Regional action plan on healthy ageing in the Western Pacific: executive summary and supplementary materials

Regional Action Plan on Healthy Ageing in the Western Pacific Executive summary and supplementary materials © W H O /Y os hi S hi m iz u WPR/2021/DSI/001 © World Health Organization 2021. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license 1Background More than 700 million people in the world are aged 65 and older. Of those, more than 240 million live in the WHO Western Pacific Region (1,2). This number is expected to double by 2050 (2). This demographic change is accelerating, particularly in countries with younger populations (Fig. 1) (2). Source: United Nations Department of Economic and Social Affairs, Population Division, 2019 (2) Fig. 1. Speed of ageing for select countries and areas in the Western Pacific Region: projected time required to transition from an ageing to aged society Ageing: 7% of the total population is aged 65 years and above Aged: 14% of the total population is aged 65 years and above 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 21001930 1940 Australia New Zealand Japan Macao SAR (China) Hong Kong SAR (China) Republic of Korea China Singapore Guam New Caledonia French Polynesia Viet Nam Malaysia Brunei Darussalam Fiji Philippines Mongolia Samoa Cambodia Tonga Kiribati Micronesia, Federated States of Lao People’s Democratic Republic Solomon Islands Vanuatu Papua New Guinea 63 64 24 44 30 18 23 17 20 22 18 18 24 13 47 30 25 46 26 44 46 34 21 44 41 44 Less than 15 years 16 to 30 years 31 to 45 years More than 46 years 2Taking early action The burden of noncommunicable disease (NCD) among people aged 70 and older in many low- and middle- income countries exceeds that of high-income countries (Fig. 2). In fact, the NCD burden in some high- income countries remained virtually unchanged between 1995 and 2019, while the NCD burden has increased in several lower-income countries.1 These findings highlight the urgent need for low- and middle-income countries to take up health promotion initiatives. 1 Molasiotis A, et al. Associations between sociodemographic factors, health spending, disease burden and life expectancy of older adults (70 years+ old) in 22 countries in the Western Pacific Region, 1995 – 2015: A secondary analysis of estimates from the Global Burden of Disease (GBD) Study 2017. Unpublished. YL Ds pe r 1 00 k, NC Ds (M et ab oli c r isk s), ag e 7 0+ ) cluster 1 2 3 Sociodemographics index Male, 1995 Male, 2019 2500 5000 7500 10000 12500 p = 0.055, p = 0.809 0.25 0.50 0.75 1.00 Fiji Brunei Darussalam Marshall Islands Kiribati Samoa TongaVanuatu Solomon Islands Papua New Guinea F.S. Micronesia Singapore AustraliaRep. of Korea New Zealand Japan Mongolia Lao PDR Viet Nam China Cambodia Philippines Malaysia 2500 5000 7500 10000 12500 p = -0.402, p = 0.089 0.25 0.50 0.75 1.00 Fiji Brunei Darussalam Kiribati SamoaVanuatu Solomon Islands Papua New Guinea Singapore Australia Rep. of Korea New Zealand Japan Mongolia Lao PDR Viet Nam China Cambodia Philippines Malaysia Female, 1995 Female, 2019 2500 5000 7500 10000 12500 p = 0.118, p = 0.6 0.25 0.50 0.75 1.00 Fiji Brunei Darussalam Marshall Islands Samoa Tonga Solomon Islands Papua New Guinea Singapore Australia Rep. of Korea New Zealand Japan Mongolia Lao PDR Viet Nam China Cambodia Philippines Malaysia 2500 5000 7500 10000 12500 p = -0.354, p = 0.137 0.25 0.50 0.75 1.00 Fiji Brunei Darussalam Kiribati Samoa Vanuatu Solomon Islands Papua New Guinea Singapore Australia Rep. of KoreaNew Zealand Japan Mongolia Lao PDR Viet Nam China Cambodia Philippines Malaysia F.S. Micronesia Kiribati Vanuatu Fig. 2. NCD burden (YLD, years lived with disability) attributable to metabolic risks between 1995 and 2019, in populations aged 70+ Notes: Sociodemographic index is a composite average of the rankings of the incomes per capita, average educational attainment and fertility rates. Findings from the countries have been grouped into clusters with common characteristics (green, blue, red). Source: Molasiotis A, et al. Associations between sociodemographic factors, health spending, disease burden and life expectancy of older adults (70 years+ old) in 22 countries in the Western Pacific Region, 1995–2015: A secondary analysis of estimates from the Global Burden of Disease (GBD) Study 2017. Unpublished. 