Healthy Ageing and the Sustainable Development Goals
Implementing the Global strategy and action plan on ageing and health will contribute to the realisation of the Sustainable Development Goals which were developed to secure “The Future We Want” for present and future generations.
Today, most people are living longer and a significant proportion of the world’s population are older people. By 2050, the world’s population of people over the age of 60 will double. This demographic change has strong implications for sustainable development. As people grow older, their health outcomes, needs and what they value can change. Supporting these changes by taking multisectoral action on ageing and health is therefore critical and will support the Decade on Healthy Ageing 2020 – 2030.
What is Healthy Ageing?
Ageing healthily is what we all aspire to. Healthy Ageing is about maintaining the functional ability that allows you to do the things you value. This means preserving both your physical and mental capacity as you age - it also means making changes to our environments (housing, transportation, public spaces etc.) so that they are accessible to and supportive of older people with varying needs and capacities.
Action to foster Healthy Ageing can help tackle inequities and ensure older people age safely in a place that is right for them, are free from poverty, can continue to develop personally and can contribute to their communities while retaining autonomy and health. Healthy Ageing will help build societies that are cohesive, peaceful, just, secure and sustainable.
A commitment to the Sustainable Development Goals means a commitment to Healthy Ageing - and a commitment to taking concerted actions to formulate evidence-based policies across all sectors that strengthen the abilities of older persons. In collaboration with Member States and international and national partners WHO needs to lead coordinated global action to foster Healthy Ageing across the Sustainable Development Goals.
Poverty and poor health are mutually reinforcing. The following actions will support Healthy Ageing and economic growth (Goal 8) by preventing older people from falling into poverty:
- having flexible retirement policies;
- ensuring tax-funded minimum pensions;
- providing older workers with access to education or vocational training, re-skilling or other means to maintain their employability so that they can remain in the workforce for longer;
- changing employers’ attitudes about the value and contributions of older workers;
- providing social assistance within the home and community for poor older people and for those without family support;
- connecting informal workers with different forms of social security and pension;
- ensuring equitable access to, and utilisation of, health and long-term care services that are integrated and coordinated to meet the needs of older people; and
- providing assistance to families that care for older family members.
The rights and well-being of older people can be protected by supporting their employment choices as well as providing a safety net for them and their families.
Older people contribute to food production but can also be very vulnerable to food insecurity. Not only do nutritional needs change as we grow older, but in times of scarcity younger people are often prioritised by families and aid programmes.
Improved nutrition can be achieved by:
- making improvements in the nutrient density of food, particularly vitamins and minerals;
- maintaining intakes of energy and proteins; and
- recognising and supporting older people who are poor, isolated and lonely to access healthy meals.
Attention to the nutrition of older people can help reverse patterns of malnutrition in older people that increase care dependency and decrease intrinsic capacity.
Healthy Ageing is fundamental to the achievement of universal health coverage (UHC), implicit in Goal 3. However, without considering the health and social care needs of the ever-increasing numbers of older people, UHC will be impossible to achieve. Currently most health systems are better designed to deal with individual acute health conditions than the more complex and chronic health needs that tend to arise with increasing age. Moreover, health systems and long-term care systems often operate independently leading to poorer outcomes, inefficient usage of services and cost shifting. A transformation of health and social systems from a disease-only focus towards the provision of integrated and person-centred care will have the greatest impact and requires attention to the following:
- ensuring continued and equitable access to disease prevention, promotion, treatment and rehabilitation throughout all stages of life;
- developing robust, integrated systems of health and long-term care orientated around maximizing function in older age; and
- making available medicines and assistive technologies that support the maintenance of functional ability where necessary.
Optimizing opportunities for good health at all stages of life will ensure that older people can maintain independence and increase their social and economic participation in society, while reducing healthcare costs.
Learning and growth do not cease in later life. Continued access to training and educational opportunities are important in older age to allow older adults to be equipped with the knowledge and skills to: manage their health better; keep abreast of developments in information and technology; adjust to the changes that ageing brings (e.g. retirement, widowhood, caregiving); maintain their identity, social connections and keep interested in life; foster contact with other generations and participate in society (e.g. by working or volunteering).
Opportunities for life-long learning should include:
- providing basic literacy and health literacy training for older adults as key foundations for learning and decision making;
- extend learning opportunities to older adults to enable them to develop new skills and knowledge and to maintain a sense of self, identity and meaning; and
- reduce material and structural barriers to older learners' participation.
