Jakub Hlávka: The fact that we are living longer is good news

In 2023, the Czech Republic had the 21^st highest proportion of people over 64 and the 29^th lowest proportion of children under 15 in the world. The project, which secured funding from the Operational Programme Johannes Amos Comenius (OP JAK) call for proposals focused on the social sciences and humanities, aims to build research capacity for basic social science research and the analysis of public policy effectiveness. Jakub Hlávka, who is also the Director of the Health Economics, Policy and Innovation Institute (HEPII), offers an in-depth overview of AGEING-CZ, which began in January this year.

One of your goals is to quantify the impact of an ageing population on health and social systems. How will you go about your research?
We examine demographic projections and associated costs in each group, from which we can extrapolate future developments. We will use the standard method of modelling how the population is likely to use health and social services. We will then be able to assess the evolution of individuals’ health over time using a more advanced microsimulation method. For instance, we have noted for some time that cardiovascular health has been improving in Czechia. We can now treat diseases more effectively, detect them earlier, and reduce the long-term burden of chronic disease for individuals. On the other hand, the growing number of older people has the opposite effect: although individuals will be healthier on average, the cumulative need for health and social services will increase. Although standard and new methods should lead to similar results, microsimulation will enable us to target interventions more effectively. For example, we could use it to reduce risk factors for failing health in old age.

What are you planning to study in the area of cancer research, given that early detection of the disease is so important?
In terms of screening, it is useful to establish the cost-effectiveness, i.e. from what age and for which people it is economically and clinically worthwhile. The risk of cancer often increases with age, so early detection can prevent high future costs. Therefore, it is beneficial to have models that can estimate the long-term impacts and benefits of early detection, such as those we plan to develop. For example, we see huge benefits with colonoscopies. Every third one detects potentially risky adenomas that could lead to cancer in the future. If the cancer is detected at stage one, there is a 90% five-year survival rate, whereas if it is detected at stage four, the chance drops to only 10%. Although screening has reduced mortality rates by more than 30% over the past decade, hundreds of thousands of eligible people in Czechia still do not undergo it.

Your research should also aim to prevent overburdening of public systems. Will you also be examining how much people care about prevention, and how this translates into public health?
This is an extremely important issue, so we want to examine it from multiple angles. One is that of accessible, quality primary care and the associated primary and secondary prevention. We know that GPs have an important role to play. By carrying out routine preventive check-ups, they can communicate the basic principles of primary prevention and improve care for chronically ill patients. Health literacy is still a problem in the Czech Republic, with half of the population not being sufficiently aware. This leads to unnecessarily risky behaviour and less than optimal use of healthcare resources. At the same time, we see that health professionals often struggle to communicate effectively with patients due to time constraints and burnout. We will explore all of this, particularly with regard to the elderly population, whose interactions with the healthcare system should bring better benefits. Primary prevention and healthy lifestyles are also related to a healthy environment, as well as perhaps to the availability of wholesome food. Some of our researchers will be looking at external factors, such as the impact of air pollution on population health. Other colleagues will examine the cognitive abilities of elderly people. As people grow older, they may lose their ability to remember how to take care of their health. They may, for instance, forget to take their medication on time or neglect to attend medical appointments. People with a neurodegenerative disease may find it difficult to navigate the healthcare system and may also be vulnerable to various kinds of scam in their everyday lives. That is why we are devoting an entire research package to investigating the cognitive abilities of the elderly, led by colleagues from the Prague University of Economics and Business.

Which other aspects of an ageing population will be of interest to you? For example, will it also cover caring for elderly people who are no longer self-sufficient?
We are certainly interested in the challenges posed by an ageing population. For example, we will also consider family members who may need to care for their parents if the government is unable to provide for sufficient aftercare and long-term care services. However, if we know that the number of people with Alzheimer’s disease is going to double – which is a fairly safe assumption for the next 20 years – we will assess what this will mean for the system and for patients. Not everyone will be able to benefit from institutional care and it is to be expected that much of this care will have to be provided at home. This requires an adaptation of community-based social and health services.