3Turning challenges into opportunities Healthy ageing increases employment participation of older adults and improves labour productivity. The main barriers to employment participation for older workers include poor physical and mental health, age discrimination, caregiving obligations, and skill and training deficits (3,4). Addressing these barriers enables older adults to stay in the workforce, improving their financial security and social participation. Workforce ageing may reduce the total factor productivity (TFP) growth (Fig. 3). However, policies that improve access to health services, improve workforce training, lower the tax wedge, and promote research and development can mitigate this adverse impact. Such policies improve labour productivity and enable older populations to contribute to economic growth (Fig. 3) (5). Fig. 3. Impact of workforce ageing on the total factor productivity (TFP) growth (red column) and the impact of different policies on reducing that impact (blue columns) in member countries of the Organisation for Economic Co-operation and Development, 1950–2014) 0 -0.2 -0.4 -0.6 -0.8 Baseline Public sector R&D (median) Reform of tax wedge Reform of ALMP on training Health policies (median) ALMP = active labour market programme; R&D = research and development Notes: Workforce ageing is defined as a percentage point increase in the share of workers aged 55–64. Source: International Monetary Fund, 2016 (5) 4 Turning challenges into opportunities Turning challenges into opportunities 5 Turning challenges into opportunities Hello! blood sugar 105 73 92-135 105 Society fails to meet the needs of older people leading to greater societal challenges Maintaining the status quo Healthier older adults are active participants in and contributors to society Social transformation 2040 6Five objectives for achieving the vision of healthy ageing 7Enable social return (Objective 1) Objective 1 Transforming societies as a whole to promote healthy ageing 8Enable social return (Objective 1) Policies in many countries tend to be based on traditional ideas that education, employment and retirement should take place during set periods of life (6). Revising these policies to support more flexible choices can enable people to undertake more diverse trajectories in their lives (Fig. 4) (7). Ageing 4.0: Integrated life-course perspectives ina society facilitating solidarity EUROPEAN CENTRE FOR SOCIAL WELFARE POLICY AND RESEARCH So ci al iz at io n Ed uc at io n (R e- )T ra in in g Ca re w or k (R e- )T ra in in g (R e- )T ra in in g Ca re w or k Second, third... chances Guaranteed income (life-course transition payments) Lifelong learning Paid work Unpaid work Source: Leichsenring, 2018 (7) Fig. 4. Population ageing: life course 9Enable social return (Objective 1) Ageism is defined as the stereotypes, prejudice and discrimination directed towards others or oneself based on age (8). Research suggests that educational and intergenerational contact interventions aimed at reducing ageism can be effective in improving attitudes, knowledge and comfort towards ageing and older people (Fig. 5) (9). Fig. 5. Meta-analysis of ageism, worldwide, 1976–2018 CI = confidence interval; dD = differences of standardized mean differences. Note: Values above 0 indicate that interventions had a positive effect. Source: Adapted from Burnes et al., 2019 (9) -0.4 -0.3 -0.2 -0.1 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Attitudes towards ageing Knowledge on ageing Comfort with older adults Anxiety about own ageing Working with older adults Eff ec t s ize , d D (95 % CI) 10 Support healthy ageing (Objectives 2–4) Objective 2 Transforming health systems to address each individual’s lifelong health needs 11 Support healthy ageing (Objective 2) Population ageing is shifting the disease burden from communicable diseases towards NCDs and other chronic conditions. With changes in illness patterns, the boundary between health and illness is becoming less distinct (Fig. 6) (10). The classic view of health Healthy Sick Healthy Sick The new view of health Source: Adapted from Nakatani, 2020 (10) Fig. 6. Changes in the concept of health 12 Support healthy ageing (Objective 2) Health at older age is a result of a lifelong accumulation of health statuses and environmental exposures. Evidence suggests that differences in self-reported limitations in daily life in middle age persist over a 20-year period, indicating that differences in self- reported health at a younger age may be predictive of health at older age (Fig. 7).2 0 20 40 60 80 Lim ita tio ns in da ily lif e ( %) 5 10 15 20 year Baseline SRH: very bad (0) Baseline SRH: bad (.25) Baseline SRH: moderate (.5) Baseline SRH: good (.75) Baseline SRH: very good (1) Fig. 7. Limitations in daily life 20-year trajectories according to different baseline (age 40–50) self-reported health (SRH) in the Republic of Korea2 2 Kwon S, Kim T, Lee D. Ageing and health: lifecourse perspective. Unpublished. Source: Kwon S, Kim T, Lee D. Ageing and health: lifecourse perspective. Unpublished. 