Health and Ageing: A Discussion Paper

Full text excerpted below

Produced by The World Health Organisation (WHO); Department of Health Promotion, Non-Communicable Disease Prevention and Surveillance

Partners

The WHO acknowledges the support of Health Canada & UNFPA through the Geneva International Network on Ageing (GINA). Both publications are produced with the partnership between WHO (Department of Health Promotion,Non-Communicable Disease Prevention and Surveillance) and Health Canada.

Please note: This paper was a preliminary discussion version of "Active Ageing - A Policy Framework" that was developed by WHO's Ageing and Life Course Programme as a contribution to the Second United Nations World Assembly on Ageing, held in April 2002, in Madrid, Spain. This final paper, available in PDF on the WHO site (click here) is intended to inform discussion and the formulation of action plans that promote healthy and active ageing.



A Summary

Introduction

The following preliminary paper presents ageing issues for global discussion before a final version of the paper is produced, called Active Ageing: From Evidence to Action. The final version will be published as a contribution to the Second UN World Assembly on Ageing in Madrid (April 2002).

Please Note: 'Older' people are women & men of age 60 & over which seems young in developed countries, but in developing countries where they have not had the same advantages in life leading them to healthy old age, 60 is older. "Variations in health status among individual older people of the same age can be dramatic. Decision-makers need to take both of these factors into account when designing policies for the 'older' populations".

Global Ageing: A Triumph and a Challenge

"Population ageing is one of humanity's greatest triumphs. It is also one of our greatest challenges. As we enter the 21st century, global ageing will put increased economic & social demands on all countries. At the same time, older people provide a precious, often-ignored resource that makes an important contribution to the socioeconomic fabric of our lives". Those aged 60 years & older are the fastest growing segment of the population in the world today. "Between 1970 & 2025, a growth in older populations of 380% is expected", giving the world a total of 1.2 billion people over the age of 60 by the year 2025. Older adults over age 80 are the fastest growing population group. The bulk of the worlds ageing population lives in developing countries which "will represent 70% of all older people worldwide". The World Health Organisation believes we can afford to get old if countries act immediately in developing "active ageing" policies & programmes that encourage the health, independence & productivity of older citizens. Policies need to address the "real needs, preferences & capacities of older people & take a life course perspective that recognizes the influence of earlier life experiences & does not compromise the needs of future older citizens".

Challenges of an Ageing Population

• Rapid Population Ageing in Developing Countries
  
  Most of the ageing population live in Asia; predominantly Eastern Asia & China. "In developing countries socioeconomic development has often not kept pace with the rapid speed of population ageing". As a result, developed countries grew affluent before they became old while developing countries are growing old before they see a significant increase in wealth. Urbanization & migration leave very few people available to take care of the elderly.
  
• Disability & the Double Burden of Disease
  
  The ageing of nations has exposed a shift in disease patterns which hit the developing countries the hardest. The "double burden of disease" is felt to strain scarce resources to the limit. Apart from malnutrition, childbirth complications & communicable diseases, it is the non-communicable diseases (heart disease, cancer & depression) which are fast becoming the leading cause of death & disability in most of the developing world. Disabilities (mental & physical) affect an older person's independence, making it difficult to carry out the basic "activities of daily living" (ADLs) & with the right policies & programmes, these disabilities can be delayed. Decision making in the area of "age-friendly" policy needs to focus on 'enabling' instead of 'disabling'.
  
  

  Please Note: "Currently, low & middle-income countries have 85% of the world's population & 92% of the disease burden, but only 10% of the world's health research spending (WHO, 2000)".
  
  

• Changing an Outdated Paradigm
  
  Traditionally, old age is seen to encompass sickness, dependence & a lack of productivity. An attitude change is necessary to one where elderly people are seen as often able & willing to work, vessels of great wisdom & experience & the realization that their help is priceless; especially in the volunteer capacity. "It is time for a new paradigm, one that views older people as active participants in an age-integrated society & as active contributors as well as beneficiaries of development". We need to "challenge the traditional view that learning is the business of children & youth, work is the business of midlife & retirement is the business of old age".
  
• The Feminization of Ageing
  
  Women live longer than men in almost all areas of the world. "Women make up approximately 2/3 of the population over age 75 in Brazil & South Africa". More of the ageing population are women who have experienced cumulative disadvantages over the years & thus more likely to be poor & suffer disabilities in old age than men. Female widows far out-number male widows who marry younger & remarry sooner. "Because of their second class status, the health of older women is often neglected or ignored". In some cultures, attitudes toward widows are degrading & destructive & "practices around burial rights & inheritance may rob widows of their property & possessions, their health & independence & in some cases, their very lives". It is thought that women's traditional role as caregivers may contribute to their increased poverty & ill health in older age. There is another problem now, where women are often left to look after their grown children who are dying of aids & the grandchildren who are left behind. It is usually the older women who are the ones taking care of their AIDS stricken grown children & the grandchildren who are left behind.
  
