· w oRLD HEALTH ORGANIZATION REGJONAL OFFICE FOR THE WESTERN PACIFIC
REPORT WORKSHOP TO REVIEW TIIE IMPLEMENTATION OF NATIONAL POLICIES FOR HEALTil CARE OF OLDER PERSONS Adelaide, Australia
l8-21 August 1'997
Manllllt Philippines May 1998
·.
(WP)OCH/ICP/ AHE/00 1-E Report series number: RS/97 /GE/21 (AUS) English only
REPORT WORKSHOP TO REVIEW THE IMPLEMENTATION OF NATIONAL POLICIES FOR HEALTH CARE OF OLDER PERSONS
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Adelaide. Australia 18-21 August 1997
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines May 1998
NOTE
The views expressed in this report are those of the participants in the Workshop to Review the Implementation of National Policies for Health Care of Older Persons and do not necessarily reflect the policies of the Organization.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Workshop to Review the Implementation of National Policies for Health Care of Older Persons, which was held in Adelaide, Australia from 18 to 21 August 1997.
CONTENTS
SUMMARY .................................................................................................................... . I. INTRC)DUCTION ............................................................................ ...... ........................... 3 1.1 1.2 1.3
I .4 2.
()bjectives ............................................................................................................... Participants and resource persons .......................................................................... ()rganization ........................................................................................................... Opening ceremony .................................................................................................
3 3 3
4
PROCEEDINGS ............................................................................................................... 5 2.1
2.2 3.
Summary of country reports ................................................................................... Sun11nary of discussions .........................................................................................
5 7
CONCLUSIONS ............................................................................................................... 11 3.1 3.2
3.3 3.4 3.5
Policies ................................................................................................................... Development of programmes for the improvement of health and quality of life of older persons ......................................................... Education and training ........................................................................................... Data collection, research and evaluation ................................................................ Guidelines for policy and programme development ..............................................
12 13 13 14 14
ANNEX I - ACif·:ND/\ ................................................................................................... 15 ANNEX 2 OF
LIST OF P/\RTICIP/\N'T'S AND MEMBERS Till~ SFCRET/\RI/\T .......................................................................... 19
Key words: Health services for the aged I Health policy I Australia
SUMMARY
A Regional Workshop to review the implementation of national policies for health care of older persons in the Western Pacific Region was held in Adelaide, Australia from 18 to 21 August 1997 in conjunction with the 1997 World Congress of Gerontology. The workshop was attended by 13 participants representing 8 countries. The demographic trends of the past decades in many countries of the Western Pacific Region arc leading to unprecedented increases not only in absolute numbers but also in the proportion of older people. The combination of the demographic shift and accompanying epidemiological transition. along with a period of generally rapid industrialization in most countries of the Region, have been identified as the key factors contributing to the impending 'crisis' in the provision of adequate health care and social support for older persons, especially in developing and newly industrialized countries. While a number of countries in the Western Pacific Region have already developed policies and programmes to improve the quality of life and well-being of older persons, the programme sti II ranks low in priority in many of the countries of the Region and there is wide \'ariation in the scope and detail of established policies and programmes. The general objective of the workshop, therefore, was to develop policies and programmes to improve the quality of life in later years. Specific objectives are: (I) (2) to review existing national policies on the health care of older persons; to discuss the implementation of these policies and programmes at national level:
and
n)
to discuss and review the specific guidelines in the development of policies and programmes for the health care of older persons.
The workshop began with a general overview and discussion of the draft guidelines for nat ion a I pol icy and programme development for health of older persons in the Western Pacific Region. The draft guidelines were reviewed and suggestions for further improvement were made in preparation for the production of a final version for distribution throughout the Region. The feasibility of the guidelines and the steps which will need to be taken to implement them in various settings were considered. A review of existing national policies and programmes was made by way of country reports which were presented by a representative from each participating country. Discussions, centred around brief working papers, followed. Topics for discussion included the essential elements of a broad framework for policy formulation on health of older persons. barriers to development of policies for health of older persons and strategies for overcoming them, guidelines for development of comprehensive health care services for older persons and feasibility process and steps required for implementation of national policies and programmes for health of older persons,
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Following this intensive series of discussions, the workshop arrived at a number of conclusions which touch on the areas of policy programme development; education and training; and data collection, research and evaluation. Participants also agreed that the Guidelines for National Policies and Programme Development for Health of Older Persons in the Western Pacific Region would provide a sound basis for future national policy formulation and planning and should be widely promulgated and recommended to Member States throughout the Region.
