Meeting on Ageing and Health in the Western Pacific, Manila, Philippines, 09-11 July 2013 : report

WPR/DHS/HCF(02)/2013 Report Series No: RS/2013/GE/26(PHL)

English only

REPORT MEETING ON AGEING AND HEALTH IN THE WESTERN PACIFIC

Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC

Manila, Philippines 9–11 July 2013

Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines August 2013

NOTE The views expressed in this report are those of the participants in the Meeting on Ageing and Health in the Western Pacific Region, 9–11 July 2013, and do not necessarily reflect the policies of the World Health Organization.

KEY WORDS: Healthy ageing, Older people, Health services, Health promotion, Life cycle, Framework for action

This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Members States in the Region and for those who participated in the Meeting on Ageing and Health in the Western Pacific Region, which was held in Manila, Philippines from 9–11 July 2013.

SUMMARY Ageing is a key public health challenge confronting Member States in the Western Pacific Region. In almost every country, the population aged 60 years and over is growing faster than any other age group, as a result of longer life expectancies and declining fertility rates. Reorienting health systems to provide older people with equitable access to services aligned to their requirements and preferences is an emerging need in developed and developing countries. WHO’s Regional Office for the Western Pacific has been strengthening its response on ageing and health. It has initiated two analytical pieces of work: (i) (ii) a comparative study of the health of older people in selected countries in the Region through secondary analysis of existing survey data; and a review and analysis of policies related to ageing and health in selected countries in the Region.

These activities have informed the development of a draft Regional framework for action on ageing and health in the Western Pacific, which was also discussed by an informal experts' consultation on ageing and health in April 2013. Ageing and health constitute the topic of an agenda item at the sixty-fourth session of the WHO Regional Committee for the Western Pacific in October 2013. A high-level panel on ageing and health will also be organized at that time. In the run-up to the Regional Committee session, a meeting was held from 9 to 11 July 2013 with WHO Member States to share findings from ongoing analysis, discuss their implications and agree upon a Regional framework for action on ageing and health. The meeting brought together representatives from 16 Member States as well as WHO staff, temporary advisers and several experts and partners from international organizations. The meeting included country presentations that described progress and key barriers to action on ageing and health and highlighted good practice examples as well as future priorities. Four technical sessions discussed each of the following four action pillars of the draft framework for action on ageing and health in the Western Pacific: (1) fostering age-friendly environments through action across sectors; (2) promoting healthy ageing across the life course and preventing functional decline and disease among older people; (3) promoting universal health coverage through age-friendly health systems; and (4) strengthening the evidence base on ageing and health. The final day of the meeting was devoted to group work, during which participants from Member States identified priorities and developed practical policy solutions on ageing and health. Overall, participants strongly welcomed efforts by WHO’s Regional Office for the Western Pacific to strengthen the work on ageing and health and specifically to develop a Regional framework for action. A number of suggestions were made during the meeting, which will inform the finalization of the draft framework as well as future technical collaboration with Member States more generally.

CONTENTS Page

1. 1.1 1.2 2. 2.1 2.2 3. 3.1 3.2 3.3 3.4 4. 5.

INTRODUCTION…………………..……………………………………………….. 1 Objectives……………………………………………………………………………..1 Opening session……………………………………………………………………….1 PROCEEDINGS.…………………..…………………………………...……………...2 Country presentations .................................................................................................... 2 Discussion……………………………………………………………………………10 TECHNICAL SESSIONS ………………………………………………………..11

Pillar 1: Fostering age-friendly environments through action across sectors .............. 11 Pillar 2: Promoting healthy ageing across the life course and preventing functional decline and disease among older people ..................................................................... 13 Pillar 3: Promoting universal health coverage through age-friendly health systems... 15 Pillar 4: Strengthening the evidence base on ageing and health .................................. 18 GROUP WORK ........................................................................................................... 20 CLOSING SESSION ................................................................................................... 20

ANNEXES: ANNEX 1 – TIMETABLE ………………………………………………………………….22 ANNEX 2 – LIST OF PARTICIPANTS …..………………………………………………..23 ANNEX 3 – GROUP WORK TABLES AND SUMMARIES ….…………………………..33 ANNEX 4 – PRESENTATIONS…………………………….………………………………49

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1.

INTRODUCTION

Ageing is a key public health challenge confronting Member States in the Western Pacific Region. In almost every country, the population aged 60 years and older is growing faster than any other age group as a result of longer life expectancies and declining fertility rates. Promoting better health through the course of life can help ensure that people stay healthier as they grow older and well into old age. Strengthening health systems to provide older persons with equitable access to services aligned to their requirements and preferences is an important part of the global agenda to promote universal health coverage. Advancing health and well-being into old age is one of the three priority directions of the Madrid International Plan of Action on Ageing, adopted at the United Nations' Second World Assembly on Ageing in April 2002. Resolution WHA65.3 on strengthening noncommunicable disease policies to promote active ageing (May 2012) requested the Director-General to support Member States on ageing, including through multisectoral approaches to healthy ageing, integrated care for older people and support for providers of formal and informal welfare services. WHO’s Regional Office for the Western Pacific has been strengthening its response to ageing and health. An informal experts’ consultation was convened in May 2011 to advise on the Region’s work on population ageing. Efforts to raise awareness on ageing were made during World Health Day 2012. Ageing and health constitute an agenda item at the sixty-fourth session of the WHO Regional Committee for the Western Pacific in October 2013. In preparation, the Regional Office has initiated: (i) a comparative study of the health of older people in selected countries in the Region, and (ii) a review and analysis of policies related to ageing and health in selected countries in the Region. Based on these efforts, a draft framework for action on ageing and health in the Western Pacific has been developed. An initial draft was discussed at an informal experts' consultation on ageing and health in April 2013. From 9 to 11 July 2013, the WHO Regional Committee for the Western Pacific held a meeting with Member States on ageing and health in Manila, Philippines, to present these activities in progress, consult with Member States, invite their feedback and discuss future actions. 1.1 Objectives: (1) (2) (3) To share findings from ongoing analysis of (a) the health of older people, and (b) policies on ageing and health in selected countries in the Region. To discuss the implications of population ageing for health and health systems in the Region. To discuss and agree upon a Regional framework for action on ageing and health.

1.2 Opening session Dr Shin Young-soo, Regional Director, opened the meeting by welcoming participants. To put the meeting into context, Dr Shin highlighted three key messages on ageing and health. First, population ageing should be considered as good news. With the

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right policies and actions, older people can continue to serve as a valuable resource for societies. Second, the window of time for action is short for low- and middle-income countries in the Western Pacific Region. This is because of the relatively faster speed with which their populations are ageing compared with developed countries, which have had longer – in some cases about a century – to prepare. Third, much is already known about what needs to be done. Dr Shin invited participants to contribute to thinking about how best to take forward the work on ageing and health in the Region. He noted the complexity of the issues, as well as the diversity of experiences within the Western Pacific Region, which required effective partnerships across stakeholders and sectors. He concluded by stressing that WHO’s Regional Office was committed to advancing the work on ageing and health in collaboration with partners. Following a round of introductions (see Annex 2 for a list of participants), the following participants were nominated as office bearers for the meeting: His Excellency Dr Bounkong Syhavong, Vice-Minister of Health, Lao People’s Democratic Republic, Chair; Mr Thai Phuc Thanh, Vice-Director Administration of Social Protection, Ministry of Labour, Invalids and Social Affairs, Viet Nam, and Ms Wang Cong, Programme Officer, Department of International Cooperation, National Health and Family Planning Commission, China, Vice-Chairs; and Ms Baleinabuli Dilitiana, Senior Research and Policy Officer, Social Welfare Department, Fiji, Rapporteur. Ms Anjana Bhushan, Technical Officer (Health in Development), Division for Health Sector Development, WHO Regional Office for the Western Pacific, provided a Regional update on ageing and health. Recent activities included an informal experts' consultation on Healthy Ageing in the Western Pacific Region in May 2011, as well as advocacy on the theme "Ageing and health – good health adds life to years" on World Health Day 2012. To strengthen the evidence base on ageing and health, the Regional Office had undertaken analysis including: (i) a comparative study on the health of older people in selected countries in the Region (through secondary analysis of existing datasets), and (ii) a review and analysis of policies on ageing and health in selected countries in the Region. These form the basis for development of a draft Framework for Action on Ageing and Health in the Western Pacific (2014–2019), which is tabled for discussion by Member States at the forthcoming sixty-fourth session of the WHO Regional Committee for the Western Pacific in October 2013. This Regional meeting is an important milestone in the run-up to the Regional Committee discussions. The aim is to consult with Member States and selected experts on the draft Framework. The inputs of participants will be vital to strengthen the framework and to contribute to the Region’s work on this issue.

2.

PROCEEDINGS

The meeting included both country presentations and technical sessions (see Annex 1 for the timetable and Annex 4 for the PowerPoint presentations from the meeting). 2.1 Country presentations

Participants from WHO Member States presented country-level developments on ageing and health. Each presentation followed a standard structure, including:

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policy context for action on ageing and health; key challenges for action on ageing and health; example(s) of good practice; and future priorities and opportunities for regional collaboration.

Each country presentation was followed by discussion among participants to identify commonalities and encourage learning on priorities and challenges. 2.1.1 Australia

Professor Julie Byles, Director of the Research Centre for Gender, Health and Ageing, University of Newcastle (a WHO Collaborating Centre), Australia, provided a brief overview of current reforms and aged care in Australia. She described five important steps of policy reform, starting with: (i) a situation analysis provided by the 2010/11 Productivity Commission Inquiry into Aged Care; (ii) enhanced public support and political will to take action; (iii) introduction of the 2012 "Living Longer, Living Better" reform package; (iv) plans for its implementation between 2013 and 2015; and (v) monitoring and evaluation, including the need for quality indicators and equity impact assessments. Professor Byles stressed the critical need to learn from policy reforms and indicators, encouraging participants to share experiences and highlight areas that they felt worked well and those that did not. 2.1.2 Cambodia

Dr Prak Piseth Raingsey, Director, Preventive Medicine Department, Ministry of Health, Cambodia, gave a presentation on the Rights and Care of Older People in Cambodia. He began by providing an overview of the policy context and background for action, including an endorsement of the Health Care for Elderly and Disabled Policy by the Ministry of Health in 1998. Since then, activities have been ongoing, despite challenges such as a rapidly growing market economy, the lack of state support and policy priority, and poor integration of older people in communities and government policies. At the same time, there have been many successful examples of government-led initiatives, which could potentially be expanded. The government supports the formation of older people’s associations (OPAs) in all provinces. Examples of good practice include the successful implementation of an integrated development programme to increase the capacity of families and communities to care for and support older people through OPAs, home-based care for frail older people, and cow and rice banks. Older people are also being integrated as advisers in planning, management and evaluation. Training in home care, in-service training for health professionals and free care services for poor and frail older people are provided. Future priorities and opportunities for regional collaboration include: (i) capacity-building in geriatrics and gerontology by facilitating fellowships and specialty training, (ii) establishing long-term care packages with sustainable financing, and (iii) stimulating the quality of services through exchange of good practices.

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2.1.3

China

Dr Cai Fei, Deputy Director of Family Development, Division of Family Development, Department of National Health and Family Planning Commission, introduced recent actions taken in China. These include expanding coverage of health insurance in both urban and rural areas, providing free annual physical examinations and health consultations and strengthening the health care system for older people, establishing health records for those aged over 65 years, improving community-based services and investing in health education for older people. Dr Cai Fei stressed that the key challenge in China was to cope with the rising number of those over 60 years, projected to reach over 200 million by late 2013 and one-third of the population by 2050. This rapid increase would create a heavy demand for health and long-term care services. Pudong, a district in Shanghai, was highlighted as a good example of action across sectors. With over 24% of the population aged 60 years or above (680 000), the district has successfully established a scheme providing medical consultations, home care services, capacity-building for active ageing, and opportunities for social engagement. Special services for vulnerable groups have been implemented, including installing emergency call devices, keeping in daily contact with older people living alone and providing nutrition subsidies for the oldest participants. Dr Cai Fei concluded by outlining three future priorities for China: implementing evidencebased policies, information sharing and introducing long-term care. 2.1.4 Federated States of Micronesia

Mr Marcus Samo, Assistant Secretary for Health, Department of Health and Social Affairs, Federated States of Micronesia, started his presentation with a brief overview of the country's demographics. The Federated States have a comparatively young population. Life expectancy rose from 60 years in 1974 to 67 years in 2000. Approximately 5.6% of the population is aged 60 years and above. Key challenges to work on ageing and health include: (i) island demographics, (ii) lack of public awareness and support, and (iii) lack of policy and services. Nonetheless, a State Senior Group in Pohnpei that promotes active and healthy ageing provides an example of good practice, which has already been expanded to other municipalities. Mr Samo stressed the importance of improving engagement with and delivery of necessary (health) services to older people, including better housing, better involvement of communities and awarenessraising. 2.1.5 Fiji

Ms Baleinabuli Dilitiana, Senior Research and Policy Officer, Social Welfare Department, Fiji, stated that the “oldest old” were the fastest growing age group in Fiji, at 4.9% growth per year. In response, Fiji has introduced three key measures, including the Social Justice Legislation (2001); the National Policy on Ageing (2011–2015); and the National Council of Older Persons (2012). Current challenges include lack of baseline data to track population ageing, bringing ageing issues into the mainstream of work in other

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sectors, and harmonizing the implementation frameworks currently in place. A good practice example of progress on ageing and health was the process leading to the establishment of the National Council of Older Persons in July 2013, through the National Council of Older Persons Decree (2012). Future priorities include implementing the key recommendations of the National Policy on Ageing in relation to health through a collaborative approach, strengthening partnerships for resource sharing and improving the efficiency of existing mechanisms and their implementation. 2.1.6 Japan

Dr Masami Sakoi, Director, Ageing and Health Division, Health and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare, summarized a wide range of legislative and policy initiatives on ageing and health adopted in Japan, outlining key features of the health and long-term care system. Current challenges include the rapid and further ageing of society (an estimated 26.5% of people will be aged 75 or over by 2055) and the likely financial impacts on long-term care insurance. Dementia was highlighted as an issue of growing importance. Changing social contexts and increasingly isolated family structures also present new challenges, along with the low salaries of care workers. Dr Sakoi stated that several good practices could be found at the local level. Japan has introduced prevention programmes at the municipal level funded by insurance premiums. Kashiwa city (Toyoshikidai) is implementing a “local inclusion care system” in which “ageing in place” is made possible through a combined system of health, social and long-term care in the home environment. Dr Sakoi highlighted dementia care as a major priority and an area for regional collaboration. Dementia exemplifies many ageing and health issues, entailing cross-clinical and cross-sectoral collaboration in primary and specialist care, as well as community support. Japan is introducing several measures to ensure that older people and society are better prepared to deal with dementia. 2.1.7 Lao People’s Democratic Republic

His Excellency Dr Bounkong Syhavong, Vice-Minister of Health, Lao People's Democratic Republic, provided an overview of the policy context for action on ageing and health, including recent steps to introduce specific legislation, development of a national policy and the establishment of institutional structures on older people and ageing. Key challenges for action include limited resources and capacities, a large rural population, often living in remote areas, and low levels of education.

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Several good practice examples exist at the local level: a home care project funded by the Korean government and implemented by the Lao Red Cross; an “Older People in Development” project involving community-based groups, also operated by the Lao Red Cross, Lao Women's Union and HelpAge International; a group for weaving handicraft textiles and Lao skirts to encourage income generation; and a “Vientiane Healthy City Programme” with the active participation of OPAs. Future priorities and areas for collaboration include poverty reduction through implementation of the National Poverty Reduction Programme, working towards the Millennium Development Goals, improved health care facilities and access for older people, and development of a strategic plan on ageing. 2.1.8 Malaysia

Dr Zaleha Abdul Hamid, Public Health Physician, Senior Principal Assistant Director, Family Health Development Division, Ministry of Health, explained that a number of policy initiatives had been implemented in Malaysia. These included: the National Policy for Older Persons, 1995 and Action Plan of National Policy for Older Persons, 1999 (both through the Ministry of Women, Family and Community Development), and the National Plan of Action for Health Care of Older Persons, 1997 and National Health Policy for Older Persons, 2008 (both through the Ministry of Health). Major challenges include the lack of human resources, including geriatricians, psycho-geriatricians and gerontologists, lack of coordination between the diverse actors involved, and the need to develop specific legislation to protect older people. The “National Blue Ocean Strategy 7 (NBOS 7): 1 Malaysia Family Care” was cited as an example of good practice, delivering outreach activities to provide holistic services for older people, those with disabilities and single mothers. This includes health screening, assessment, consultation, treatment and referral (if needed), as well as services for bed-ridden older people at home. Dr Zaleha Abdul Hamid concluded by underlining the area of human resources for health as a high priority for Malaysia, including both training for and exchange of experts in ageing. 2.1.9 Mongolia

Dr Khishgee Majigzav, Officer-inCharge, Policy Coordination for Noncommunicable Disease Prevention and Control, Division of Public Health Department of Policy Implementation Coordination, Ministry of Health, Mongolia, summarized the policy context for action on ageing, including the Law on Social Welfare for the Elderly, revised in January 2012, the Law on Citizen’s Health Insurance (2002), the Law on Health (2011), the National Strategy for Population Ageing in Mongolia (2009–2030) and the National Program on Ageing and Elderly Health (2014–2020), which is now being finalized. The relatively high prevalence of multiple morbidities among older people was highlighted as a key challenge for action. Dr Majigzav noted that only 0.6% of older people were healthy, while 8 out of 10 had multiple morbidities. Limited numbers of trained

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geriatricians and geriatric nurses create additional challenges to appropriate delivery of care. The government is making important strides to address these issues. For example, an agefriendly family health centre was opened in 2007; multidisciplinary geriatric teams were introduced in 2009; voluntary and interest-based clubs facilitate disease prevention and health promotion; and the government aims to cover health care expenses for older people. Reforms in health care financing and insurance for long-term care are an important priority, as is capacity-building in gerontology and geriatrics, and improving prevention and screening services. 2.1.10 New Caledonia Ms Nalina Tirougnanasammandamourtty, Department Head of Social Welfare, and Mr Philippe Rieux, Deputy Chief of Service Department of Social Protection, New Caledonia, stressed that the population aged over 60 in New Caledonia was predicted to rise from 28 000 in 2010 to 61 000 in 2030 (the total population is currently 245 580). Recent activities have included establishing basic coverage for all and full coverage for chronic illness and disability; guaranteed basic retirement pension above the national poverty line for older people; improvements to the health care system, including a specialized geriatric hospital, 25 health care centres and a new general hospital; and support to older people by introducing a new social security model. Key challenges include the need to maintain older people’s health during the course of their lives and in an appropriate environment with greater community support, prevention programmes tailored to the needs of older people, and increasing equitable access to social and health care services. With limited resources, the need to deliver effective care in a financially sustainable manner is crucial. An office created by an OPA in the Southern province of New Caledonia was highlighted as an example of good practice. It provides a single entry point for information and coordination of all services for older people and their families, collection of both quantitative and qualitative data for evaluation of the family, social, medical, psychological and financial situation, and development of a personalized support plan. Future priorities include efforts to survey older people’s expectations, finalizing the New Caledonia Geriatric Plan (2014–2019), preventing ill-health among older people through an integrated policy promoting healthy behaviour and strengthening the health and social financing systems to ensure sustainability of service delivery for older people. 2.1.11 Palau Dr Sylvia Osarch, Physician, Home Health, and Rebecca Koshiba, Social Worker, Palau, outlined the policy context in their country, describing laws for protection from violence, introducing senior citizens’ day, setting the age of retirement at 60, and other general legislation affecting older people. The key challenges are the need to introduce specific laws to protect senior citizens from abuse, to introduce more support programmes, to provide social services, transportation support and discount benefits, and to address cultural beliefs in relation to family roles, nursing homes and hospice care. Several good practice examples exist at the local level, including projects providing home care (covering palliative care), meals on wheels, weaving and carving, along with exercise programmes and income support activities. Future priorities include developing a social health department, increasing political and community awareness, expanding hospitals to include hospice and respite care, and introducing laws to protect older people.

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2.1.12 Papua New Guinea Dr William Lagani, Manager, Family Health Services, National Department of Health, and Dr Lloyd Ipai, Chief Physician, National Department of Health, provided an overview of ageing and health in Papua New Guinea. Within the total population of 7.1 million in 2011, 5% were aged 60 years or older and 50% were under 16 years old. Although there is no specific policy for older people in Papua New Guinea, the National Health Plan (2011–2020) covers all citizens in principle, and provides free health care services to children under seven years and adults aged 60 years and over. Among the seven priorities of the government over the next five years is to provide free primary health care services for all and to subsidize specialized care. The retirement age has been increased from 55 to 60, and the government has recently proposed the introduction of a pension. Key challenges include lobbying for political support for appropriate policy development. Future priorities include developing a policy on ageing and health that covers pensions and free primary health care, conducting evidence-based research in line with the regional research agenda, and exchanging experiences with and learning lessons from other countries on ageing and health. 2.1.13 Philippines Dr Irma L. Asuncion, Officer in Charge-Director IV, National Centre for Disease Prevention and Control, Department of Health, gave a presentation on ageing and health in the Philippines, where the population of those aged 60 years or above amounts to seven million people (6.9% of the total population). Relevant legislative and policy instruments include Republic Acts such as the Expanded Senior Citizens Act 2010; Department of Health administrative orders such as the one granting a 20% discount to senior citizens on healthrelated goods and services; and the Plan of Action for Senior Citizens 2012–2016. Key challenges for action include the full implementation of these acts and executive orders, increasing the number of health workers and geriatric specialists by institutionalizing gerontology and geriatrics in medical and allied curricula and hospital wards, as well as providing better home- and community-based care for older people. The establishment of management structures including a National Coordinating and Monitoring Board for policy development and monitoring the implementation of the Act, as well as a local management structure called the Office of Senior Citizens Affairs, which coordinates activities of senior citizens and facilitates and monitors the implementation of the Act, were highlighted as examples of good practice. Future priorities include introducing recognition and awards for age-friendly cities, improving reporting and monitoring of agerelated health indicators, and enhancing gerontology and geriatrics training. Participation in regional forums to exchange experiences and lessons learnt was seen as a key opportunity.

