Global Development Institute podcast
Global Development Institute podcast
In Conversation: Gindo Tampubolon on healthy ageing around the world
A conversation with Gindo Tampubolon, GDI's Reader in Global Health, to discuss his research on global healthy ageing and his work as a lead expert for the World Health Organization's Life Course & Healthy Ageing expert group as part of the UN's Decade of Healthy Ageing Initiative.
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Intro music Anna Banana by Eaters
Speaker 1 [00:00:02] Welcome to the Global Development Institute podcast. Based at the University of Manchester, we're Europe's largest research and teaching institute addressing poverty and inequality. Each episode, we'll bring you the latest thinking, insights, and debate in development study.
Speaker 2 [00:00:30] Welcome to the Global Development Institute podcast. I'm your host, Louisa Han, research communications officer here at GDI. And today I'm sitting with our redoing global health, Gindo Tapuboron, to discuss some of the ways his research on aging around the world is influencing decision makers and shaping discourse on this vital topic. So, yeah, just to start off, Gindo, I'll let you introduce yourself and your research interests.
Speaker 3 [00:00:55] Hi, thanks very much Lisa. I'm Gindo and I teach global health here at the Global Development Institute and I study healthy aging around the world. The nice thing about this setup at GDI is we do our research and we teach based on our research. And as Lisa mentioned earlier, we also advise based on our research. So when we advise the British government, or international organizations, or government around the world, we base it on our own research.
Speaker 2 [00:01:34] Great, thank you. So I guess before we get into some of the details of what you're doing at the moment and your roles, maybe you could just tell us a little bit about why you're so passionate about health, global health, issues surrounding aging etc. What kind of what gets you up in the morning?
Speaker 3 [00:01:52] Yes, I do get up in the morning excited actually, no honestly. I did mention the setup that is unique to GDI, that is one that keeps me going. And more specifically, of course health is very important. You don't need COVID-19 pandemic to remind you of that. I think people are beginning to realize and more and more people are beginning to realize that money is not everything and what else? Family, of course, but health is very, very near the top. Wherever you are, what stage in economic development, what stage in life, and now of course I'm also talking about aging. The stage in life where people have finished their working age, for instance. When I look more closely at it around the world, that's what Global Development Institute is very well known for, when I look at it round the world suddenly I find that it is actually a huge challenge. But even more so in the Global South. So these two things, health is very important and aging is very important and extremely important in the global south, that really is put together a combination that challenge me every morning, that excites me every morning.
Speaker 2 [00:03:33] Mm-hmm, yeah. You can't swap quality of life for, you know, money or anything, can you? Absolutely, yeah So, yeah, let's start off with some of the basics. There are kind of marked differences to how population growth and aging is unfolding across the global north and the global south.
Speaker 4 [00:03:54] Absolutely.
Speaker 2 [00:03:55] So you know I've personally noticed quite a lot of media coverage that's talking about low fertility rates and you know this kind of potential crisis of elder care in the global North societies, you know particularly in European countries for example, and they're talking about you know boosting birth rates etc. So I wonder if you could just kind of set the scene a little for us globally.
Speaker 3 [00:04:17] Yes, yes. Every now and then we face with this or being reminded in the public by politicians, by experts, by our own experience of the challenge that population put to our ways of life and our views of how the world and the planet is coping. And of course recently issues about low fertility rate in Europe or in the global north becomes really important because it has a mirror image of that, namely older people care. If there is not enough fertility, then it is not difficult to imagine sooner or later. There will not be enough people to put into the coffer of society to look after people who have put their saving investment in the past, so caring for older generation in the population, the same population. But I think as you dig a bit deeper into it, this is only a challenge for the global north. I did alluded to it earlier. In fact, I'll give you a picture, I give you a number in fact. If we look at how rapid a population age, how rapid the ratio of people needing care to people actually providing care. So how rapid population aging has happened in the global north and is happening in the global south. It is stark. What took France or the UK a century is taking China a couple of decades. So five times more rapid. And China is not the only one. Soon India. And these are massive, massive populations. These are not driven by failure, this is actually driven by human achievements, social progress, medical advances, really behind that. Now we have to think carefully about the consequences of population aging to make that the quality of life. Of people in older age, and by the way we are at one point, really their quality of life will not be compromised. So this is the challenge not only in the global north, but even more so in the Global South.
Speaker 2 [00:07:19] Great, thank you. So, and how did you kind of, in your research on global aging, how did you explore kind of the size and the quality of the challenge and what this sounds like?