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l. INTRODUCTION
The Workshop to review the implementation of national policies for health care of older persons in the Western Pacific Region was held in Adelaide, Australia from 18 to 21 August 1997. 1.1 Objectives
The general objective of the workshop was to develop policies and programmes to improve the quality of life in later years. Specific objectives were: (I) (2) to review existing national policies on the health care of older persons; to discuss the implementation of these policies and programmes at national level:
and (3) to discuss and review the specific guidelines in the development of policies and programmes for the health care of older persons. The agenda and schedule of activities in the workshop is seen in Annex 1. I .2 Participants and resource persons
The workshop was attended by 13 participants representing 8 countries. The full list of participants can be seen in Annex 2. Dr Kiyomichi Fuj isaki, from Japan, was elected Chairman and Mrs Joanna Tan Soek-cheng, from Singapore, was elected Rapporteur, supported by Ms Penny Edwards from Australia. 1.3 Organization
The workshop was predominantly conducted in round-table format. Discussion for the first half of day one concentrated on reviewing the draft guidelines for policy and programme development in the region. In the second half of day one, a review of existing national policies and programmes in each country was made by way of presentations from a representative of each of the participating countries. On the second day of the Workshop and briefly on the third, discussion (aided by brief working papers) focused on the following topics: • • Framework for policy formulation on health of older persons; Barriers to development of policies for health of older persons and strategies for overcoming them; Guidelines for development of comprehensive health care services for older persons; and Feasibility, process and steps in implementation of national policies and programmes for health of older persons.
•
•
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The outcomes of these discussions were further refined during the final session of the third day. Finally, conclusions were drawn, discussed thoroughly and agreed upon by all participants. Conclusions from the Workshop will form the basis for further action to improve the health and well-being of older persons throughout the Region. 1.4 Opening ceremony
The workshop was opened on behalf of the Regional Director by Dr Linda Milan, Regional Adviser in Occupational Health. She briefly described the issues associated with the increasing population of older persons in the Western Pacific Region. It has been widely recognized that the demographic trends of the past decades in many countries of the Western Pacific Region have led to unprecedented increases in both the number and proportion of older people in the population. The rapid increase in the number of older persons has significant implications in both social and economic terms. Specifically, there are implications for areas such as health care, the financing of the needs of older persons, their accommodation and the role of the older persons in a rapidly changing and urbanizing society. In response to this, governments need to develop appropriate policies and programmes. Although ageing and health care of older persons is often not yet a priority issue for policy-makers and health planners in many countries of the Western Pacific Region, there is a growing need to pay more attention to the important health issues associated with population age mg. While a number of countries have developed policies and programmes to improve the quality of life and well-being of older persons, the programme still ranks low in priority in many countries of the Region and there is a wide variation in the scope and detail of established policies and programmes in each country of the Region. The Regional Adviser in Occupational Health concluded by wishing participants a fruitful and worthwhile workshop. Professor Gary Andrews, Director, Center for Ageing Studies, Flinders University, a WHO Collaborating Centre for Research on the Epidemiology of Ageing in Adelaide, South Australia, welcomed the participants to Adelaide. He said that the assembled group of participants represented a very experienced, highly distinguished group and that a great deal could therefore be expected to come from the workshop in a relatively short period of time, given the vast pool of experience to draw from. He reiterated the main objective of the workshop which was to revise the draft guidelines and to produce a final product that could be adopted throughout the Region. The diversity of the Western Pacific Region meant that the guidelines would need to have wide variation and therefore the guidelines that apply to the Region may indeed be applicable globally. No set of guidelines, however, is perfect, and he hoped that discussions during the workshop would aid the development of the policy guideline document. He concluded by wishing everyone a successful workshop and an enjoyable stay in Adelaide.
