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TRANSCRIPT
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Agenda
For a Definition of Active Ageing
ALIAS Workshop
Towards an Active Ageing: Tools and Policies
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Università di Milano - Bicocca 27 marzo 2012 Ludovico Ciferri
IUJ - ISMB
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Agenda
• Concept
• Definitions
• Policies
• Proposal
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Agenda
• Concept
• Definitions
• Policies
• Proposal
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A catch term
The term ‘active ageing’ has become the catch word of international and national ageing policy development. The impetus of structural ageing on the world’s population has lent urgency to international agencies such as the UN, the WHO, the OECD, and the EU to provide leadership and direction in negotiating the looming economic and social challenges ahead.
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A new concept
Active ageing is not a new concept, yet efforts to embed and generally use the term in operation have been influenced by both emerging evidence from extensive ageing research and different political agendas.
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An agreed definition
At present no one definition agreed to by key international agencies prevails and thus, there is a paucity of literature comparing countries’ active ageing implementation strategies and their subsequent progress. On top, there seems not to be consensus on its definition even within single countries.
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The 1960s
The term ‘active ageing’ can be traced back to the early 1960s in the United States of America (USA) where it was argued that the key to ‘successful ageing’ was activity and financial success. ‘Successful ageing’ was said to rely upon people maintaining into old age the activity patterns and values typically associated with middle age.
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Yet…
The approach was criticised for being too idealistic. It placed “unrealistic expectations on ageing individuals to maintain higher levels of activities associated with middle age into their advanced old age” and made no account for other confounds such as disability, illness, frailty, inter-cultural relevance, obesity, drug or alcohol addiction or a lifetime of inactivity (generalisations about the ageing process and homogenizing older people).
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The 1980s
In the USA in the 1980s, a new strategy for ageing was promoted –‘productive ageing’. This concept incorporated a life course perspective; that communities, workplaces (and older people themselves) have much to gain from older people being active well beyond the usual retirement age. Activists petitioned for the rights of older people to take up alternatives to retirement, such as continued full-time or part-time employment.
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Then…
This action coincided with US policymakers’ growing concern for the implications of an ageing population on healthcare and pension expenditure. At the same time, it became a key component of the social policy proposals of the EU and OECD.
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The 1990s
In the 1990s a new concept of active ageing began to emerge, influenced by WHO. This was a broader approach to active ageing, extending the emphasis to include health, and active participation and the inclusion of older citizens in all areas of family, community and national life. WHO summed up its policy by stating that: “years have been added to life; now we must add life to years”.
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Early 2000s
By the early 2000s, WHO, OECD, and EU policies were actively promoting the term ‘active ageing’ emphasizing important domains of influence such as human rights, the specific needs of older people, health outcomes and inequalities, cultures and the social determinants of health and illness.
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Agenda
• Concept
• Definitions
• Policies
• Proposal
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Recent trends
At present no one definition agreed to by key international agencies prevails and thus, there is a paucity of literature comparing countries’ active ageing implementation strategies and their subsequent progress. The literature available has been largely collated by international organisations promoting active ageing and these documents are influenced by the organisational interpretation of the term.
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Selected references
• UN Declaration of Human Rights – adopted and proclaimed by General Assembly in 1948 • UN Principles for Older People – adopted by the United Nations General Assembly in 1991 • UN World Social Situation: The Inequality Predicament (2005) • WHO The Social Determinants of Health (2005), drawing the attention of governments, civil society, international organizations, and donors to pragmatic ways of creating better social conditions for health • WHO Europe Region’s. The Solid Facts (2003) • Health Inequalities: A Challenge for Europe (2005), Presidency of the European Union • Health Inequalities: A Challenge for Europe (2005), Presidency of the European Union • WHO’s Ottawa Charter for Health Promotion. The first WHO International Conference on Health Promotion (Nov. 1986) presented a charter for action to achieve “health for all” by the year 2000 and beyond • WHO’s Bangkok Charter for Health Promotion (2005), agreed to by participants at the 6th Global Conference on Health Promotion, held in Thailand • WHO’s Active Ageing – A policy framework (2002) • Report on Socio-Economic Differences in Health Indicators in Europe (2003), German Institute of Public Health
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WHO 1/2
At the Second United Nations World Assembly on Ageing in Madrid 2002, WHO defined active ageing as “the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age”. The WHO definition stresses that activity refers to the continuing participation of seniors in social, economic, cultural, spiritual and civic affairs, not just on their ability to remain physically active or participate in the workforce. WHO, through its active ageing agenda, focuses on the human rights of older people and the UN principles of independence, participation, dignity, care and self-fulfilment. .
