Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 7

J Rehabil Med 2018; 50: 309–316
SPECIAL REPORT
REHABILITATION: THE HEALTH STRATEGY OF THE 21 ST CENTURY
Gerold STUCKI, MD, MS 1–3 * Jerome BICKENBACH, LLB, PhD 1–3 *, Christoph GUTENBRUNNER,
MD 4 and John MELVIN, MD 2,5
From the 1 Department of Health Sciences and Health Policy, Faculty of Humanities and Social Sciences,
University of Lucerne, Lucerne, 2 Swiss Paraplegic Research (SPF), Nottwil, 3 ICF Research Branch, a
cooperation partner within the World Health Organization Collaborating Centre for the Family of International
Classifications in Germany (at DIMDI), Nottwil, Switzerland, 4 Department of Rehabilitation Medicine,
Hanover Medical School, Hanover, Germany, 5 Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA, USA.*Both of these authors contributed equally to this paper.
There is strong evidence that population ageing
and the epidemiological transition to a higher in-
cidence of chronic, non-communicable diseases
will continue to profoundly impact societies
worldwide, putting more pressure on healthcare
systems to respond to the needs of the people
they serve. These trends argue for the need to
address what matters to people about their
health: limitations in their functioning that affect
their day-to-day actions and goals in life. From
its inception, rehabilitation, 1 of the 4 health
strategies identified in the Declaration of Alma
Ata in 1978, has had functioning as its outcome
of interest. Its practitioners are from fields that
include physical and rehabilitation medicine, oc-
cupational therapy, physiotherapy, speech and
language therapy, orthotics and prosthetics,
psychology, and evaluators of functioning inter-
ventions, including assistive technologies. De-
mographic and epidemiological trends suggest
that the key indicators of the health of popula-
tions will be not merely mortality and morbidity,
but functioning as well. This, in turn, suggests
that the primary focus of healthcare will need to
respond to actual healthcare demands generated
by the need for long-term management of chro-
nic conditions, including, in particular, the sca-
ling up and strengthening of rehabilitation. This
is the case for thinking that rehabilitation will be-
come the key health strategy of the 21 st century.
Key words: rehabilitation; health strategy; fun-
ctioning.
Accepted Dec 28, 2016; Epub ahead of print
Jan 31, 2017
J Rehabil Med 2018; 50: 309–316
Correspondence address: Gerold Stucki, Swiss Para-
plegic Research (SPF), Guido A. Zäch Institute, 6207
Nottwil, Switzerland. E-mail: gerold.stucki@paraple-
gie.ch 
T
here is strong evidence that fundamental de-
mographic and epidemiological trends (glo-
bal ageing and the transition to a higher incidence
and prevalence of chronic, non-communicable
diseases), as well as advances in curative medi-
cine, will profoundly impact societies worldwide.
These trends, and their drivers and immediate
consequences, arguably point to a significant shift
in emphasis in healthcare and health policy to
the long-term management of chronic conditions
and impairments, which is the natural domain of
rehabilitation.
The objectives of this paper are to assemble the
best demographic and epidemiological evidence
about future trends, in order to build on the current
conceptualization of the health strategy of reha-
bilitation, compared with other health strategies,
and, utilizing the powerful notion of functioning
as a health indicator, set out the best case for the
proposition that rehabilitation is the key health
strategy for the 21 st century.
WORLDWIDE POPULATION AGEING
Both the absolute number and proportion of
the population of older people are increasing
dramatically worldwide (1). Population ageing
(the increasing proportion of older persons in the
population) is arguably one of the most significant
social transformations of the 21 st century, with
direct and obvious implications for healthcare and
health policy, for many other sectors of society,
including labour, housing, transportation, social
protection, and for the very structure of families
and intergenerational ties.
As Fig. 1 shows, the population worldwide
aged 60 years or older is increasing dramatically
(2, 3). Although currently high income countries,
such as Japan, Germany and Finland, have the
highest prevalence of older persons, in 30 years
time 80% of the world population aged 60 years
or older will live in low- and middle-income
countries (3). Globally, the number of people
over 60 years of age is increasing faster than any
other age group (1).
These population ageing trends are not only
unprecedented in human history, they affect all
regions of the world. Ageing rates, moreover, will
increase over time (4).
There are 2 key drivers of population ageing:
increasing life expectancy and declining fertility
rates (1). Both of these phenomena are the result
of worldwide socioeconomic development and,
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2018 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2200