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2. PROCEEDINGS
2.1
Summary of country reports
Country reports were presented by a representative from each participating country. These reports outline the present situation of each country and identified any specific issues relevant to policy and programme development, including major initiatives and problems being encountered. The following is a brief summary of each country report. The full report for each country will be available on request. China Over the past decade, China has experienced rapid population ageing. The majority of older persons live in rural areas. Health care networks, generally community-based, exist in both urban and rural areas. Health care of older persons in China has traditionally been integrated into the overall health policies and programmes for the entire population. These programmes include health education, health promotion and protection, prevention and control of disease, rehabi Iitation and training of health professionals. Comprehensive health care, involving general practitioners, community nurses, other health workers and volunteers is becoming increasingly prevalent in both urban and rural areas. Health insurance programmes are being improved so that more older people, particularly in rural areas, have economic access to health care. 'Training of health professionals has also been enhanced. Recently, the State Council formulated a national policy guideline focusing on reform and development of health care. Under this, health care of older persons is an imp01iant component. Fiji The proportion of the popu Iat ion aged over 60 years in Fiji is expected to reach 15% by 2020. Local awareness activities began in 1993 with a WHO-sponsored workshop on policy planning for the health care of the elderly. Other activities followed, and a national programme for health care of the elderly was forrnulated. The focus of this programme was to preserve the dignity, independent and autonomy of older persons in the context of family and community in such a way that ageing will be a positive and fulfilling phase of a complete life. The FUi Ministry of Health is taking positive steps to deal with the issue of care of older persons before major problems arise. Accessibility to good quality acute care has been recognized as an issue. Japan Japan will face the highest proportion of older persons to the whole population in the 51 world in the early 21 century. The implementation of services for older persons is mostly carried out at local level. Services include preventive care, including health checks and education, institutional and non-institutional care and social and medical insurance schemes for older people. Community-based services included home delivery of medical and welfare services for older persons, day services and voluntary services. A ten-year Strategy to Promote Health Care and Welfare for the Elderly (Gold Plan) was drawn up in 1989 and implemented in 1990 to develop the infrastructure for public health care and welfare service for older persons by 1999. The lack of a national coordinating mechanism is seen as a major constraint to efficient health care provision for older persons.
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Malaysia The proportion of the population aged over 60 in Malaysia is expected to reach 11.3% by 2020. Health care of the older persons in Malaysia was introduced as a strategy under the Ministry of Health in its 7111 Malaysia Plan ( 1995-2000). The Health Care Programme for the Elderly is to be implemented in phases between 1997 to 2000. There are two organizational structures to develop policies for older persons. These are the National Advisory and Consultative Council (Welfare Ministry) and the National Health for the Elderly Council (of the Health Ministry). Four community-based projects were started in 1996 under the Elderly Health Care Programme. There are plans to expand these to nine other states. Research on ageing and health of older persons is presently being carried out by the Ministry of Health, as well as local universities in the country. Programmes to provide health and medical facilities to meet the needs of the ageing population are currently underway, however these efforts are constrained by a shortage of trained health workers and professionals, and also a lack of adequate finances. Philippines The ageing of the population is f~1st becoming a high priority issue in the Philippines. The Philippine Government has responded positively in recognition of the rapid increase in the population of older persons and has begun to introduce policies and programmes. T'he Medium-Term Philippine Development Plan, 1992-1999, specified the need to provide appropriate privileges and benefits for older persons. The passage of Republic Act 7432 established the Office of Senior Citizens Affairs in 1540 municipalities and 64 cities all over the country. The enactment of Republic Act 7879 (Senior Citizens Act) established day care centres for senior citizens in every municipality and city. Constraints to effective implementation of the national programme for health of older persons include the lack of action addressing specific health concerns of older people, a lack of adequately trained human resources for health of older persons, as well as a lack of information necessary to plan further community health programmes. Republic of Korea The Government has put together a comprehensive programme to address issues brought about by the rapid ageing of the population. Economic security, which is recognized as an important factor in promoting quality of life of older persons, is addressed through income maintenance programmes, a national pension system and an old age allowance. The Livelihood Protection Law also ensures a minimum standard of living for older persons. Leisure and recreation are also being addressed through establishment of senior club houses, senior schools and multipurpose centres for older persons. Other programmes are the elderly honour programme, housing service, home care and institutional care services. The Elderly Welfare Division, under the Ministry of Health and Welfare, directs policy orientation, provides budgetary support for programmes and collects administrative information regarding the older persons. A research and information programme is being conducted by the Korean Institute for Health and Social Am.irs (KIHASA) and the Government actively supports national health promotion programmes. Primary health care services in the form of home-help service centres, day care centres and short-term care centres are also provided. The level of training of primary health care personnel, specifically trained in geriatrics, is currently limited and it is suggested that the training of this type of personnel should be upgraded.
