Healthy Aging in the Global Context

Topics Covered Context of Global Aging The World Health Organization (WHO) World Report on Ageing and Health Offers new viewpoints of the dynamic nature of policy necessary to enhance a person’s capacity to age well irrespective of illness, morbidity or other health conditions Provides concepts of functional ability, intrinsic capacity, environmental characteristics Offers public health strategies and actions aimed at health care and long-term care that optimize healthy aging The Global AgeWatch Index Measuring and monitoring the multi-dimensional nature of quality of life and well-being of older adults WHO World Report on Ageing and Health

The Context of Global Aging The world is ageing fast. By 2030, there will be more people over 60 than under 10. Already there are more adults over 60 than children under 5. As fertility declines and life expectancy increases, the proportion of people aged 60 and over is projected to grow in all regions of the world. Yet people’s experiences of later life vary enormously depending on where they live. Old age is still often considered from the economic perspective, with assumptions of what the ageing population will cost. Yet well-being in later life is an accumulation of experiences throughout life. http://www.helpage.org/global-agewatch/

The Context of Global Aging (continued) Countries that support human development throughout life are more likely to have higher rates of participation of older people in volunteering, working, and engaging in their communities. Every person should be able to live the best life that they can at every stage, with dignity and freedom of choice. As countries age, they need to invest in supporting the contributions, experience, and expertise of their growing number of older citizens. http://www.helpage.org/global-agewatch/

WHO World Report on Ageing and Health: 5 Priority Areas Sustained commitment and action to formulate evidence-based policies that strengthen the abilities of older persons. Align health systems to be better organized around older people’s needs and preferences, designed to enhance older peoples intrinsic capacity, and integrated across settings and care providers. Develop governance systems, infrastructure and workforce capacity for long-term care. Enhance universal health coverage, address non-communicable diseases, and develop people-centered and integrated health services. Create age-friendly environments to combat ageism, enable autonomy and support Healthy Ageing in all policies and at all levels of government. Improve measurement, monitoring, and understanding.  WHO World Report on Ageing and Health

WHO’s Alternative Viewpoint on the Implications of Population Ageing Research suggests that contributions of older adults far outweigh any investments that might be needed to provide the health services, long- term care and social security that they require.  Rather than portraying expenditures on older people as a cost, these are considered as investments that enable the well-being and various contributions of older people. WHO World Report on Ageing and Health

WHO’s Alternative Viewpoint on the Implications of Population Ageing These investments include expenditures on health systems, long-term care and on enabling environments more broadly. The direct return on some of these investments include better well-being and increased participation in society. Less direct benefits include allowing family members to remain in the workforce instead of at home caring for older relatives and fostering social cohesion by sharing risk across the community. WHO World Report on Ageing and Health

WHO Report on Ageing and Health: Key definitions Healthy Ageing is the process of developing and maintaining the functional ability that enables well-being in older age. Functional ability comprises the health-related attributes that enable people to be and to do what they have reason to value. Functional ability is made up of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. Functional ability = individual intrinsic capacity + environmental characteristics + interactions WHO World Report on Ageing and Health

WHO Report on Ageing and Health: Key definitions (continued) Intrinsic capacity is the composite of all the physical and mental capacities of an individual. Environment characteristics comprise all the factors in the extrinsic world that form the context of an individual’s life. These include – from the micro level to the macro-level – home, communities, and the broader society. Within these environments are a range of factors, including the built environment, people and their relationships, attitudes and values, health and social policies, the systems that support them, and the services that they implement. Well-being is considered in the broadest sense and includes domains such as happiness, satisfaction, and fulfilment. WHO World Report on Ageing and Health

Five Interconnected Domains of Functional Ability The crucial abilities to: ■ Move around ■ Build and maintain relationships ■ Meet own basic needs ■ Learn, grow, and make decisions ■ Contribute WHO World Report on Ageing and Health

WHO Public Health Framework for Healthy Ageing WHO World Report on Ageing and Health