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2.1.14 Republic of Korea Mr Kim Woo Gi, Senior Deputy Director, Division of Long-Term Care Insurance Management, Ministry of Health and Welfare, Republic of Korea, outlined the policy environment for ageing and health, including the predicted continuing rise of those aged 65 or above from 11% in 2010 to 38% by 2050, and a continuing decline in fertility rates, which began in the 1970s. Current policies for healthy ageing were highlighted, including the Korean long-term care insurance. Available to those aged 65 or above, or those under 65 with geriatric diseases, it establishes three categories of care: first class care, offered to those confined to bed; second class care, targeted at people in wheelchairs; and third class care, for those unable to leave their homes without assistance. A number of examples of good practice exist: a programme for early detection of dementia, a national health screening service and a denture support service. Exercise and education programmes, e.g. "Healthy for 100 years", are offered in local community centres, village halls, parks and through self-help groups. Future challenges include the rising costs of care and the urgent need to develop policies that reduce the gap between healthy life expectancy and life expectancy, thereby improving the quality of life of older people. 2.1.15 Samoa Ms Louisa Apelu, Assistant Chief Executive Officer, Division for Women, Ministry of Women, Community and Social Development, and Ms Sarah Filemu, Principal Nurse, Monitoring and Regulations, Health Service Performance, Quality Assurance, Nursing and Midwifery, Ministry of Health, gave a presentation on policy developments in Samoa. These included the Sector-Wide Community-Based Outreach Programme, the Senior Citizens Pension Scheme, the National Noncommunicable Disease (NCD) Prevention and Control Policy (2010–2015) and the Intermediate Care Policy, aimed at establishing a continuum of care. Key challenges remain with regard to ensuring better coordination, implementation and monitoring of resources for ageing and health, and other competing priorities such as child health and disability. Examples of good practice are seen in the importance of training family members to provide care for their older relatives at home. Future priorities and opportunities for regional collaboration include options for integrating older people’s needs into NCD strategies, prioritizing human resources for health, especially nursing, and linking up with relevant regional and international agendas, including reporting on the Convention on the Elimination of All forms of Discrimination Against Women, the Convention on the Rights of the Child and the Millennium Development Goals.

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2.1.16 Tonga Dr Malakai Ake, Chief Medical Officer, Public Health, Ministry of Health, gave a presentation on ageing in Tonga. He provided a brief overview of the health system, in which health services are free at the point of delivery for all citizens, including older people. However, there are no specific laws, policies or health services for older people. Families have traditionally provided care for older people, along with moral and financial support, and continue to do so. As such, the government has yet to produce specific policies or laws on ageing. The development of the WHO Framework and the Regional Committee discussions offer an excellent opportunity to start discussions about appropriate national legislation, policy and services. A recent milestone was the introduction of a government monthly pension allowance, which indicates the growing importance of the issue of ageing. 2.1.17 Viet Nam Ms Phuong Thi Thu Huong, Chief, Information, Analysis and Dissemination Section, Centre for Population Research, Information and Database, General Office for Population and Family Planning, gave a presentation on ageing and health in Vietnam, where 10.2% of the population are aged 60 years and above. Older people’s issues have been addressed in the Constitution, the Law on Protection and Care of the Elderly, the Population and Reproductive Health Strategy (2011–2020) as well as the National Program on Action on the Elderly (2012–2020). Key challenges for action include managing the large proportion (twothirds) of older people living in rural areas, the rapid rate of growth of the "oldest old", the large proportion of older women and widows with specific health risks, and a lack of social security for all older people. The burdens of co-morbidities and the lack of health system capacity to respond appropriately to older people’s needs were highlighted as important priorities. An intergenerational self-help club initiative, started through HelpAge International in 2010, was described as an example of good practice. This community-based initiative has expanded to 10 provinces, comprising 600 clubs and 30 000 members, 70% of whom are from lowincome groups. Their activities include income generation, health care, protecting older people’s rights, home-based care and capacity-building. The initiative aims to improve the quality of life and health of older people, encourage community participation, raise awareness of older people’s roles, and highlight the importance of respect towards older people. Future priorities for Viet Nam include: sharing research and data on ageing, exchanging experiences and lessons on health care options for older people, training of caregivers and greater participation of the private sector. 2.2 Discussion

In the discussions that followed the country presentations, participants noted the rich and diverse experiences and achievements of countries. It was suggested that three typologies could be used to capture developments and discuss options for progress on ageing

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and health: countries' level of economic development; their stage in the demographic transition; and their stage in the epidemiological transition. Many contributions highlighted the usefulness of learning from different countries, particularly in the area of health system responses to ageing. While there was substantial diversity across countries of the Western Pacific Region, many faced similar challenges. Country representatives saw added value in exchanging experiences, as well as a role for WHO to collate examples and encourage dialogue across countries in the Region. Participants also commented on the need for more research and better data. The collection and use of data on ageing and health was considered a cornerstone of effective national policy-making. The question of how to ensure comparability of data, including ways of standardizing ageing and health indicators across different countries, was considered. Examples of good practice included the WHO Study on Global AGEing and Adult Health (SAGE). China was among the countries included, and an ageing index was developed by the United Nations Population Fund (UNFPA) and HelpAge International. Some participants noted that, given demographic and social changes such as urbanization and women's increased participation in the labour force, the traditional role of families in caring for older people was increasingly breaking down. Community-based care options might thus offer promise, but would need further research and policy attention. Participants acknowledged that individuals, families, communities and different sectors and levels of government needed to work in partnership to develop and implement policies on ageing and health effectively. Working across sectors and through strengthened partnerships would be crucial. Participants highlighted the benefits of adopting whole-systems, whole-ofsociety and intergenerational approaches. Raising awareness on the importance of older people’s contributions could help combat negative stereotypes of ageing.

3.

TECHNICAL SESSIONS

The technical sessions included discussions on each of the four pillars of action of the draft framework:     Pillar 1: Fostering age-friendly environments through action across sectors. Pillar 2: Promoting healthy ageing across the life course and preventing functional decline and disease among older people. Pillar 3: Promoting universal health coverage through age-friendly health systems. Pillar 4: Strengthening the evidence base on ageing and health.

Each session began with a summary of the action pillar, followed by comments from selected experts to provide additional information and discussions among participants. 3.1 Pillar 1: Fostering age-friendly environments through action across sectors

Ms Anjana Bhushan provided an overview of Pillar 1, aimed at fostering age-friendly environments through action, engagement and collaboration across sectors and stakeholders, including local communities, families and older people themselves. She highlighted the following four relevant issues:

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the need to address the underlying determinants of the health of older people through actions in sectors such as housing and transport; the leadership role of the health sector for collaboration and action across sectors; the need to build age-friendly cities and communities; and the need for participation and empowerment of older people.

Ms Bhushan concluded her presentation by introducing the following suggested actions under this pillar:       advocate for age-friendly policies and initiatives within health promotion programmes; advocate for intersectoral action by identifying and supporting options for whole-ofgovernment and whole-of-society initiatives across sectors; strengthen existing multisectoral mechanisms to address and integrate ageing and health issues as a core objective of their work; build new and extend existing networks or partnerships; strengthen public awareness; advocate for and provide inputs to the development of monitoring and evaluation tools and guidelines for age-friendly environments; and  strengthen analysis and dissemination of good practices with respect to action across sectors to promote agefriendly environments.

In his comments, Dr John Beard, Director, Department of Ageing and Life Course, WHO Geneva, outlined three reasons to act now: namely, economics, human rights and creating a fair and equitable society. It is important not to frame ageing as a homogeneous phenomenon, but to recognize the diversity of older people. He highlighted the need to adapt responses to the changing society and culture through an integrated and holistic response. Dr Beard stressed that the resources spent in responding to ageing and health issues were in fact a valuable investment. He suggested that the framework should communicate the need to “reinvent ageing” and should include strengthening intergenerational links and ties with older people’s organizations as a strategic approach. Dr Beard introduced the WHO Global Network of Age-friendly Cities and Communities, which aims to foster the exchange of experience and mutual learning and create inclusive and accessible urban environments for older people. The network provides a global platform for information exchange and mutual support. Efforts are being made to develop indicators to assess the age-friendliness of cities or communities. The network has the potential for expansion in the Western Pacific Region. Mr Eduardo Klien, Regional Director, HelpAge International East Asia/Pacific Regional Development Centre, commented that older people should be seen as resources for society, not as a burden. Mr Klien welcomed the Framework's inclusion of the idea of OPAs as a potentially effective mechanism to address the needs of older people. He stated that

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multifunctional OPAs were a cost-effective community-based mechanism through which programmes for older people’s social participation, self-care, home care, health checks and income security had been implemented. Viet Nam alone has more than 600 OPAs, which comprise an example of good practice. Mr Klien concluded by stressing that important policy-relevant lessons could be learnt from existing innovative practices across the Region. In the discussions that followed, participants expressed their general agreement with this pillar of the draft Framework. Positive examples such as OPAs and the WHO Global Network of Age-Friendly Cities and Communities provide important lessons and can potentially be adapted to other country contexts. Issues pertaining to health equity, human rights and economic development were raised. Participants stressed that limited resources should not prevent policy-makers from taking steps to address inequities in access, and investments should be made in all people’s health, based on need and not age. They welcomed efforts to reframe ageing as a positive development, which represents the success of public health and development policies, and older people as resources to society. Strengthening public awareness of ageing should be a key area of work. The leadership role of the health sector in ensuring intersectoral action on ageing and health was recognized. As the country presentations showed, many Member States have developed comprehensive policies, plans and institutional arrangements for fostering intersectoral action on ageing and health. It is crucial to build appropriate capacity at all levels to identify and support options for whole-of-government and whole-of-society initiatives. 3.2 Pillar 2: Promoting healthy ageing across the life course and preventing functional decline and disease among older people Ms Britta Baer, Technical Officer (Gender, Equity and Human Rights), Division for Health Sector Development, WHO Regional Office for the Western Pacific, gave a presentation summarizing the second action pillar on promoting healthy ageing across the life course and preventing functional decline and disease among older people. The objective is to reduce exposure to risk factors and promote healthy behaviours across all stages of life, empower people to maintain their health as they grow older and prevent functional decline and ill-health among older people. Older people represent a large share of those with NCDs and often have co-morbidities. Health in old age is to a large extent determined by conditions and choices (e.g. whether to smoke, exercise and eat a healthy diet) made in early life. Empowering people to maintain their health as they grow older is therefore an important dimension of healthy ageing. At the same time, efforts are needed to prevent ill-health among older people. Reducing functional and cognitive decline and frailty among older people can significantly improve their quality

14

of life and maintain their independence. The second pillar includes the following suggested actions:       Bring healthy ageing into the mainstream across the course of life in health promotion and disease prevention efforts. Increase the coverage of and access to targeted priority interventions for health promotion and disease prevention for older people, tailored to their specific health needs. Place priority on addressing functional decline and frailty among older people. Improve health literacy among older people and promote their knowledge about the options for health promotion and disease prevention activities in their communities. Pay attention to the specific needs of population groups with higher exposure to NCD risk factors. Advocate for research on the life-course stages that are most critical to older people and develop monitoring and evaluation tools for healthy ageing and disease prevention among older people.

In her presentation, Dr Susan Mercado, Director, Building Healthy Communities and Populations, WHO Regional Office for the Western Pacific, framed healthy ageing as expanding health and well-being, rather than merely preventing disease. The promotion of healthy lifestyles in younger years is critical for preventing cardiovascular disease, diabetes, chronic respiratory disease, cancers and other NCDs. Younger and older people need access to appropriate health promotion and disease prevention efforts. Dr Mercado pointed out additional health issues (beyond reducing exposure to risk factors such as tobacco and alcohol and improving diets and physical activity) of special relevance to older age groups. These included mental health (especially dementia), injuries and falls, disability, dental and sexual health. New lifestyle challenges – for example, living alone vs living with the family – could determine the onset or outcome of disease. Society’s resources, such as educational institutions, could potentially be used to strengthen older people’s capacities. Community-based solutions have provided substantial opportunities for the empowerment and inclusion of older people, to detect problems and manage care as needed. Such an approach to healthy ageing would go beyond merely preventing disease and allow for sustainable improvements in the health and wellbeing of older people. In his comments, Mr Andres Montes, Population Affairs Officer, Asia and Pacific Regional Office, UNFPA, congratulated WHO’s Regional Office for its leadership on ageing and health and welcomed the development of the draft Framework. Mr Montes welcomed the Framework's human rights-based approach, which is in line with efforts by other United Nations agencies as well as recent commitments by Member States. It also facilitates going beyond measuring life expectancy to take into account the quality of life of older people. Mr Montes also welcomed the emphasis on function in the second pillar of the Framework, which is a core issue of concern to older people. As the draft Framework recognizes, progress will depend on political commitment and evidence-based advocacy to promote

15

healthy ageing and mobilize communities, including younger generations. UNFPA has been working with HelpAge International and other partners to develop a new global index on ageing. Mr Montes concluded by stressing UNFPA's readiness to collaborate with WHO on ageing and health. In the discussions that followed, participants expressed general support for the issues included under the second pillar of the draft Framework. NCD prevention, including through multisectoral action, is an important entry point for action on ageing and health, given that older people comprise the largest share of those with NCDs, including multiple morbidities. Advocacy with policy-makers, communities and families is needed on the importance of conditions and choices in earlier years in determining health and well-being in older age. Rebranding of ageing should correct assumptions that automatically associate ageing with illhealth. Community mobilization, social inclusion and mutual support among older people can help promote healthy ageing. Health promotion and disease prevention efforts need to be tailored to the specific needs of older people, including the tackling of priority health concerns such as dementia, functional decline, frailty, etc. Participants recommended adding a suggested action on disability. 3.3 Pillar 3: Promoting universal health coverage through age-friendly health systems

Ms Anjana Bhushan presented an overview of the third pillar on strengthening agefriendly health systems. The objective is to strengthen age-friendly health systems to provide acceptable and accessible health services of sufficient quality across the care continuum. This pillar raised discussions on key issues in the following broad health system areas: leadership and governance; health workforce; health financing; service delivery; and essential medicines and technology. Suggested actions are as follows: (1) Leadership and governance:     Take into account the needs of older people in the design, implementation and evaluation of health sector plans, with a special focus on encouraging genderresponsive, equity-enhancing and human rights-based action on ageing and health. Advocate for the inclusion of health issues and the needs of older people in national laws, policies and actions on ageing as well as in national development plans. Exploit synergies between ageing and health and other priority agendas receiving high-level attention. Raise awareness of health and ageing issues, framing older people as resources for society and ensuring their participation in health-related decision- and policy-making at all levels.

(2) Health workforce:    Ensure that health workforce planning and development take account of the numbers of and skills of health workers needed. Ensure that health workers have improved understanding and skills to provide agefriendly care. Ensure recognition and improve working conditions and staff retention for those providing services to older people.

16    

Explore ways of providing support for home-based, community and informal caregivers. Build expertise in specialties of particular relevance. Organize multidisciplinary and comprehensive networks of health professionals and care facilities. Build capacity among older people in self-care, expanding on innovative models of informal and community care; disseminate good practice and foster the creation of networks in this area.

(3) Health financing:      Strengthen health financing systems to support integrated service delivery, paying particular attention to excluded older people. Develop appropriate benefit packages to address the health needs of older people, including especially vulnerable households. Stimulate research, documentation and dissemination of good practices within and across Member States on tackling financial barriers to access to health services needed by older people. Explore options to ensure adequate fiscal space for the financing of health and longterm care. Prioritize the development of long-term care options, including at home and in communities, to avoid inappropriate use of health care facilities and to support the health and participation of older people in society.

(4) Service delivery:         Advocate for service delivery models that are responsive to the health needs and expectations of older people. Evaluate existing services for their age-friendliness, address gaps and reduce agerelated barriers to access. Enhance the quality of service delivery with a view to meeting the specific health needs of older people. Strengthen age-friendly primary health care as an appropriate entry point for older people to access the broader continuum of care. Place priority on specific services that support the health and functioning of older people. Evaluate and strengthen existing capacity to address and manage co-morbidities including through appropriate care pathways and collaboration mechanisms. Stimulate analysis and learning on innovative models for delivering care, including in self-, home and community care. Develop or strengthen mechanisms and networks to ensure coordinated delivery of health and social care for older people with chronic conditions and long-term care needs.

(5) Essential medicines and technology:  Advocate for equitable and universal access to essential medicines and health technologies, as part of the right to health of older people and to maintain health and active participation optimally in society.

17    

 

Support the monitoring and review of prescribing practices and rational use of medicines, with a focus on older people’s specific pharmaceutical care needs. Improve the availability, quality and safety of medicines by reducing regulatory barriers to marketing and strengthening good regulatory practices and enforcement. Ensure equitable access by older people to appropriate financial protection mechanisms and increase evidence-informed decision-making on inclusion of affordable essential medicines and technologies in benefit packages therein. Monitor global trends in trade and intellectual property rights affecting access to essential medicines and technologies, and incentivize supplier investments including research and development for essential medicines and health and assistive technologies. Increase the health literacy/awareness of older people, their caregivers and communities to improve demand for the right essential health and assistive technologies. Increase availability and access to assistive technologies by: o developing appropriate quality standards and regulatory frameworks to ensure quality and safety and guidance on their use to address functional decline with ageing; and o strengthening incentives for research and development of low-cost and/or cost-effective, robust assistive technologies to support ageing populations in resource-limited settings.

Dr Gulin Gedik, Acting Director, Division for Health Sector Development and Team Leader (Human Resources for Health), WHO Regional Office for the Western Pacific, provided a brief overview of the link between ageing and universal health coverage. To achieve universal health coverage, it is critical to build a health workforce with the skills and competencies relevant to population ageing, including for example being able to work in teams to deal with comorbidities. Ageing has several implications for health workforce planning, including the number, age and skill sets of health workers required to respond to the health needs of older people. Health professional education will need to ensure sufficient numbers of both general health workers with the required skills and competencies and those with specialized skills in areas such as gerontology. Ms Laura Hawken, Technical Officer (Health Services Development), Division for Health Sector Development, WHO Regional Office for the Western Pacific, gave a presentation on health sector stewardship to manage country resources for the benefit of the entire population, which entails intelligence, vision and influence. While ageing is fundamentally a whole-of-government issue requiring multisectoral responses, the health sector has an important leadership role. Older people need access to age-friendly primary care as well as specialist, long-term and palliative care. A whole-systems approach to ageing and health that works towards integration of services across the continuum of care will be essential to respond to the needs of older people.

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Dr Alex Ross, Director, WHO Centre for Health Development, Kobe, gave a presentation on the role of innovation in promoting universal health coverage. Innovation potentially to improve access to affordable, durable, acceptable medical and assistive devices can improve older people’s quality of life, tackle functional decline and morbidity, and promote a more harmonious and inclusive society. Priority areas for innovation include vision, hearing, mobility, cognitive functioning, social inclusion, managing co-morbidities and supporting caregivers. Fostering such innovation has important implications for health system areas such as financing, human resources, quality assurance and regulation. Dr Ross provided a brief update on activities of the WHO Centre for Health Development, including the First WHO Global Forum of Innovation for Ageing Populations, to be held in December 2013. In the discussions that followed, participants welcomed the strong focus on health systems in the draft Framework. They agreed that the health sector should play an important leadership role. Potential avenues for operationalizing a whole-systems approach were considered, including ways of ensuring a continuum of care that spanned health, social and long-term care for older people. Health workers need to have skills to respond to the needs of older people and to work in multidisciplinary teams. Equitable health financing mechanisms and the availability and appropriate use of medicines and health technologies are critical, along with strengthened partnerships and political commitment. Member States expressed interest in receiving guidance on how to integrate ageing and health concerns into different aspects of health system policies and actions. Participants agreed that, despite diversity across the countries of the Western Pacific Region, Member States had much to learn from each other. WHO can compile good practices, synthesize lessons learnt and support policy dialogues and study tours. 3.4 Pillar 4: Strengthening the evidence base on ageing and health

Ms Britta Baer provided an overview of the fourth pillar of the draft Framework. The objective is to strengthen evidence-informed policy- and decision-making on ageing and health in the Western Pacific Region. Ms Baer stressed that reliable information was key to evidence-based policy-making. There is a need to strengthen the collection, analysis and use of quantitative information on the health status of older people, disaggregated by age, sex and other social stratifiers. There is also a need to improve longitudinal monitoring and completeness of patient records and history data across points of service delivery and areas for better quality health care for older people. Further efforts are needed to ensure appropriate standardization of methodologies and indicators so as to encourage comparisons across countries. There is also a need to bridge knowledge gaps on ageing and health through research and analysis of policies, laws and actions and their implementation. In addition, appropriate knowledge translation can ensure that available evidence effectively feeds into policy-making. The fourth pillar of the draft Framework included the following suggested actions:

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       

Improve capacity in Member States to collect, monitor and analyse data. Increase efforts to collect quantitative and qualitative data on the availability, accessibility, appropriateness and quality (AAAQ) of health and social care and key underlying determinants of health. Improve the analysis and evaluation of existing efforts and their implementation. Implement appropriate health data standards to increase access, sharing and use of individual-level health and medical records over time, across geographies and between public and private providers. Stimulate research, documentation and dissemination of good practices. Improve knowledge translation to inform policy-making. Advocate for the empowerment of older people and their support networks, foster their health literacy and ensure their participation. Strengthen partnerships across sectors and with different actors in the Region to support data collection and identify research priorities.

