health needs The migration of health workers is (could be) the response to these changes 46
About 4.4 % of all physicians in Italy were born abroad, an increase of 1 % since 2004 47
A much larger proportion, 28.4 % of nurses registered with the Italian Nursing Federation are from outside Italy 48
In according to the Italian welfare state model, policies related to workforce ageing are characterized by a high proportion of expenditure on old-age pensions, reflecting the low labour-force participation of older workers and early retirement ages It is also characterized by reliance on support from family networks 49
Considering the continuing ageing of the population, and in particular the health workforce, there is a need for more emphasis in policy development on increasing some concepts (Active ageing ) that appear at policy level, but have not yet been implemented in practice 50
Considering the very strong social dialogue with stakeholders and trade unions, there is a need to work with social partners focusing on the health indicators, working conditions and organization referred to the ageing and older workers 51
The aim is to promote a new culture, learning to manage workplace safety and health in the context of the ageing workforce 52