The COVID-19 pandemic is providing urgent context for research and discussions on care for older people to be translated into practical use. At the same time, the crisis brings into sharp focus more general questions about equity and fairness in health and social care.
According to the World Health Organization Regional Office for Europe, over 95% of COVID-19 deaths occur in those older than 60 years. At the Department of Global Health and Social Medicine at King’s College London, academics are looking into both the bioethical as well as the social and economic challenges facing health and social care systems today in the context of ageing populations.
Professor Mauricio Avendano Pabon, Director of the Institute of Gerontology at King’s explained how most countries do not have well-established long-term care systems. Those that do, found themselves ill-prepared to deal with the challenges of providing care at home and at long-term care facilities such as nursing homes.
“Most countries do not have well-established long-term care systems for older people, with exceptions in Europe, North America and a few countries in Asia. This raises major questions about how to address the needs of older people affected by COVID-19 and their families,” he said.
Coming from a health economics background, research fellow Dr Ludovico Carrino observes that funding for long-term care systems is critical during this period.
“We know that COVID-19 affects older people disproportionately, which has put the spotlight on the resources that care homes have to provide care. Social care is also critical during social distancing policies, which may cause older people more difficulties in receiving the care that they need,” Dr Ludovico said.
An interdisciplinary approach
Learning to manage the health and social care needs of older people requires a special set of social science skills and a deep, interdisciplinary understanding of how policies across different areas influence older people, their families and society.
At King’s, the MA/MSc Gerontology & Ageing course aims to train students for leading roles in their own organisation or government to influence policymaking and the way we prepare for an ageing population.
The MA/MSc Gerontology & Ageing builds awareness around multidisciplinary perspectives on ageing, which is the first step towards influencing the provision of health and social services. The course also enables students to develop the skills to use research to inform decision and policy.
“We place an enormous emphasis on research skills that students can apply both within and beyond the academic setting, for example, to evaluate which policies would be better in their own organisation or country to address the needs of older people,” said Professor Avendano.
Though policymakers and national health systems have the most influence over the rights of older people, social and private organisations are becoming more important.
The MA/MSc gathers the views of geriatricians, clinicians, demographers, policy analysts, sociologists, and other social scientists in designing and integrating health and social systems to support the needs of an ageing population.
Equipped with knowledge and skills, graduates go on to influence decision-making in governments, national health and social care systems, and international organisations such as Age UK or the World Health Organization.
Another challenge faced by ageing populations is the lack of equitable access to social care. In most countries, most care is provided by family members such as spouses or adult children. Those in lower socioeconomic groups face difficulties in meeting the care needs of their older family members, while at the same time balancing work and caring for children.
“Over 95% of care is provided by ‘informal’ carers — unpaid family members or spouses who are predominantly women. Some may have to leave the workforce and bear new physical and emotional tolls alone. Many end up in poverty’, said Dr Carrino.
Dr Gry Wester, Lecturer in Bioethics explained the tough balance this entails:
“On the one hand, social care is costly, so governments are often reluctant to support older people unless family members cannot provide informal care.
“On the other hand, the burdens of providing informal care are distributed very unequally. There is a need for solutions that recognise and value the important work that informal caregivers do and provide support to mitigate the burdens involved with providing informal care.”
A bioethics perspective on COVID-19 for governments and societies
The MSc Bioethics & Society addresses ethical questions that arise in the context of the life sciences, health care and public health.
Bioethics addresses questions spanning from the level of the individual — for example in the context of the physician-patient relationship, and the impact of emerging biotechnologies such as genome editing on reproductive decisions — to broader questions around social justice and health, such as fairness in the allocation of health and social care and the structures of institutions and systems.
“In terms of questions around the design of health and social care systems, from a bioethical perspective, we are interested in going beyond accounting for the differences that exist between systems across the world, to say something about which kind of system is better from the point of view of fairness,” Dr Wester explained.
She posited, “Everyone needs health care, and a good health system must ensure universal access — but who should be entitled to what, and who should pay for it?”
“Should health care be free only for the poor, or should it be free for everyone, independently of level of income? And to what extent should we allow those who can afford it to purchase more and better health care?”
The COVID-19 pandemic has exposed the weaknesses of countries like the US, where the market-based healthcare system ties healthcare insurance to employment. Over 35 million people are now without jobs, and thus without health insurance at this critical time.
The pandemic also raises other acute ethical questions about priority-setting in health care. When there is a shortage of ventilators or staff, who should get treatment first? What other treatments or services should be put on hold to create the capacity to deal with the pandemic?
Questions such as these require us to think carefully about what values are at stake and the different trade-offs involved. The Bioethics & Society MSc draws on concepts, theories and methods from philosophy and the social sciences to equip students to grapple with complex societal challenges involving health.
With rigorous training, graduates go on to guide policy and action in governments, think tanks, as well as research and ethic committees in hospitals and private companies.
“Graduates return to their professional lives with a broadened perspective and valuable problem-solving skills. Bioethics expertise is extremely useful in a diverse range of professional contexts,” Dr Wester said.
Caitlin Gardiner, part-time student of the Bioethics course, agrees. “Bioethics is just so applicable [not just] to my work as an accident and emergency doctor, but also to all areas of society. To study it, — then think about these issues on the ground while I’m working, while I’m thinking about my practical life — has been wonderful.”
Widening your expertise at the Department of Global Health and Social Medicine at King’s will prepare you for a rewarding step-up in your career, where you influence real change for those who need it most.
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