Professor Julie Byles gave a presentation summarizing findings from an analysis on the health status of older people in selected countries of the Western Pacific Region, commissioned to inform the development of the draft Framework. She described the wide diversity in the Western Pacific Region, highlighting differences in the demographic transition and health status of older people across countries. Data indicated that, despite many country-specific variations, all countries in the Region faced population ageing. Although some countries have comparatively young populations, the fastest growth in the 60+ age group is taking place in low- and middle-income countries, leaving them much less time to put suitable policies in place. Professor Byles highlighted available data sources and information gaps, echoing concerns about the lack of data disaggregation and the need for standardized methodologies and indicators. Dr Manju Rani, Senior Technical Officer (Health Research Policy), Division for Health Sector Development, WHO Regional Office for the Western Pacific, outlined a conceptual framework of research domains applicable to topics related to ageing and health. She suggested that research should not be a standalone activity, but should cut across all areas and actions foreseen in the draft Framework. She stressed that the complexities of ageing would be most conducive to multidisciplinary research, ranging from basic and clinical research to policy analyses. Demographic health surveys have generated invaluable data on child and maternal health and have fostered collaborative research, advocacy and ongoing monitoring and impact evaluation of several

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health interventions. Similar initiatives may be suitable in the area of ageing and health. Dr Rani concluded by highlighting that knowledge generation would need to go hand in hand with its translation into practical solutions, and more specifically towards changing behaviours, practices and policies. In the discussions that followed, participants agreed that evidence-based policies were essential as the basis for actions included under the other three pillars. Others recognized the usefulness of the analysis that had been conducted and presented. WHO's support is needed to translate good evidence-based research into policy, which remains a practical challenge. Community and national-level research can build the ageing and health agenda in each country. Practical challenges include a lack of agreement on the definition of terms such as ‘frailty’. 4. GROUP WORK

On the third day of the meeting, participants undertook group work in small country groups, with support from WHO staff and temporary advisers. The objectives were to identify country-specific issues in relation to ageing and health and to develop practical actions to address them. The group work materials, outcomes and presentations are provided in Annex 3. In the feedback session, it was noted that most countries prioritized action in a health systems area, highlighting the strong relevance of ageing to health sector development. Many participants noted that the separation of issues during the group work had been helpful for discussing specific issues and prioritizing actions as appropriate to the context in each country. However, ageing and health is a cross-cutting area, and requires a holistic, wholesystems approach. Participants also repeatedly stressed the need for an intersectoral response on ageing and health, with the health sector (and the Ministry of Health) leading to convene partners. Similarly, WHO could support Member States by using its convening powers to bring together different stakeholders, encourage learning and strengthen partnerships. Participants emphasized the need to raise awareness on ageing and re-conceptualize it as a positive trend, with older people as resources to society. The importance of strengthening information (both quantitative and qualitative) was underlined. Several participants noted the relatively low prioritization of ageing in several countries in the Region, and the need to strengthen political commitment. The draft Framework and the upcoming Regional Committee discussions represent good opportunities to mobilize such commitment and foster policy dialogue on ageing and health in the Western Pacific.

5.

CLOSING SESSION

Ms Anjana Bhushan thanked the participants for their useful contributions. She noted that a wealth of information had been generated during the meeting, particularly in identifying country-specific priorities on ageing and health. WHO’s Regional Office for the Western Pacific would finalize the draft Framework based on comments received from participants and share a revised version in advance of the Regional Committee Meeting in October 2013. She encouraged all participants to inform or brief relevant departments and ministries in their countries and looked forward to remaining engaged on this important issue.

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Dr Gulin Gedik, Acting Director, Division for Health Sector Development, WHO Regional Office for the Western Pacific, remarked on the growing importance of ageing and health, stressing the need to act urgently. She spoke about the challenge of bringing together diverse voices and partners to promote sustained action. WHO stands ready to support Member States in this area, in collaboration with other partners. Dr Gedik thanked participants for their contributions and the office bearers for their hard work during the meeting. His Excellency Dr Bounkong Syhavong, Vice-Minister of Health of the Lao People’s Democratic Republic and Chair of the Meeting, concluded the consultation by warmly thanking participants for their active participation. Their helpful advice would inform finalization of the draft Framework to be presented to and discussed by the WHO Regional Committee at its sixty-fourth session in October 2013. If endorsed, the Framework has the potential to strengthen political commitment on ageing and health, guide WHO's work in this area, and support Member States in developing country-specific policies and actions that respond to the needs of older people.

Annex 1- Timetable

MEETING ON AGEING AND HEALTH IN THE WESTERN PACIFIC REGION, 9–11 JULY 2013, MANILA  Time  8:00  08:30  Tuesday, 9 July 2013 REGISTRATION Session 1: Opening session   Opening remarks: Dr Shin Young‐Soo, Regional Director   Introduction of participants   Objectives of the meeting    Overview of ageing and health in the Western Pacific Region  (Anjana Bhushan, WHO Regional Office)   Group photo  Wednesday, 10 July 2013 Session 5: Country presentations (contd)   Mongolia   New Caledonia   Palau   Papua New Guinea   Philippines    Republic of Korea    Discussions BREAK Session 6: Fostering age‐friendly environments through  action across sectors   Overview of Pillar 1, draft Regional Framework for  Action on Ageing and Health   Comment (John Beard, WHO HQ)   Comment (Eduardo Klien, HelpAge International)   Discussions  LUNCH Session 7: Country presentations (contd)  Samoa   Tonga   Viet Nam   Discussions     From 14:00:  Session 8: Promoting universal health coverage through  age‐friendly health systems   Overview of the Pillar 3 draft Regional Framework for  Action on Ageing and Health   Comment (Gulin Gedik, DHS, WHO Regional Office) BREAK Session 8: Promoting universal health coverage through  age‐friendly health systems (contd)   Comment  (Alex Ross, WHO Kobe)   Comment (Laura Hawken, WHO Regional Office)   Discussions    Thursday, 11 July 2013 Session 9: Group work  Issue analysis and prioritization    Issue selection   Barrier analysis   

10.00  10:30              12:00  13:00 

Session 2: Strengthening the evidence base on ageing and health  Overview of Pillar 4, draft Regional Framework for Action on  Ageing and Health    Presentation on the health of older people in selected countries  in the Region (Julie Byles, University of Newcastle, Australia)   Comment (Manju Rani, WHO Regional Office)   Discussions  Session 3: Country presentations   Cambodia   China   Federated States of Micronesia   Fiji    Japan   Lao People’s Democratic Republic    Malaysia   Discussions 

Session 9: Group work (contd)  Root cause analysis   Solutions and policy suggestions 

Session 9: Group work (contd)  Presentations from group work   Next steps    

15:00  15:30 

17:30 

Session 4: Promoting healthy ageing across the life course and  preventing functional decline and disease among older people   Overview of Pillar 2, draft Regional Framework for Action on  Ageing and Health   Comment (Susan Mercado, DHP, WHO Regional Office)   Comment (Andres Montes, UNFPA)  Discussions  RECEPTION 

Session 10: Conclusions and closing   Next steps   Closing remarks 

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Annex 2 – List of Participants MEETING ON AGEING AND HEALTH IN THE WESTERN PACIFIC REGION 9 to 11 July 2013 Manila, Philippines

FINAL LIST OF PARTICIPANTS, TEMPORARY ADVISERS, OBSERVERS AND SECRETARIAT

1.

PARTICIPANTS Dr Prak Piseth Raingsey Director, Preventive Medicine Department Ministry of Health #151-153 Avenue Kampuchea Krom, Phnom Penh Tel.: +855 12 862 022; Fax.: +855 23 427 956 E-mail: pisethrainsey@gmail.com Dr Khuon Eng Mony Deputy Director, Preventive Medicine Department Ministry of Health #151-153 Avenue Kampuchea Krom. Phnom Penh Tel.: +855 12 862033; Fax: +855 23 427956 E-mail: monykhemara@yahoo.com

CAMBODIA

CHINA

Dr Cai Fei Deputy Director of Family Development Division Family Development Department National Health and Family Planning Commission 14 Zhichun Road, Haidian District, Beijing Tel: + 86 10 62030599; Fax: +86 10 62030865 Email: 514953729@qq.com Ms Wang Cong Programme Officer Department of International Cooperation National Health and Family Planning Commission 14 Zhichun Road, Haidian District, Beijing Tel: +86 10 62030633; Fax: +86 10 62030831 Email: cwang@npfpc.gov.cn

FIJI

Ms Baleinabuli Dilitiana Senior Research and Policy Officer Social Welfare Department P.O. Box 3628 Lami, Suva Tel: +679 3312199; Fax: +679 3303829 Email: dbaleinabuli@govnet.gov.fj

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Dr Setareki Sowani Sub-Divisional Medical Officer Macuata P.O. Box 104 Labasa Health Centre, Labasa Tel: +679 7102819; Fax: +679 8818115 Email: setareki.sowan@govnet.gov.fj JAPAN Dr Masami Sakoi Director, Ageing and Health Division, Health and Welfare Bureau for the Elderly Ministry of Health, Labour and Welfare 1-2-2 Kasumigaseki, Chiyoda, Tokyo 100-8916 Tel.: +81 3 3595 2490; Fax: +81 3 3595 4010 E-mail: sakoi-masami@mhlw.go.jp Dr Yuka Murakami Section Chief, Ageing and Health Division, Health and Welfare Bureau for the Elderly Ministry of Health, Labour and Welfare 1-2-2 Kasumigaseki, Chiyoda, Tokyo 100-8916 Tel.: +81 3 3595 2490; Fax.: +81 3 3595 4010 E-mail: murakami-yuka@mhlw.go.jp LAO PEOPLE’S DEMOCRATIC REPUBLIC H.E. Dr Bounkong Syhavong Vice-Minister of Health Ministry of Health, Vientiane Tel: +856 21 253017; Fax: +856 21 214003 Email: bounkongs@yahoo.com Dr Nazatul Shima Mokhtar Senior Principal Assistant Director Melaka State Health Department 75450 Ayer Keroh, Melaka Tingkat 3, 4 & 5, Wisma Persekutuan Jalan Business City Bandar MITC, 75450 Ayer Keroh, Melaka Tel.: +60 19 288-0606; Fax: +60 6 234-5958 E-mail: n_shima@mlk.moh.gov.my Dr Zaleja binto Abdul Hamid Senior Principal Assistant Director, Family Health Development Division Ministry of Health Malaysia Block E10, Complex E, Federal Government Administrative Centre, 62590, Putrajaya Tel.:+603 8883 4043; Fax.: +603 8888 6175 E-mail: zaleha@moh.gov.my

MALAYSIA

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MICRONESIA, FEDERATED STATES OF

Mr Marcus Samo Assistant Secretary for Health Department of Health and Social Affairs FSM National Government P.O. Box PS 70, Palikir Tel: +691 320 2619; Fax.: +691 320 5263 E-mail: msamo@fsmhealth.fm Ms Eleanor Mori Gender Development and Human Rights Officer Department of Health and Social Affairs FSM National Government P.O. Box PS 70, Palikir Tel.: +691 320 2619; Fax.: +691 320 2619 E-mail: emori@fsmhealth.fm

MONGOLIA

Dr Khishgee Majigzav Officer-in-Charge Policy Coordination for Noncommunicable Disease Prevention and Control Division of Public Health Department of Policy Implementation Coordination Ministry of Health, Ulaanbaatar Tel.: +976 99184874; Fax: +976 11320916 E-mail: khishgee@moh.mn Dr Oyunkhand Ragchaa Director of National Gerontology Center Center, Sukhbaatar District, Ulaanbaatar 14192 Tel.: +976 11 350801; Fax: +976 11 350801 E-mail: ragchaah@yahoo.com

NEW CALEDONIA

Mr Philippe Rieux Deputy Chief of Service Department of Social Protection DPASS – NC, 3 Bis Angle des Rues Republique et Gallieni BPNC 98851, Noumea CEDEX Tel: +68725 2205; Fax: +68725 2231 E-mail: philippe.rieux@gov.nc Ms Nalina Tirougnanasammandamourtty Department Head of Social Welfare DPASS SUD 5rie Gallieni; 98800 Noumea Tel: +687 799069; E-mail: nalina.tirou@province-sud.nc

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PALAU

Dr Sylvia Osarch Home Health Service and Palliative Care Physician, Family Practice, Belau National Hospital One Hospital Road, Ministry of Health, P.O. 602, Koror Tel: +680 488 2552; Fax: +680 488 1211 E-mail: s_osarch@palau-health.net Ms Rebecca Koshiba Social Worker/Program Manager, Ministry of Health P.O. Box 8042, Koror Tel: +680 488 2212; Fax: +680 488 1211 E-mail: rebeccakoshiba@gmail.com

PAPUA NEW GUINEA

Dr William Lagani Manager, Family Health Services National Department of Health P.O. Box 807, Waigani Tel: +3013711; Fax: +3239710 E-mail: william_lagani@health.gov.pg Dr Lloyd Ipai Chief Physician National Department of Health Port Moresby General Hospital Private Mail Bag, P.O. Box 111, Boroko Tel: +675 324 8200; Fax: +675 325 0342 E-mail: pomgen@daltron.com.pg

PHILIPPINES

Dr Irma L. Asuncion Officer in Charge-Director IV National Center for Disease Prevention and Control Department of Health San Lazaro Compound, Manila Tel: +632 709 0955; Fax: +632 711 0380 E-mail: doc_irma@yahoo.com Atty Germaine Trittle Leonin Unit Head/Planning Officer IV National Coordinating and Monitoring Board Policy Development and Planning Bureau Department of Social Welfare & Development Batasan Complex, Constitutional Hills, Quezon City Tel: +632 951 7123; Fax: +632 931 8130 E-mail: gtpleonin@dswd.gov.ph

REPUBLIC OF KOREA

Mr Kim Woo Gi Senior Deputy Director Division of Long-term Care Insurance Management Ministry of Health and Welfare 75 Yulgong-ro, Jongno-gu, Seoul 110-793

WPR/DHS/HCF(2)/2013/IB/2 page 27

Tel: +822 010 3679 9027; E-mail: kwgda@korea.kr

Ms Jeong Jin Kyoung Assistant Director Division of Ageing Society Policy Ministry of Health and Welfare 75 Yulgong-ro, Jongno-gu, Seoul 110-793 Tel: +822 010 2753 2112; Fax: +822 2023 8471 E-mail: jinkyoung4@korea.kr SAMOA Ms Louisa Apelu Assistant Chief Executive Officer Division for Women Division Ministry of Women, Community and Social Development MWCSD Private Bag, Apia Tel: +68 5 27752; Fax: +68 5 22539 E-mail: lapelu@mwcsd.gov.ws Ms Sarah Filemu Principal Nurse Monitoring and Regulations, Health Service Performance QA Nursing & Midwifery Ministry of Health Private Mail Bag, Apia Tel: +68 5 68142; E-mail: saraf@health.gov.ws TONGA Dr Saia Ma'u Piukala Clinical Service, Care and Treatment Ministry of Health P.O. Box 59, Nuku'alofa Tel: +676 23 200; Fax: +676 24 210 E-mail: saafaapea@hotmail.com Dr Malakai 'Ake Chief Medical Officer Public Health Ministry of Health P.O. Box 59, Nuku'alofa Tel: +676 23 200; Fax: +676 24 291 E-mail: drmalakaiake@gmail.com/make@health.gov.ton VIET NAM Mr Thai Phuc Thanh Vice-Director Administration of Social Protection, MOLISA No. 35 Tran Phu Street, Hanoi Tel: +84 912012901; E-mail: thaiphthanh@yahoo.com

WPR/DHS/HCF(2)/2013/IB/2 page 28

Ms Phuong Thi Thu Huong Chief Information, Analysis and Dissemination Section Center for Population Research, Information and Database, General Office for Population and Family Planning, Hanoi Tel: +84 (0) 918 433221; Fax: +844 373 31951 E-mail: huongp99@yahoo.com

2.

TEMPORARY ADVISERS Professor Julie Byles Director, Research Centre for Gender, Health and Ageing University of Newcastle, University Drive, Callaghan New South Wales 2308, Australia Tel.: +61 2 4042 0668; Fax: +612 4042 0044 E-mail: Julie.Byles@newcastle.edu.au Mr Eduardo Klien Regional Director HelpAge International East-Asia/Pacific Regional Development Centre 6 Soi 17, Nimmanhaemin Road, Suthep, Muang Chiang Mai, Thailand Tel: +66 53 225440; Fax: +66 53 225441 E-mail: eduardo@helpageasia.org

3. UNITED NATIONS POPULATION FUND

OBSERVERS/REPRESENTATIVES Mr Andres Montes Population and Development Specialist Asia and Pacific Regional Office United Nations Population Fund 4th Floor United Nations Service Building Bangkok 10200, Thailand Tel: +662 68760164; Fax: +622 28028715 E-mail: amontes@unfpa.org Professor Chen Xueping Representative of WFPHA and Director Nursing Department Hangzhou Normal University Beijing, China Tel: +86 571 28865559; E-mail: 65386590@qq.com

WORLD FEDERATION OF PUBLIC HEALTH ASSOCIATIONS

WPR/DHS/HCF(2)/2013/IB/2 page 29

DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT, PHILIPPINES

Ms Florita R. Villar Undersecretary Policy and Plans Group, Alternate Chairperson, National Coordinating and Monitoring Board, Policy and Plans Cluster Head, Department of Social Welfare and Development, IBP Road, Batasan Pambansa Complex Constitutional Hills, Quezon City 1126 Tel: +632 931-9131; Fax: +632 931 8191 E-mail: frvillar@dswd.gov.ph Ms Patricia Luna Bureau Director, Social Technology Bureau Department of Social Welfare and Development, IBP Road, Batasan Pambansa Complex, Constitutional Hills Quezon City 1126 Ms Pacita D. Sarino Assistant Bureau Director Protective Services Bureau, Department of Social Welfare and Development, IBP Road, Batasan Pambansa Complex Quezon City 1126 Tel: +63-2 951-7437; E-mail: pdsarino@dswd.gov.ph Ms Marilyn Moral OIC-Division Chief/Social Technology Bureau Department of Social Welfare and Development, IBP Road, Batasan Pambansa Complex Constitutional Hills, Quezon City 1126 Tel: +632 9517124; Fax: +632 9512803 E-mail: mbmoral@dswd.gov.ph Ms Fritzie C. Barrameda SWO III/Standards Bureau, Department of Social Welfare and Development, IBP Road, Batasan Pambansa Complex Constitutional Hills, Quezon City 1126 Tel: +632 951 7125; E-mail: prettyfretzels@yahoo.com

DEPARTMENT OF HEALTH, PHILIPPINES

Dr Maria I. Elizabeth Caluag Medical Officer V, Department of Health San Lazaro Compound, Sta Cruz, Manila Tel: +632 7322493; E-mail: elizabethcaluag@yahoo.com Ms Remedios Guerrero Supervising Health Programme Officer DDO-NCDPC, Department of Health San Lazaro Compound, Sta Cruz, Manila Tel: +632 732 2493; E-mail: jing_s_guerrero@yahoo.com

WPR/DHS/HCF(2)/2013/IB/2 page 30

Dr Shelley de la Vega Associate Professor University of the Philippines College of Medicine Director, Institute on Aging, National Institute of Health and President Philippine College of Geriatric Medicine, Manila E-mail: delavega.shelley@yahoo.com 4. WHO/WPRO SECRETARIAT

Dr Gulin Gedik Acting Director, Division for Health Sector Development and Team Leader, Human Resources for Health World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000, Philippines Tel: +63 2 528 9816; Fax: +63 2 521 1036; E-mail: gedikg@wpro.who.int Dr Susan Mercado Director, Building Healthy Populations and Communities World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000 Tel.: +6 32 528 9852; Fax.: +63 2 521 1036 E-mail: mercados@wpro.who.int Ms Anjana Bhushan (Responsible Officer), Technical Officer, Health in Development World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000 Tel.: +63 2 528 9814; Fax: +63 2 528 9072 E-mail: bhushana@wpro.who.int Dr Manju Rani Senior Technical Officer, Health Research Policy, Division for Health Sector Development, World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000 Tel: +63 2 528 9048; Fax: +63 2 521 1036 Email: ranim@wpro.who.int Ms Laura Hawken Technical Officer, Health Services Development

WPR/DHS/HCF(2)/2013/IB/2 page 31

World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000 Tel: +63 2 528 9806; Fax: +63 2 521 1036 Email: postmas@wpro.who.int Ms Britta Baer Technical Officer, Gender, Equity and Human Rights Division for Health Sector Development World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000 Tel: +63 2 528 9084; Fax: +63 2 521 1036 Email: baerb@wpro.who.int Ms Sarah Korver Intern, Division for Health Sector Development World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000 Tel: +63 2 528 9845; Fax: +63 2 521 1036 Email: korvers@wpro.who.int Mr John Park Intern, Division for Health Sector Development World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000 Tel: +63 2 528 9846; Fax: +63 2 521 1036 Email: parkj@wpro.who.int WHO/HQ Dr John Beard, Director, Department of Ageing and Life Course World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27 Tel.: +41 22 79 13404; Fax: +41 22 79 10746 E-mail: beardj@who.int Dr Alex Ross Director, WHO Centre for Health Development I.H.D. Centre Building 9F, 5-1, 1-chome, Wakinohama-Kaigandori, Chuo-ko, Kobe 651-0073, Japan Tel.: +81 78 230 3102; Mobile: +81 802435 1861 Fax: +81 78 230 3178; E-mail: rossa@who.int

WHO/KOBE

WPR/DHS/HCF(2)/2013/IB/2 page 32

Annex 3 – Group work tables and summaries

WPR/DHS/HCF(2)/2013/IB/2 page 33

Task 2: Cambodia  Issue  Lack of health workers with appropriate skills  Limited activities on health promotion and NCD prevention across the life course  Integrated health service delivery to ensure the continuum of care  Equitable financing of health and long‐term care Impact (0–5)  5  5  5  Feasibility (0–5)  4 3 2 Total (0–25)  20 15 10

             

    Task 5: Cambodia  Problem  statement  Lack of skilled and  competent health  staff to  provide/manage  quality health care  for older people    Cause  1. There is no existing  training at basic and  postgraduate levels.  Solution ‐ Include care of older  people within school  curriculum.  Request assistance  from international  and regional  academics.  Advocacy. Budget planning.  Financing schemes.  Practical actions 1.1 In‐service training to health professions at all  levels.  1.2 Develop and adapt curriculum. 1.3 Short‐term geriatric and gerontology training. 2.1 Disseminate information on ageing issues  among policy makers in different sectors.  2.2 Prepare action plan and costing for short term,  medium term and long term.  2.3 Use existing health care financing scheme to  facilitate older people’s access to health care.  3.1 Multisectoral awareness raising on older  people’s health issues for health staff, government,  partner and media.  3.2 Raising awareness on health and ageing related  to social, physical and environmental to OPA.  3.3 Develop information, education and  communication (IEC) materials.  Effective x Feasibility =  Overall  5 4 20

         

‐

5 5 5 5 5 5

4 3 4 3 3 5

20 15 20 15 15 25

2.

