A global strategy for healthy ageing

4 World Health • SOth Year, No. 4, July-August 1997 A global strategy for healthy • ageing Alexandre Kalache & Ilona Kiekbusch The young ond the old enrich each other's lives. Photo WCC/P. Williams © O has restructured its rogramme on the health of he elderly and given it a new name: Ageing and Health. Reflecting rapid population ageing worldwide, this area of health care is becoming a dominant concern as we approach the next millennium. The changes in the programme are re- flected in its new title. It implies that our focus is on ageing as part of a whole life rather than on a static age group set apart from the rest of the population. With this came the adoption of the new perspectives that guide the programme's activities: • approaching ageing as part of the life cycle rather than compart- mentalizing the health care of the elderly; • promoting long-term health: there is increasing awareness of the need to focus on the process of healthy ageing since, whether early or late in life, people have many opportunities to improve their health status as they age; • observing cultural influences: the settings in whjch individuals age play an important part in their health and well-being; • adopting community-oriented approaches: throughout the world, even in the richest coun- tries, the vast majority of older people live in the community and it is at this community level that most of their problems will have to be dealt with - often outside the health sector but usually with implications for health; • recognizing gender differences: there are important differences in men's and women's health and ways of living, and they become more pronounced in later life; • strengthening intergenerational links: emphasis is placed on strategies to maintain cohesion between generations and a com- mon understanding of ethical issues - as populations age, vital issues must be considered such as undue hastening or delaying of death, human rights, long-term care, and abuse. Our focus is on ageing as part of a whole /if e rather than on a static age group set apart from the rest of the population. A global strategy All these dimensions are of central relevance to the programme and are reflected in activities as interrelated elements that to- gether compound our "global strategy for healthy ageing". An activity component of crucial importance relates to the strengthen- ing of the existing information base; a huge amount of information has been generated in recent years, but it needs storing, checking for accuracy and putting into an accessible form for the use of health professionals, policy-makers and the public. Such information also enhances people's capacity for self-help and self-care. The ways in which we dissemi- nate information are important, since they determine our chances of influ- encing behaviour and decision- making among all the people concerned, who include the public, politicians, health professionals and care providers within the family. Effective information exchange in its turn helps us to develop research programmes that are relevant, non- repetitive and health-oriented (as opposed to disease-oriented). All this leads to new training needs, espe- cially as regards transferring special- ized medical knowledge to the primary care level. Primary health World Health • SOth Year, No. 4, July-August 1997 care workers often have only basic training. However, especially in developing countries, they are the ones most likely to be responsible for helping people to "age well" and to provide health care for older persons when needed. This will call for appropriate policies at every level. WHO's work on ageing and health cannot be restricted to an individual programme. In practice, this means that the "ageing" compo- nents of other WHO programmes have to be highlighted and devel- oped. Such an ageing component is present in virtually all programmes - from Mental Health to Nursing, from Primary Health Care to Noncommu- nicable Diseases, from Reproductive Health to Rehabilitation. In this respect, a major role of the Ageing and Health Programme is to act as a catalyst for action. This has been facilitated by the development of a conceptual framework illustrated by the graph below. The graph refers to the concept of functional capacity and the ageing process. For a number of functional capacities (for example, respiratory capacity, muscular strength, cardio- vascular performance) we reach a "maximum" early in adulthood. From there on, there is a decline. However, this decline can be faster or slower depending on a number of individual characteristics, often associated with living conditions and behaviour. For instance, our ventila- tory capacity reaches a maximum at around 25 years of age. A slow decline in this faculty is associated with factors such as physical activity and living in an environment free of air pollution. A fast decline could, for example, be associated with cigarette smoking. A person follow- ing the first "decline" curve will not reach the disability threshold until very late in life, if ever (as death may occur earlier). In contrast, the life- long smoker may develop emphy- sema at the age of 60 and survive many years with a poor quality of life. Thus it is only later in life that the difference between those who experience a rapid decline in func- tional capacity and those who experi- ence a slow one will be clearly manifested. A life-course perspective to maintain the highest possible level of functional capacity O early life interventions to ensure the hi ghest possible functional capacity O adult life interventions aimed at slowing down the decline age O for those in older age above the disability threshold, previous interventions need to be reassessed O for those in older age below the di sability threshold, interventions are aimed at improvi ng the quality of life Maintaining an optimal physical, mental and social capacity from birth to death is a lifetime process requiring interventions by individuals, communities and health services throughout the whole span of life . Graph by WHO/Ageing and Health Programme This conceptual framework has been shared throughout WHO in order to stimulate other programmes and divisions to adopt policies that will: • bring functional capacity to the highest level early in Life, for example, through good nutrition, physical activity and education; s • place as many individuals as possible on the "slow" curve - i.e. slowing down the decline; • reassess interventions which, as a result of ageing-associated changes such as retirement, widowhood and the onset of specific diseases, need to be adapted to the new context; • intervene for those who fall below the threshold of di sability, for example, to restore sight by a cataract operation or mobility by a hip replacement; or where this is no longer feasible (for instance, for a stroke patient with major residual disability) , to intervene in such a way as to ensure the best possible quality of life. By working with other divisions and technical programmes of WHO around the world, and with other agencies in many fields of activity, the Ageing and Health Programme is taking on one of the big challenges of the next century. And for those who feel gloomy rather than celebrative about ageing, some good news. At least in some parts of the world, the prospects for healthy ageing seem good: evidence is now emerging, for instance, that, in spite of living longer, North Americans are enjoy- ing lower rates of disability. A very recent study suggested that if the disability rates prevailing in 1982 had persisted, by 1996 there would have been 1.2 million more disabled elderly people in the USA than in fact there were. • Dr Alexandre Ko/ache is Chief of the Programme on Ageing and Health and Dr /Iona Kiekbusch is Director of the Division of Health Promotion, Education and Communication, World Health Organization, 1 2 1 1 Geneva 27, Switzerland.