Securing the Future: Why Long-Term Care is Essential for Health and Economic Equity

In a compelling new policy brief titled “Fostering individual health and financial well-being through robust care systems”, the World Health Organization (WHO), in collaboration with research leaders from the University of Trieste, the London School of Economics and Political Science, the WHO Regional Office for Europe, the European Observatory on Health Systems and Policies, and the University of Lisbon, makes a powerful case for urgent investment in long-term care (LTC) systems. The report asserts that true social and economic development is unattainable in any society where older people fall into poverty and suffer neglect simply because they need care. Strong, publicly financed LTC systems, the authors argue, are not only necessary for protecting the health and dignity of aging populations but also for ensuring intergenerational economic equity and resilience.

The Ageing Population and the Rising Tide of Care Needs

The demographic shift toward an aging population is both rapid and far-reaching, bringing with it a sharp increase in care needs. As life expectancy rises globally, so does the number of years people live with physical or cognitive impairments. The report underscores that over 50% of people aged 85 and older face at least one significant limitation in their ability to perform daily activities like bathing, walking, or eating. This figure rises steeply with age, reflecting a pattern observed across countries as diverse as Australia, China, India, and Indonesia. A key insight is the growing gap, now estimated at 9.5 years on average, between life expectancy and healthy life expectancy. This means that while people are living longer, they are also spending more of those years in poor health, often requiring consistent support and care services.

The COVID-19 pandemic has further exacerbated this situation, contributing to long-term declines in health and increasing the overall demand for LTC. Despite this, most individuals remain dangerously underprepared, with widespread misconceptions about future care needs and the assumption that health insurance will cover costs. This underestimation leads to insufficient financial planning, leaving many vulnerable to catastrophic expenses later in life.

When Health Care Ends and Financial Strain Begins

Even in high-income countries, the absence of strong LTC systems pushes older adults and their families toward financial ruin. The WHO report highlights that nearly half of older people requiring care in such settings would fall into income poverty without public LTC services. In Europe, one in four users of LTC services experiences catastrophic out-of-pocket expenditures, often wiping out family savings and deepening inequality. These costs disproportionately affect low-income households and caregivers, creating a vicious cycle of hardship that transcends generations.

Unlike health care systems, which are typically protected by caps on individual spending and benefit guarantees, LTC systems frequently expose users to unbounded financial risk. Many nations cap the amount of care their public systems will fund, regardless of individual need. As a result, those with high care needs, such as people with dementia, stroke survivors, or frail elderly individuals, are left facing immense personal costs. Only seven OECD countries currently ensure that no older adult will fall into poverty as a result of accessing LTC.

The Gendered Burden of Care

The unequal burden of LTC is especially severe for women, who form the majority of both care recipients and caregivers. In many countries, women live longer than men and are more likely to live alone in old age, increasing their reliance on formal care. At the same time, they are more likely to provide unpaid care to family members, often at the expense of their own careers, education, and long-term financial security. In Japan, for example, women outnumber men three to one in institutional care settings, highlighting the scale of their care needs.

This dual role, being both the primary providers and recipients of LTC, amplifies the economic disadvantages women face. Informal caregivers, most of whom are women, frequently leave the workforce or reduce their working hours to provide care, leading to lower lifetime earnings, reduced pensions, and fewer savings. These effects compound across generations, making caregiving a key vector of gendered economic inequality.

The Call for Bold Policy Shifts

The WHO report does not stop at diagnosis, it offers a clear prescription. It advocates for sweeping policy reforms to expand public investment in LTC, remove caps on individual out-of-pocket payments, and broaden eligibility criteria to make services accessible to more people. Importantly, it emphasizes the need to support informal caregivers not just with financial stipends but also with structural protections like flexible working arrangements, paid caregiving leave, respite services, and caregiver training. Such policies would allow caregivers to remain employed and economically active while still supporting family members in need.

Countries that have adopted more universal and generous LTC policies are already seeing dividends: better physical and mental health outcomes for older adults, lower rates of family impoverishment, and improved quality of life across the board. The report makes it clear, this is not just about caring for the elderly; it’s about investing in societal well-being and economic sustainability. With aging populations now a global reality, the cost of inaction is rising daily.

The WHO calls for a paradigm shift in how countries view long-term care: not as a private burden, but as a public good. The care dividend, improved well-being, financial protection, and intergenerational equity are within reach. The moment to act is now.