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Singapore At present, Singapore's population can be considered "young". However, by 2030, older persons will comprise 20% ofthe total population. Various committees have been established to look into the needs of older persons and a national policy on ageing has evolved. There is no coordinating body for policy on ageing. However, the National Advisory Council on the Family and Aged, the Ministry of Community Development, the Ministry of Health, and the National Council of Social Services, together with other government bodies, provide a comprehensive range of welfare and medical services for older persons. These services include acute geriatric hospital services; inpatient hospital care in community-hospitals and chronic sick hospitals; inpatient residential care in nursing homes; and community-based health care; which includes day rehabilitation and home care services. A systematic research and information programme to support the development of services for older persons is also provided. Primary health care services in Singapore arc provided. However, there is no specific component for the older population. llcalth care personnel receive training, but not specifically on the needs and the care for older persons. VietNam There arc policies in VietNam, as embodied in the Constitution, ensuring that the Government and society take responsibility f()f' caring for older persons, particularly homeless old people. Gerontology is a new discipline in VietNam. llowevcr, since 1970, a geriatrics project has been implemented. In 1980, a geriatrics research unit was created, and in 1983, the Institute of C!crontology was established. Primary health care specifkally for older persons. day care centres and nursing homes have not been established. However, general health f~1cilities which also cater to uldcr persons arc present in almost every precinet or village. Family support for older persons is still very strong, particularly in rural areas, and there is an increasing recognition of the need for preventing the impact of the new lifestyle which may erode the good tradition of respect for older persons. A project to set up older people's service centres in the communities during 1997 to 1999 will be developed by the Institute of Gerontology. 2.2
Summary of discussions Discussion of the draft guidelines
2.2.1
The Chairman opened the discussion of the draft guidelines by saying that he considered the document to be very comprehensive. Referring to the introduction portion of the document, Professor Andrews acknowledged that some of the background and demographic information were out of date, and that the Region is facing rapid changes in terms of politicaL economic and social circumstances. Professor Andrews therefore requested the participants to send more current country information to the Centre for Ageing Studies, Adelaide for inclusion in the final document. The participants continued to discuss and comment on each chapter of the draft guidelines as follows: (I) Principles Family orientation Every participant was aware that the family cannot work alone. The level of family support for older persons in Australia was discussed. In Australia, multigenerational households
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are not common and older people live with spouses, or alone, or occasionally with children. There is evidence that additional support is needed, i.e. programmes for in-home support, respite etc. Domiciliary care services currently provide 15-20% of care to the community, the rest is provided by family. The Government has shifted more responsibility for caring for older persons to the family. Domiciliary care services therefore try to train family care givers. Gender Men and women have dillerent problems and needs and also different attitudes regarding health care. Older women live longer and tend to have more disabilities than older men. Older women are often the primary care givers for older spouses. However, the productivity of women should not be limited by their can:·giving role. Traditional care In the Western Pacific Region, older persons are more likely to use traditional care. This must, therefore, be taken into account There should be some mention of traditional care in the final guidelines document, an integrated approach between traditional and modern care. In the Republic of Korea, the inlluence (lf traditional care is growing, particularly for older persons. This may cause problems because of inadequate regulation. Comprehensive care There is a need to combine health care access with prevention of disease and disability. Teachers of health care techniques and training courses should be able to demonstrate the differences that are involved in geriatric care. There is now pressure to make some hospital services home-based. Productivity The importance of maintenance of health (productivity) should be stressed more in the final guidelines document. Productivity needs to be discussed in the introduction, or included as a principle in the final guidelines document. It is important to link productivity with participation. It is not restricted to 'productive' in economic terms. Productivity is the key message of the WHO global programme on ageing. If people can contribute and be productive then ageing does not pose a problem. Productivity must be seen in the broader sense since the contribution of older people cannot always be quantified. (2) Policies
