Introduction

The UN World Population Ageing Report for 2009 stressed the implications of population ageing for the viability of intergenerational support systems and the sustainability of social security and healthcare systems (UN 2010a). These concerns are amplified in countries where the speed at which population ageing occurs is greatest, many of which are countries where social security and healthcare systems are least well developed. The significance of the trends is enormous. In this chapter the focus is on the data on life expectancy and on mortality and morbidity rates, and on the implications of these as a basis for policy making on health and care. It sets the scene for the discussion in subsequent chapters. Since policies both influence and are influenced by the data, a critical approach is necessary which questions approaches to information gathering and interpretation as well as analysing the basis on which policy priorities are established.

The production of information on ageing, health and care is influenced by a range of factors: practical, methodological, conceptual and political. Studies of global inequalities in health, for example, are often based on comparisons between regional groupings of countries, which have traditionally been organised in these ways, based on preconceived ideas about their comparability that are derived in part from colonial histories (Day et al 2008). Within these regional groupings there are significant variations between countries in patterns of health, which highlight the important of political and cultural contexts as well as broad measures of socioeconomic status. International comparisons are open to question also because of the scale of difference in population size, which, as pointed out by Lloyd-Sherlock (2010), presents a distorted picture. National-level data also obscures inequalities within countries and, in some cases, the extent of inequalities calls into question the value of the national data. For example, in India, as Mini (2009) pointed out, between different states the patterns and trends in mortality and morbidity vary enormously. In the state of Kerala the figures are more comparable to those in high-income countries than to other Indian states. Inequalities in health between ethnic groups are also masked by national-level data.