13 Support healthy ageing (Objective 3) Objective 3 Providing community- based integrated care for older adults tailored to individual needs 14 Support healthy ageing (Objective 3) Care needs are growing, but long- term care remains underdeveloped. In 2015, about 8.7 million people in East and South-East Asia were identified as requiring long-term care. This number is expected to double by 2035 (Fig. 8) (11). However, workforce shortages remain, even in countries with more developed long-term care systems, such as Japan and the Republic of Korea (11). 0 10 20 30 40 50 60 70 6 11 2 5 9 2 7 13 3 35 4 5 2 60 7 4 33 4 5 2 57 7 4 33 4 5 2 56 6 4 34 3 5 2 56 6 4 34 3 5 2 55 5 4 32 3 5 2 52 5 3 30 2 5 2 49 4 3 28 2 5 2 46 4 3 26 2 5 2 43 4 2 24 2 4 2 39 3 2 21 2 4 2 34 3 2 17 2 4 29 14 2 4 24 11 20 4 9 16 3 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060 2065 2070 2075 2080 2085 2090 2095 2100 Ca re ne ed in m illi on pe rso ns China Japan Indonesia Viet Nam Thailand Rep. of Korea Other Source: Hayashi, 2016 (11) Fig. 8. Estimates of care need in East and South-East Asia (in millions of older persons) 15 Support healthy ageing (Objective 3) Social relationships may be predictive of mortality rates. A meta-analysis found that individuals’ experiences within social relationships were a significant predictor of mortality. Their influence was also found to be similar to other well- established risk factors for mortality (Fig. 9) (12). Social Relationships: Overall findings from this meta-analysis Social Relationships: High vs. low social support contrasted Social Relationships: Complex measures of social integration Smoking <15 cigarettes daily Smoking Cessation: Cease vs. continue smoking among patients with CHD Alcohol Consumption: Abstinence vs. excessive drinking (>6 drinks/day) Flu Vaccine: Pneumococcal vaccination in adults (for pneumonia mortality) Cardiac Rehabilitation (exercise) for patients with CHD Physical Activity (controlling for adiposity) BMI: Lean vs. obese Drug Treatment for Hypertension (vs. controls) in populations > 59 years Air Pollution: Low vs. high 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Fig. 9. Comparison of the relative risk of mortality across several conditions BMI = body mass index, CHD = coronary heart disease Note: Smaller numbers indicate lower risk. Source: Holt-Lunstad, Smith & Layton, 2010 (12) 16 Case study: social prescribing pilot in Shangrao, China Social prescribing describes a variety of schemes that connect patients to volunteer and social services available in their communities. This process, mediated by link workers, allows patients to access services that may be better suited to addressing the underlying causes of their health issues. A social prescribing toolkit has been developed to support the introduction of social prescribing in the Western Pacific Region. The toolkit was piloted in the city of Shangrao in early 2021, as part of the city’s strong commitment to improve the mental health care of older adults. The pilot was very well received by patients and staff and is currently being scaled up. Link workers conduct patient assessment (upper photo). Group discussion with the link worker team (lower photo). © W H O /Tuohong Zhang 17 Support healthy ageing (Objective 4) Objective 4 Fostering technological and social innovation © W H O /Kate Tracy O ng 18 Support healthy ageing (Objective 4) Bengkel Teknologi Senior (Malaysia) runs workshops to help older people (over the age of 55) use technology with the goal of increasing their technological capacity, skills and competency. Bengkel Teknologi Senior Time banking apps (China) foster mutual support of older people. Time credits obtained by volunteering in support of older people can be redeemed by volunteers in future times of need. Adapting to population ageing requires new and innovative ways of thinking and working. 19 Digital access: a social determinant of health Studies show that digital access may be a social determinant of health. There is a strong association between the levels of Internet usage and good health and well-being (FIg. 10) (13). These include lower depression risks as well as higher levels of self-rated health, activities of daily living and social relationships. The effect of Internet usage on health outcomes has been shown to be independent of income, educational attainment and other socioeconomic status. It is comparable to the effect of socioeconomic status on the same health outcomes (14). At the same time, some older people find themselves in the wrong side of the so-called “digital divide”, due to various physical and social disadvantages. For example, older people with higher incomes are more likely to have better access to the Internet (14). 