Policies formulated should be consistent with a country's social, demographic, economic and political conditions. Prior to or along with the formulation of policies, consultations should be held with all the concerned sectors regarding implementation mechanisms and related issues. There needs to be national commitment and a national statement to provide direction. Coordinating mechanism Problems exist where there is overlap between agencies, e.g., health and welfare. The role of the coordinating mechanism is to unite these agencies and other sectors involved in the health
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and care of older persons. It is important that their respective roles are clarified and their functions complement each other. Difficulties in coordination were reported by many of the countries of the Region. A common problem encountered was who should be leading the team. The participants also emphasized that, since a broad range of services are being made available to the older persons, who after all are the centre of initiatives on ageing and health, a truly coordinated approach should be adopted at all levels, including at the lower or the community level. Quality of care Standards of care provided in the community and or residential care need to be established and imposed. This is made all the more necessary because older persons, who are recipients of such care, often complain. It is also important that older persons are educated on the natural process of ageing so they may better understand their situation.
Health promotion and disease prevention llealth education should be included in a comprehensive health care programme for older persons. People must be empowered and educated to make the right choices. There is a problem with the term 'disease prevention'. It was suggested that 'Prevention, education and health pnmmtion' would be a better title for this section of the document. Functional capacity of older persons should be stressed and education for life, must have a 'life course' perspective.
Participants ugn:ed thai this is still the preferred model of care for older persons. However, due to changing family nnd societal traditions brought about by economic development, industrialization and urbanization, alternative models of care are becoming more relevant and accepted. Rehabilitation Participants stressed that a very important objective of rehabilitation is to restore older persons in the mainstream of society and to enhance their productivity. Medical services In addition to providing general health or medical services, certain specialized services also need to be integrated into the total care of older persons. An example given was mental health services. Dementia is a common problem encountered among older persons and hence should be stressed in the guidelines. Residential care Too much attention has been paid to residential care in the draft guidelines document. More information should be included about community care. Definitions need to be clear, i.e., residential care, long-term care, day care, institutional care etc.
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Human resources development A hierarchy of personnel involved in the care of older persons should be identified and appropriate training at each level should be provided. Nongovernmental organizations Participants suggested that nongovernmental organizations should also be involved early on in policy formulation and planning. Nongovernmental organizations are often able to recruit more volunteer support. The aid they provide is more direct and flexible. Examples of nongovernmental organizations need to be given in the final guidelines document. It was suggested to define voluntary organizations, non-profit organizations and charitable organizations. (4) Implementation
The steps for implementation do not need to be followed in order as they arc all components which make policies achievable. Discussion of' funding and commitment by government organizations should be included in the llnal guidelines document.
There was scHne cliscussio1J regarding the e:.:a111plcs pf policies and programmes included in the draft guidelines document. Mote cunent nrc needed. Participants were asked to resubmit examples of policies and programmes. that all examples be included in an appendix. There was much discussion ition of certain terms used in the draft guidelines dncumcnt (e.g. n:sidential It was suggested that a glossary of terms be included in the guidelines. I I I
Discussion of framework for pol in fonnulation on health of older persons
In this session, participants were asked to itkntify the essential elements of a broad frame\vork that can form the basis l<x policy dcwlopment for the improvement of health and quality of life i~lr older persons. Much of the first discussion on the draft policy guidelines \Vas applicable to this topic. Lssential clements in a comprehensive framework for policy include a national coordinating mechanism, public education, human resource development, consultation, etc . The leaders of government must be aware of the needs of older people, even at a community/local level. Communication between agencies must be at all levels and coordination must revolve around the individual older person. Much can be learned from 'coordinated' or 'managed' care approaches, as they allow coordination of activities around an individual. It was emphasized that, while a broad framework for policy formulation is provided, it is important that policies are consistent with each country's sociaL demographic, economic and political conditions. Moreover, prior to or as part of the policy formulation process, consultations on implementing mechanisms should be undertaken with concerned groups.
