Aging Without Care: WHO Reveals Stark Health Gaps in European Older Populations

A new report by the World Health Organization (WHO) sheds light on a growing public health challenge in the WHO European Region, unmet health and social care needs among older adults. As life expectancy climbs and populations age, health systems across Europe face increasing pressure to adapt. The report warns that longer lives are not necessarily healthier ones, particularly when access to affordable, timely, and quality care remains unequal.

By 2050, over 35% of the region’s population will be aged 60 or older. While universal health coverage (UHC) is a stated goal under the Sustainable Development Goals (SDGs), the evidence shows that many older Europeans are slipping through the cracks. In some countries, catastrophic health expenditures, defined as health costs exceeding 40% of a household’s disposable income, affect more than 15% of families. This financial burden is especially acute in countries like Armenia, Georgia, and Ukraine, where health systems rely heavily on out-of-pocket payments.

Two Key Datasets, One Alarming Picture

To understand the scale of unmet needs, WHO researchers used a two-pronged approach. First, they conducted a systematic review of 30 peer-reviewed studies covering 44 of the region’s 53 countries. Second, they analyzed data from two major population surveys: the European Health Interview Survey (EHIS) and the Survey of Health, Ageing and Retirement in Europe (SHARE).

These surveys allowed the researchers to quantify the prevalence of unmet health and social care needs and to compare estimates across different data sources. But they also revealed a troubling inconsistency: EHIS data showed significantly higher rates of unmet health care needs compared to SHARE. For example, in Portugal, 40.9% of older adults reported unmet health care needs in EHIS, while SHARE data indicated a more modest 27% in Greece as the highest figure. Unmet social care needs, defined as assistance with daily activities like bathing, dressing, or cooking, were even more widespread, with countries like Croatia and Estonia reporting figures above 50%.

The discrepancy stems largely from methodological differences. EHIS asks about delays in receiving care, while SHARE focuses on care that was completely forgone. EHIS also includes mental health services in its definition of health care, whereas SHARE includes specialist and optical care. These distinctions have real policy implications, as inconsistent data leads to inconsistent interventions.

Four Barriers: Why So Many Go Without Care

The report categorizes the reasons for unmet needs into four main barriers: affordability, availability, accessibility, and acceptability.

• Affordability: High out-of-pocket costs prevent many from seeking care, particularly in Eastern and Southeastern Europe.

• Availability: Long waiting times and overburdened systems delay treatment, even for urgent needs.

• Accessibility: Geographic barriers, like distance from care providers, especially affect those in rural areas.

• Acceptability: Cultural or psychological reasons, such as fear of doctors or mistrust of the system, were also noted, especially during the COVID-19 pandemic when fear of infection led many to avoid health facilities altogether.

Each country shows a unique mix of these barriers. In Ireland, for instance, 62.7% of unmet health care needs were due to long wait times, while in Türkiye, affordability and accessibility were dominant concerns.

The Intersectional Burden: Who Gets Left Behind?

The study’s intersectional analysis, combining age, sex, and place of residence, revealed important disparities. Women over 70 living in rural areas were often the most likely to experience unmet needs, particularly in countries like Denmark and Slovenia. However, data inconsistencies made it difficult to draw universal conclusions.

Smaller sample sizes in rural areas, particularly in the SHARE dataset, resulted in wider confidence intervals and potentially less reliable results. The researchers caution that this underrepresentation could mask the true scale of the problem among vulnerable subpopulations. Still, across the board, those aged 60–69 in urban settings also reported relatively high rates of unmet needs, suggesting that even proximity to services does not guarantee access.

Toward Harmonized Solutions: The Road Ahead

The report makes several concrete recommendations to improve measurement and reduce unmet needs. First, it calls for harmonization of survey methods, including clearer definitions and more consistent questions. It proposes standardizing how unmet care is measured, especially distinguishing between those with no need and those whose needs were fully met.

Second, the report urges the inclusion of social care indicators in global monitoring systems like the WHO’s Global Health Observatory. It also advocates for improved survey instruments that capture the full range of formal and informal care providers, from hospitals to family caregivers.

Finally, the authors recommend mixed-methods research that combines large-scale surveys with qualitative interviews. This would allow researchers to better understand the lived experiences behind the statistics, particularly for groups often excluded from surveys, such as migrants, the cognitively impaired, or the institutionalized elderly.