There is no funding  or technical support  from government or  partners. 

‐ ‐ ‐

3.

Perceptions from;  health care staff,  government and  partners. 

‐

Raising awareness.

5 5

5 5

25 25

WPR/DHS/HCF(2)/2013/IB/2 page 34

Task 2: China  Issue  Integrated health service delivery to ensure continuum of care Health workers with appropriate skills  Strengthening the evidence base on ageing and health Impact (0–5)  5  4  4  Feasibility (0–5)  5 5 5 Total (0–25)  25 20 20

           

    Task 5: China  Problem  statement  An effective and  cooperative  mechanism on  ageing and health  under the existing  coordination  needs to be  improved.  Cause  Solution Practical actions Effective x feasibility =  overall  4 4 5 5 5 5 5 4 5 5 4 5 5 4 4 5 5 4 20 16 20 25 20 20 25 20 20

1.

Lack of information  and evidence.  Lack of integrated  policy. 

‐  Provide information  and seek evidence. 

2.

3.

Lack of national  guidance on  integrated health  services delivery in  the community. 

1.1 literature and policy review.  1.2 National survey. 1.3 Dissemination of results and advocacy. ‐ Establish cross‐sector  2.1 Policy dialogue and meetings across sectors. policy on integrated  2.2 Leadership advocacy. health service.  2.3 Preliminary testing of policies in different regions  (with different economic and social contexts).  ‐ Formulate national  3.1 Identify existing good models.  guidance.  3.2 Analyse the feasibility of models under different  circumstances.  3.3 Collect and disseminate good practice examples  of local innovation to fit the national guidance. 

           

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Task 2: The Federated States of Micronesia  Issue  Health workers with appropriate skills  Building partnerships and ensuring the participation of older people Health promotion and NCD promotion across the life course Impact (0–5)  4  4  5  Feasibility (0–5)  4 5 5 Total (0–25)  16 20 25

           

    Task 5: The Federated States of Micronesia  Problem  statement  Services for older  people are not  available  Cause  Solution Practical actions Effective x feasibility =  overall  4 4 4 4 3 5 4 5 3 4 4 4 16 20 12 16 12 20

1. Lack of providers.  2. Lack of priority and  policy.  3. Lack of clarity of need.

‐ Specialized training.  ‐ Home care training.  ‐ Building the evidence  (moving from liability  to opportunity myth).  ‐ Conduct a situational  analysis. 

1.1 Conduct geriatric course/training. 1.2 Train home caregivers.  2.1 Collect data. 2.2 Package and disseminate.  2.3 Monitor and evaluate. 3.1 Conduct a situational analysis. 

WPR/DHS/HCF(2)/2013/IB/2 page 36

Task 2: Fiji  Issue  Leadership and governance on ageing and health Strengthening the evidence base on ageing and health Health promotion and NCD prevention across the life course Impact (0–5)  5  4  4  Feasibility (0–5)  4 4 5 Total (0–25)  20 20 25

           

    Task 5: Fiji  Problem  statement  The government  needs to  strengthen the  evidence  base/structural  approach,  collaboration and  partnership to  address NCD  issues or concerns.  Cause  Solution Practical actions Effective x feasibility =  overall  4 5 4 4 4 4 4 4 4 4 5 5 5 4 4 5 5 5 16 25 20 20 16 16 20 20 20

1.

Lack of data to  ‐ determine the scope  and management of    the target group    being dealt with.  Lack of structured  approach  (leadership and  governance).  ‐

Increase  knowledge base. 

1.1 Intersectoral action‐oriented strategies. 1.2 Secure political will. 1.3 Encourage private sector and civil society  participation.  2.1 Secure political will. 2.2 Establish structured model that is holistic and  harmonized.  2.3 Monitoring and evaluation framework. 3.1 Secure political will. 3.2 Secure partnerships. 3.3 Monitoring and evaluation analysis.

2.

Increase  leadership and  governance. 

3.

    Lack of collaborative  ‐ approach to address  NCDs. 

Secure innovative  partnerships for  healthy ageing. 

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Task 2: Japan Issue  Integrated health service delivery to ensure continuum of care Preventing diseases and functional decline among older people Building partnerships and ensuring the participation of older people Impact (0–5)  4  3  4  Feasibility (0–5)  4 4 3 Total (0–25)  16 12 12

           

    Task 5: Japan  Problem  statement  Cause  Solution Practical actions Effective x Feasibility =  Overall  2 4 4 2 3 4 4 4 3 4 4 3 3 3 8 12 16 8 9 12 12

Informal sectors  1. need support  from the  government and  medical  specialists in  order to promote  2. integrated health  service delivery  to ensure the  3. continuum of  care. 

Informal carers have  ‐ To make an organization  minimal power.  that assists in collaboration  of informal carers. 

It is unclear who can  make up the  informal sector.  There is a traditional  model in Japan  (formal care  oriented by medical  specialists). 

‐ To grasp who can make up  the informal sector.  ‐ To make people, as well as  specialists, understand the  importance of step‐down  care to respond to the  needs of older people in  Japan. 

1.1 Obtain information of good practice  examples from prefectures.  1.2 Think about functional schemes to organize  and support informal carers.  1.3 If there are already good organizers, support  them.  2.1 Obtain information on good practice, see examples from prefectures.  2.2 Survey who is already working in Japan 3.1 Increase the awareness and appeal of existing  evidence on the needs of older persons.  3.2 Inform people of good practice examples of  informal workforce. 

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Task 2: Lao People’s Democratic Republic  Issue  Health promotion and NCD prevention across the life course Health workers with appropriate skills  Equitable financing of health and long‐term care Impact (0–5)  5  5  5  Feasibility (0–5)  3 4 2 Total (0–25)  15 20 10

           

    Task 5: Lao People’s Democratic Republic  Problem  statement  Increasing  numbers of older  people with  chronic diseases  and disabilities,  but not enough   qualified health  caregivers to deal  with this situation.  Cause  Solution Practical actions Effective x feasibility =  overall  5 4 5 4 4 4 4 4 4 4 4 5 4 5 4 4 4 3 20 16 25 16 20 16 16 16 12

1.

No appropriate  competency in  ageing and health  care. 

‐  

Build up  competency. 

2.

No expertise inside  ‐ Lao People’s  Democratic Republic  in ageing and health. 

Look for ways to  build ageing  health expertise.   

3.

Lack of funding. 

‐

Secure and  sustain the  funding.   

1.1 Develop training institutions appropriate to the  need.  1.2 Set up the specific curriculum and introduce into  faculties of nursing and medicine.  1.3 Train existing staff in health centres, family  members and volunteers.  2.1 Request assistance from abroad; WHO, HAI and  universities.  2.2 Exchange and study visits with advanced  partners.  2.3 Send health professionals to study overseas for  long‐term training.  3.1 Include in health budget specific allocation for  training.  3.2 Request assistance from development partners. 3.3Promote the contribution of family members and  local authorities. 

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Task 2: Malaysia  Issue  Preventing disease and functional decline among older people Fostering age‐friendly environments that promote the health and participation of older people Building partnerships and ensuring the participation of older people Impact (0–5)  5  4  4  Feasibility (0–5)  4 2 3 Total (0–25)  20 8 12

           

  Task 5: Malaysia  Problem  statement  Cause  Solution Practical actions Effective x feasibility =  overall  5 4 20

Health‐seeking  1. behaviour of older  people and  informal carers are  the leading factors  for older people  not attending  clinics for  treatment, early  2. screening and  continuum of care. 

Clinics are  ‐ unpopular and  feared by some  older people. 

Provide  information and  a conducive  environment for  older people. 

Self‐ medication  (traditional  medicine). 

‐

Increase  awareness and  regulation. 

3.

Awareness  among  informal  carers. 

‐

Provide  information to  informal carers. 

1.1 Increase outreach programmes from health care  providers, health clinic, panel advisers, community and  NGOs.  1.2 Conducive environment for older people: for example, fast track lane, reduce waiting time and specific activities  for older people.  1.3 Disseminate information through religious activities/  assembly.  2.1 Disseminate health education material through various  methods.  2.2 Increase enforcement and act through the respective  authorities.  2.3 Home care nursing/home visit staff need to identify  older people on traditional medicine.  3.1 Disseminate IEC materials. 3.2 Provide training for carers. 3.3 Training for health care providers at a national and state  level to give correct information to carers and encourage  them to bring older people to clinics. 

5

4

20

5 5 3 4 4 4 5

3 4 3 3 5 3 4

15 20 9 12 20 12 20

                         

WPR/DHS/HCF(2)/2013/IB/2 page 40

Task 2: Mongolia Issue  Leadership and governance in ageing and health Health workers with appropriate skills  Equitable financing of health and long‐term care Impact (0–5)  5  5  5  Feasibility (0–5)  2 4 1 Total (0–25)  10 20 5

           

    Task 5: Mongolia  Problem  statement  Cause  Solution Practical actions Effective x feasibility =  overall  4 5 5 5 5 5 4 4 2 3 2 2 1 1 4 3 8 15 10 10 5 5 16 12

Inadequate  1. professional  education  across all levels  2. of the  workforce.  3.

Lack of expertise in  geriatrics.  Competing priorities  (for example,  paediatrics, RH, STI,  etc.).  Government and  donors do not give  priority to ageing issues. 

‐ Training of existing and  new workforce.  ‐ Improve the value of older  people. 

1.1 Send staff to other countries for training. 1.2 Bring experts to Mongolia to train. 1.3 Support schemes for local training. 2.1 Awareness campaign for the public. 2.2 Change negative beliefs about older people. 3.1 Make arguments regarding economic and  human rights issues.  3.2 Delegates to attend high‐level meeting in other countries and with WHO.  3.3 Visits by high‐level experts to highlight the  important issues on ageing. 

‐ Convince the government  and donors of the  importance of ageing and  the need for good health  care for older people. 

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Task 2: New Caledonia  Issue  Health promotion and NCD prevention across the life course Participation of older people  Health workers with appropriate skills (health and social) Impact (0–5)  3  4  4  Feasibility (0–5)  4 2 2 Total (0–25)  12 8 12

           

    Task 5: New Caledonia  Problem  statement  Health prevention  policy started late  in 1994 before the  ageing of the  population  became a major  demographic  issue, and  therefore does not  include the health  of older people,  and especially  NCDs.  Cause  Solution Practical actions Effective x feasibility =  overall  4 4 4 3 4 3 5 5 3 5 3 4 20 20 12 15 12 12

1.

Priority was to cure  first. 

‐ To develop prevention  programmes including  ageing and health  prevention. 

1.1 Include geriatric skills to develop such  programmes. 

2.

3.

No special  representation or  inclusion of  prevention of ageing  effects.  Lack of geriatrics  culture and  education. 

1.2 Develop preventive action that includes  older people.  ‐ To communicate and make  2.1 Develop research and evaluation to  people aware of the issue,  demonstrate the importance of older people.  both politically and among  2.2 Financing of communication programmes. the wider population.  3.1 Include geriatric skills in nursing,  medicine, social workers and schools.  3.2 Meetings for families and further  communication. 

‐ Education, training for all  levels of workers and  families. 

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Task 2: Palau  Issue  Strengthening the evidence base on ageing and health Leadership, community work and governance on ageing and health Preventing diseases and functional decline among older people Impact (0–5)  5  5  4  Feasibility (0–5)  3 5 2 Total (0–25)  15 25 15

           

    Task 5: Palau  Problem  statement  Cause  Solution Practical actions Effective x feasibility =  overall  5 5 5 3 5 5 15 25 25

The leadership and  1. the community do  not know about  the issues of  ageing and health. 

Different priority  focus as a result of  cultural norms. 

‐ Increase awareness. ‐ Change norms in the  community. 

1.1 Evidence‐based information. Data are required to conduct a situational analysis.  1.2 Educate leaders and community through media  outreach.  1.3 Have the community and caregivers make lots of  noise (rally support). 

WPR/DHS/HCF(2)/2013/IB/2 page 43

Task 2: Papua New Guinea  Issue  Leadership and governance on ageing and health Essential medicines and health technologies for older people Preventing diseases and functional decline among older people Impact (0–5)  5  5  4  Feasibility (0–5)  3 4 4 Total (0–25)  15 20 16

           

  Task 5: Papua New Guinea  Problem  statement  Cause  Solution Practical actions Effective x feasibility =  overall  5 4 4 5 4 5 3 3 4 5 4 4 3 5 2 3 4 3 25 16 16 15 20 10 9 12 12

 Supply of  1. essential  medicines is thinly  spread between all  age groups, and  therefore older  people compete  2. for limited  supplies.  In  addition to  essential medicine,  3. health  technologies are  rarely available. 

No evidence‐based  procurement of essential  medicines and  technologies: i.e. supply  and demand are  mismatched.  Tedious tendering process.

‐ Planning  mechanism  for predicting  demand. 

1.1 Develop a planning model for procurement. 1.2 Work with AUSAID on the distribution of the 100%  health facility kits.  1.3 Evaluate the planning model on a yearly basis. 2.1 Procure drugs and supplies from WHO‐approved  and prequalified pharmaceutical companies.  2.2 Input from WHO on rational use of drugs. 2.3 Get rid of tendering system.  3.1 Investigate the chain of distribution and the  procurement process.  3.2 Education/awareness on medication and health  technology sold in authorized outlets.  3.3 Increase the number of authorized dispensing  outlets. 

‐ Regulate  tendering  process.  ‐ Impose  heavy  penalties on  corruption. 

Corrupt procurement and  distribution practices. 

WPR/DHS/HCF(2)/2013/IB/2 page 44

Task 2: The Philippines  Issue  Preventing diseases and functional decline among older people Health promotion and NCD prevention across the life course Integrated health service delivery to ensure continuum of care Impact (0–5)  5  5  5  Feasibility (0–5)  5 5 4 Total (0–25)  25 25 20

           

    Task 5: The Philippines  Problem  statement  Limited  resources  have  constrained  efforts on  health  promotion  and NCD  prevention.  Cause  Solution Practical actions Effective x feasibility =  overall  5 5 5 5 5 5 5 4 5 5 5 5 25 20 25 25 25 25

1.

2.

3.

Lack of political will: i.e.  budgetary allocations by  congress.  Society perspective on  ageing and older people,  specifically prioritization  and “investment” in older  people.  Inequitable distribution  of resources/wealth and  socioeconomic status. 

‐ Inform and influence  government officials.   ‐ Identify champions.  ‐ Develop behavioural  change through  communication  materials, KASB and  advocacy efforts.  ‐ Better coordination  and maximization of  resources.  ‐ Communicate,  coordinate and  collaborate. 

1.1 Identification and profiling of targets; audience  augmentation.  1.2 Review and conduct research, studies and surveys. 2.1 Media (TV, print, radio and social/interpersonal) 2.2 Sectoral participation/viability/representation of older  people as “active, functional and productive”.  2.3 Meeting dialogues with various stakeholders. 3.1 Engage members of the social protection cluster e.g.  Department of Health, Department of Social Welfare and  Development (DSWD).  3.2 Mapping of resources and profitable mechanisms, i.e.  PHILHealth, social security system.  3.3 Assessment (?) of areas needing equal distribution of  resources. Make recommendations. 

5 5

4 4

20 20

WPR/DHS/HCF(2)/2013/IB/2 page 45

Task 2: The Republic of Korea  Issue  Equitable financing of health and long‐term care Fostering age‐friendly environments that promote the health and participation of older people Integrated health service delivery to ensure continuum of care Impact (0–5)  4  4  4  Feasibility (0–5)  3 4 3 Total (0–25)  12 16 12

           

    Task 5: The Republic of Korea  Problem  statement  The need to  increase  national long‐ term care  premiums to  pay for older  people.  Cause  Solution Practical actions Effective x feasibility =  overall  3 3 4 4 4 3 3 4 4 4 3 2 4 3 3 4 3 2 12 9 8 16 12 9 12 12 8

1.

Increasing  ageing  population.  Increasing life  expectancy.  Limited long‐ term care  services. 

‐ Promotion of  fertility.  ‐ Promotion of  healthy life  expectancy.  ‐ Promotion of long‐ term care insurance  system. 

2.

1.1 Government financial aid to child care.  1.2 Building child‐friendly environments.  1.3 Improvement of public awareness.  2.1 National health screening service.  2.2 Older people’s exercise programme.  2.3 Promoting healthy lifestyles, diet and well‐being. 3.1 Better budget control. 3.2 Continuance of system. 3.3 Upgrading service quality through education, training and  skills. 

3.

WPR/DHS/HCF(2)/2013/IB/2 page 46

Task 2: Samoa  Issue  Leadership and governance on ageing and health Health workers with appropriate skills  Health promotion and NCD prevention across the life course Impact (0–5)  5  5  5  Feasibility (0–5)  3 4 5 Total (0–25)  15 20 25

           

    Task 5: Samoa  Problem  statement  Communities and  targeted groups  are empowered  through  information  dissemination,  consistent and  widespread public  awareness  programmes.  Cause  Solution Practical actions Effective x feasibility =  overall  5 5 5 5 4 5 5 5 5 5 4 3 4 4 3 5 4 4 25 20 15 20 16 15 25 20 20

1.

Budget. 

‐ Increase budget  allocation.   ‐ Ensure key messages  are consistent and  evidence‐based.  ‐ Sector‐wide  approach. 

2.

Inconsistent key  message. 

1.1 Conduct a budget review on ageing allocation. 1.2 Include a budget measure in budget bid for future. 1.3 Develop a workplan based on budget. 2.1 Review and repackage key messages across all  sectors including NCD prevention.  2.2 Pre‐ and post‐test key messages for target groups. 2.3 Disseminate messages. 3.1 Meeting for the health sector on issues of ageing. 3.2 Discuss ageing issues and opportunities for  integrated efforts.  3.3 Integrate into current sector programmes.

3.

Slow  implementation  action efforts. 

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Task 2: Tonga  Issue  Leadership and governance on ageing and health Fostering age‐friendly environments that promoting the health and participation of older  people  Building partnerships and ensuring the participation of older people Impact (0–5)  5  4  4  Feasibility (0–5)  4 5 4 Total (0–25)  20 25 16

             

  Task 5: Tonga  Problem  statement  Lack of  awareness of  health care  workers to  provide easily  accessible  services to older  people.  Cause  Solution Practical actions Effective x feasibility =  overall  5 5 4 4 5 5 5 5 4 5 4 4 4 4 5 5 4 4 25 20 16 16 20 25 25 20 16

1.

Lack of training  of health care  workers.  Lack of hospital  policy.  Lack of public  knowledge. 

‐ Training.

2.

‐ Develop policy.

3.

‐ Media campaign  coverage. 

1.1 In‐house training of health care workers. 1.2 Curriculum incorporation (training institutionally). 1.3 Education of health care workers and the public about  ageing population.  2.1 Taskforce (evidence). 2.2 Technical sub‐committee. 2.3 National health development committee endorsement. 3.1 Mass media campaign by Ministry of Health. 3.2 Mass media campaign by NGOs.  3.3 Churches and old people networking. 

WPR/DHS/HCF(2)/2013/IB/2 page 48

Task 2: Viet Nam Issue  Fostering age‐friendly environments that promote the health and participation of older people Preventing diseases and functional decline among older people Leadership and governance on ageing and health Impact (0–5)  3  4  4  Feasibility (0–5)  3 2 2 Total (0–25)  9 8 8

           

  Task 5: Viet Nam  Problem  statement  Cause  Solution Practical actions Effective x feasibility =  overall  5 4 4 5 4 5 4 4 5 4 4 4 4 4 4 4 3 4 20 16 16 20 16 20 16 12 20

Weak  1. Weak capacity.  ‐ Capacity‐building. multisectoral  coordination at a  national and  2. Lack of evidence.  ‐ Providing data/  local level.  information.  3. Restricted  financial  resources.  ‐ Mobilization of  funding. 

1.1 Training/refreshing. 1.2 Experience/lessons sharing.  1.3 Developing training materials.  2.1 Conducting research survey.  2.2 Communication and advocacy.  2.3 Strengthening research and analysis capacity. 3.1 Greater participation of stakeholders. 3.2 Restructuring of budget. 3.3 Efficient use of funds.

                         

WPR/DHS/HCF(2)/2013/IB/2 page 49

Annex 4: Presentations

Annex 4 - Presentations

Meeting objectives

Ageing and health: updates from the Western Pacific Region

1.

to share findings from ongoing analysis of (i) health of older persons; and (ii) policies on ageing and health in selected countries in the Region; to discuss the implications of population ageing for health and health systems in the Region; and to discuss and agree upon a regional framework for action on ageing and health.