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WHO 2/2
Closely aligned with this approach to active ageing are the social determinants of health published in The Solid Facts (WHO 2003), which focuses on ten primary areas for tackling health issues across the lifespan: the social gradient; stress; early life; social exclusion; work; unemployment; social support; addiction; food; transport. This multi-dimensional strategy operates both at an individual and societal level. It calls for greater cross portfolio collaboration for national policy reform, requiring the integration of all relevant sub-policy areas of national government and research, such as employment, health, social protection, social inclusion, transport and education.
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OECD 1/3
The OECD defines active ageing more narrowly as “the capacity of people, as they grow older, to lead productive lives in the society and the economy”. This means that people can make flexible choices in the way they spend time over life – learning, working, and partaking in leisure activities and in giving care. The main focus of the OECD policy is to promote choice for older people to remain productive. This reform agenda seeks to explore methods to maintain or enhance people’s (over 50 years) productive capacity.
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OECD 2/3
OECD’s definition is somewhat constricted, and the OECD’s resulting policy approach focuses largely on: • the critical transition from work to retirement, particularly the financing and length of retirement; • the choice of flexible options for the work-retirement transition; the health, social and economic wellbeing of people of traditional retirement age; and, • the contribution to the economy and society of those people choosing to remain in the workforce.
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OECD 3/3
The OECD places responsibility largely on individuals and assumes that all retirees are in the position to make autonomous, individual choices. This policy focus is intentionally narrow to simplify monitoring and reporting processes and therefore does not take into account the various environments that influence health and wellbeing across the life course.
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EU
The EU defines ‘active ageing’ as “coherent strategy to make ageing well possible in ageing societies. Active ageing is about adjusting [sic] life practices to the fact that we live longer and are more resourceful and in better health than ever before, and about seizing the opportunities offered by these improvements”. In practice it means adopting healthy lifestyles, working longer, retiring later, and being active after retirement. The EU definition incorporates a life course perspective and is closer to the WHO definition than the OECD’s, but is framed more practically.
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Agenda
• Concept
• Definitions
• Policies
• Proposal
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Policy implementation
The inconsistency of the meaning of the term ‘active ageing’ makes the goal of identifying common ground at global discussions and comparing policy implementation and research more complex, both internationally and nationally. This has not halted the drive to address the potential problems associated with increasing longevity within global populations, which are coupled with a shrinking workforce in many developed countries and expanding health care demands and needs. A very significant level of policy development has already occurred within a generalised understanding and interpretation of the WHO active ageing framework.
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WHO 1/3
The World Health Organisation's (WHO) Active Ageing Framework was launched in 2002, and is an umbrella health and wellbeing policy term. Active ageing is defined as: “the process of optimising opportunities for participation, health, and security in order to enhance quality of life as people age”.
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WHO 2/3
‘Active ageing’ as an emerging policy direction internationally is further informed by the WHO Social Determinants of Health focus: • culture • gender • economic determinants (income, social protection, and work) • health and social services (health promotion and disease prevention, curative services, long term care, and mental health services) • social environmental determinants (social support, absence of violence and abuse, and education and literacy)
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WHO 3/3
Cont. from prev. page • physical environment (safe environments, access to services, people living in rural environments, accessible and affordable transport, safe housing, fall prevention, and clean water, clean air and safe foods) • personal determinants (genetics, biology, and psychological factors) • behavioural determinants (tobacco use, physical activity, healthy eating, oral health, alcohol, medications, health problems induced by diagnosis or treatments, or adherence to long term therapies)
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Common elements
Five elements of active ageing - financial security, being active socially, mentally and physically and workforce participation - may be found in much of the international and national l i terature about policies’ development and implementation, although with different emphasis. Some of the international approaches are quite visionary and try to take a full account of the social and political context in which they operate and strive to develop policies that can shape environments resulting in better health and enhanced quality of life across the life course.