2.2.3 Discussion of barriers to development of policies strategies for overcoming them
f~lr
health of older persons and
In this session participants were asked to examine the barriers to achieving comprehensive national policies for health of older persons. Among the barriers identified and discussed were inadequate budgets and financial support and legitimate competition with other health and social policy priorities. Divergence of health and welfare authority functions and insufficient collaboration among disciplines and services, and between levels of government, have also been
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among the common problems encountered by countries. Furthermore, the low profile of issues associated with ageing and a lack of knowledge and understanding of 'healthy' or 'active' ageing contributes to the relatively slow development of policies and programmes for the health and well-being of older persons. 2.2.4 Discussion of guidelines for development of comprehensive health care services for older persons The structures and services existing in the participants' respective countries, as well as the strengths and weaknesses of these structures, were discussed. Elements of a comprehensive health care programme for older persons, as set out in the draft guidelines, were touched upon. However, many ofthese elements had previously been discussed in the review of the draft guidelines on day one of the workshop. 2.2.5 Discussion offeasibility, process and steps in implementation of national policies and programmes for health of older persons In this session, participants were asked to discuss the key steps in implementation of appropriate community health care services for older persons. The importance of a national advisory mechanism to oversee the development ofthe national response to population ageing and the needs of older persons was acknowledged. Health promotion, prevention and education programmes must be stepped up to promote the concept of 'healthy' or 'active' ageing. Demographic and health care service data is essential to attaining effective care for older persons. The group agreed that the steps for implementation do not need to be followed in the order as set out in the draft guidelines. However, the group emphasized that the steps are all essential components in making policies achievable.
3. CONCLUSIONS
The workshop provided a venue for lively and productive discussions on such subjects as policies, programmes, the need for training, research and other issues related to ageing and health. Despite the great diversity of countries and of situations obtaining in each country, some conclusions were reached on how the above issues should be approached. Briefly, the workshop agreed on the following guiding principles: (I) Policies and programmes, to be effective, need to have strong central government support, as well as clearly defining the roles and functions of participating agencies or groups. Ultimately, it is the older person -his health, his quality of life, his participation (2) and productivity- who is at the cent;·e of all initiatives in ageing and health. Therefore. it is but necessary that at every level, there should be coordination of services that are being provided. (3) Home or community-based care is still the preferred mode of care. In this connection, support to the family and the carers, in a variety of ways, is necessary. It is also recognized that in certain instances, home or community-based care is no longer the
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best or appropriate way of caring for older persons. Options such as different levels of residential care need to be considered. (4) Support activities or programmes such as education, training and research are important elements and should be pursued as part of the comprehensive approach to improving the health of older persons. Conclusions from the workshop will form the basis for fmiher action to improve the health and well-being of older persons throughout the Region. Following an intensive series of discussions over three days the participants arrived at the following conclusions: 3.1
Policies (I) The focus of policy is not only to ensure the health of older persons but also to achieve the objectives of healthy, successful and active ageing, and to enhance participation and productivity among the older population. (2) The initiation of action to l~xmulate and update national policies on health and health care services for the older population is urgently required. (3)
/\n important llrst step in aehitving policy and pn1gramme development is to raise the level of avvareness nf the needs of the older population in terms which arc easily understood by policy and decisiotHlWkers.
(4) /\ttentinn needs to be tn the development of a comprehensive approach to identifying the health needs of older populations and effectively addressing these needs in the context nf each country's dtmwgraphic situation, socioeconomic circumstances, health care and welfare structures. (5)
Participants agreed that issues related to population ageing deserved high priority from govcmmcnts, !\ stron!,!. nnd clearlv cntm~~iated central government commitment to addressing the issm~s of active ageing and health of older per<;ons is an important function in effective policy and programme development.
