The global population of 60 years and above crossed 1 billion in 2020, which represents about 13.5 per cent of the total 7.8 billion. That figure is two and a half times greater than the number forty years ago, and is projected to surpass 2 billion by the year 2050. In this backdrop, the UN General Assembly declared 2021-30 as the 'UN Decade of Healthy Ageing' in December 2020. Prior to that, the World Health Assembly convened by WHO had adopted the 'Global Strategy and Action Plan on Ageing and Health' in 2016 with the goal of applying evidence-based approaches to maximise the abilities of older persons (aged 60-plus). It was grounded in the concept of healthy ageing and rights-based response to the ageing of people. Another of its objective was to prepare for a 'Decade of Healthy Ageing' that was ultimately endorsed by the World Health Assembly in August 2020 before adoption by the UN General Assembly.
The World Health Organization (WHO) has recently published a report titled 'Decade of Healthy Ageing: Baseline Report' with the goal of transforming the way the policy-makers and service-providers engage with older people. In a foreword to the report, the WHO Director General wrote: "Humans now live longer than at any time in history. Global life expectancy has doubled since 1900, and continues to rise, although there remains a wide disparity between the countries with the shortest and longest life expectancy. But adding more years to life can be a mixed blessing if it is not accompanied by adding more life to years. With birth rates dropping and people living longer, leadership and innovation are needed at all levels and in all sectors to realize the dividends of longevity, and to ensure that these benefits are experienced equitably within and across countries".
Coinciding with the outbreak of Covid-19 pandemic that disproportionately affects older people, the decade of healthy ageing (2021-30) is focusing on four key areas of action at multiple levels and sectors, with the aim of promoting health, preventing disease, maintaining intrinsic capacity and enabling functional ability. The areas of action are: change how people think, feel and act towards age and ageing; ensure that communities foster the abilities of older people; deliver person-centred integrated care and primary healthcare services that are responsive to them; and extend access to long-term care for older people who need it. All these actions are expected to foster healthy ageing and improve the wellbeing of older people, at least 142 million among them cannot meet their basic needs today.
The WHO report introduces healthy ageing, actions and enablers, as well as pathways to accelerate the impact by 2030. It provides a baseline and documents advances and scenarios for improvements. It explains how older citizens and stakeholders can act together to optimise functional ability, and recommends the next steps to bolster collaborations and impacts by 2023 - the next reporting landmark. The report proposes that optimising functional ability is critical to healthy ageing, and stakeholders must invest in data collection and analysis to monitor this. Actions should be taken to make a measurable impact on older citizens and they must be engaged at all stages in the process.
The functional abilities cover the capability to meet one's basic needs; learn, grow and take decisions; remain mobile; possess skills to build and maintain relationships as well as the ability to contribute to society. All these combine the intrinsic capacity of individuals, the environment they live in, and how they interact with the environment. The areas of action are supported by four 'enablers', viz. meaningful engagement with older people, families, caregivers and others; building capacity for integrated action across sectors; linking stakeholders to share experiences and learn from others; and boosting data, research and innovation for expediting implementation geared towards optimising the functional ability of older people.
The current status of healthy ageing show that some 14 percent older people worldwide are unable to meet their basic needs, implying they cannot dress on their own, get or take own medication, and manage their money, bills or finances. Consequently, enabling environment is needed at homes and communities to support their needs and foster their abilities to promote wellbeing. The intrinsic capacities of older people related to physical and mental abilities demonstrate considerable diversity. Although declines occur with ageing, these are not inevitable, as some at the oldest ages (90 plus) show the same capacity as those of younger ones (60-64 years). Therefore, comprehensive information on abilities, additional standardisation of data, more innovation in collection, analysis, usage and interoperability of information, and further involvement of older people in policy-making are required across sectors.
Healthy Life Expectancy (HALE) - the overall indicator for measuring the impact of WHO's 'Triple Billion Goals', reflects the extent years of life are spent in good health, which has been endorsed for the decade's action plan. Member-states are already committed to many of these elements in the targets for other strategies and action plans like the 2030 Agenda for Sustainable Development. The underlying determinants of healthy ageing can be shaped through appropriate policies and multi-sector collaborations.
In order to achieve improvements by 2030, learning is required from practices that improve the functional ability of older people. Besides, learning from diseases is also needed, especially the approaches related to addressing non-communicable diseases. Healthy ageing requires optimising functional ability among the diseased, as well as integrated care that focuses on older people's capacities cum disease management.
The main thrusts of the decade are to optimise functional ability and accelerate measurable impact on the lives of older people. It is also linked to the 'Triple Billion Goals' of WHO: one billion more people benefitting from universal health coverage; one billion more getting better protection in health emergencies; and one billion more enjoying better health and wellbeing. Mankind should now work together to boost the abilities and wellbeing of their older generations, who gave and continue to give so much to societies and nations across the globe.
Dr Helal Uddin Ahmed is a retired Additional Secretary and former Editor of BangladeshQuarterly.