How do we build a world for Healthy Ageing?

WHO is planning for healthy ageing

The World Health Organisation (WHO), in collaboration with its United Nations partners, has recently unveiled a landmark report marking the first significant milestone in the UN Decade of Healthy Ageing. This decade, spanning 2021 to 2030, is a critical period dedicated to enhancing the lives of older individuals worldwide. The report, a testament to the concerted efforts since 2020, provides an in-depth analysis of the strides made in fostering healthy ageing, juxtaposed against the backdrop of unprecedented challenges, notably the COVID-19 pandemic. This global health crisis disproportionately affected older adults, with over 80% of COVID-19 related fatalities occurring among those aged 60 and above.

The WHO’s comprehensive report derives its insights from an extensive survey conducted between late 2022 and early 2023, encompassing 136 countries. It presents a comparative study with its 2020 predecessor, revealing significant progress in several areas. Notably, there’s been over a 20% increase in countries implementing legislation against ageism and enhancing access to assistive products for the elderly. Furthermore, more nations are adopting policies for comprehensive health and social care assessments for ageing populations and developing age-friendly cities and communities.

Despite these advancements, the report underscores the need for sustained and intensified efforts as the Decade progresses. Alarmingly, less than a third of the surveyed countries reported having adequate resources to address the UN Decade’s four critical areas of action: reshaping perceptions about age and ageing, creating communities that harness the abilities of older individuals, delivering integrated and person-centred healthcare, and ensuring access to long-term care for those in need. A notable area lagging in progress is the establishment of national multi-stakeholder forums on ageing and health, which saw a mere 7% increase. So what key areas are WHO honing in on to combat these issues? 

Combating ageism

The World Health Organisation’s (WHO) latest report urgently addresses the pervasive issue of ageism, which manifests as stereotyping, prejudice, and discrimination based on age. This global problem deeply impacts healthcare, employment, and media, significantly harming older people by reducing their life expectancy, quality of life, and overall health. Ageism contributes to poverty, insecurity, and a heightened risk of violence and abuse, particularly affecting older women and those with disabilities.

The WHO report shows notable progress in fighting ageism. Between 2020 and 2022, 83% of surveyed countries have implemented legislation against age-based discrimination, marking a significant rise from 60% in 2020, with substantial advances in African and South-East Asian regions. The report underscores the importance of policies and laws for human rights protection, educational efforts, and fostering intergenerational connections.

Crucially, the report highlights the ongoing global efforts to protect the human rights of older individuals. Over 60% of countries now have mechanisms to uphold these rights, although disparities remain between high-income and low- to middle-income nations. Internationally, significant milestones include the ratification of the Inter-American Convention and the African Union Protocol on the Rights of Older Persons, focusing on the prohibition of age discrimination and protection of older people’s human rights.

A particularly poignant section of the report is the abuse of older people, defined as harmful actions within a relationship of trust. The WHO identifies key priorities for addressing this during the UN Decade of Healthy Ageing, including combating ageism, enhancing data on abuse prevalence, and developing effective interventions. Initiatives are in place to scale up solutions and improve abuse prevalence data, underlining the urgent need for continued global action against ageism and abuse of older individuals.

Age-friendly environments

Creating age-friendly environments is essential for enhancing the quality of life as people age, as highlighted in the World Health Organisation’s recent report. These environments, which include improvements in health, long-term care, transportation, housing, and social support systems, enable older individuals to maintain their independence, health, and active participation in community life.

The report emphasises that creating age-friendly environments is a multi-sectoral effort, requiring collaboration across various levels of government and the involvement of stakeholders, including older people themselves. The WHO Global strategy and action plan on ageing and health, along with the Madrid International Plan of Action on Ageing (MIPAA), have identified the development of such environments as a strategic priority.

Significant progress has been made in this area, with data from 2020 and 2022 showing an increase in countries with national programs supporting age-friendly cities and communities. The African and Western Pacific regions have seen notable improvements. This progress aligns with the growing membership in the Global Network for Age-friendly Cities and Communities.