(6) Ministries of 1kalth must play a central role in identifying and responding to issues associated with health of older persons and should show leadership and accept responsibility for mobilizing interscctoral responses to improving and sustaining the health and quality of life of the older community. Serious coordination issues could be avoided through the establishment nf clear structural relationships and clear distinction of the roles of competitive agencies involved in issues associated with the health of older persons. (7) Action to improve the health and access to comprehensive health care service of older persons must be undertaken through partnerships between government, nongovernmental organizations, the private (for profit) sector, families and the community generally. Consultation between relevant government agencies and a broad range of service providers is essential to ensuring the feasibility and effective implementation of policies. (8) The diversity which exists within and between the countries ofthe Western Pacific Region necessitates the formulation of policies and programmes that are consistent with the social, cultural, demographic, political and economic circumstances of each country.
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3.2
Development of programmes for the improvement of health and quality of life of older persons (I) Older people will take their place as citizens with access to the fullest possible range of activities and obligations. They will have access to the same services and opportunities, contribute in the same areas in keeping with their wishes and abilities, and enjoy and participate in the same activities and challenges which are available to people of all ages. (2) Priority needs to be given to the development of preventive services and programmes throughout the entire life course, ultimately directed to the promotion of good health in old age and the maintenance of healthy and active ageing.
(3) In recognition that many older persons utilize traditional and alternative health practices, attention should be given to ensure that these practices are integrated into the overall system of support for the aged. ( 4) Attention should be given to primary health care needs of older persons and to the need to develop effective and efficient community-based health care as the mainstay of health care delivery to the older population. (5) The special requirements of older persons, including gender and culturally determined needs, should be accommodated. Medical care policies and programmes must adjust to the growing emphasis on the health needs of older people and the increased emphasis on chronic disease and disability assessment and management. (6) The support needs of families and others caring for older persons must be taken into account in order to help families and local communities to effectively carry on traditional practices of providing for their older members. (7) The long-term care needs of older persons including their need, in certain circumstances, for residential services, must be acknowledged and attention given to monitoring and maintaining quality of care in long-term care settings. (8) Coordination must occur at every leveL but ultimately must ensure that the individual elderly person receives quality care in a timely and orderly manner. 3.3 Education and training (I) Investment in human resources development for health of older persons is critical to ensuring that comprehensive high quality health care services will be able to be provided to the older population in the future. Action needs to be taken now in view of the long time involved in education and training. (2) All persons working with the older population (including professionals, primary health care workers and family care givers) must receive some level of education and training to ensure that services are provided in a manner which is safe and effective for both recipients and providers of care. (3) There should be increased opportunities to receive more specialized and intensive training for health or other workers involved in the care of older persons.
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3.4
Data collection, research and evaluation ( l) Data collection and analysis, research and evaluation should be undertaken on a systematic basis. These should be aimed at identifying needs, supporting policy and planning and the assessment and review of services and programmes for health and quality of life of older persons. (2) Inadequate funding and competing priorities are serious constraints to policy and programme development. There is a need to develop and promote cost-effective models to address the health-related needs of older persons.
3.5
Guidelines for policy ancLru:ogramme development
The 'Guidelines for national policies and programme development for health of older persons in the Western Pacific Region' provides a sound basis for future national policy formulation and planning and should be widely promulgated and recommended to Member States throughout the Region.
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ANNEX I
AGENDA
I. 2. 3. 4. 5.
Opening ceremony Election of officers Consideration ofthe agenda Workshop overview Overview of Guidelines for national policies and programme development for health of older persons in the Western Pacific Region Country reports Policy formulation on health of older persons Development of comprehensive health care services for older persons Implementation of national policies and programmes for health of older persons Conclusions ('losing ceremony
6. 7. 8. 9. I 0. II.
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Annex 1
18 August, Monday 8:30a.m. Opening ceremony Welcome remarks Introduction of participants Election of chairperson and rapporteur Consideration of the agenda Workshop overview Prof Gary Andrews Dr Ludomyr Mykyta Dr Linda L. Milan
9:00
(1.111.
Overview of the Drat! Guidelines for Nat ion a I Policies and Programme Development I'Pr I kalth of Older Persons in the Western Pac i fie Region ( 'ofTec break Country reports Lunch break Country reports Closing
Prof Gary Andrews
I 0:15a.m.
I 0:30a.m. 12:00 noon I :30 p.m.