2. 3.

Anjana Bhushan, Technical Officer (Health in Development) Meeting on Ageing and Health in the Western Pacific Region

Your inputs are vital and much appreciated! 2 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

1 | Manila, 9-11 July 2013

Varying demographic transitions Percentage of Men and Women age 60 and over by Countries, WPRO, 2010 Papua NG Solomon Is Brunei Vanuatu Lao PDR Cambodia Mongolia Philippines Samoa Fiji Malaysia Viet Nam Tonga China Singapore R. Korea Hong Kong New Zealand Australia Japan 0 4.2 4.5 4.8 5.2 5.7 6.1 6.4 6.8 7.4 7.9 8 8.8 8.9 12.7 15 15.9 16.1 19 19.9 31.6 5 10 15 20 25 30 35

Ageing-related challenges in the Region

1. 2. 3. 4. 5.

Social determinants, socioeconomic challenges Increasing disease burden: health promotion, prevention agenda Weak health systems and services: need for age-friendly response Equity, gender, human rights issues Inadequate evidence base

Women Men

Source: United Nations Dept of Economic and Social Affairs, Population Division, World Population Prospects: The 2008 Revision Meeting on Ageing and Health in the Western Pacific Region Meeting on Ageing and Health in the Western Pacific Region

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Time taken for population aged 60 years and above to double, selected countries, Western Pacific Region

Morbidity and disability in older people Top 10 causes of DALYs lost for men, 60-79 years, Western Pacific Region (2004) Top 10 causes of DALYs lost for women, 60-79 years, Western Pacific Region (2004)

Population aged 60 years and above (%)

1940 14%

1950

1960

1970

1980

1990

2000

2010

2020

2030

2040

2050

2060

Lao People’s Democratic Republic Philippines

Hong Kong (China) New Zealand

7% Australia Japan China Fiji Cambodia Papua New Guinea

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2010 Revision

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Annex 4 - Presentations

Literacy in population aged 60 years and above, selected countries, Western Pacific Region (2000) 100 90 80 70 Literacy rate Literacy rate

Republic of Korea 100 90 80 70 60 50 40 30 20 10

China

60 50 40 30 20 10 0 60-64 65-69 Age 70+ Men Women Total

Men Women Total

0 60-64 65-69 Age 70+

Malaysia 100 90 80 Literacy rate 100 90 80 70 60 50 40 30 20 10 0 60-64

Cambodia

70 Literacy rate 60 50 40 30 20 10 0 60-64 65-69 Age 70+ Men Women Total

Men Women Total

65-69 Age

70+

Source: United Nations, Department of Economic and Social Affairs. World Population Ageing 1950-2050

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Initiating a response Informal Experts’ Consultation on Healthy Ageing in the Western Pacific Region (05/11) World Health Day 2012: Ageing and health--good health adds life to years. Ageing, gender and women’s health: – Module on Ageing, Integrating Poverty and Gender into Health Programmes: A Sourcebook for Health Professionals – Women and Health in the Western Pacific Region: Remaining Challenges and New Opportunities—chapter on older women 9 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Key events 2013 Informal Experts’ Consultation on Ageing and Health in the Western Pacific Region, 9-10 April 2013, Manila Consultation on Ageing and Health in the Western Pacific Region, July 2013 Regional Committee Meeting, 25-29 October 2013 Follow-up country support

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Background Regional framework for action on ageing and health

DRAFT Regional Framework for Action on Ageing and Health in the Western Pacific Region

Comparative analysis the health situation of older people in selected countries

Review and analysis of policies on ageing and health in selected countries

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Annex 4 - Presentations

Vision An age-friendly Western Pacific Region where older people are adequately supported for maintaining their health and leading active lives, where population ageing is regarded as an opportunity and the health of older people as a resource for society, where the highest attainable standard of physical and mental health is framed as a fundamental right of all older people, without discrimination, and where the participation of older people in all aspects of daily life is recognized and upheld as a core principle. The vision assumes that healthy ageing is a recognized component of action across the life course and across sectors, ensuring that older people live in environments that support them in remaining healthy, active, empowered and socially engaged, as well as in having access to age-friendly health systems and information. 13 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Goals a) Promote increased understanding of ageing and health in the Western Pacific Region b) Suggest actions to address new challenges and set priorities on ageing and health in the Region c) Strengthen leadership on ageing and health in the Region

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Timeframe The regional framework for action on ageing and health covers six years (three WHO biennia) from 2014 to 2019.

Pillars of action on ageing and health 1. Foster age-friendly environment through action across sectors 2. Promote healthy ageing across the life course and prevent functional decline and disease among older people 3. Promote universal health coverage through age-friendly health systems 4. Strengthen the evidence-base on ageing and health

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AGED CARE IN AUSTRALIA Thank you Julie Byles President Australian Association of Gerontology

http://www.wpro.who.int/topics/ageing/en/

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Annex 4 - Presentations

Policy Reform – Step 1 Situation analysis 2010/11 Productivity Commission Inquiry into Aged Care http://www.pc.gov.au/projects/inquiry/aged-care/report

Policy Reform – Step 3 Public support and political will http://agewellcampaign.com.au

Examined social, clinical and institutional aspects of aged care addressed the interests of special needs groups developed regulatory and funding options for residential and community aged care examined the future workforce requirements of the aged care sector recommended a path for transitioning from the current arrangements to a new system examined whether the regulation of retirement living options should be aligned more closely with the rest of the aged care sector assessed the fiscal implications of any change in aged care roles and responsibilities.

Policy Reform – Step 2 2012 Living Longer, Living Better http://www.livinglongerlivingbetter.gov.au help people to stay at home through home support program Consumer directed care Carer support and respite care

Policy Reform – Step 4 2013 -2015 Implementation Aged Care Reform Implementation Committee Aged Care Financing Authority Gateway to aged care services to help older Australians be informed, assessed, and move through the aged care system http://www.myagedcare.gov.au/welcome-my-aged-care streamlined quality regulation and complaints system National Aged Care Alliance http://www.naca.asn.au On 28 June 2013, five Bills forming the Living Longer Living Better package of bills received Royal Assent and passed into law.

consumer advocacy better connecting lonely and socially isolated Improving knowledge of older people’s needs tackle the dementia epidemic: in home and residential care, improved hospital and primary care increased focus on people with younger onset dementia Earlier diagnosis

More and better residential aged care Aged Care Financing Authority/ improved Aged Care Funding Instrument stronger aged care workforce. better health connections through: complex health care, multidisciplinary care, service innovation

support for older Australians from diverse backgrounds including indigenous Australians and those from different cultural backgrounds

Policy Reform- Step 5 Monitoring and Evaluation Use of linked data from large surveys and health and aged care administrative data sets Access to data for researchers Quality indicators Equity impact assessment Feedback loop for continuous monitoring and improvement

RIGHTS AND CARE OF OLDER PEOPLE IN CAMBODIA MEETING ON AGEING AND HEALTH IN THE WESTERN PACIFIC REGION 9-11 July 2013 Manila Prak Piseth Raingsey Director Preventive Medicine Department 24 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Annex 4 - Presentations

Policy context for action on ageing and health The findings of the 1998 study on the situation of older people in Cambodia revealed that many development programs implemented by government and NGOs have excluded older people in their activities due to their old age. March 1999 MOH endorsed the Health Care for Elderly and Disabled Policy Goal: Promote healthy ageing and disabled among Cambodian population General Objective : To pay attention on ageing and disabled care by integrating into existing health care system and collaborate with other sectors especially with MOSALVY, IOs, NGOs and civil society. Specific Objective : 1- To improve healthy ageing and disabled people 2- Human Resource development 3- To promote health education ( NCDs risk factors ) 4- Establish home based care for elderly and disabled people 25 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Policy context for action on ageing and health 1999 the RGC had proclaimed the celebration of October 1 as the International Day for Older Persons In September 2001 "National Forum on Older People” attended by elderly with equally diverse and economic backgrounds. Representatives also attended the forum from 12 national and international NGOs and members of the Inter-Ministerial Committee representing 12 government ministries. Recommendations from the national forum were presented to the International Forum on Older People in Madrid, Spain in April 2002. 2003 the National Committee for the International Day for the Elderly and Ageing People has approved the Policy for the Elderly. Goal : Care for the well being of the elderly population and take appropriate and timely action to respond to its problems and needs according to defined priorities such as social, health, economic and participation scheme. The government’s support to the formation of Older People’s Associations (OPAs) in all provinces in Cambodia. 26 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Key challenges for action on ageing and health Older people has struggled on how to adapt to a rapidly changing market economy and a flood of foreign technology and culture. Older people cannot rely on any form of state support Both government and non-government organizations failed to effectively address the needs and tap the potentials of the older people The government’s strategic five-year plan has included the elderly sector but failed to develop concrete plans and adequate budget to implement it. Government agencies responsible for providing basic services and protection to the elderly lacked the necessary manpower, facilities and materials resources to effectively respond to the needs and problems of older people. The huge expense of medical cares very often push older people to prioritize the food and livelihood security of their families in favor of their health and medical needs. Meeting on Ageing and Health in the Western Pacific Region

Good practice example Older people are a valuable resource, which government empower to work together as advisor, planning management and evaluation of development programs. A successful implementation of an integrated development program in the countryside has increase the capacity of immediate families and communities to care and support for the elderly sector ( ODA, Home Based Care for Frail Elderly, Cow and Rice Bank) Training on Home Care for the Elderly to VHSG In Service Training on Health Care for the Elderly to the PHC staffs. Free care services for poor and frail elderly and disabled as well

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Future priorities and opportunities for regional collaboration Capacity building on geriatric and gerontology by supporting to appeal fellowship for specialities Regional network for health professional to apply comprehensive career opportunity Provide appropriate packages for long term care of chronic diseases through financing mechanism scheme Stimulate the quality of services by exchange of good practices for appropriate needs of elderly people

THANK YOU

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Annex 4 - Presentations

Policy context for action on ageing and health Achieve full coverage of basic medical insurance in both urban and rural areas.

Responding the largest ageing population actively

Subsidy by public finance in NCMS

Cai Fei Department of family development National Health and Family Planning Commission China 31 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

(RMB/per capita ) 32 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Policy context for action on ageing and health Strengthen the medical service system for the elderly. Improve the community health service network. Urban : 25,400 community clinics 454,000 personnel Rural: 37,300 township-level clinics 662,900 village-level clinics (by the end of 2012) 33 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Policy context for action on ageing and health Provide free annual physical examination and health consultation; establish health record for elders over 65 years. Prevent age-related disease through health education.

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Key challenges for action on ageing and health Rapid growth in the number of aged population. over 65 years : 123 million (by the end of 2011) over 60 years: 194 million (by the end of 2012) Population over 60 years will exceed 200 million by the end of 2013. The pace of population ageing in China is 1.5 times than that of world average level. In 2050, one in three of the Chinese is 60 years or older. 35 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Key challenges for action on ageing and health Heavy demands for health service by aged population. Long-term care is urgently needed.

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Annex 4 - Presentations

Good practice --Actions across sectors in Pudong A district in Shanghai Population aged 60 or above : 680,000, 24.41% of the total Population aged 80 or above :118,000, 17.2% of aged population

What they do Establish a home-based old-age care scheme across sectors. Provide services: home care, capacity building for active ageing, consultation, health services, and social links. Pay special attention to the vulnerable elderly group: install emergency call devices for the elderly living alone or the frail elderly; keep a daily contact with elderly people living alone;provide nutrition subsidy for the oldest-old. Volunteers are organized to help the elderly .

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Future priorities and opportunities for regional collaboration Evidence based policy making process Information sharing Long-term care services

FSM’s Elderly

Marcus Samo Eleanor S. Mori Federated States of Micronesia

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Policy context for action on ageing and health Life Expectancy: 1973: 60.0yrs/ 1980:64.8yrs/ 1994:65.2yrs/ 2000:67yrs (FSM Census, 2000) About 35.7% of the total population were aged 0-14 years, 58.7% were aged 15-59 years, and 5.6% were aged 60 years and above. The median age is 21.5 years, an increase of about 3 years since 2000, indicating the FSM population is ageing. FSM Census 2010 Age 60+: 5,654 (FSM Census 2000), 5,601 (FSM Census 2010)

Key challenges for action on ageing and health Island demographics/population Lack of awareness and support Lack of policy; services

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Good practice example Establishment of State Senior Groups (Pohnpei) Expansion into the municipalities October 1: International Day of Older Persons

Future priorities and opportunities for regional collaboration “Recognition through Accommodation” Identify to engage and deliver Involve communities: Awareness Support

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WAY FORWARD…

“We want to develop a policy that will concentrate on community support in health promotion, mental health support and family home care training.” Dr. Vita A. Skilling

The Republic of Fiji

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Annex 4 - Presentations

Ageing Trends in Fiji _____________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________ ______________________ ___ ___________________

Figure 1: Projected population 60 years of age and over in Fiji 2000-2050 190,000 170,000 150,000 130,000

• Ageing is occurring rapidly in Fiji; • The rate of growth of the 60+ population will likely remain above 3% per year for the next 20 years; • The “oldest old” is the fastest growing age group in Fiji (4.9% per year); • Over the next 5 years, 15,000 people in Fiji will be added to the old population (3,000/year). • Annual increase will peak in 2025 at 3,200 and will still be around 3,000 in 2050;

Num ber

110,000 90,000 70,000 50,000 30,000 10,000 20 00 20 15 20 20 20 35 20 50 20 05 20 10 20 25 20 30 20 40 20 45

Year

Figure 2: Projected population 60 and over in Fiji 2000-2050 by sex 100,000 90,000 80,000 70,000 Number 60,000 50,000 40,000 30,000 20,000 10,000 Male Female

Figure 3: Projected increase in the 80 and over population in Fiji 2000-2050 29,000 25,000 Population 80 and over 21,000 17,000 13,000 9,000 5,000

20 00 20 05

20 15 20 20

20 10

20 25 20 30

20 35 20 40

20 45 20 50

1,000 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 Year

Year

What is in place to address the issue?? • Fiji’s Social Justice Legislation of 2001; • Fiji’s National Policy on Ageing [2011-2015]; • Fiji’s National Council of Older Persons [2012];

National Ageing Policy Goal 4: Healthy Living ________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________ ____________

Objectives (1) Improve the overall health of older persons; Strategies • i. Integrate provisions for older persons in all health sector planning and programming; • ii. Strengthen primary health-care services to meet the needs of older persons;

Annex 4 - Presentations

National Ageing Policy Goal 4: Healthy Living (2)

Key Challenge _____________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ _____________ ___ __________

Improve understanding of the health status and needs of the older persons Strategies: i. Develop awareness raising programmes on nutrition for older persons; ii. Review training programmes for health professionals (including those working in psychiatric services) on the care and support of older persons.

• Baseline data to ascertain the realities of ageing in context; • • Mainstreaming ageing into the different sectors; Commitment to implementation via the existing mechanisms (urban and rural settings); Resourcing/ Outsourcing funding required; Harmonizing implementation frameworks.

• •

Good practice: _________________________________________________________________________________________________________________________________

Future Priorities: ________________________________________________________________________________________________________________

1. Legislating the establishment of the National Council of Older Persons. Fiji on 4th July, 2013, officially established its National Council of Older Persons as per the National Council of Older Persons Decree (2012)

• Collaboratively implement the key recommendations of the National Policy on Ageing in relation to Health; • Strengthen partnerships for resource sharing; • Using existing mechanisms refine sustainably inclined approaches of implementation.

THANK YOU Ageing and Health Policies in Japan SAKOI Masami, M.D., M.P.H. Director, Ageing and Health Division Health and Welfare Bureau for the Elderly Ministry of Health, Labour and Welfare Japan

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1.Policy context for action on ageing and health in Japan Rate of 65+ in total pop.

Long-Term Care Insurance System in Japan Insurers (Municipalities) Nation Prefecture Municipality

Policies and Schemes 1961: Universal Pension System 1961: Universal Health Care 1963: Elderly Welfare Law (start of Special Nursing Home; SNH) 1973: Free Health Care for Elderly 1982: Elderly Health Act 1983: Partial Co-payment for Elderly 1988: Municipalities to make health and welfare plans for Elderly 1989: Gold Plan (National Strategy to secure Elderly services) 1994: New Gold Plan 1995: Aging Society Basic Law 2000: Long Term Care Insurance 2006: Elderly Abuse Prevention Law

1960s Beginning of Elderly Welfare

5.7% (1960) 7.1% (1970)

25 12.5 12.5

premiums 50% 10%

Insured Participants (All citizen over 40) Category 1: over65 Category 2: 40-64

1970s Expansion of Expenditure for Elderly healthcare

1980s Hospitalization and Bedridden elderly Elderly issues recognized as Social Problem

9.1% (1980)

1990s Implementation of Gold Plan

12.0% (1990) 17.3% (2000)

Service Providers

90% Service

Certified

2000s Long Term Care Insurance

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2.Key challenges for action on ageing and health in Japan Further ageing of society 2008 Proportion of people aged ≥ 75 10.4% 2015 13.1% 2025 18.2% 2055 26.5% (Age)

Population Pyramids in Japan 2011 2015 2025

–Increase in dementia patients –Increase in elderly living alone –Rapid aging especially in urban area

Increase in cost of the Long-Term Care Insurance System –\7.8 trillion in 2010 → \21 trillion in 2025 (Estimate, Cabinet Secretariat)

Low salaries for common care workers

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Estimated number of the Elderly with dementia in Japan from the Long-term care insurance statistics* (10,000 600 ） (％: Proportion among elderly population）

Estimation of Future Forms of the Elderly Households (10,000 households)

500 12.8%

Number of households headed by people 65 and older

400 11.3%

300 200 100 0 2010 9.5％

10.2%

280

345

410

470 68.6% 63.3%

2015

2020

2025

*Independence degree of daily living for the elderly with dementia degree II and over

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Annex 4 - Presentations

3. Good practice examples in Japan -Local prevention programmesVarious prevention programmes are provided by municipalities using insurance premium

Good practice examples in Japan -Embodiment of the local inclusion care system in Kashiwa CityKashiwa city realizes home medical care and definite aim working and aim at the concrete construction of the local inclusion care system in Toyoshikidai housing complex in season at the beginning of 2014. → A model to embody the policy of the most recent country

Image of the future Toyoshikidai area

The system which medical care, nursing, a care service receive at home is set and residents are at home and can live a life in peace forever *Child care support center *Community medicine base Area base zone Way of the four seasons（Way for exclusive use of the bicycle walker） *Community dining room *Mini-vegetable plant

*House for elderly people with the service *Home medical care, nursing, care service for for 24 hours

park 公園

Commerce, life convenience institution zone

67

There is a place of a variety of activity in an area and can play an active part well forever

68

4. Future priorities and opportunities for regional collaboration - Dementia Policies Medical Care System and Training Programmes for Dementia in Japan Medical Center for Dementia (185) Community General Support Centers [Core Centers] Specialized Medicine Info Center

Direction of Dementia Policy in Japan

○ ○

Changeing the Tide Throwing up the resignation that “Suffering dementia will inevitably end up in hospitalization or institutionalization”, we strive to realize a society where “One’s own will shall be respected, and one can live in pleasant and familiar surroundings as long as possible and practicable, even after they suffer dementia.” For this purpose, by introducing following seven measures based on the new perspective, we aim to develop a standard dementia care pathway which will change, - rather turn -, the conventional tide. 1. Development of Standard Dementia Care Pathway 3. Improved Health Care Services to support Living in Community 4. Improved LTC Services to support Living in Community Care Services Early Intervention Daily Care Acute Exacerbation Medical Services Routine Medical Care

Care Services

Specialized Medicine

Community Liaison

[Regional Centers]

2. Earlier Diagnosis & Intervention

Seminar Programme to Train Dementia Support Doctors (2,000)

Dementia Support Doctors Seminar Programme to Upskill Dementia Practice (30,000)

Noticing Diagnosis Routine Medical Care

Primary Care Practitioners Meeting on Ageing and Health in the Western Pacific Region

5. Better Support for Daily Living and Family Caregivers 6. Reinforcement of Measures for Younger Onset Dementia

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7. Acceleration of Human Resources Development 70 | Manila, 9-11 July 2013

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The Lao People’s Democratic Republic Lao PDR is a landlocked country, covers an area of 236,800 square kilometres, Bordered by China, Viet Nam, Cambodia, Thailand and Myanmar. Most of the area is covered with plateau and forests and approximately 70% of the population are involved in subsistence agriculture. Presented by Dr Bounkong SYHAVONG Vice Minister of Health 71 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Ageing and Health in the Laos PDR

The Lao population is approximately 6.5 million with an estimated 5.26 % of the population who are ageing.

