Why it started

The measurement, understanding and monitoring of unmet health need is important to the 2030 UN Sustainable Development Goals and the WHO global impact framework. As populations age, health needs shift, and the predominant disease burden is increasingly due to chronic diseases and associated disabilities. Many of these chronic diseases, their risks and consequences, are modifiable and their outcomes can be improved through accessing quality health and social care services. But in many countries, health and social needs of older people are not being met for a portion of the population. The gap represented by unmet need raises issues of equity in service coverage and universality of health care. However, current measures of universal health coverage (UHC) do not assess unmet need, nor do they adequately capture services that older persons require, including social care. An agreed standard measure of unmet health and social care needs for older people that can be applied across countries is required to allow ongoing monitoring and to enable improvement in coverage, equity, and quality of care.

How it started

Since 2020, the WHO Centre for Health Development (WHO Kobe Centre), in partnership with other WHO departments and external experts, has conducted a series of studies to explore the issue of unmet need especially as it relates to older persons. An initial scoping review was carried out to synthesize knowledge about the theoretical and conceptual constructs that are key to understanding the care needs of older people and what equity in healthcare access would mean for them. This was followed by a systematic review and meta-analysis to estimate the prevalence of unmet health and long-term care needs among older people based on published statistics, mostly from high-income countries. In the third phase of this research program, secondary analysis was performed on available survey datasets covering 83 countries of all income levels to estimate the prevalence of unmet health and social care needs of older people and the comparability of data sets. This series of research underscored the need to improve data and methods for measuring unmet need, especially for older people and social care. Good data on unmet need for health and social care could fill an important gap in the metrics currently being used for global monitoring of progress toward Sustainable Development Goal 3.8 on universal health coverage and other related 2030 agenda.

To build on this progress the WHO Kobe Centre funded a team of international researchers to gather expert knowledge on the content and contextual aspects relating to the measurement and monitoring of unmet health and social care needs of older people through a series of meetings and consensus processes (Colloquia).

Finding the right people

Measurement and understanding of unmet health and social care needs for older people is multidimensional and requires a holistic approach that includes perspectives for the individual, their needs, and circumstances; the health care service, system, and setting; the overall fabric of society including values and attitudes to ageing, tolerance of inequity; and the general economic and political context.

To ensure we identified potential members that can be considered experts in these areas, the project team used a variety of methods to identify these experts (snowballing from papers identified in the development of the initial proposal, keyword research/title search, snowballing from existing networks, searching staff lists of organisations/institutes/committees dedicated to older people research/policy).

Identified potential experts were then mapped by sector, speciality (Social models of health and social care, Health care policy, Health needs of older people, long-term care for older people, Health services research, Health economics, Measurement, evaluation, and psychometric methods, Epidemiology/statistics, Regional insights and representation), position (senior position/author, up and coming, general), affiliations/memberships with institutes/organizations/committees that represent older people, gender, and geography/WHO region. Using this methodology 368 individuals were identified as possible colloquia participants. The list was then mapped by the discipline they identified as working, the research topics their papers cover, any notable memberships/positions they hold/organizations and institutes they are affiliated with, the size of the network of other researchers they have published with, the region the institute they are affiliated with is located, and gender.

The list was then categorised into: 1) discipline experts, based on a high level of expertise and need for a balance of insight and technical skills, 2) regional experts, with insights into systems and settings in different countries across WHO regions, and 3) primary audience, being the broader field of academics, commentators, and other stakeholders. Individuals identified as being in a senior position or having an extensive body of work in relation to unmet needs or measures relating to unmet needs, and also have experience in research/services for older people numbered twenty-six (including the eight members involved in the project proposal). There were four additional individuals identified who met the above criteria except were emerging in their field. There were 32 individuals identified as having published work in the fields of interest to this project, with four of these individuals also being identified as having important regional insights. One hundred and twenty-two individuals were identified as not being specifically researching/working in the fields of interest but were working in related fields. These individuals were classified as the audience for the project outcomes. The remainder of identified individuals were classified as not meeting the scope of the project or had retired or were deceased.

Invitations to join the colloquia were sent to seventy-two experts, with forty-nine agreeing to participate in the colloquia. In total 59 individuals (49 identified experts along with the 10 original members of the grant) participated.  A copy of their name and country of residence by WHO region can be found below.

We can’t know what we don’t know

Throughout the first three months of 2023 discussions relating to the measurement and monitoring of unmet health and social/support care needs of older people at a global level were conducted with the colloquia. These discussions centred around three main themes:

• Drivers of unmet health and social/support care needs

• Measures, methodology and sources of data

• Knowledge gaps and research agenda

An overview of the issues along with the outcomes of these discussions can be found in our resource section.

Building the Consortium

Members of the consortium were identified from an expression of interest process. All participants of the colloquia were invited to continue into the consortium. In addition, an expression of interest form was created and placed on the project’s website and shared by colloquia participants throughout their professional networks. In total 43 people expressed interest in joining the consortia and became the founding members of CARE∞TRACK.