4:00 p.m. 19 August Tuesday 8:40a.m. 9:15a.m. 10:30 a.m. 11:00 a.m. 12:15 noon 2:00p.m.
Opening of the World Congress of Gerontology World Congress video-conference Coffee break Continuation of the World Congress video-conference Lunch break Discussion of Framework for policy formulation on health of older persons (Working paper No. I) Coffee break Discussion on barriers to development of policies for health of older persons and strategies for overcoming them (Working paper No.2) Closing
3:30p.m. 4:00 p.m.
5:30p.m.
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Annex 1
8:30a.m.
World Congress of Gerontology- WHO Symposium: What kind of practitioners do we need to train for the 21st century? Coffee break Continuation of WHO Symposium Lunch break World Congress Parallel Sessions Coffee break Discussion of Guidelines for Development of Comprehensive Health Care Services for Older Persons (Working paper No. 3) Discussion of Feasibility, Process and Steps in Implementation ofNational Policies and Programme for Health of Older Persons (Working paper No.3) Closing
10:00 a.m. 10:30 a.m. 12:00 noon 1:00 p.m. 2:30p.m. 3:00p.m.
4:00p.m.
5:30p.m. 21 August, Thursday 8:30a.m. 10:00 a.m. 10:30 a.m. 11:45 a.m. 12:00 noon 1:30 p.m. 3:30p.m.
World Congress of Gerontology- Thematic Plenary Sessions Coffee break Conclusions Sum-up and closure Lunch break Meeting of Heads of collaborating centres Closing Dr Linda L. Milan
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ANNEX2
LIST OF PARTICIPANTS AND MEMBERS OF THE SECRETARIAT
I. PARTICIPANTS
CHINA
Dr Jin Shengguo Deputy Division Director Division of Elderly Care and Rehabilitation Department of Medical Administration Ministry of Health Beijing Professor Zhu Hanmin Vice-President Hua Dong (East China) Hospital 221 Y an-an Road, West Shanghai Dr Xu Dalin Vice-Director Health Bureau Jing An District Shanghai Municipality Dr Margaret Cornelius Acting Assistant Director Primary and Preventive Health Services Ministry of Health Suva
JAPAN
Dr Kiyumichi Fujisaki Director Department of Public Health Administration National Institute of Public Health Tokyo Dr Hiroshi Shibata Vice-Director Tokyo Metropolitan Institute of Gerontology 35-2 Sakaecho, Itabashi-ku Jokyo Ill
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Annex 2
Dr Nobuo Koinuma Professor, School of Medicine Tohoku University School of Medicine 2-1 Seiryo-machi, Aoba-ku Sendai MALAYSIA Dr Nor Aini Bte Moh'd. Noor Assistant Director Family Health Department Ministry of Health Level 3, Block E Jalan Dungun 50490 Kuala Lumpur Dr David Lozada Director Noncommunicable Disease Control Service Department of Health San Lazaro Compound, Sta. Cruz Manila Mr Kyong-Ho Park Director Elderly Welfare Division Ministry of Health and Welfare Government Complex II J5-v~mggi-do. 427 760 Professor Sang Chul Park Professor and Director The Ageing and Physical Culture Research Institute Seoul National University
PHILIPPINES
REPUBLIC OF KOREA
ss.mtl SINGAPORE Mrs Joanna Tan Soek·cheng Assistant Director Project and Funding Division of Elderly Services Ministry of Health ~ing~uoJ~
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Annex2
VIETNAM
Professor Tran Due Tho Director National Institute of Gerontology Bach Mai Hospital Hanoi
2. TEMPORARY ADVISER
Dr Ludomyr Mykyta Western Domiciliary Care and Rehabilitation Service Community Service Department Queen Elizabeth Hospital Woodville Park Adelaide Australia
3. CONSULTANT
Professor Gary Andrews President 1997 World c:ongrcss of Gerontology Science Park, Bedford Park A~~JiiiillLiQ4 2
Australia
3. SECRETARIAT
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC
Dr Linda L. Milan Regional Adviser in Occupational Health Mr Chan Hyoung Park Technical Adviser, Health of the Elderly