0.66* 0.81 0.71* 0 0.2 0.4 0.6 0.8 1 1.2 Depression Self-rated health Hypertension Diabetes Ris k r ati o o f e ac h h ea lth ou tco me s b y i nte rn et us e Internet non-use Internet use Ref. Ref. Ref. Ref. 0.76* **p<0.01, * p<0.05. Adjusted for age, sex, equivalized household income, educational attainment, working status, living arrangement, preexisting disease (hypertension, diabetes, cardiovascular disease, stroke, cancer, respiratory disease), self-rated health, activities of daily living, depression, population density Health outcomes by Internet use : Longitudinal study 2016-2019 Fig. 10. Associations of Internet use and subsequent health outcomes Source: Kondo et al., 2021 (14) 20 Case study: virtual health coach A virtual health coach has been developed to promote health among older adults in an engaging and accessible manner. This interface is specifically designed to overcome some of the common barriers faced by older people in using technology. The virtual health coach is a web-based application that answers health- related questions. In its final form, this virtual platform could be turned into a smartphone app that also provides personalized features such as health tracking and nudging. 21 Case study: Viet Nam’s intergenerational self-help clubs Intergenerational self-help clubs or ISHCs are volunteer-based organizations that promote the well- being of individuals who are poor and most disadvantaged in society, with the majority of them being older adults. They provide a wide range of activities and support services, including social and cultural, income generation, lifelong learning, health promotion and community-based care. © H elpAge International in Vietnam 22 Research, monitoring and evaluation (Objective 5) Objective 5 Strengthening monitoring and surveillance systems and research on older adults © W H O /Aya Yajim a 23 Research, monitoring and evaluation (Objective 5) Three quarters of the world’s countries have limited or no comparable data on healthy ageing or on older age groups, and this situation contributes to the invisibility and exclusion of older people. 0 10 20 30 40 50 60 AFR AMR EUR SEAR Yes No WPREMR 28 14 5 16 4 15 5 11 5 16 4 15 5 6 10 13 4 Not reported WHO regions: AFR = Africa, AMR = Americas, EMR = Eastern Mediterranean, EUR = Europe, SEAR = South-East Asia, WPR = Western Pacific Source: WHO, 2020 (15) WHO regions: AFR = Africa, AMR = Americas, EMR = Eastern Mediterranean, EUR = Europe, SEAR = South-East Asia, WPR = Western Pacific Source: WHO, 2020 (15) “ ” 2018 2020 Globally 28% 32% AFR 11% 11% AMR 29% 43% EMR 14% 24% EUR 53% 55% SEAR 36% 45% WPR 15% 15% Fig. 11. Number of countries with cross-sectional, nationally representative data on health status and needs of older people, in the public domain, 2020 Fig. 12. Percentage of countries reporting availability of cross-sectional, data on health status and needs of older people, in the public domain, 2020 24 Recommendations for Member States and role of WHO © W H O /Paulus 25 Enable social return (Objective 1) Recommendations for Member States Identify and review policies that create barriers for older adults, such as in health, employment, learning and social participation. Facilitate the participation of older adults in decision-making processes at all levels using community-based participatory tools and approaches. Support the development and implementation of training programmes to combat ageism in society and internalized ageism. Create opportunities for intergenerational engagement and social participation of older people. Role of WHO Support Member States to review relevant policies. Develop advocacy and communication materials that offer positive representations of ageing. 26 Support healthy ageing (Objective 2) Recommendations for Member States Develop a national plan for health system transformation in collaboration with all relevant sectors and stakeholders and strengthen integration between healthy ageing and NCD programmes. Raise awareness about the impact of the social determinants of health. Develop national and/or subnational programmes on age-friendly cities and communities. Strengthen the primary health care capacity to provide quality care for older adults and advocate for universal health coverage. Role of WHO Support country-tailored, national-level initiatives and partnerships including with United Nations agencies, international donors, the private sector, civil society and other sectors. Consolidate evidence and identify promising policy options for health system transformation, including addressing the social determinants of health. Develop tools to raise awareness among older adults about the importance of disease prevention and health promotion. 