Continued personal growth enables older people to continue to do what they value, retain the ability to make decisions and preserve their independence and autonomy. Healthy Ageing supports the promotion of lifelong learning.
Women tend to live longer than men, on average, and thus comprise the majority of older persons, especially at advanced ages. For example women account for 54 per cent of the global population aged 60 years or over and 61 per cent of those aged 80 years or over in 2015. Women contribute in a multitude of ways for example through working, child care and long-term care. Women's frequent restricted participation in the paid workforce has many negative consequences in later life, including a greater risk of poverty, less access to quality health and social care services, a higher risk of abuse, poor health and reduced access to pensions. Empowerment of older women can be supported by:
- robust systems that promote equitable workforce participation; and
- social pensions (non-contributory cash transfers to older people) which can help to raise the status of older women within households, enable older people to continue to have a role in household decision-making, and improve access to services.
Pursuing gender equality throughout the life-course can lead to better later life outcomes, and enhanced well-being.
While there is strong evidence for some of the actions needed to foster Healthy Ageing, many knowledge gaps remain and the link between evidence and policy and practice are not always clear. For example, clinical trials routinely exclude older participants and those with comorbidities, despite the fact that these are the people who are most likely to use the interventions being tested. A coordinated effort is urgently needed to:
- make older people visible by disaggregating data based on age and measuring Healthy Ageing;
- ensure research is responsive to the needs of older adults and policy makers;
- foster innovation that targets the changes that population ageing brings. For example eHealth technology, that can virtually link older adults with services, can improve health and social outcomes. Devices such as wearable health monitoring tools can help older adults maintain independence, avoid hospitalization, and improve quality of life; and
- communicate data and research in ways that are relevant to those in multiple sectors and to older people themselves.
These efforts need to be institutionalized, rather than marginal, and involve multiple sectors.
Most of the diversity seen in older age arises from the physical and social environments we inhabit (for example home, neighbourhood and community). Environments will influence one older person differently from the next depending on factors such as gender, ethnicity or level of education. These influences can result in unequal access to services and support.
To foster Healthy Ageing for all, the policy responses need to be:
- framed in ways that enable as many people as possible to be as healthy as possible for as long as possible;
- crafted in ways that overcome, rather than reinforce inequities;
- ensure that the people with the greatest health need at any point in time are prioritised as they are likely to also be those with the fewest resources to call on to address this need; and
- breakdown the many barriers that limit the ongoing social participation and contributions of older people.
Healthy Ageing - means considering these inequitable relationships, when developing policies across all sectors.
Cities, communities and other human settlements are key to enabling people to live long and healthy lives. For example in developing countries, the share of older people in urban communities will multiply 16 times from 1998 to 2050, to a total of 908 million.
Age-friendly cities and communities are environments that allow all people to maximize their capacity and their ability across the life course. Creating environments that are truly age friendly requires action in many sectors – health, long-term care, transport, housing, labour, social protection, information and communication – by many actors – government, service providers, civil society, older people and their organizations, families and friends.
Age-friendly cities and communities:
- recognize the wide range of capacities and resources among older people;
- anticipate and respond flexibly to ageing-related needs and preferences;
- respect older people’s decisions and lifestyle choices;
- protect those who are most vulnerable; and
- promote older people’s inclusion in and contribution to all areas of community life.
Working to create cities and communities that are sustainable and accessible to all requires a process across the life course that progressively improves the fit between people’s needs and the environments in which they live.
To achieve Goal 16 a paradigm shift is needed in the way that society understands ageing. Pervasive ageist stereotypes of older people as uniformly frail, burdensome and dependent are not supported by evidence and limit society’s ability to appreciate and release the potential human and social resources inherent in older populations.
Ageism – stereotypes, prejudice and discrimination against older people on the basis of their chronological or perceived age – creates barriers to developing good policies, both on health and broader development. Research suggests that ageism may be even more pervasive than sexism and racism with serious consequences both for older people and society at large. Actions to ensure more just societies and stronger institutions that benefit all include:
- disseminating evidence-based awareness campaigns about ageing;
- tailoring advocacy messages to all relevant sectors on how they can contribute to Healthy Ageing;
- communicating the best practices of other successful intersectoral strategies that have contributed to Healthy Ageing; and
- encouraging legislation and policies against age-based discrimination in all aspects of society.
Tackling ageism and the invisibility of older people through intersectoral action between various levels of government and amongst government and non-governmental actors will be critical to shape institutions towards sustainable inclusivity and to empower older people to achieve things previous generations could never imagine.