Speaker 3 [00:07:28] This is what is striking, this is what striking as you probably remember my latest blog this year with the Global Development Institute. When I begin to look at it, the stark evidence is about 90% of what we know about aging, about caring, about quality of life, about dignity, about 90 percent of good evidence is from the Global North. When 90% of people who are experiencing, populations who are experiencing aging, is in the global south. And so we really need to invert that. We really need it to get more good evidence to help everybody around the world, but certainly we need more good evidence from the global South. Even more to work together, looking at the global healthy aging, and GDI is the best place for that.
Speaker 2 [00:08:32] Yeah definitely. So in terms of some of the some of that research that you mentioned that's very global north oriented is there anything specific you can think of that any disparities between over north and south that are under research.
Speaker 3 [00:08:48] I already alluded to it earlier, I think. One is the speed of aging is actually much more rapid in the global South.
Speaker 2 [00:08:58] Okay
Speaker 3 [00:08:59] five times, in the case of China, if you compare it with France. Other countries are of the same order, double or triple the speed. And we're talking about the size. So the size and speed of this is really need to be brought into our attention because it's so easy to think about. Population aging, oh that must be Japan, that must be Europe. But the challenging population aging is actually, when you look at the size, when you looks at the speed, is the middle-income countries. And let me tell you what it means in practice in politics. We already mentioned about caring for older people. Here is a stark potential. If China need all the carers... For their older people, there is no chance Britain will get the carers they want from overseas. No way you can compete against China. When China put their minds into, we need carers for our older people. So it is a global challenge. It is not something in the Global South because of the labor market for caring for older people that is global.
Speaker 2 [00:10:39] And in terms of the factors that influence how well you age, I mean, there's probably quite a few, right? What are those? Poverty, is it, you know, what kind of intersecting things you're looking at?
Speaker 3 [00:10:52] This is what is nice about or what is fortunate about some work that I did in the past. So, exactly 10 years ago, the WHO published the report on aging and health, no mention of childhood in there. So that's a WHO world report on health and aging. Exactly 10 years ago, no mention of childhood. In exactly the same year I published the work on childhood actually matter for old age health. So growing up in poverty matters whether we grow old in infirmity or in health. So that was one of the major factor that was out of the frame 10 years ago, but fortunately they caught up with it. So now exactly 10 years, just last month they published the live course framework for healthy aging and in fact the subtitle of that implementation guidance. So, countries now. Are equipped, if not invited, to think about this factor.
Speaker 2 [00:12:25] Right, yeah, definitely seems like a matter of, you know, just social justice to precisely think about that. Yeah. This is probably a good time to have a little talk about your relationship with the UN Decade of Healthy Aging Initiative. So if you could just tell us basically what it is, how did this kind of connection come about?
Speaker 3 [00:12:43] Yes, so by now I hope you can see that in the public mind, these ideas of aging challenge, these ideas are making sure that they have quality of life is everywhere and the United Nations put this initiative, this decade is the United Nations decade of healthy aging. And, of course, the custodian of that is the World Health Organization. And, as I mentioned earlier, one thing that we brought into the conversation is the importance of childhood, or more popular these days, the importance of looking at the whole life course. And UN Decade of Healthy Aging has run of course for five years and in the good practice of international initiatives, we really need to look and review to see whether we need mid-course correction. And so, they assembled experts from around the world to look at whether the initiative is going to achieve its purpose of delivering healthy aging to the global population and One way of looking at that is to... Check whether indeed we have covered all the necessary factors that we really need to bring into the frame. So life course, childhood, and I just, as I said, happened to wrote about it ten years ago, so it's sort of timely.
Speaker 2 [00:14:34] Great. So in terms of practicalities, you're the lead for this life course in Healthy Aging group, right? So if you could just tell us a little bit how this actually shapes your daily research and activities.
Speaker 3 [00:14:47] Exactly. So, life course from cradle to grave. Ideally, we would have good data from 200 odd countries, representative populations that we have followed over 80 years. None of that is around, right? Yeah. Even if we have all the goodwill in the world, all the money in the world. The skills to do that is not around. I don't need to remind you of the COVID-19 pandemic and how important information and how lacking information was. So we'll have to make do with what is available. So I gathered whatever is available that can help me to reconstruct the life course of people from around the world. And when reconstructing their life course, have to do it very, very carefully because memory is fallible. I don't know whether you still remember your holidays four or five years ago, the lovely dinner you have in the restaurant, the name of that restaurant. That was five years ago. What if I ask you something? Decade. What if we ask these older people something 70 years earlier? But we really need to ask them that because we want their life course to be understood, to help them in the last part of the life course. So I reconstruct carefully all around the world, and that's the basis of the research. That leads to policy advising that we do. I mean, this is standard GDI. We do research carefully before we teach, before we advise.