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Agenda
• Background
• Definition
• Policies
• Proposal
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Age-friendly cities
Active ageing could be progressed more easily using the devised five elements of active ageing - financial security, being active socially, mentally and physically, workforce participation - fostered at actionable level. The proposal is to look at them within “Age-friendly Cities”, a realm in which needs and aspirations or elderly people should be pursued.
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Checklist of essential features of AfC
WHO’s “Checklist of Essential Features of Age-friendly Cities” (2007) is based on the results of the WHO Global Age-Friendly Cities project consultation in 33 cities in 22 countries. The checklist is a tool for a city’s self-assessment and a map for charting progress. This checklist is intended to be used by individuals and groups interested in making their city more age-friendly. For the checklist to be effective, older people must be involved as full partners. In assessing a city’s strengths and deficiencies, older people will describe how the checklist of features matches their own experience of the city’s positive characteristics and barriers. They should play a role in suggesting changes and in implementing and monitoring improvements.
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Macro-domains
Eight macro-domains encompass everyday life’s aspects: • Outdoor spaces and buildings • Transportation • Housing • Social participation • Respect and social inclusion • Civic participation and employment • Communication and information • Community and health services
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Outdoor spaces and buildings
☐ Public areas are clean and pleasant. ☐ Green spaces and outdoor seating are sufficient in number, well-maintained and safe. ☐ Pavements are well-maintained, free of obstructions and reserved for pedestrians. ☐ Pavements are non-slip, are wide enough for wheelchairs and have dropped curbs to road level. ☐ Pedestrian crossings are sufficient in number and safe for people with different levels and types of disability, with nonslip markings, visual and audio cues and adequate crossing times. ☐ Drivers give way to pedestrians at intersections and pedestrian crossings. ☐ Cycle paths are separate from pavements and other pedestrian walkways. ☐ Outdoor safety is promoted by good street lighting, police patrols and community education. ☐ Services are situated together and are accessible. ☐ Special customer service arrangements are provided, such as separate queues or service counters for older people. ☐ Buildings are well-signed outside and inside, with sufficient seating and toilets, accessible elevators, ramps, railings and stairs, and non-slip floors. ☐ Public toilets outdoors and indoors are sufficient in number, clean, well-maintained and accessible.
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Transportation
☐ Public transportation costs are consistent, clearly displayed and affordable. ☐ Public transportation is reliable, frequent, including at night and on weekends/ holidays. ☐ All city areas and services are accessible by public transport, with good connections and well-marked routes and vehicles. ☐ Vehicles are clean, well-maintained, accessible, not overcrowded and have priority seating that is respected. ☐ Specialized transportation is available for disabled people. ☐ Drivers stop at designated stops and beside the curb to facilitate boarding and wait for passengers to be seated before driving off . ☐ Transport stops and stations are conveniently located, accessible, safe, clean, well lit and well-marked, with adequate seating and shelter. ☐ Complete and accessible information is provided to users about routes, schedules and special needs facilities. ☐ A voluntary transport service is available where public transportation is too limited. ☐ Taxis are accessible and affordable, and drivers are courteous and helpful. ☐ Roads are well-maintained, with covered drains and good lighting. ☐ Traffic flow is well-regulated. ☐ Roadways are free of obstructions that block drivers’ vision. ☐ Traffic signs and intersections are visible and well-placed. ☐ Driver education and refresher courses are promoted for all drivers. ☐ Parking and drop-off areas are safe, sufficient in number and conveniently located. ☐ Priority parking/drop-off spots for people with special needs are available and respected.