Are you also considering respite services, which provide support for carers when they are tired and need a break?
Yes, day care centres for seniors and similar facilities are certainly one type of service that can help prevent burnout and prevent seniors from ending up in care homes earlier than necessary. These facilities can benefit both families and the system itself. We will try to estimate the predicted needs for different types of capacity, such as homes for the elderly, day care centres, and community-based services that the government needs to create. Although our grant programme focuses on science, we would like our outputs to have a practical impact. It is not just about estimating capacity needs; it is also about understanding deeper connections. Our aim is to map our current position and identify what will be needed in ten or twenty years’ time. This will contribute to the scientific understanding of what healthy ageing really means, and how we can create the right conditions for it – especially in the Czech context. We will also outline specific potential barriers faced by the elderly and their families in need of support to ensure that ageing has the least negative impact possible.

Another of your objectives is to identify opportunities that will promote the employment and employability of older people.
The labour market already indicates a high demand for workers. In general, we can expect the number of working age people to decline. At the same time, the need for health and social services will keep growing, even though we have new technologies such as artificial intelligence available. I anticipate that the labour shortage will become even more severe, so it would be a great help if younger seniors could participate more in the care for older seniors, for example through part-time work, volunteering or paid employment. If we fail to manage this situation, many young people in the workforce will be burdened with caring for their loved ones and this will also adversely affect the economy. We certainly have to plan for an ageing population, which will require an increase in health and social services. At the same time, however, we must ensure that we do not lose to international competition. This means not neglecting the knowledge economy, in which young people can develop and become innovative and competitive on a global scale.

Your research will provide forecasts of what the situation will be like in twenty and thirty years time. Does this mean that some of your findings may already have an impact on the lives of today’s 50-year-olds?
It could certainly help people who are not yet dependent on health and social care. We are talking about people in their sixties, for example, but especially about people born in the Husák era of the 1970s and 1980s – the 50-year-olds who will be entering retirement or senior age at a time when the population will be ageing very rapidly. If the current systems are not reformed, the availability of adequate social and health care may well be much worse than it is today. I hope that the Ministry of Health and the Ministry of Labour and Social Affairs will recognise our results, for example by providing more support for home and long-term care, where there is a significant shortage of staff and beds. In addition to long-term care, we stress that the high level of morbidity in the Czech population is a problem, as it reduces productivity and increases the cost of care. I would like our research to lead to better coordination and outcomes of care for the chronically ill, particularly those from disadvantaged areas of our country. If we can delay the onset of chronic disease, people in their fifties and seventies won’t require expensive care in a few years’ time,  which would bring enormous relief to the health and social systems.

As a health economics expert and principal investigator, you oversee five research packages involving leading researchers from several Czech universities. How did you go about finding people you want to work with?
Since the establishment of the Health Economics, Policy and Innovation Institute (HEPII) at the MU Faculty of Economics and Administration, we have had the advantage of being able to establish collaborations with top researchers across various fields of the social and natural sciences. Consequently, we recognise that ageing is a complex phenomenon that cannot be viewed purely from clinical or economic perspectives. The fact that we are living longer is good news. However, health care and support must adapt to this. It is not enough for economists to calculate the financial impact of an ageing population; we also need to understand the reasons behind illness and the factors that enable people to live healthier lives, as well as the most effective organisational structures for healthcare. That is why I also enlisted the help of experts from the RECETOX centre at Masaryk University, as well as from various other departments at Charles University, the Czech Technical University, Prague University of Economics and Business, and Mendel University. I also worked with many other partners, including the Institute of Health Information and Statistics and the Health Insurance Bureau. Few research grants in Czechia have such a great potential to bring together top researchers from so many different fields. That is why we are very pleased about the cooperation made possible by such a large-scale project.