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Annex 4 - Presentations

Policy context for action on ageing and health -Social Welfare Strategy 2011-2020 -National Policy towards the Elderly in the Lao PDR(2004) -Decree (No 156/PM) on the Approval and Declaration of Application of the Nation Policy towards the Elderly in the Lao PDR -National Committee of the Elderly with The Deputy Prime Minister as President - Association of older people set up 2011 73 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Key challenges for action on ageing and health -Laos is a developing country with a small population and limited resources -Laos was severely effected by the Indochinese war with many people still being killed and injured by unexploded ordinance(UXO). -Many of the Laos population live in remote areas with limited resources and facilities -Low level of education 74 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Good practice example Home Care Project funded by the Korean government and implemented by the Laos Red Cross. Fifty people supported in seven villages in the Naxaithong District, Vientiane Capital Older people in Development project. Community based solidarity groups aimed at improving the quality of life for older people. Operated by Laos Red Cross, Laos Women's Union and Help Age International in LuangPrabang Province. Involving twenty villages in the Paxeang district. Meeting on Ageing and Health in the Western Pacific Region

Good practice example Handicraft weaving of textiles and Laos skirt Group in Phone Hong District, Vientiane Province using the Village Circulating Fund to implement activities which generate incomes for ageing people and therefore improve their living conditions. Active participation of Elderly Association Members in the “ Vientiane Healthy City program “ 's action encouraging people to do physical exercise, reduce or stop smoking..... Meeting on Ageing and Health in the Western Pacific Region

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Future priorities and opportunities for regional collaboration -Poverty reduction through the implementation of the National Poverty Reduction Program - Millennium Development Goals and other government strategies. -Improved health care facilities and access for the ageing. -Strategic plan for the Ageing population to be developed and implemented. Meeting on Ageing and Health in the Western Pacific Region

< MALAYSIA HEALTH CARE SERVICE FOR ELDERLY Dr. Zaleha Abdul Hamid (Public Health Physician) Senior Principal Assistant Director Family Health Development Division Ministry of Health Malaysia

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Annex 4 - Presentations

Policy context for action on ageing and health National Policy for Older Persons in 1995 and the Action Plan of National Policy for Older Persons 1999 (Ministry of Women, Family and Community Dev.) National Plan of Action for Health Care of Older Persons in 1997 (Min. of Health). National Health Policy For Older Persons in 2008 – Policy Statement • To ensure healthy, active and productive ageing by empowering the older persons, family and community with knowledge, skills, an enabling environment; and the provision of optimal health care services at all levels and by all sectors. – Strategies • 7 strategies 79 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Key challenges for action on ageing and health Human Resource / Man Power – Geriatricians, psychogeriatricians, and others…

Coordination – lack of coordination e.g multiple agencies do training MOH – carers Welfare department – volunteer other NGOs - carers

Law to protect elderly (e.g Child Law)

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Good practice example 1996 –health care service for elderly was introduced and integrated in the Primary Health Care “National Blue Ocean Strategy 7 (NBOS 7): 1Malaysia Family Care” which delivered an outreach activity to provide a holistic services for persons with disabilities, elderly and single mothers. – For the elderly in the institution, the services given were health screening, assessment, consultation, treatment and referral (if needed), and for the bed-ridden elderly at home, the services given were health screening, assessment, consultation, treatment and referral (if needed), home assessment and recommendation for modification (if needed) and training for their care givers. 81 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Future priorities and opportunities for regional collaboration Man Power – Training – for experts – Exchange of experts

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Brief introduction… Total population 2.8 million – 14 under 27.2% – 15-64 68.8% – 65 and over 4%

AGEING AND HEALTH IN MONGOLIA M.KHISHGEE MINISTRY OF HEALTH, MONGOLIA

Life Expectancy is 68.7 – Male 64.9 – Female 74.2

Elderly people – Men 60 and over – Women 55 and over

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Annex 4 - Presentations

Policy context for action on ageing and health Law on Social welfare for the elderly, newly revised on Jan 19, 2012 Law on Citizen’s health insurance, Apr.25, 2002 Law on Health, newly revised on May 05, 2011 National strategy for population ageing in Mongolia (20092030) National program on Aging and Elderly health (2014-2020) Under processing

National strategy for population ageing in Mongolia (2009-2030)

Strategy to prepare for population ageing – Objective 1. Increase employment – Objective 2. Enhance social security for employed population – Objective 3. Promote decent births of women with aim to maintain the favourable population age structure for longer period of time

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National strategy for population ageing in Mongolia (2009-2030) Strategy to improve livelihood of older people – Objective 1. Strengthen income security for older people by ensuring their participation in development and expanding opportunities for accessing the benefits – Objective 2. Reduce morbidity among older people by improving accessibility and quality of health care, health information and promotion for healthy ageing – Objective 3. Foster a positive image of and attitude to older persons among people and create an age-friendly environment for older people to enjoy a life of dignity enabling them to live and work in their families, society and community while mutually helping each other 87 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Key challenges for action on ageing and health • The prevalence of disease among elderly and their mental and social health status, 2011 • 0.6 % are healthy • 8 out 10 are ill (1 elderly has 3-4 diseases) • Geriatrician 11, geriatric nurse 20 in nationwide № 1 2 3 4 5 Disease Cardiovascular system disease Urogenital system disease Musculoskeletal and connective tissue disease Eye and its adnexa disease Mental and behavioural disease % 81.2 60.5 55.8 55.2 39.3

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Nutritional status among older persons Health needs Admission to hospital

Health needs In quantity Percentage share in health needs Percentage share in total needs

299 80 51 76 384 251 394 150 441 17

14 3.7 2.4 3.5 17.9 11.7 18.4 7.0 20.6 0.8 100

24.8 6.6 4.2 6.3 31.8 20.8 32.6 12.4 36.5 1.4 36.8 (1207)

Long term care at state institutions Be at state nursing home Have palliative care To be served at state sanatorium Access to homecare Have rehabilitation treatment To be at day care center Spend time at the resort To see a doctor Total 89 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

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Annex 4 - Presentations

Other need, which is required for the elders Other needs Have a family Have place for spending free time Visit the elderly club Make a friend Go for tourism To be employed Have a caregiver Total 91 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Fostering age-friendly environments through action across sectors “Age-friendly family health center” since 2007

In quantity 37 426 293 335 163 85 62

Percentage share in other needs 2.6 30.5 20.9 23.9 11.6 6.1 4.4 100 91

Percentage share in total needs 3.1 35.3 24.3 27.8 13.5 7.0 5.1 29.9 (1207)

Multidisciplinary geriatric team since 2009

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Promoting healthy ageing across the life course and preventing functional decline and disease among older people • Develop suitable exercise for the elderly and organize competition among elderly in different age group • Voluntary and interest based clubs are working

Promoting universal health coverage through age-friendly health systems • Government covers the healthcare service expense for the elderly people.

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Strengthening the evidence base on ageing and health Research on determining physical, mental and social health of elderly, 2009-2011 Research on commonly used medication, assistive devices for the elderly and age-friendly environment, 2009 Research on health and social protection for the disabled elderly, 2011 Survey on elderly malnutrition, 2010-2012 Survey on determining caregiver burden of elderly with dementia, 2010-2012 95 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Future priorities and opportunities for regional collaboration • • Reforms in health care financing and health insurance in long term care Capacity building of gerontology and geriatrics • • Built the special geriatric service for the elderly in health system of Mongolia Open the center with multi function addressed to elderly including inpatient and outpatient hospital

• National survey to determine special needs of elderly • Improve prevention and screening for all ages of population

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Annex 4 - Presentations

THANK YOU FOR YOUR KIND ATTENTION!

AGEING AND HEALTH 9th - 11th July 2013

NEW CALEDONIA

Miss Nalina TIROU Mr Philippe RIEUX 97 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

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Policy context for action on ageing and health A modern and efficient social protection A basic coverage for all and a full coverage chronic illness and disability.

NEW CALEDONIA Population : 245 580 > 60 years : 2010 : 28 000 2030 : 61 000

Guaranteed means for our elders Raising the basic retirement pension and the basic welfare above the national poverty line (01/01/2012). Renovation of the health system A specialized geriatrics hospital, twenty five health care centers and building a new territorial general hospital (opening 2015). Supporting ageing and caring for older people

Life expectancy : Men : 74,4 Women : 80,7

Creation of a social security for disabled persons and aged persons (01/07/2009) : - based on a global assessment (medical, psychological and social) - offering a personalized age-friendly response - developing specific health care services for the elderly

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Key challenges for action on ageing and health Cultural, social and medical challenges : The most important challenge is to maintain during life course the elderly in a good environment including community support and social participation. 2nd challenge is to create a specialized health prevention programme for healthy ageing. 3rd challenge is to increase equality and accessibility to social and health care services. Financial and economic challenges : - control impacts of ageing upon health and social security spending. - develop health and social care workforce, education, training programme to improve geriatric culture.

Good practice example A single office created by an association for the elderly in the Southern Province of New-Calédonia A single place for information and coordination toward the elderly and their families : - about all the social security measures - about all the services and old people’s homes. A single place to evaluate family, social, medical, psychological and financial situation and to develop personalized support plan. A single place to collect information and evidence about ageing and to take a census of quantitative and qualitative data.

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Future priorities and opportunities for regional collaboration Questionning directly the elderly to know about their expectations. Finalizing the New Calédonia geriatric plan (20142019). Preventing the effects of ageing by an integrated policy promoting healthy behaviour (food, hygiene, brain and physical activities, social activities). Strengthen health and social financing systems by a specific and appropriate tax system. 103 | Manila, 9-11 July 2013 Meeting on Ageing and Health in the Western Pacific Region

Ageing and Health in the Western Pacific Region—July 9---11--Manila Dr. Sylvia Osarch—Physician— home health Rebecca Koshiba—Social worker REPUBLIC OF PALAU

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Key challenges for action on ageing and health Policy context for action on ageing and health Violence protection law—Apply to all ages There is a law designating May 5th as Senior Citizen’s Day Retirement Law at age 60 Law against human trafficking Law protecting mentally ill people Child protection Law Meeting on Ageing and Health in the Western Pacific Region

Specific law protecting senior citizens from Abuse: – – – – Physical Verbal Neglect Environment

Lack of support programs – Social services – Discount benefits and accessibility –parking, buildings, stores. – Lack of activities, transportation –wheel chair bound

Cultural Beliefs – Do not believe in nursing home, respite and hospice care – Children are expected to take care of their parents. 106 Manila, 9-11 July 2013 | Meeting on Ageing and Health in the Western Pacific Region

105 Manila, 9-11 July 2013 |

Good practice example MCCA – Meals on wheels – Weaving and carving plus exercise, Senior citizen’s day – Monthly stipend– those with no income

Future priorities and opportunities for regional collaboration Develop Social health department Increase political and community awareness Expand hospital for Hospice or Respite care Specific protection law against elderly.

BNH – Home health services/Palliative/IEA

Others – Social security – Pension plan – Medical savings Account, Health care funding—Insurance

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Annex 4 - Presentations

Snap shot of Papua New Guinea Population of 7.1 million (Census 2011) with 40% under the age of 15 and 5% are 60yrs and above

Workshop on Ageing and Health in the Western Pacific Region, 9-12 July 2013

Fertility Rate 4.3%; Growth Rate 2.7% 800 languages &1000 dialects with many ethnic & sub ethnic groups, clans and sub-clans in 22 provinces

Dr Lloyd Ipai/Dr William Lagani Participants Representing PNG

86% of population lives in rural areas; only 3% of roads are paved & many villages can only be reached on foot Most travel between provinces is by air; even within provinces and districts

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Policy context for action on ageing and health papa mama boy

No specific policy for Ageing Population in PNG However National Health Plan 2011-2020 generally covers all including the elderly population – Free health care services for <7yrs and 60yrs+ Currently one of the 7 priorities of the Government for the next 5 yrs is on “Free Primary Health Care services for all and subsidized specialist care” Retirement age has been increased from 55 yrs to 60 yrs of age (compulsory retirement at 65yrs old) Government is currently proposing pension for the Ageing population

girl boy girl

girl

boy

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111

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Key challenges for action on ageing and health To initiate the development of the ageing and health policy as soon as possible – Cultural values for the care of the elderly is rapidly changing

Good Practice Examples Relatives and Family members taking care of the elderly both at home and in the health facilities (when sick) This is a cultural norm in PNG and must be maintained at all cost

Lobby for political support and also support from other stakeholders and government agencies (such as Department for Community Development)

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Annex 4 - Presentations

Future Priorities and Opportunity for Regional Collaboration Develop the Policy on Ageing and Health and include – the Free Primary Health Care and subsidized specialist care services for the elderly – Pension – Cultural norms and values must be protected and promoted

Thankyou

Conduct evidence-based research as per Regional Research agenda To learn lessons from other developed countries like Japan, Australia, China, as well as from other developing nations 115 Manila, 9-11 July 2013 | Meeting on Ageing and Health in the Western Pacific Region

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Philippines • Older persons/elderly (Senior Citizens)- 60 years old & above • The population of 60 years or older was 3.7 million in 1995 (5.4% of total population).

PHILIPPINES

• Population increased to about 4.8 million or almost 6% in 2000. (NSCB). • At present there are 7M senior citizens (6.9% of the total population), 1.3M of which are indigents.

Department of Social Welfare & Development Institute on Ageing-National Institute for Health Department of Health

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Policy context for action on ageing and health • RA 9994: Expanded Senior Citizens Act of 2010: An Act Granting Additional Benefits and Privileges to Senior Citizens • RA 7432: An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges • Phil. Plan of Action for Senior Citizens 2012-2016 provides guidance on advancing health and well-being into old age • DOH Administrative Orders: 1. AO No. 2012-0007: Guidelines on the Grant of 20% Discount to Senior Citizens on Health Related Goods and services and for Other Purposes 2. AO No. 2010-0032: Guidelines and Mechanisms to Implement the Provisions of RA No. 9994 3. AO No. 2011-0018: Guidelines on Influenza and Pneumococcal Immunization

Key challenges for action on ageing and health • Strengthening implementation and monitoring of Republic Act 9994 (ESCA 2010), especially on the 20% discount on health and social services • Expansion of coverage of immunization, to cover more senior citizens • Health benefit packages for the elderly and increase insurance coverage of non-indigent elderly (no previous employment – no SSS, no GSIS) • General lack of capacity among health workers (at all levels) on promoting and managing health of the elderly • Inadequate number and maldistribution of geriatric specialists (geriatricians) and gerontologists (160 geriatricians, 60% based in Metro Manila) • Weak home- and community-based care of the elderly • Expansion of the coverage of the pension for the elderly

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Meeting on Ageing and Health in the Western Pacific Region

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Annex 4 - Presentations

Key challenges for action on ageing and health • Establishment of geriatric wards or units in all government and private hospitals • Institutionalizing Gerontology and Geriatrics in medical and allied curricula • Implementation and monitoring of the PPASC 2012-2016

Good practice example • At the national level, the National Coordinating and Monitoring Board (5 national agencies & 5 NGOs) has been created for policy development, address operational issues and monitor the implementation of RA 9994 provisions. • Presence of local management structure: Office of Senior Citizens Affairs (OSCA) which coordinates activities of senior citizens and monitors and facilitates implementation of RA 9994 in place in all local government units, as mandated by law (ID card & Purchase Slip Booklet) • Involvement/Participation of senior citizens, geriatricians, and other stakeholders in policy and programme development, e.g development of DOH administrative guidelines and national laws (Federation of Senior Citizens Association of the Philippines, Coalition of Services of the Elderly)

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Future priorities and opportunities for regional collaboration • Annual celebration of Elderly Filipino Week and various activities such as fitness camp for the elderly in selected areas • Provision of influenza and pneumococcal vaccines to poor senior citizens • Recognition and awards program for age-friendly cities • Participation in Regional meetings and sharing of experiences with other countries on promoting health of the elderly including development of a regional journal on care of the older people • Ageing, NCDs included in the MDGs • reporting, monitoring

• Technical collaboration on ASEAN projects on home care/ community-based support programs and researches on social pension and active ageing • Gerontology/geriatric courses/programs for health human resource development • Standardization in the definition of terms Meeting on Ageing and Health in the Western Pacific Region Meeting on Ageing and Health in the Western Pacific Region

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Maraming Salamat! Policy for Healthy aging In Korea 2013. 7.

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Annex 4 - Presentations

Contents I

Policy environment for Healthy Aging

Ⅱ

Current major Policy for Healthy Aging Policy direction for Healthy Aging

I

Policy environment for Healthy Aging

Ⅲ

Trend of longevity increases population over 65 In particular, population over 75 grows Portion of Senior Population (%)

Total 4.53 Fertility Rate (N) # of newborns101 (in 10K)

3.43 2.83 1.66 1.57 1.63 1.47 1.30 1.17 1.18 1.15 1.25 1.24 1.191.15 1.23

Senior Population (10K) 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0

1.12 1.08

65∼74 yrs Over 75 yrs

86 66 65 72 63 55 49 49 47 44 45 49 47 44 44 47 '70 '75 '80 '85 '90 '95 '00 '01 '02 '03 '04 '05 '06 '07 '08 ’09 ‘10 ’11

Population over 65 (Aging rate) Population over 75

1,504 32.5% 28.4% 24.3% 35.5%

1,616 38.2%

40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0

1,181 19.9%

770 481 9.9% 11.0% 12.9% 15.6%

1983) 1983) 2.1 → ’05 ’05) 05) 1.08 → ’11 ’11) 11) 1.24 ’12) 12) 11.8% 11.8% → ’30 ’30) 30) 24.3% 24.3% → ’60 ’60) 60) 40.1% 40.1%

’05

’10

’15

’20

’25

’30

’35

’40

’45

’50

□ Seniors frequent diseases

□ Elderly cause of death and mortality (ten thousand)

Ranking

Disease

Person

Rate/10years

(

1 2 3 4 5 6 7 8 9 10

Hypertension Dorsalgia(back pain) Acute bronchitis Periodontal disease Gonarthrocace Gastritis, Duodenitis DM(diabetes) Acute nasopharyngitis(Common cold) Endodontium, Periapical disease Senile cataract

<2011년 <2011년 진료비 통계 지표, 지표, 건강보험심사평가원> 건강보험심사평가원>

215 124 123 122 113 97 76 70 66 64

4.8 5.6 8.1 4.6 5.3 3.7 9.2 -2.3 2.4 4.6

1 2000

위

2

위

3

위

4

위

단위 인구 만명당 명 : 10

)

5

위

Cancer (929.7) Cancer (865.4) Cancer (882.4) Cancer (847.8) Cancer (1,275.9) Cancer (553.6)

Cerebrovascular disease

2009

2010

2011

male

(785.3) Cerebrovascular disease (410.7) Cerebrovascular disease (409.4) Cerebrovascula r disease (381.1) Cerebrovascular disease (411.4) Cardiopathy (361.7)

Cardiopathy (358.9) Cardiopathy (332.6) Cardiopathy (344.0) Cardiopathy (361.2) Cardiopathy (360.3) Cerebrovascular disease (360.2)

Diabetes (218.4) Diabetes (146.6) Diabetes (153.1) Diabetes (155.4) COPD (180.7) Diabetes (141.6)

COPD (209.1) COPD (124.4) Pneumonia (127.6) Pneumonia (143.2) Diabetes (175.3) Pneumonia (125.8)

female

<2012년 고령자 통계, 통계청>

Annex 4 - Presentations

Medical care fee of older persons health promotio n service

Ⅱ

Current major Policy for Healthy Aging

visiting health services

public health centers

physical activities including exercise & nutrition guidance

Chronic disease manageme nt services

health examination services

Source: National Health Insurance Corporation, 2012.

‘health examination program at the time of lifetime turnover’: From 2007, age 66 years the early examination program for the dementia detection delivered to persons aged 60 and over with government budgets.

Medical care fee of older persons • Health and exercise service(건보공단등) • Visit the health care service(보건소)

<Senior health promotion>

43.6283 <Early health screening> • • •

46.2379

<Treatment support> • support dementia care expenses • Eyesight recovery surgery support

39.4296

Early detection of dementia service Life-cycle-specific health screenings Eye examination

•

Geriatric ensure enhanced (Denture)

12.4236 (31.6%)

14.1350 (32.4%)

15.3768 (33.3%)

< Care >

• Long-term care Insurance • Care hospital

2009

2010

2011

Source: National Health Insurance Corporation, 2012.

Who can apply? □ Early detection program in public health centers - Target : 60+ elderly - MMSE-DS test

65+ aged or under 65 aged with geriatric disease Approved as 1st ~ 3rd class based upon 2-stage assessment results * (1st stage) assessment in home * (2nd stage) rating in LTC needs certification committee

Who can use?

- For those fourd to be high-risk group, costs for dementia diagnosis test are supported

□ Cognitive disorder test as part of National Health Examination - Target : All who turn 66, 70, 74years of age - (The primary questionnaire) 5 questions → (Secondary) 15 questions

1st Class

2nd Class

3rd Class

Staying in bed all day long

Staying in Wheelchair all day long

Staying in home and hard to go out without help

Annex 4 - Presentations

□ Target - more than 65years Basic livelihood security and some of the near poor □ Contents : Public health centers refer target patients to clinics or hospitals for denture services - Follow-up service : 1years

□ Target : 66+ Participants of National Health Insurance & Medical Aid beneficiaries □ Contents - Primary screening items : Examination and Consultation, Elderly function test, etc.(total: 26 items) - Secondary screening items : Hypertension·Diabetes test, Mental health check( Dementia, Melancholia), Lifestyle checks(Smoking, Physical activity, Nutrition, Drinking) - Cancer screening : Gastric cancer, breast cancer, Colorectal cancer, Liver cancer, Uterine cervical cancer

□ Implementer : City·Country·State Public health center(Dental clinic, National or Public hospital dental department)

□ Healthy for 100years Exercise classes - Implementer : National health Insurance service - Exercise guidance : Three times a week, 6 months Yoga, Tai chi and so on - Lecturer : Sports for all related lisence holders - Place

Ⅲ

Policy direction for Healthy Aging

▶ (Facility) senior center, Village hall ▶ (Outside) Park, Vacant lot : 135 ▶ Self-help groups : 60

: 3,487

* 2012 : Lecture(230,000 times), 80,000people

Japan Life expectancy Healthy life expectancy Remaining life expectancy

Uk 80 72 8

Switzerlan d 82 75 7

America Korea 79 70 9 80 71 9

2020 Korea 82(Prediction) 76(Goal) 6

THANK YOU !