Overarching Public Health Strategies Focus on both functional ability and intrinsic capacity of older adults. Align health services and long-term care supports to address the needs of those whose intrinsic capacities are: High functioning Declining At significant loss WHO World Report on Ageing and Health

Overarching Public Health Strategies (continued) 3 key areas for action: Make the places we live much more friendly to older people Shift from health systems that are designed around curing acute disease to systems that can provide ongoing care for chronic conditions Develop long-term care systems that can reduce inappropriate use of acute health services and ensure people live their last years with dignity WHO World Report on Ageing and Health

Public Health Strategies For older adults with high and stable levels of intrinsic capacity, public health strategies should focus on the following: Building and maintaining this level for as long as possible. Health systems will need to detect and control disease and risk factors early. Environmental strategies will be crucial in encouraging healthy behaviors, both by building personal skills and knowledge, and through the implementation of broader environmental strategies, such as taxing tobacco or providing safe and pleasant environments for physical activity. Environments will also have a role in enabling functional ability, with particular emphasis on removing barriers to the expression of this capacity. WHO World Report on Ageing and Health

Public Health Strategies (continued) For older adults with declining intrinsic capacity, public health strategies should focus on the following: During this stage, diseases may have become established, and the emphasis of health systems will generally shift from prevention or cure to minimizing the impacts of these conditions on a person’s overall capacity. Services are needed to help stop, slow, or reverse declines in capacity. The role of the environment in enabling functional ability will broaden as capacity falls, with strategies that help people overcome these decrements. For example, if physical capacity becomes limited public seating may make shopping more achievable by providing a place for an older person to rest, or good street lighting may allow an older person with slight visual impairment to get home in the evening. The role of the environment in enabling healthy behaviors will continue to be important for this segment of the older population, but the emphasis may change. For example, physical activity may be promoted as much for building and maintaining muscle mass and balance as for reducing the risk of disease. WHO World Report on Ageing and Health

Public Health Strategies (continued) For older adults with declining intrinsic capacity: Health systems will need to detect and control disease and risk factors early. Environmental strategies will be crucial in encouraging healthy behaviors, both by building personal skills and knowledge, and through the implementation of broader environmental strategies, such as taxing tobacco or providing safe and pleasant environments for physical activity. Environments will also have a role in enabling functional ability during this period, with particular emphasis on removing barriers to the expression of this capacity. WHO World Report on Ageing and Health

Public Health Strategies (continued) For older adults at high risk of/significant losses in intrinsic capacity, public health strategies should focus on the following: The focus of the public health response is the provision of long-term care. The role of long-term care systems is to enable an older person to maintain a level of functional ability consistent with their basic rights, fundamental freedoms, and human dignity. This requires both ensuring the optimal trajectory of intrinsic capacity and enabling older people to perform with dignity the basic tasks that are necessary for their well-being. WHO World Report on Ageing and Health

Public Health Strategies (continued) For older adults at high risk of/significant losses in intrinsic capacity: Early care to reduce declines in capacities might include family members encouraging older people to become more active and assisting them with this as well as encouraging them to eat well. Later care may include support for basic tasks, such as washing and cooking, but will also need to be fully integrated with health systems to ensure that trajectories of capacity are optimized. These tasks will be made easier if the older person lives in an enabling environment (for example, in a home that is fully wheelchair accessible, or a dementia-friendly community for someone with cognitive decline). WHO World Report on Ageing and Health

About The Global AgeWatch Index 2015 The Global AgeWatch Index is the first-ever overview of the well- being of older people around the world. It has been possible to include only 96 countries at this stage because of current data limitations. However, these 96 countries include 91% of the world's population aged 60 and over. The aim is both to monitor progress and steadily extend the Index to include all countries. As well as global analysis, Global AgeWatch is focusing on the regions, hearing from older people themselves, and looking at the widely varying geographic trends. For the first time the Global AgeWatch Index makes international comparisons of quality of life in older age possible. The Index is a tool to measure progress and aims to improve the impact of policy and practice on ageing populations. http://www.helpage.org/global-agewatch/