Speaker 2 [00:16:59] And in terms of kind of a makeup of the research teams who you're working with, what does that look like? It's trouble.
Speaker 3 [00:17:06] It's from all around the world, from Canada to Australia, Asia and Africa. So people who are... Interested in this and experts in this. And then in a typical WHO or other international organizations, we have a primus inter paris lead, so the first among equal. So that's how I lead the experts that come from all around the world. And tomorrow we're going to meet and the day after tomorrow too. The nice thing about COVID for the first time in this podcast, something good come out of it. It's so easy for us now to set up online meeting. So easy for to share information and so on. So tomorrow and the after we'll do that. Look at progress and to point out where to next. We have done a lot of research work on these reconstructing the life course of people from around the world and we look their allostatic load one measure of the Body wear and tear through the life course from their birth up to their 70 years old and so on We're going to report also on their memory. How does their life course? However, whatever shape it took Matter for their memory later on things like that. We're not going to share. We are going to discuss. We going to advise
Speaker 2 [00:19:02] Great, I look forward to hearing how it all goes afterwards. You alluded earlier a little bit to policy makers and kind of the way in which your research has been received. I wonder if you could tell us a little more about that in terms of, has there been any kind of barriers to understanding or any sort of instances of things that are getting lost in translation? How do you have those relationships?
Speaker 3 [00:19:23] We are fortunate, I can give you two examples, one with the UK ones and the other one, of course, with the WHO. All good stories, I think, in that all it needs is persistence and clarity. So, with the UK, this is the Chief Medical Officer, Professor Chris Witte. The latest report, 2023, is also on healthy aging. And right, bang, in the middle of the report is the frailty, the downside, the other side of healthy aging, so frailty. In the middle the report is the frailty map that we produce for the country. All the local authorities really need to look into this because their local authority is shaded a bit darker compared to the neighboring local authority, they really need to spend some more money on maintaining the health of other people in that. So right bang in the middle of the UK Chief Medical Report on healthy aging is our research. So that's a good story of how our research feed into government policy. And last year was the university 200 years. We invited Professor Sir Chris Whitty to give a talk here and he remembered that piece. So in a conversation he thanked us, the team and because right back in the middle of that report was our work. So that's good story. The other one is also good, but it needs a bit more persistence. With the WHO, for instance, like I said, I wrote about the importance of life course or childhood ten years ago, when exactly the same year the WHO published... Would report on health and aging and childhood was not there at all. And so it does require a bit more patience to repeat and to vary the presentation of exactly the same idea. So for instance in the original report I said one way to understand how material childhood poverty matter is to look at their overcrowding. Did they grow up in an overcrowded homes? Only 10 years later, in the report that I mentioned earlier that the WHO advised countries to implement, to guide life course framing of health, there it is, crowding. So whether they have good housing conditions, whether the homes are overcrowded, they really need to look into that. But that's after a few meetings, unlike with Sir Chris Witte. So maybe it's to do with the fact that WHO is an international. They look at hundreds of countries, right? So those are good stories. Honestly, I can't rack my brain to tell you the other side of the story. Not that, but I'm fortunate.
Speaker 2 [00:23:11] Yeah yeah yeah sounds great um so in terms of let's go back to this the decade the initiative which concludes yeah 2030 2030 so this is the same time as the sdg's like yeah yeah yeah not expire whatever the word is um deadline uh so kind of how do you see your work kind of
Speaker 3 [00:23:34] So this will end in 2030, but I'm actually very excited about it because although this will end 2030, what we have in place is going to be useful for countries around the world beyond that. The recognition that this is a challenge, not only for the Global North, not primarily for the global north, I think it's beginning to dawn on people. The size and the speed of it really moving center stage and it's not going to fall off the cliff by 2030. So the recognition is there. But also the more important bit is we now put in place the frame that is useful beyond talking about healthy aging. The frame of life, of course, understanding. Understanding quality of life and one of my specific tasks for the WHO, understanding dignity towards the end of life, is something that is shaped through the life course. I I do not think it will go away. It is so appealing once you put them in front of everybody. So what's going to happen? We don't know. But these two things are not going to go away, that we really need to get good evidence from the Global South when we're talking about healthy aging to redress the imbalance I raised earlier. And one of the tools that we put in place is really useful everywhere around the world, whatever outcomes of wellbeing that we're interested in. Quality of life, dignity, life course, shaping is here to stay beyond 2030.
Speaker 5 [00:25:37] I think that's a great place to wrap it up on. So thanks very much, Gindo, and good luck with your meeting tomorrow.
Speaker 3 [00:25:42] Thank you very much. Thank you. Thank you