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Housing
☐ Sufficient, affordable housing is available in areas that are safe and close to services and the rest of the community. ☐ Sufficient and affordable home maintenance and support services are available. ☐ Housing is well-constructed and provides safe and comfortable shelter from the weather. ☐ Interior spaces and level surfaces allow freedom of movement in all rooms and passageways. ☐ Home modification options and supplies are available and affordable, and providers understand the needs of older people. ☐ Public and commercial rental housing is clean, well-maintained and safe. ☐ Sufficient and affordable housing for frail and disabled older people, with appropriate services, is provided locally.
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Social participation
☐ Venues for events and activities are conveniently located, accessible, well-lit and easily reached by public transport. ☐ Events are held at times convenient for older people. ☐ Activities and events can be attended alone or with a companion. ☐ Activities and attractions are affordable, with no hidden or additional participation costs. ☐ Good information about activities and events is provided, including details about accessibility of facilities and transportation options for older people. ☐ A wide variety of activities is offered to appeal to a diverse population of older people. ☐ Gatherings including older people are held in various local community spots, such as recreation centres, schools, libraries, community centres and parks. ☐ There is consistent outreach to include people at risk of social isolation.
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Respect and social inclusion
☐ Older people are regularly consulted by public, voluntary and commercial services on how to serve them better. ☐ Services and products to suit varying needs and preferences are provided by public and commercial services. ☐ Service staff are courteous and helpful. ☐ Older people are visible in the media, and are depicted positively and without stereotyping. ☐ Community-wide settings, activities and events attract all generations by accommodating age-specific needs and preferences. ☐ Older people are specifically included in community activities for families. ☐ Schools provide opportunities to learn about ageing and older people, and involve older people in school activities. ☐ Older people are recognized by the community for their past as well as their present contributions. ☐ Older people who are less well-off have good access to public, voluntary and private services.
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Civil participation and employment
☐ A range of flexible options for older volunteers is available, with training, recognition, guidance and compensation for personal costs. ☐ The qualities of older employees are well promoted. ☐ A range of flexible and appropriately paid opportunities for older people to work is promoted. ☐ Discrimination on the basis of age alone is forbidden in the hiring, retention, promotion and training of employees. ☐ Workplaces are adapted to meet the needs of disabled people. ☐ Self-employment options for older people are promoted and supported. ☐ Training in post-retirement options is provided for older workers. ☐ Decision-making bodies in public, private and voluntary sectors encourage and facilitate membership of older people.
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Communication and information
☐ A basic, effective communication system reaches community residents of all ages. ☐ Regular and widespread distribution of information is assured and a coordinated, centralized access is provided. ☐ Regular information and broadcasts of interest to older people are offered. ☐ Oral communication accessible to older people is promoted. ☐ People at risk of social isolation get one-to-one information from trusted individuals. ☐ Public and commercial services provide friendly, person-to-person service on request. ☐ Printed information – including official forms, television captions and text on visual displays – has large lettering and the main ideas are shown by clear headings and bold-face type. ☐ Print and spoken communication uses simple, familiar words in short, straightforward sentences. ☐ Telephone answering services give instructions slowly and clearly and tell callers how to repeat the message at any time. ☐ Electronic equipment, such as mobile telephones, radios, televisions, and bank and ticket machines, has large buttons and big lettering. ☐ There is wide public access to computers and the Internet, at no or minimal charge, in public places such as government offices, community centres and libraries.
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Community and health services
☐ An adequate range of health and community support services is offered for promoting, maintaining and restoring health. ☐ Home care services include health and personal care and housekeeping. ☐ Health and social services are conveniently located and accessible by all means of transport. ☐ Residential care facilities and designated older people’s housing are located close to services and the rest of the community. ☐ Health and community service facilities are safely constructed and fully accessible. ☐ Clear and accessible information is provided about health and social services for older people. ☐ Delivery of services is coordinated and administratively simple. ☐ All staff are respectful, helpful and trained to serve older people. ☐ Economic barriers impeding access to health and community support services are minimized. ☐ Voluntary services by people of all ages are encouraged and supported. ☐ There are sufficient and accessible burial sites. ☐ Community emergency planning takes into account the vulnerabilities and capacities of older people.
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Takeaway points
• Active ageing can be measured when fostered
• Every-day life’s domains are the realm
• The Age-friendly Cities example