83 76 7

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Policy context for action on ageing and health Sector Wide Community Based Outreach Program: Fanau & Aiga Ma Nuu Manuia-Healthy Village & family Wellbeing Program Senior Citizens Pension Scheme National NCD Prevention & Control Policy 2010 - 2015

AGEING IN SAMOA

Free Hospitalization & Medications, public transport Intermediate Care Policy-assures continuous care at home (family focus on caring for the elderly) National Women’s Policy & National Disability Policy

PRESENTED BY SARA FILEMU AND LOUISA APELU

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Key challenges for action on ageing and health

Good practice example

Resources which impacts on coordination, implementation and monitoring efforts

Sector wide approach

Competing priorities children, youth, disability etc

Disaggregated data on older persons by age & gender . 147 Manila, 9-11 July 2013 | Meeting on Ageing and Health in the Western Pacific Region

Training of family members to care for the elderly at home

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Future priorities and opportunities for regional collaboration Integrate elderly care needs/objectives into NCD strategies of Pacific Health Architecture FA’AFETAI In terms of nursing HRH needs for elderly care ensure integrating as a key strategic focus for South Pacific Chief Nurse & Midwives Alliance plans Linking up with other regional platforms on CEDAW, CRC, MDGs, THANK YOU

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AGEING IN THE KINGDOM OF TONGA

• Currently there is no special law/ policy/ health service for ageing.

TONGA Dr Malakai ‘Ake

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AGEING IN THE KINGDOM OF TONGA

AGEING IN THE KINGDOM OF TONGA

• This is because Tonga assumes since ancient times - care for ageing is a normal routine. Responsibilities of immediate/ extended families and this includes financial/ moral support as well as Palliative Care as there are no hospices, old peoples homes, etc.

• Hopefully once this regional framework is endorsed by RCM, planning for laws/ policy/ services for ageing will commence.

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AGEING IN THE KINGDOM OF TONGA

AGEING IN THE KINGDOM OF TONGA

• However a milestone for ageing happened this year when the Government stated a monthly pension/ allowance.

• Health services in Tonga are free at the point of delivery for all including for older people.

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Percent of the population aged 60+ 1989-2012

POPULATION AGEING AND HEALTH ISSUES IN VIET NAM

Phuong Thi Thu Huong General Office for Population and Family Planning Ministry of Health Source: General Statistics Office, Results of the Population Change and Family Planning Survey 2012.

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Ageing index, 1989-2012

Policy context for action on ageing and health Issues of older persons are addressed in legal documents: Constitution, Criminal Law, Law on the Elderly, Law on Marriage and Family, Labour Law... Law on Protection and Care of the Elderly, Population and Reproductive Health Strategy (2011-2020) Government’s decrees, decisions on care, support for the elderly National Program on Action on the Elderly, 2012-2020

Source: General Statistics Office, Results of the Population Change and Family Planning Survey 2012. 159 Manila, 9-11 July 2013 | Meeting on Ageing and Health in the Western Pacific Region

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Key challenges for action on ageing and health Ageing: Rapid growth among the oldest population Two-third of the elderly live in rural areas Older women make a larger proportion More widows at older ages Lack of a social security system appropriate for older persons Meeting on Ageing and Health in the Western Pacific Region

Key challenges for action on ageing and health Health: Burden of dual diseases Higher risk of disability, special care services Older women are facing with more health risks Response of the health system to older persons’ increasing needs

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Good practice example Mutual-help inter-generation club Started in 2010, in 10 provinces, community-based 600 clubs, 30.000 members (70% are poor elderly) Activities: income generation, health care, protecting older persons’ rights, home-based care, capacity building… Impact: improving life and health of older persons, greater community participation, awareness on older persons’ roles, attitudes and respect towards the elderly… Meeting on Ageing and Health in the Western Pacific Region

Future priorities and opportunities for regional collaboration

Sharing research, data on ageing Exchanging experiences in health care for older persons Training of care giving Greater participation of private sector

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Thank you for your attention! 1. Foster age-friendly environments through action across sectors

PILLARS OF ACTION ON AGEING AND HEALTH

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Objective To foster age-friendly environments through action, engagement and collaboration across sectors and stakeholders, including local communities, families and older people themselves.

Background Role of determinants in health e.g. transport Leadership role of the health sector for collaboration and action across sectors Age-friendly cities and communities Participation and empowerment of older people

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Suggested actions Advocate for age-friendly policies and initiatives within health promotion programmes. Advocate for intersectional action by identifying and supporting options for whole-of-government and whole-of-society initiatives across sectors. Strengthen existing multi-sectoral mechanisms to address and integrate ageing and health issues as a core objective of their work. Build new and extend existing networks or partnerships. Strengthen public awareness. Advocate for and provide inputs to the development of monitoring and evaluation tools and guidelines for age-friendly environments. Strengthen analysis and dissemination of good practices with respect to action across sectors to promote age-friendly environments. Dr John Beard Director, Department of Ageing and Life Course, WHO HQ

WPRO Meeting on Ageing and Health

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Why Act? Economics Human Rights Creating a Fair and Equitable Society – "Society for All Ages"

Years of Life Lost Age 60 and Over

171 |

172 |

Key Points Diversity Shared burden Needs integrated response Society and culture is changing

Earning Enough

173 |

174 |

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WHO Global Network of Age-friendly Cities

Ageing Preparedness Index health 9 sustainability 8 7 6 capacity to change 5 4 3 2 1 pensions 0 physical environment Series1 social environment education

Health care

participation

LTC burden on family

security

175 |

176 |

WHO Global Network of Age-friendly Cities and Communities

Comments to Pillar 1

9 – 11 September 2013 Québec City, Canada afc2013.ca 177 |

Eduardo Klien Regional Director HelpAge International East Asia/Pacific

How to go from intentions to practice ? Associations of older people: an approach to cost effective age friendly environments How to go from general agreement to action? •Is it awareness of the magnitude of change? •Is it understanding of the risks of inaction? •Is it evidence (pilot projects, research, analysis)? •Is it a “correct” advocacy strategy? •“No quick fixes” but there is a short “window of opportunity”

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What are OPAs? • Community based organisations, mainly in poor contexts • Multifunctional • About 50-60 members • Adapted to specific contexts • They can become sustainable (durable) organisations Why Multifunctional? Meet the real needs for people Adapt to local context Inclusive Create synergies between activities

Under the health Component: Self-care (healthy living)

Under the health Component: Homecare (community based volunteer)

Nutrition (Awareness)

Physical Exercise

Volunteer based Homecare (10-20 minutes daily/weekly)

Family Care (Monthly awareness)

(At least 2 visits per week)

Under the health Component: Health care: Checkups, health insurance and access

Scalability of the ISHC model

Rapid replication of the ISHC in Vietnam 700 600

Number of ISHCs

500 400 300

Since 2006, more than 600 ISHCs have been replicated in urban, rural and remote mountainous communities to date . 201

600

423

467

245

200

167 Health checkup Health Insurance and access (On going)

100

60 0 2006 2007 2008 2009 2010 2011 2012

(Every 6 months)

2006 2007 2008

2009

2010 2011 2012

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Who is mentioning OPAs? • • • • • • • • MIPAA review after 10 years ASEAN National Policies on Ageing WHO ICPD UNFPA UNDESA WB

Back to the question: How to go from acceptance to action? Political will grows from: • Awareness of need and potential • Understanding of viability (cost effectiveness) • Political interest • Knowledge of how to do it • Multisectoral commitment • Multistakeholder involvement

PILLARS OF ACTION ON AGEING AND HEALTH

Thank you 2. Promote healthy ageing across the life course and prevent functional decline and disease among older people

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Objective To reduce exposure to risk factors and promote healthy behaviours across all stages of life so as to empower people to maintain their health as they grow older and to prevent functional decline and ill-health among older people by responding their specific health needs.

Background Reduce exposure to risk factors and promote healthy behaviours across the life course Empower people to maintain their health as they grow older Prevent functional decline and ill-health among older people

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Suggested actions • Mainstream healthy ageing across the life course in health promotion and disease prevention efforts. • Increase the coverage of and access to targeted priority interventions for health promotion and disease prevention for older people, tailored to their specific health needs. • Place priority on addressing functional decline and frailty among older people. • Improve health literacy among older people, promote their knowledge about the options for health promotion and disease prevention activities in their communities. • Pay attention to the specific needs of population groups with higher exposure to NCD risk factors. • Advocate for research on life-course stages that are most critical to older people and develop monitoring and evaluation tools for healthy ageing and disease prevention among older people. 193 Manila, 9-11 July 2013 | Meeting on Ageing and Health in the Western Pacific Region

Disease or well-being? Do we just want to prevent disease or expand health as a resource for living? Dr Susan Mercado Director, Division for Healthy Communities and Populations WHO Regional Office for the Western Pacific

Risk reduction • Promotion of healthy lifestyle in younger years is critical for the prevention of cardiovascular disease, diabetes, chronic respiratory disease and cancer. • But are there other risks in this age group? (Beyond tobacco, alcohol, diet and physical activity) • What are the lifestyle (vs. behavioural) risks of this age group?

• Mental health – dementia ( 35.6 million globally), depression and suicide (higher in older persons)

• Injuries and falls – 28-35% in people aged 65 <; increases to 32-42% in people aged 70< - 4-5% of older persons face some form of abuse, the greater the disability or dependence the higher the risk • Disability – blindness, deafness

• Dental health – loss of ability to chew • Sexual health • Diminished mobility

New lifestyle challenges that may determine the advent / outcome of disease • Living alone vs. living with the family • Expanding one’s social network vs. staying within a comfort zone • Learning new things vs. doing what one has been doing before

Possible parameters for measuring the impact of interventions • “Connectedness” • Learning institutions and workplaces that open their doors to older persons • Educational programmes for early detection and referral of disease at the community level • Self-reported health and well-being

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Objective To strengthen age-friendly health systems which provide acceptable and accessible health services of sufficient quality to be effective across the care continuum

PILLARS OF ACTION ON AGEING AND HEALTH

3. Promote universal health coverage through age-friendly health systems

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Health system building blocks

Leadership & governance: Background Health law, policy and practice to take into account population ageing Laws, policies and practice on ageing to take into account health issues Whole-government and whole-of society approaches to ageing and health – Leadership from Ministry of Health

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Leadership & governance: Suggested actions Take into account the needs of older people in the design, implementation and evaluation of health sector plans, with a special focus on encouraging gender-responsive, equity-enhancing and humanrights based action on ageing and health Advocate for the inclusion of health issues and needs of older people into national laws, policies and actions on ageing as well as into national development plans. Exploit synergies between ageing and health and other priority agendas receiving high-level attention. Raise awareness for health and ageing issues, framing older people as resources to society and ensuring their participation in health-related decision- and policymaking at all levels.

Health workforce: Background Increasing demand for health workers Changes to skills and competences Need for age-friendly generalists as well as specialists – professional education

Role of informal carers – Support required? – Role of families and communities – Role of older people

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Health workforce: Suggested actions Ensure that health workforce planning and development take account of the numbers of and skills for health workers needed. Ensure that health workers have improved basic understanding and skills to provide age-friendly care. Ensure recognition and improve working conditions and staff retention for those providing services to older people. Explore ways of providing support for home-based, community and informal caregivers. Build expertise in specialties of particular relevance Organize multi-disciplinary and comprehensive networks of health professionals and care facilities. Build capacity among older people in self-care, expanding on innovative models of informal and community care, disseminate good practice and foster the creation of networks in this area.

Health financing: Background Links between population ageing and health care costs – Acute events and end-of-life care – Chronic care – Social security/ income

Financial protection for chronic health conditions, acute health shocks and determinants e.g. transport and rehabilitation No perfect model but several options – Equity considerations – Political voice of older people

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Health financing: Suggested actions Strengthen health financing systems to support integrated service delivery, paying particular attention to excluded older people. Develop appropriate benefit packages to address the health needs of older people, including especially vulnerable households. Stimulate research, documentation and dissemination of good practices within and across Member States on tackling financial barriers to access to needed health services by older people. Explore options to ensure adequate fiscal space for the financing of health and long-term care. Prioritize the development of long-term care options, including at home and in communities, to avoid inappropriate use of health care facilities and to support the health and participation of older people in society.

Service delivery: Background Reorientation of service delivery systems: – Management and care of (often multiple) chronic conditions – Interfaces and coordination between sectors

Integrated service delivery models to ensure the continuum of care – Ageing to be mainstreamed across service delivery systems

Need for age-friendly primary care as well as agefriendly specialist care Interface between health and long-term care: – Role of families and communities – Transitional care models

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Service delivery: Suggested actions Advocate for service delivery models that are responsive to the health needs and expectations of older people. Evaluate existing services for their age-friendliness, address gaps and reduce agerelated barriers to access. Enhance the quality of service delivery with a view to taking into account the specific health needs of older people. Strengthen age-friendly primary health care as an appropriate entry point for older people to access the broader continuum of care. Place priority on specific services that support health and functioning of older people. Evaluate and strengthen existing capacity to address and manage co-morbidities including through appropriate care pathways and collaboration mechanisms. Stimulate analysis and learning on innovative models for delivering care, including in self-, home- and community-care. Develop or strengthen mechanisms and networks to ensure coordinated delivery of health and social care for older people with chronic conditions and long-term care needs. Meeting on Ageing and Health in the Western Pacific Region

Medicines & technology : Background Barriers vs. opportunities – Barriers: Out of pocket expenditure, adverse events – Opportunities: older people’s quality of life, empowerment and participation

Challenges with regard to the availability, accessibility, acceptability, and quality of essential medicines and health technologies – Equity considerations

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Medicines & technology: Suggested actions Advocate for equitable and universal access to essential medicines and health technologies, as part of the right to health of older people and to optimally maintain health and active participation in society. Support the monitoring and review of prescribing practices, rational use of medicines with focus on their specific pharmaceutical care needs. Improve the availability, quality and safety of medicines by reducing regulatory barriers to marketing and strengthening good regulatory practices and enforcement. Ensure equitable access by older people to appropriate financial protection mechanisms and increase evidence-informed decisionmaking on inclusion of affordable essential medicines and technologies in benefit packages therein.

Promote universal health coverage through age-friendly health systems Dr Gulin Gedik WHO Regional Office for the Western Pacific

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Medicines & technology: actions (contd.) Monitor global trends in trade and intellectual property rights affecting access to essential medicines and technologies, and incentivise supplier investments including research and development for essential medicines and health and assistive technologies Increase health literacy/awareness of older people, their caregivers and communities to improve demand for the right, essential health and assistive technologies. Increase availability and access to assistive technologies by: – developing appropriate quality standards, regulatory frameworks to ensure quality and safety and guidance on their use to address functional decline with ageing – strengthening incentives for research and development of low-cost and/or cost-effective, robust assistive technologies to support ageing populations in resource-limited settings

Myths about Universal Health Coverage 1. UHC is free services for all. 2. UHC is only about treatment. 2. 3. 3. UHC is everyone covered by health insurance. 4. UHC is only about health financing. 5. UHC is not a concern for priority health programmes or global health initiatives. 6. UHC means immediate free coverage for all possible health . interventions, regardless of the cost. 7. UHC means abandoning the health MDGs.

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214

Universal Health Coverage (UHC) Access to good quality of needed services – Prevention, promotion, treatment, rehabilitation and palliative care

Three Dimensions of UHC

Financial protection – No one faces financial hardship or impoverishment by paying for the needed services.

Equity – Everyone, universality

Health Systems Financing

215

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How to define health workforce?

Health professional education –guiding principles

“The stock of all individuals engaged in the promotion, protection or improvement of health of the populations”

Health Systems Financing

Collecting and using intelligence

Formulating health policy defining vision and direction

Exercising influence partnerships and regulation

Laura Hawken, WHO Regional Office for the Western Pacific

219

220

Vision Intelligence Housing Education Employment Environment Health Social welfare Agriculture Trade Finance Public service

Influence Transport Security Communication Justice Foreign Affairs 221 222

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Vision Intelligence Health Financing Health Workforce Information Medical products and technologies Service Delivery 223

Influence Improved health (level and equity) Responsiveness Social & financial risk protection Improved efficiency 224

Access Coverage

Quality Safety

Leadership Governance

Information

Health workforce

Service Delivery Medical Products Technology

Finance

225

Service Delivery

226

How the community enters and interacts with the health system What types of facilities and services available at each level When facilities or services are open, e.g. 24/7 Who does what - the number and mix of staff at each level, what they can and should do, and how they work together

Payment – OOP or Insurance? Pricing of services Referral system, controls on access to higher level services and incentives to providers and patients to comply Linkages between levels of service, e.g. communication, transport, supervision, specialist visiting, financial linkages, etc. Non-state providers role and how they interact with state services to support reaching national and local health goals 227

228

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230

231

232

233

234

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235

236

WHO Centre for Health Development (Kobe)

Pillar 3: Ageing and Health Systems Technological and Social Innovation July 10, 2013 Meeting on Ageing and Health in the Western Pacific Region Manila, Philippines Alex Ross Director, WKC

237

In the context of universal health coverage • Current increased attention on universal coverage has created some kind of momentum and platform for developing national health financing systems • Services = promotion, prevention, treatment, rehabilitative, palliation • Who? Everyone! • Financing models Innovation 239

Access to primary health care, long term care and palliative care Primary Healthcare System

Social and technological innovation

Long term care Palliative care

Ageing in Place

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Promote health across the life course Early Life Growth and development

Adult Life Maintaining highest possible level of function

Older Age Maintaining independence and preventing disability

Disability threshold

Rehabilitation and ensuring the quality of life

Age

Many types of innovation • • • • • • • • Technological innovation Medical innovation Social innovation Disruptive innovation Frugal innovation Reverse innovation Strategic innovation Innovative financing

Health Systems, Ageing, Innovation: goals • Healthy, productive, active ageing – Quality of life

• Keeping people in their homes • Reduced health and social costs – Compressing morbidity – Prevention (and life course)

• More harmonious society – Social inclusion – Reduced loneliness

• Improved environment • Affordable, durable, acceptable medical devices and assistive devices • Integrated approach to rollout of new approaches and technologies

Innovation, Health Systems-Sector, & Ageing • Innovation – New products, approaches – Adaptations: across disciplines, specific to LMIC environment

Innovation, Health Systems-Sector, & Ageing • Technological and Social Innovations – Health technologies: • Medical devices • Assistive devices

– Information, communication technologies • Including mHealth, telemedicine, health informatics

– Pharmacology – Social and built environment: intersectoral, urban planning – Community and integrative models of care, service delivery

• Health systems – Metrics: Urban HEART, AFC core indicators

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Some priority needs • • • • • • • • • Vision Hearing Mobility Maintaining cognitive functioning Social inclusion Managing co-morbidities, functional decline risk Reducing hospitalization/institutionalization Supporting caregivers Built environment

Heath technologies for ageing population Ideally should be •

Principles • • • • • • • • • Simple Literate Sustainable Adaptable Replicable Scalable Equitable Responsive Increase compliance Respond to the needs of people (observed and surveyed) (acceptability) Priorities epidemiologically guided Health and governance system variations Durability and meeting environmental conditions Health technology assessment/resource allocation Focus on monitoring and evaluation to track effectiveness and efficacy

• Safe • Effective – Quality

• • • • •

• • • • •

Affordable Available Appropriate Accessible Acceptable

Availability – who has them? • More than a billion people, or 15% of the population experience disability, of which 110-190 million adults experience very significant disability • Unmet need for Assistive Devices is considerable in low, middle, and high-income countries • In many low-income and middle-income countries, only 5%-15% of people who need them have them. For example; – 360 million people globally with disabling hearing loss (5.3% of the world’s population). – An estimated one-third of those over 65 years of age are affected by disabling hearing loss. – About 20% of people with hearing loss require hearing aids. – Current hearing aid production meets around only 10% of the global need and only 3% of the need in developing countries.

Barriers – Leadership and governance – low priority, lack of policies • Older populations may not be a priority in health systems

– Financing and affordability • No financial schemes for purchasing the devices needed • Family out of pocket payment and some insurance to pay for treatment and products.

– – – – • • • •

Service delivery Human resources Production Awareness, cultural and social barriers

Push-pull for device industry : interest? Lack of industry-academia/innovator-government-civil society dialogue Most are devices for chronic diseases High demand for innovative affordable devices for home health care and rural populations

Health system implications/requirements - I • National policy: – National plans, strategies: health, other sectors – Ageing policies – Innovation hubs, research

•

Integration: – – – – – – Social + technological innovation Community-based health systems, social welfare… Technical expertise, Community & health system backup requirements NCDs, life course programmes Disabled population programmes Key other sectors: e.g. social services, telecom, education, etc

High Tech Low Tech • • •

Service delivery – Local networks: PHC, hospitals, NGOs, Universities… – Local context + social/cultural values

Measurement: equity, use Needs assessment – – – – Community-driven Literacy Product usability Sigma, related issues

•

Evidence – Preferred product profiles (minimum standards)

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Health system implications/requirements - II • • • Clinical trials facilitation Regulatory – Capacity, standards – Data Base & Registry of End-Users and Service Providers

What is needed to promote availability of appropriate interventions ?

Financing – – – – Health technology assessment Market forecasting and financing mechanisms (linked to UHC) Eligibility, different insurance systems, affordability Taxes/incentives

• • • • •

Human resources – Training

Quality assurance: Safety and efficacy Procurement systems Technology transfer – IP regimens – Local production, South-south

• Innovators need to know what needs and limitations are. • Manufacturers need to know what the market is, and what the regulatory environment is. • Governments (health care providers) to communicate the policies and market. • Users (health care workers) to communicate their needs and limitations. • Users (individuals) need to be empowered to make decisions on their health care

WHO Compendiums – Devices, eHealth

Promoting access to appropriate interventions: technology Prioritise Interventions: Disease burden, efficacy, IP

Technological Innovation • Assistive Technology: – Affordable assistive devices, tools or aids that restore and extend human function

• Housing, Transport, and urban planning innovations Solution exists Price / suitability not an issue Solution exists suitability an issue Solution exists Monopoly Price an issue Solution doesn't exist

– Innovative building designs, development of ‘fall-safe’ floors, etc.