27 Support healthy ageing (Objective 3) Recommendations for Member States HEALTH Improve the capacity of primary care to assess and monitor the intrinsic capacity of older people using WHO Guidelines on Integrated Care for Older People (ICOPE). Adopt relevant recommendations from WHO guidelines for immunization, hepatitis B and C, tuberculosis, dementia and palliative care in the national plan for ageing. Develop national strategies to promote lifelong oral health care, including improving accessibility of oral health services. LONG-TERM CARE Promote self-care training for older adults and training for paid and unpaid caregivers. Provide a range of services that support ageing in place, such as day care, short-term stays that are supplemented by long-term care facilities. Take action to prevent and respond to violence against older adults, such as through awareness campaigns, improved training for caregivers, enhanced standards of care in facilities and strengthened policies that protect older adults. SOCIAL SERVICES AND SUPPORT Provide community-based opportunities for continual social participation, such as social activities, health promotion, lifelong learning and volunteering. 28 Support healthy ageing (Objective 3) Recommendations for Member States COORDINATION Provide appropriate training to health professionals on the social determinants of health. Consider training nurses, social workers and community volunteers to become “link workers” who can help connect older adults to services in their communities. Support communities to host community dialogues, such as World Cafés to engage community members and other key stakeholders to determine services that the community needs. Role of WHO Support Member States in collecting evidence on delivering integrated care, self-care and long-term care and developing evidence-based technical materials accordingly. Support Member States to provide training for capacity-building of workforces for health and long-term care. Contribute to research, documentation and dissemination of best practices on coordinated services for older adults, including coordination among health, long-term care and social service systems. 29 Support healthy ageing (Objective 4) Recommendations for Member States Encourage technological and social innovations to support healthy ageing. Consult older adults in the development of technological and social innovations. Consider issues of equity, particularly in the accessibility of technology for older adults. Encourage the use of safe, affordable and effective digital technology in integrated care in collaboration with relevant sectors. Role of WHO Contribute to research, documentation and dissemination of best practices on innovations. Document and evaluate innovations. 30 Research, monitoring and evaluation (Objective 5) Recommendations for Member States Build a strong national monitoring and surveillance system that collects, analyses and interprets data, including national-level, age-disaggregated data using five-year brackets throughout adulthood. Invest in longitudinal data surveys and mixed methods research on the health and functional status of older adults, including subpopulations of older adults. Promote research collaboration between academic institutions, nongovernmental organizations and communities. Build in monitoring and evaluation mechanisms into programme, policy and health system design to better understand their impact. Disseminate research findings to relevant decision-makers to inform development of policies, programmes and services. Role of WHO Advocate for improved qualitative and quantitative research on older adults. Provide technical support for Member States to improve data collection and research on older adults. 31 Key factors for success © W H O /Y os hi S hi m iz u ✔ Political commitment, capacity- building and leadership. ✔ Multisectoral and multi-stakeholder coordinating mechanism and plan at the national level. ✔ Well-designed systems and policies to promote healthy ageing. ✔ Positive public perception and support for healthy ageing. ✔ Sufficient financial and human resources for implementation. 32 Backcasting the vision of healthy ageing Source: WHO/Yoshi Shimizu Proposed actions for today, 2025 and 2030 to achieve the vision of healthy ageing in the Western Pacific Region in 2040 Today Countries start advocacy, planning and implementation ✔ Build a case for change ✔ Strengthen capacity for data collection ✔ Plan national strategy ✔ Leverage existing assets for programmes 2025 Countries implement national policies and systems for healthy ageing ✔ Adopt innovation ✔ Research on older people ✔ Establish multisectoral coordination for social transformation ✔ Identify resources 2030 Countries begin transformation of different sectors based on national policies ✔ Scale up innovation ✔ Refine policies and services based on evidence ✔ Establish community- based integrated care 2040 Healthier older adults are thriving and participating in society 33 References Source: WHO/Yoshi Shimizu 1. 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