Notable examples include Age Friendly Ireland’s initiatives, which have led to the creation of the world’s first age-friendly hospital, airport, and other facilities. Ireland’s “Healthy Age Friendly Homes” program aims to support older people in living well in their communities, including access to housing grants and home improvements. Another example is the Philippines, where the National Commission of Senior Citizens is developing a framework for age-friendly environments, with projects underway in various municipalities.

To guide these efforts, the WHO published a guide in 2023 for national programs on age-friendly cities and communities, outlining strategies and identifying key domains for creating such environments. Additionally, the World Bank’s report “Silver hues: building age-ready cities” suggests strategies like universal design, multigenerational spaces, and better transportation systems.

The report also discusses the importance of social and financial protection in age-friendly environments, noting that almost 60% of surveyed countries have implemented actions to support income generation for older people. However, disparities exist, especially in low-income countries.

Finally, the report acknowledges the challenges of social isolation and loneliness among older people, exacerbated by the COVID-19 pandemic. Strategies to address these issues include both face-to-face and digital interventions, and the importance of creating age-friendly environments in emergency situations is also highlighted, underscoring the need for age-inclusive responses in humanitarian crises.

Integrated care

The report highlights the necessity of integrating older people in actions towards universal health coverage. This includes ensuring non-discriminatory access to essential health services, encompassing prevention, treatment, rehabilitation, palliative, and end-of-life care, without financial burden. However, most health systems currently are not optimized for the needs of older people, often focusing on acute conditions rather than chronic ones more common in old age. The lack of flexibility and a multidisciplinary approach in these systems, coupled with a shortage of trained health and care workers, hampers effective person-centred care.

Improving primary care, a crucial entry point for older people into the health system, demands a skilled workforce, sustainable financing, appropriate legislation, better data availability, age-friendly environments, and the elimination of ageism. The WHO Global strategy and action plan on ageing and health aligns health systems with the needs of older people, promoting improved intrinsic capacity and functional ability, access to high-quality, integrated care, and a strengthened workforce.

Progress in the first phase of the Decade includes a rise in countries with national policies for comprehensive health and social care assessments for older people, increasing from 48% in 2020 to 71% in 2022. The WHO’s ICOPE approach, including a comprehensive person-centred assessment, is pivotal in transforming health and social care systems. Successful implementations of ICOPE in various countries have demonstrated the approach’s adaptability and effectiveness, despite challenges like workforce shortages, financing issues, and digital technology limitations.

Strengthening the health and care workforce is crucial, with 64% of countries having plans to enhance their geriatric and gerontology workforce. Training programs in ICOPE have been conducted in several countries, with high satisfaction levels among participants.

Access to health and assistive products is also a key area of progress. The percentage of countries with legislation supporting access to assistive products for older people increased to 73% in 2022 from 47% in 2020. WHO’s initiatives, including the Global report on assistive technology and training in assistive product provision, aim to improve access. Furthermore, outpatient services and pharmaceutical products are increasingly available free of charge for older people in many countries.

Overall, the report underscores the importance of integrated care for older people, focusing on improving health systems, enhancing workforce capabilities, and ensuring access to essential health services and products.

A decade of healthy ageing worldwide

WHO’s report on the UN Decade of Healthy Ageing highlights significant advancements and ongoing challenges in enhancing the lives of the elderly worldwide. Progress includes legislative efforts against ageism, developing environments conducive to independent living for the elderly, adapting health systems for integrated care, and enhancing long-term care policies. However, regional disparities and the need for further development in these areas persist. The report underscores the importance of continued global collaboration to ensure older individuals enjoy dignified, healthy, and integrated lives in society.

World Health Organisation in Collaboration with UN (2023) Progress report on the United Nations Decade of healthy ageing, 2021-2023, World Health Organization. Available at: https://www.who.int/publications/i/item/9789240079694