  

  Please Note: Click Here for the Impact of Aids on Older People in Africa: Zimbabwe Case Study
  
  

• Ethics & Inequities
  
  The ageing have rights, which in some countries are stripped or ignored through negative attitudes toward elderly people. "Advocacy, ethical decision-making & the upholding of rights of all older people must be central strategies in any plan on ageing". What happens to a person in youth can reflect what will happen in old age i.e. poverty. "For older people who are poor, the consequences of these earlier experiences are worsened through further exclusion from health services, credit schemes, income-generating activities & decision-making". In many instances, many older people are not able to keep their dignity & independence or participate in health services, credit schemes, income-generating activities & decision-making. These conditions are often worse for older people living in rural areas & in situations of conflict or humanitarian disasters. Women are universally disadvantaged in terms of poverty & exclusion; therefore, programmes focussing on women continue to be a priority. It has been found that health & socioeconomic status are strongly linked. Increasing gaps between the rich & poor & ultimately, inequalites in health status, is a problem which needs to be addressed. "Failure to address this problem will have serious consequences for the global economy & social order, as well as for individual societies & people of all ages".

Active Ageing: The Concept and Rationale

What is necessary for active & positive ageing? "Active ageing is the process of optimizing opportunities for physical, social & mental well-being throughout the life course, in order to extend healthy life expectancy, productivity & quality of life in older age". The WHO coined the phrase "active ageing" in the late 1990s & is meant to portray a more inclusive message than "healthy ageing". It is the hope that all groups will adopt the term "active ageing" in their work with ageing issues. The word 'active' relates to "continuing involvement in social, economic, spiritual, cultural & civic affairs, not just the ability to be physically active". As previously stated, active ageing & health are directly related. When policies support active ageing:

• fewer adults will die prematurely in the highly productive stages of life
• fewer older people will have disabilities & pain associated with chronic diseases
• more older people will remain independent & enjoy a positive quality of life
• more older people will continue to make a productive contribution to the economy & to important social, cultural & political aspects of society in paid & unpaid jobs & in domestic & family life
• fewer older people will need costly medical treatment & care services (WHO, forthcoming).

There are sound economic reasons to promote "active ageing"; one of which is that costs are less to prevent disease than to treat it. "It has been estimated that a $1 investment in measures to encourage moderate physical activity leads to a cost-saving of $3.2 in medical costs alone (U.S. Centres for Disease Control & WHO, 1999)". Social interaction is directly linked with mental health & psychological wellness. "In Japan, older people who reported a lack of social contact were 1.5 times more likely to die in the next 3 years than were those with higher social support".

What Determines Active Ageing?

• Factors in the Social Environment: Education, literacy, human rights, social support, prevention of violence & abuse (please see note below on "elder abuse")
• Factors in the Physical Environment: Urban/rural settings, housing, injury prevention
• Person Factors: Biology & genetics, adaptability
• Economic Factors: Income, work, social protection
• Health & Social Services: Health promotion, disease prevention, long-term care, primary care
• Behavioural Factors: Physical activity, healthy eating, cessation of tobacco use, control of alcohol problems, inappropriate use of medication

In addition, gender & culture determines active ageing in that they influence all the above determinants. "Gender can have a profound effect on such factors as social status, how older people access health care, meaningful work & nutritious foods. Cultural values & traditions determine to a large extent how a given society views older people & whether or not co-residency with younger generations is the preferred norm. Cultural factors can also influence personal behaviours & health".

Please Note: "Elder abuse is a single or repeated act, or lack of appropriate action occuring within any relationship where there is an expectation of trust which causes harm or distress to an older person. It includes physical, sexual, psychological & financial abuse as well as neglect & is notoriously under-reported in all cultures. It is a violation of human rights & a significant cause of injury, illness, lost productivity, isolation & despair".

The Policy Response

If the world does not respond to the ageing dilemma there will be socioeconomic & political consequences everywhere. We will all be old one day, as will our children. What kind of a world do we want for ouselves & for children to come? The policy framework requires action on 3 basic pillars: Health & independence, productivity & protection. Policies must involve all of us in many sectors of society.

Key Intersectoral Policy Proposals are as follows:

• Reduce the prevalence of risk factors associated with major diseases & increase the prevalence of factors that protect health & well-being throughout the life course.
• Develop health & social service systems that emphasize health promotion, disease prevention & the provision of cost-effective, equitable & dignified long-term care.
• Prevent & reduce the burden of excess disabilities, especially in marginalized populations.
• Enable the active participation of older people in all aspects of society.
• Improve health & increase independence by providing protection to older people, particularly in difficult times
• Stimulate research & share knowledge ("Involve older people in efforts to develop research agendas on active ageing, both as advisors & as investigators".)

The Importance of International Dialogue

"With the launch of the International Plan of Action on Ageing, the 1982 UN World Assembly on Ageing marked the turning point in awareness of the challenges posed by an ageing world. In April 2002, the Second UN World Assembly on Ageing will be held in Madrid, Spain. It will adopt a revised international plan of action on ageing". The WHO plays an important part in the global awareness of ageing issues by offering a framework for discussion by all countries. The WHO is hopeful that the Health and Ageing paper will further the discussion & exchange of experiences between countries & foster recommendations for policies & programmes promoting active ageing throughout the world.

Source

This is a summary of the presentation, Health & Ageing: A Discussion Paper, provided direct to The Communication Initiative.

The complete document was prepared by Peggy Edwards, a consultant based for 6 months at WHO under the sponsorship of Health Canada (The Canadian Ministry of Health). The process of preparing the document was guided by Alex Kalache & Irene Hoskins & assisted by Ingrid Keller (WHO, Department of Health Promotion, Non-Communicable Disease Prevention & Surveillance).

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