INCLUSIVITY AS IT TRULY IS

The statement made by Ramig Guliyev, Head of the Health Policy Department at the Ministry of Health of Azerbaijan, at the international scientific and practical conference dedicated to World Lung Day, marked an important milestone. Following the results of 2025, average life expectancy in the country confidently surpassed the global average. This significant demographic shift signifies a triumph for national medicine, enhanced socio-economic conditions, and the advancement of healthcare infrastructure. However, these statistics mask a significant medical, economic and social undercurrent. The primary challenge is that the increase in quantitative indicators by itself has ceased to be the sole objective. The qualitative component of the additional years is becoming increasingly important, particularly the state of health with which a person crosses the older age threshold. As Ramig Guliyev emphasised, recent biomedical data show a shift towards non-communicable pathologies in terms of morbidity and mortality. As the Ministry of Health representative noted, official global statistics indicate that approximately 74% of all deaths worldwide today are attributable to non-communicable diseases. This means that the so-called "diseases of civilisation" account for three out of every four fatalities. This trend is gaining rapid momentum in our country, requiring a restructuring of prevention and social adaptation systems.

Statistical gap

In order to assess the real quality of life of an older person, international organisations focus on a special WHO indicator: HALE (Healthy Life Expectancy). The statistical snapshot reveals a significant gap between overall life expectancy and the period lived free from severe chronic ailments and disability. The average life expectancy indicator in Azerbaijan exceeded 77 years following the results of 2025, demonstrating an outstripping of global dynamics by more than four years compared with the global level of 73 years. According to the WHO, the healthy life expectancy in the country is between 62 and 65 years, with a global median of approximately 63 years. This indicates the formation of a statistical gap of about 12-14 "unhealthy" years, which a person is forced to live with health restrictions. In the global structure of causes of mortality, there has been a steady increase in the share of non-communicable pathologies, which account for approximately 74% of all outcomes on a global scale. These conditions arise from a combination of modern lifestyle factors, physical inactivity, urbanisation, poor nutrition, chronic stress and environmental influences. This category includes cardiovascular diseases (such as ischaemic heart disease, myocardial infarction, arterial hypertension, and atherosclerosis), oncological pathologies of various localisations, as well as chronic respiratory diseases (such as chronic obstructive pulmonary disease and bronchial asthma, which are directly associated with air quality and smoking). Furthermore, the following list includes metabolic disorders, primarily type 2 diabetes mellitus and obesity, neurodegenerative and mental disorders (Alzheimer's disease, dementia, chronic depressive states), as well as musculoskeletal disorders (osteochondrosis, osteoporosis) that develop due to a sedentary lifestyle. In this context, the official employment rate of the population over 65 years old in Azerbaijan is approximately 15-18%, while in countries with a high active longevity index, this figure exceeds 25%. This indicates a significant potential for integrating the older generation into economic and public life. The discrepancy between overall and healthy life creates a significant social and medical burden. In the absence of measures to sustain activity during this period, the additional years in question are often characterised by a struggle against chronic pathologies.

Scientific research

Scientists confirm that biological ageing is malleable, and the key factor in preserving cognitive functions and health at an older age is not so much genetics as the degree of social and labour involvement. The largest 85-year longitudinal Harvard Study of Adult Development in the history of medicine proved that preserving social connections, mental activity, and professional or public usefulness slows down neurodegenerative processes more strongly than drug therapy. People who continue to engage in meaningful activity after 60-65 years have a 30% lower risk of developing dementia and severe forms of depression. In turn, research by the UN Economic Commission for Europe within the framework of the Active Ageing Index concept shows that countries creating conditions for flexible employment and continuous education of older people record a reduction in inpatient medical care expenditures by 18-22%. Publications on the epidemiology of non-communicable diseases confirm that manageable physical and intellectual employment reduces systemic marker inflammation and slows down the progression of chronic obstructive pulmonary disease and cardiovascular failure.

Seventy-seven years: quantity or quality?

The continuation of labour or public activity at an older age represents not a forced necessity, but a powerful biological and psychological mechanism called "staying afloat". Retirement accompanied by sharp isolation from the habitual rhythm frequently provokes the so-called "learned helplessness syndrome" and leads to the rapid manifestation of existing chronic pathologies. In order for the older generation to fully pass on experience and maintain independence, society and employers must form suitable conditions. An important role is played by the introduction of flexible employment formats, including transition to part-time work, mentoring, remote consulting roles, and partial employment. In parallel, the adaptation of workplaces is required with an emphasis on ergonomics, a reduction in physical load, and consideration of age-related features of vision and the musculoskeletal system. No less necessary are retraining and digital adaptation programmes, helping to master basic digital services and remain in demand. Involvement gives an older person their main support—a sense of self-worth, a preserved social circle, and regular mental stimulation.

Expert views

The cited statistics from the Ministry of Health of Azerbaijan are reflected in the conclusions of clinicians, sociologists, and public health specialists. According to clinical observation data and reports from the Azerbaijani Society of Cardiology, in recent years the profile of an older age group patient has substantially transformed. On the one hand, the introduction of high-precision diagnostics, the expansion of interventional procedures (including angiography and stenting), and the development of emergency care have significantly reduced mortality from acute conditions. On the other hand, clinical medicine today faces high comorbidity: an older patient, as a rule, is revealed to have a combination of several chronic ailments—coronary heart disease, arterial hypertension, diabetes mellitus, and respiratory pathologies. That is why early preventive diagnostics and risk factor control at the stage of 50-60 years become a key condition for a person to meet the milestone of 77 years preserved, rather than in a state of severe disability. Sociological analysis of demographic processes in the country shows that Azerbaijani society traditionally has a high level of family support for older people, which acts as a natural protective factor against socialisation and loneliness. However, urbanisation and changing household structures are altering familiar roles. Today, it is no longer enough for the older generation simply to be surrounded by loved ones—there is an increasing demand for social self-realisation. Research in the field of active longevity confirms that older citizens who maintain professional or public activity demonstrate significantly higher psychological resilience and cognitive preservation. From the perspective of healthcare organisation, the introduction and expansion of the Compulsory Medical Insurance (CMI) service package by the State Agency on Compulsory Medical Insurance fundamentally changes the economics of combating non-communicable diseases. The treatment of advanced forms of chronic pathologies and their complications places a colossal financial burden on the system. That is why the state strategy naturally shifts the emphasis towards regular clinical examination, primary screening, and the work of the primary link, which makes the population's longevity economically sustainable.

Balance of opportunities

When evaluating the quality of life experienced by older members of the Azerbaijani community, it is possible to identify a robust national foundation, alongside areas where systemic changes are required. On the one hand, the social and family framework, which guarantees emotional support and makes basic medical care accessible thanks to the CMI institution, remains a strong side. Nevertheless, the primary challenges persist in the development of a barrier-free urban space (convenient transport, ramps, adapted environment), the establishment of institutional frameworks for the flexible employment of retirement-age specialists, and the cultivation of a population-wide culture of preventive health care – the habit of undergoing regular preventive examinations before the onset of severe symptoms. It is clear that surpassing the 77-year average life expectancy in Azerbaijan is a significant accomplishment, demonstrating the nation's advancement. This outcome establishes a new benchmark for responsibility. The transition from quantitative growth to the qualitative content of each lived year requires the pooling of efforts from medicine, the social sphere, and employers. This will ensure that the added years become a time of active, full, and dignified life for Azerbaijanis.