Healthy Ageing in perspective

Written by

Global Health Unit, Department of Health Sciences, University Medical Center Groningen

Published in February 2026

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In the early 1980s, when I started working as a doctor in a small remote hospital in Africa, nearly all patients suffered from infectious diseases like malaria, respiratory tract infections, and tuberculosis. HIV-AIDS was just coming up as an epidemic. Children were admitted with measles, rubella and other vaccine-preventable diseases. We hardly saw patients with cardiovascular diseases, diabetes, asthma or cancers. We did not have medicines for hypertension, chronic obstructive pulmonary disease (COPD) or other non-communicable diseases (NCDs).

How much has changed in the past 50 years!

Now more than 50% of all pathology in low- and middle-income countries (LMICs) is caused by NCDs. [1, 2, 3] The epidemiologic transition has gone much faster than in high-income countries. Part of this transition is caused by the spectacular rise in life expectancy in LMICs (from 42 years in 1960 to 72 years in 2023). [4] NCDs generally affect more older people. In addition, urbanisation and lifestyle as well as environmental, socioeconomic, and health‑system factors have a significant impact on the changing pathology. [5] However, health systems in most LMICs are not ready to tackle the new demands for NCD prevention and treatment. Especially the primary healthcare services are inadequate. [6] Health workers are inadequately trained, clinics are not sufficiently equipped, and medicines are not available.

The financial burden due to NCDs in LMICs is enormous: for the patients, the families and the health systems. The chronic character of NCDs plays a big role in increasing costs. The impact of the NCD disease burden on society is on the rise, not in the last place because of increasing disability. Inadequate financing is still a major problem for addressing NCDs. [7]

Later in my career, I assisted countries in making a shift in health care provision and incorporating prevention, early diagnosis, and treatment of NCDs in the health services. When preparing the latest Health Strategic Plan for Tanzania (2020-2025), we calculated that the health budget should at least be doubled for giving the minimal primary healthcare services required for NCDs (from 75 USD per capita to 150 USD per capita). Such a budget increase was not considered to be realistic.

As NCDs are closely related to socio-economic and cultural factors (e.g. smoking, diet, physical activities), LMICs can make their own choices when it comes to tackling NCDs in an appropriate way, avoiding the trap of high-income countries where prevention is inadequate, obesity is staggering, and treatment costs are exploding. LMICs must find smart solutions to address upcoming needs and socio-economic factors.