Longevity is one of the greatest achievements of medical advancements in the last century, and the challenge for the 21st century is the development of sound health and social care systems that would ensure quality of life in later years at the individual level, as well as continued and sustained social and economic development at the societal level.

For developed countries, chronic diseases with disabilities have emerged as the primary causes of morbidity and mortality, while developing countries have to struggle with the double burden of infectious as well as chronic diseases. A new approach is required to effectively address these new trends.

The strategy to achieve the above requires a shift in health systems development from heavy investments primarily in “high tech” acute care, to community based primary care that is age-friendly in approach. Primary health systems need to move away from the current episodic approach to care to one that provides a comprehensive range of services - from health promotion and prevention to disease management and long term care - with programmes that delay onset of disability, ameliorate its progress, and strengthen older people’s ability for self-care.

Due to the inherent nature of chronic diseases to be progressive through time, intertwine with social needs and have acute exacerbations, an effective health system also needs to be integrated in multiple dimensions. Health care delivery systems need to be internally integrated across the acute, community and long term care sectors, while integration with social services would be critical. For effective prevention of disabilities, a life course approach would also be essential.

Effective implementation of such a strategy would require the establishment of several key mechanisms. Adequate funding schemes for integrated health and social care systems need to be developed, preferably in such a way to incentivize the use of “up front” primary care services (i.e. preventive care and disease management) in order to optimize health outcome (and thus decrease acute care cost). Systematic manpower training, especially in community geriatrics, is essential to build up adequate numbers of trained health and social care professionals to meet growing demand with rapidly ageing populations. In order to develop a cost effective health and social care system, research in this area needs to be developed so as to provide essential evidence to inform the development of such a system.