The Global AgeWatch Index 2015: How data is compiled Developed and constructed by HelpAge International (HelpAge) from international data sets drawn from the United Nations Department of Economic and Social Affairs, the World Bank, World Health Organization, International Labour Organization, UNESCO, and the Gallup World Poll. Brings together a unique set of internationally comparable data based on older people's income status, health status, capability (education and employment), and enabling environment. These domains have been selected because they were identified by older people and policy makers alike as key enablers of older people's wellbeing. http://www.helpage.org/global-agewatch/

The Global AgeWatch Index 2015: How data can be used To inform the policy debate on aging by measuring health, social, and economic progress as a means to promote improvements. In 2010, more than one in eight U.S. adults ages 65 and older were foreign-born, a share that is expected to continue to grow. The U.S. older adult immigrant population rose from 2.7 million in 1990 to 4.6 million in 2010, a 70% increase in 20 years. Understanding both the unique characteristics of foreign- born older adults and the challenges some of them face is important as policymakers and planners address the well- being and health of the United States' domestic and immigrant aging population. http://www.prb.org/Publications/Reports/2013/us-elderly-immigrants.aspx

The Global AgeWatch Index Domains

Domain 1. Income Security The income security domain assesses people's access to a sufficient amount of income, and the capacity to use it independently, in order to meet basic needs in older age. http://www.helpage.org/global-agewatch

Domain 2: Health status The three indicators used for the health domain provide information about physical and psychological wellbeing. http://www.helpage.org/global-agewatch

Domain 3: Capability The employment and education indicators in this domain look at different aspects of the empowerment of older people. http://www.helpage.org/global-agewatch

Domain 4: Enabling environment This domain uses data from Gallup World View to assess older people's perception of social connectedness, safety, civic freedom and access to public transport - issues older people have singled out as particularly important. http://www.helpage.org/global-agewatch

The Global AgeWatch Index Domains Each domain has a value score, and the average is used to calculate the final ranking All indicator values are expressed as positive values, so that the higher the value, the higher the ranking of the country. Each indicator value is then expressed in “normalized” terms. Minimum and maximum values are used to normalize each of the indicators to fall between 0 and 100 The geometric mean of the individual indicator values is calculated within each domain. These results give four domain-specific indexes. The weight assigned to each indicator within a single domain is not always assumed to be the same. Finally, the overall aggregated Index is calculated as the geometric mean of the four domain-specific indexes (using their normalized values). The weights used for each of the four domains to reach the overall Index are assumed to be the same. http://www.helpage.org/global-agewatch

Global AgeWatch Global Report http://www.helpage.org/global-agewatch

Country-Specific Commentary

The Global AgeWatch Index: Key Findings and Limitations Inequality in health, education, and income levels of older people is increasing between top-ranked, high-income countries and bottom- ranked, predominantly low-income countries. Austerity measures hitting older people in Europe and North America. The 2008 financial crisis affected pensions across Europe. Other negative impacts included widespread cuts to health and home care, subsidized transport, and high unemployment rates among the 50 to 65 age group. In the USA, the old age poverty rate, which varies significantly between racial and ethnic groups, has risen substantially, probably reflecting the persistently high unemployment rates following the recession. Success means building independence. The countries doing best in the Index have social and economic policies supporting older people’s capabilities, well-being, and autonomy and do not rely on families to support their relatives alone. They have long-standing social welfare policies delivering universal pensions and better access to healthcare, as well as action plans on ageing. http://www.helpage.org/global-agewatch/

The Global AgeWatch Index: Key Findings From Global Perspective There are millions missing from the data. In the third year of the Index, it is still only possible to rank 96 out of 194 countries. Regional and national gaps are significant. Only 11 African countries out of 54 are included because internationally comparative data on older people is missing. Equally in the Caribbean, Pacific, and Middle Eastern regions, the evidence on the wellbeing of older people is incomplete. Women are particularly affected. There is an urgent need for better gender analysis when considering wellbeing and dignity in old age. Older women suffer particularly, as gender-based policy making tends to draw from widely available data sets that do not record data for age groups beyond the age of 49. http://www.helpage.org/global-agewatch/