• Development of IT-based communication and decision support technologies – Personal surveillance and alarm systems

Establish Policy

Preferred product profile

Tech Transfer

Create solution

Technological innovations: Meeting needs of developing countries • Biomedical discoveries, technological innovations— are public goods, and the context and needs may vary across developed and developing countries – individual developing country may not have capacity, incentives and resources to investment in these innovations – Establishment of International or regional research or product development partnerships – Facilitate investments for technological innovation affordable and suitable for developing countries context

WHO Centre for Health Development, Kobe

FIRST WHO GLOBAL FORUM ON INNOVATION FOR AGEING POPULATIONS 10–12 December 2013 Kobe, Japan

The Forum is a platform where discussions and interactions across diverse stakeholders with an interest in keeping ageing populations healthy can occur and lead to new innovations

Ensuring that rapidly ageing populations (the majority in developing countries) remain healthy, productive and independent for as long as possible, requires frugal innovations that meet the greatest needs; are safe, effective, affordable, accessible and available, and acceptable to the user. THE OBJECTIVES OF THE FORUM ARE TO: Highlight specific examples of successful innovations Communicate core set of information on ageing populations’ needs to drive future innovations Identify inter-linkages between technological innovations and health/social delivery systems Identify specific actions to encourage innovation for ageing populations Identify priority research needs and actions

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Global Forum on Innovation for Ageing Populations • First of its kind • Convenes government, research community/innovators, industry, health care workers, and civil society • Outcome – Key research and development needs: connecting needs to seeds – Priority actions required to facilitate broader response for and availability of technologies to ensure maximum independence, longevity, productivity, health of ageing – Dialogue across sectors

INNOVATIONS IN MEASUREMENT

URBAN HEART URBAN HEALTH EQUITY ASSESSMENT AND RESPONSE TOOL

URBAN HEART

User-friendly guide to identify and act on health inequities

Assessment: an indicator guide Response: guide to best practices

Target audiences Local/national authorities Academia and communities

Urban HEART (concepts and framework)

Urban HEART User Manual

Urban HEART Core Indicators Health outcomes Physical environment & infrastructure Access to safe water Access to improved sanitation

URBAN HEART COUNTRIES

2008-09 2010-11 2012

Social and human development Completion of primary education Skilled birth attendance Fully immunized children Prevalence of tobacco smoking

Economics

Governance

Infant mortality

Unemployment

Government spending on health

Diabetes

Tuberculosis

Road traffic injuries

Disclaimer: The boundaries and names shown and the designation used on all maps do not imply official endorsement or acceptance by the United Nations

2008-09

2010-11

2012

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URBAN HEART COLLECTION OF CORE INDICATORS Indicator collected Indicator not collected

Core Indicators for Cities/Communities to Monitor their “Age Friendliness” • Based on Urban HEART • Starting point: Age Friendly City domains + new key issue areas (e.g. economic security, more on health) • Core set of indicators – Based on existing indicators and information systems – Limited number – Ability to tailor to local needs

• Piloting review underway • Further consultation: next few months • Monitoring framework NUMBER OF CITIES

The original monitoring framework for Age Friendly Cities

Proposed changes to the monitoring framework • Inclusion of the pilot study domains: governance, health and economic security. • To use the literature to search for a potential foundation on which to base the framework. • To use the literature to create core elements of focus which reflect the cross-cutting themes of the domains.

Updated monitoring framework for Age Friendly Cities DRAFT

J-AGES Japan Gerontological Evaluation Study (J-AGES) Longitudinal study of the elderly population in Japan since 1999 Based on a bio-psycho-social model of health To develop a benchmarking system to evaluate Japanese policies on healthy ageing Financed by Ministry of Health, Labor and Welfare

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Ageing and health in Japan J-AGES HEART J-AGES is a population-based survey for the elderly across Japan Focused on social determinants of health and social environment J-AGES harmonized with Urban HEART to form J-AGES HEART in 2011 In 2010/11 questionnaires: 170,000 older people an d responded by 112,123 individuals across 31 municipalities in 12 prefectures (response rate: 66.3%)

Survey Items • Health status indicators: self-rated health, chronic conditions, health behavior, oral health, nutrition/diet, tobacco, alcohol, ADL/IADL, etc • Psychological indicators: depression, subjective wellbeing, etc • Social indicators: social support, social capital, social participation • Socioeconomic status indicators: income, education, relative deprivation, pension, etc • Environmental indicators: road safety, parks and recreation, accessibility, etc

Source: Nihon Fukushi University

JAGES HEART 2011 Core Indicators Health outcomes: Summary indicators All-cause mortality Cause-specific mortality Rate of response to Basic checklist Number of remaining teeth Parks or roads suitable for walking Proportion of medical checkup recipients (over the past year) Proportion of people with smoking habits Walking time BMI Proportion of people with a high QOL Depression Self rated health Proportion of “Tojikomori” older individuals Proportion of participation in sports meets Proportion of volunteer participation Number of projects for social exchange such as ‘salons’ Average taxable income Budget amount for projects to prevent the need for longterm care (per older individual) Long-term care insurance premium (by income class)

Core indicators 2011 Governance Economics Human & Social development 1. All-cause mortality 2. Proportion of people eligible for long-term care 3. Proportion of new certifications for long-term care requirement 4. Proportion of people with a high QOL 5. Self rated health 6. Cause-specific mortality 7. Rate of response to Basic checklist 8. Number of remaining teeth 9. low BMI 10. Depression 11. Parks or roads suitable for walking 12. Number of falls in a year 13. Proportion of having health checkup (over the past year) 14. Proportion of people with smoking habits 15. Walking time 16. Number of “shut-in” older individuals 17. Proportion of participation in sports clubs 18. Proportion of volunteer participation 19. Number of projects for social exchange such as ‘salons’ (community center programs) 20. Average taxable income 21. Proportion of welfare benefits 22. Budget amount for projects to prevent the need for long-term care (per older individual) 23. Long-term care insurance premium (by income class)

Proportion of eligibility for long-term care Proportion of new certifications for long-term care requirement

Number of falls in a year

Proportion of welfare benefits

FOR ILLUSTRATIVE PURPOSES

90%

Self-rated health: “Very/Somewhat good” Kobe 82.7% 82.1% 81.4% 80.8% 80.2% 80.3% 80.5%

Physical env.

FOR ILLUSTRATIVE PURPOSES

Specific

Summary indicators

Health outcomes: Disease-specific indicators

Physical environment & infrastructure

Social & human development

Economics

Governance

Nagoya 87.2% 100%

Physical environment: Parks and pedestrian paths 72.6% 72.7% 75.3% 77.9% 78.3% 78.4% 79.7% 79.8% 81.2% 81.7%

Kobe 85.1% 85.2%

There are parks and pedestrian paths good for walking and exercising

Proportion reporting "very good" or "somewhat good" health

82.8%

85%

Mean 79.5% 79.7% 79.2% 79.4% 78.8%

83.5%

80%

71.9%

78.2%

78.0%

78.2%

78.2%

78.0%

77.6%

77.9%

77.2%

77.1%

74.0%

75.2%

75.9%

76.1%

76.7%

72.8%

50%

67.6%

70%

40%

65%

30%

20% 60%

Courtesy: Prof. Kondo, Nihon Fukushi University Courtesy: Prof. Kondo, Nihon Fukushi University

38.7%

50.8%

75%

53.3%

60%

63.6%

63.6%

64.1%

70%

65.5%

65.6%

66.6%

80%

66.8%

67.4%

67.9%

68.4%

69.1%

69.3%

71.1%

71.9%

82.5%

90%

Annex 4 - Presentations

FOR ILLUSTRATIVE PURPOSES

Social-physical environment: Places to visit for a casual drop in 56.8% 58.5% 62.3% 55.3% 55.5%

FOR ILLUSTRATIVE PURPOSES

70%

100%

Social capital: Trust in the community 78.9% 88.3% 76.1% 73.3%

There are homes or facilities where I can casually drop in

60%

46.8%

46.4%

46.9%

45.5%

45.2%

42.9%

43.2%

43.4%

42.2%

41.8%

42.0%

40.6%

40.6%

40.7%

39.0%

39.6%

72.4%

72.2%

37.4%

37.7%

36.9%

70%

30%

60%

20%

50%

10%

40% 0%

Courtesy: Prof. Kondo, Nihon Fukushi University

Courtesy: Prof. Kondo, Nihon Fukushi University

Rate of falls from below 15% to over 45% Percentage of people who fell down at least once in the past year (entire older population) 2010 survey

FOR ILLUSTRATIVE PURPOSES

Proportion of people engaging in sports-related activities Hirai, AGES Project (2009，unpublished)

71.9%

67.4%

67.7%

67.9%

68.0%

69.0%

69.3%

40%

35.6%

36.6%

70.9%

71.1%

71.7%

71.9%

72.1%

The percentage of all respondents (total n=15,515) who answered that they participate in sports activities (ground golf, gateball, walking, jogging, fitness, etc.)

• The difference 3.5 times • After adjusting for age: 21.6-67.4% 20.5% Courtesy: Prof. Kondo, Nihon Fukushi University

72.2%

72.5%

73.4%

73.7%

73.8%

74.6%

75.5%

80%

76.1%

77.5%

50%

Kobe

Courtesy: Prof. Kondo, Nihon Fukushi University

％ of Participation in hobby group & Depression JAGES HEART 2011 (GDS-15:>=10) N=31 municipalities (limited to 75+ y.o.) FOR ILLUSTRATIVE PURPOSES http://www.doctor al.co.jp/WebAtlas/ WHK/Double_WH K/atlas.html

FOR ILLUSTRATIVE PURPOSES

Example of Web GIS

Kobe

of Depression

Kobe

Kobe Courtesy: Prof. Kondo, Nihon Fukushi University

％ ％ of Participation in hobby group

Courtesy: Prof. Kondo, Nihon Fukushi University

http://www.doctoral.sakura.ne.jp/WebAtlas/JAGES_HEART/28100_Kobe/Single/atlas.html

78.2%

FOR ILLUSTRATIVE PURPOSES

78.4%

78.6%

78.8%

Kobe

Perception that people in the community can be trusted (%)

90%

48.5%

49.3%

50.0%

51.0%

51.2%

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FOR ILLUSTRATIVE PURPOSES

Changes in rate (%) during four years 14

Experiences of fall during the previous year(%)

12

7 municipalities

10

◆2006 ■2010

8

6

4 0 10 20 30

Courtesy: Prof. Kondo, Nihon Fukushi University

Participation in sports clubs(%)

Finding innovative solutions to public health issues

THANK YOU! http://www.who.int/kobe_centre

First WHO / Habitat Global Report on Cities and health (2010) Key Focus: Inequities

PILLARS OF ACTION ON AGEING AND HEALTH

4. Strengthen the evidence base on ageing and health

Urbanization and Health 288 Manila, 9-11 July 2013 | Meeting on Ageing and Health in the Western Pacific Region

Annex 4 - Presentations

Objective To strengthen evidence-informed policy- and decisionmaking on ageing and health in the Western Pacific Region by stimulating the collection, analysis and use of quantitative and qualitative data that are disaggregated by relevant social stratifiers, such as age, sex and ruralurban residence; as well as needed research. To improve longitudinal monitoring and completeness of patient records and history data across points of service delivery and areas for better quality health care for older people.

Background Reliable information on ageing in relation to health is critical – Disaggregation of data

Standardization of methodology and indicators – e.g. Study on global AGEing and adult health.

Review of policies, laws and actions – and their implementation Knowledge translation

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Meeting on Ageing and Health in the Western Pacific Region

Suggested actions Improve capacity in Member States to collect, monitor and analyse data. Increase efforts to collect quantitative and qualitative data on AAAQ of health and social care and key underlying determinants of health. Improve analysis and evaluation of existing efforts and their implementation. Implement appropriate health data standards to increase the access, sharing, and use of individual-level health and medical records over time, across geographies, and between public and private providers. Stimulate research, documentation and dissemination of good practices. Improve knowledge translation to inform policy-making. Advocate for the empowerment of older people and their support networks, foster their health literacy and ensure their participation. Strengthen partnerships across sectors, and with different actors in the Region to support data collection and identify research priorities. 291 Manila, 9-11 July 2013 | Meeting on Ageing and Health in the Western Pacific Region

Health of older persons in selected countries in the Western Pacific Region Professor Julie Byles Priority Research Centre for Gender, Health and Ageing

The World Health Organisation Collaborating Centre for International Longitudinal Studies on Gender, Ageing and Health.

37 countries and areas: around 235 million people 60+

Western Pacific Region Population Ageing • Countries are ageing at different rates, and are at different stages of population ageing. Fastest growth in the 60+ age group is taking place in low and lower middle income countries. Older people can be a resource for their families and communities •

¼ of world population

Health of older people Non-communicable disease burden has increased. communicable diseases, and unintentional injury burden remains high. Health inequalities among people 60 years or over. Opportunities to improve health and participation in older age.

•

•

•

• Source: http://hiip.wpro.who.int/hiip/portals/0/CountryProfiles/Western_Pacific_Regi on.png

•

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Republic of Korea • Population by age and sex, 2010 (Median age 38 years) • Population by age and sex, 2030 (Median age 47 years)

Population trends in younger and older age groups, 1950- 2100 • Republic of Korea

Population trends in younger and older age groups, 1950- 2100 • Republic of Korea • The Lao People’s Democratic Republic 35 30 25 20 15 10 5 0

Proportion of people aged 60+ and 80+ years 2010 60+ 2030 60+ 2010 80+ 2030 80+

Australia

Rep. Korea

China

Malaysia

Lao

The Philippines

Life Expectancy at birth Viet Nam Philippines, the Lao People’s Democratic Republic, the Malaysia China Korea, the Republic of Australia 0 20 40 60 80 100 Women LE Men LE

Healthy Life Expectancy at birth (selected countries) Viet Nam Philippines, the Lao People’s Democratic Republic, the Malaysia China Korea, the Republic of Australia 0 20 40 60 80 100

Women LE Men LE Women HALE Men HALE

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Workforce Participation Viet Nam Philippines, the Lao People’s Democratic Republic, the Malaysia China Korea, the Republic of Australia 0 10 20 30 40 50 60 Women LE Men LE

Need for help with daily tasks men and women 60+ (moderate, severe or extreme difficulty)

Self-rated health men and women 60+ (moderate/ bad/ very bad)

Age standardised percentage of men 60+ reporting moderate, bad or very bad self-rated health, by education tertile,

Conclusion • • • • Population ageing has important social, economic, political and cultural implications. Risks of chronic illness and disability increases with older age, but older people also represent a population of survivors who make significant contributions to their families and communities. Many opportunities exist to encourage optimal health and participation by older people, and to maximise the potential for future generations to age well. Improvements in older people’s health cannot be achieved in isolation, but require a multisectoral approach to promote health capacity across the lifespan, provide supportive environments and social policies, and to provide adequate and effective health and long term care for those in need.

Strengthening the Evidence Base on Ageing and Health Dr. Manju Rani Senior Technical Officer (Health Research and Policy) July 9, 2013 Meeting on Ageing and Health in Western Pacific Region Manila, Philippines

•

Annex 4 - Presentations

Measurement of Problem

Biomedical & Clinical Research Understanding determinants

Evaluating Solutions Health Systems and Policy analyses

Biomedical

Technological innovation

Multidisciplinary research

Translation and delivery of solutions

Behavioral and Social Sciences

Epidemioological

Development of Solutions

• For better prevention, and management of age-related disease (e.g. dementia) and functions • Development of early functional markers for biological and psychological ageing and surviving without functional decline • Challenges: – Expensive with uncertain success – Ethical issues, cost-benefit analysis

Technological Innovation • Assistive Technology: – Affordable assistive devices, tools or aids that restore and extend human function

Epidemiological Research • Monitoring and understanding the health trends among older people – Understanding the distribution (time, place, person) of age-related morbidity and mortality – Understanding determinants (social, economic and physical environment, individual characteristics and behaviors) for active and healthy life – Identification of critical phases of life and risk factors which in a whole life perspective are significant predictors for early loss of functional ability .

• Housing, Transport, and urban planning innovations – Innovative building designs, development of ‘fall-safe’ floors, etc.

• Development of IT-based communication and decision support technologies – Personal surveillance and alarm systems

Behavioural and Sociological research – To understand social & environmental determinants of adoption & maintenance of healthy behaviours – Understanding the concept of social cohesion and social capital in an ageing and age-integrated society – Changing family structures & other social institutions (e.g. Marriage) and influence of availability of informal care within family and on the future demand for health and social care

Health Systems and Policy Research • What are the policy’s proposed aims, objectives, interventions, targets, timescales and funding • Who does the policy affect? • Does the proposed policy address the identified issues? • What are the values and theoretical models underpinning the policy? • Long-term comparison of different health strategies

Annex 4 - Presentations

Health Systems and Policy Research (2) • Amendment of “Law of Protection of Rights and Interests of the elderly” in China this month forcing young children to visit their parents regularly • What would the feasibility, cost and impact of this measure? • Will this improve the cognitive ability and health status of the elderly? What may be other outcomes? • Development of innovative model of coordinated service provision based on sound rationale and conceptual basis.

Multidisciplinary research • Ageing a complex bio-psycho-social process. • Financing and provision of healthcare is embedded within other policy issues like employment, taxation, social security systems. • Research on labor markets: – Older people’s attitude for life-long learning, and preferences for staying longer in the work-force – Analysis of late-life career patterns among wage earners or the self-employed

• Need for multidisciplinary and multi-sectoral approach to research

Take Home Message :1 Take home message 2: A Large Translational Research Agenda Translating existing knowledge into behaviours, practice and policies.

Need for a balanced multidisciplinary research approach : a full spectrum of basic and clinical research through to population surveys and policy analyses.

Substantial emerging evidence and Translational Research agenda • Translating already available knowledge into policy and practice – Known relationships between ill health & tobacco, physical inactivity, poor diet, alcohol misuse, high BP and cholesterol – Knowledge about impact of social & built environment in facilitating healthy ageing – Need to reform health systems to make them age-friendly The research challenge is how to translate the knowledge about risk factors , social environment into effective action, behaviour change, and treatment regimens?

Way Forward: Strengthening Evidence base • Developing multi-disciplinary and multi-stakeholder partnerships to implement research agenda: Public, private, industry, universities, civil society, etc. • Establishing a priority research agenda with consensus • Institutionalizing systems to generate, analyze and use routine statistics and data on healthy ageing • Building capacity for research and data analysis • Mobilizing resources for special research studies and routine surveys: • Better dissemination of findings to government, industry, and communities

Annex 4 - Presentations

Technological innovations: Meeting needs of developing countries • Biomedical discoveries, technological innovations— are public goods, and the context and needs may vary across developed and developing countries – individual developing country may not have capacity, incentives and resources to investment in these innovations – Establishment of International or regional research or product development partnerships – Facilitate investments for technological innovation affordable and suitable for developing countries context

Take Home Message :2

The first priority in developing countries may be to build systems in the form of periodic populationbased surveys that collect data on multi-disciplinary and multi-sectoral issues relevant to healthy ageing

Setting Systems for Multi-disciplinary Statistics on Older People (1): Demographic statistics: More readily available • Counts of older population by age, sex, residence, work, HH status ,employment(?) • Census, inter-census projections Economic & social Status ; & labor force participation: • % of elderly population classified as poor • Employment rates, attitudes towards labor force participation • % of older people receiving any pension; pension as proportion of total income • % of older men and women living alone? • % of older men and women having access to informal family support if needed

Setting Systems for Multi-disciplinary Statistics on Older People (2) Health Status: morbidity and mortality • Age- and cause-specific mortality: Vital Registration system? • Morbidity including cognitive and functional disability : periodic surveys • Prevalence and trends in life style risk factors : periodic surveys • Health life expectancy at age 60 years

Access, affordability, and use of health care • • • • • % older people covered with health insurance schemes % of older people with hearing disability having a hearing aid % of older people with correctable vision disability having services % of older people immunized for influenza/pneumonia Per capita health expenditures for 65+ population versus 25-64 year old

Generating Evidence on Ageing: Way Forward • A full spectrum of multi-disciplinary research approarch • Immediate priority: Institutionalizing periodic populationbased surveys of older people covering multi-disciplinary domains – Existing national health surveys (e.g. DHS, MICS, STEPS, etc): • 60+ population traditionally excluded from large scale national health surveys

Thank you

– Existing ageing surveys • Are adhoc, mostly externally driven, designed and funded, with poorly analyzed and used data – Comparative regional or global survey initiatives (pros & cons)

• A critical number of longitudinal studies in selected countries • Research translation

Any comments, suggestions, and questions are welcome...

Annex 4 - Presentations

Objectives Undertaken in country groups To identify country-specific issues in relation to ageing and health

Introduction to group work

To develop practical actions to address these issues

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Meeting on Ageing and Health in the Western Pacific Region

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Meeting on Ageing and Health in the Western Pacific Region

TASK 1: Issue analysis

TASK 2: Issue selection matrix Issue Impact (0-5) Feasibility (0-5) Total (0-25)

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Meeting on Ageing and Health in the Western Pacific Region

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Meeting on Ageing and Health in the Western Pacific Region

TASK 3: Barrier analysis Barrier Impact (0-5) Feasibility (0-5) Total (0-25)

TASK 4: Root cause analysis

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Meeting on Ageing and Health in the Western Pacific Region

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Meeting on Ageing and Health in the Western Pacific Region

Annex 4 - Presentations

TASK 5: Solutions and practical actions Problem statement Cause Solution Practical Actions Effective x Feasibility = Overall

Structure and timetable Session 9 – Group work

0830-1000 1000-1030 1030-1200

Break Practical Actions Effective x Feasibility = Overall

Session 9 (contd.) – Group work

Lunch Practical Actions Effective x Feasibility = Overall

1200-1300

Session 9 (contd.) – Group work presentations

1300-1430

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Meeting on Ageing and Health in the Western Pacific Region

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Meeting on Ageing and Health in the Western Pacific Region