Seventieth Regional Committee for Europe: virtual session, 14–15 September 2020: final report on implementation of the Strategy and Action Plan on Healthy Ageing in Europe 2012–2020

W O RL D HE AL TH O R GAN I ZA T I ON RE GI ON AL O FF I CE FO R EU RO PE UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Telephone: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eugovernance@who.int Web: http://www.euro.who.int/en/who-we-are/governance Regional Committee for Europe EUR/RC70/8(M) 70th session Virtual session, 14–15 September 2020 12 August 2020 200641 Provisional agenda item 6 ORIGINAL: ENGLISH Final report on implementation of the Strategy and Action Plan for Healthy Ageing in Europe, 2012–2020 This report provides background information and an overview of the progress in implementation of the Strategy and Action Plan for Healthy Ageing in Europe, 2012–2020. It is submitted to the WHO Regional Committee for Europe at its 70th session in September 2020, in line with resolution EUR/RC62/R6. EUR/RC70/8(M) page 2 Background 1. In 2012, the WHO Regional Office for Europe developed the Strategy and Action Plan for Healthy Ageing in Europe, 2012–2020 (adopted in resolution EUR/RC62/R6). The aim of the Strategy and Action Plan was to promote increased action among Member States in the implementation of policies to promote healthy ageing and so enable more people to live longer and in good health. 2. This document provides an overview of the progress made in the WHO European Region in the period 2012–2020. The final version of the report will reflect the full results of a policy survey of Member States, launched in February 2020. This survey will inform a global status report that will provide a baseline for the Decade of Healthy Ageing 2020–2030 – known in short as the Decade – the second global action plan for healthy ageing. Key policy and strategic developments 3. The European Region has the highest median age of all the WHO regions. Since 2010, the median age in the Region has grown by more than two years, and it is projected to grow by another 2.5 years by 2030. Healthy ageing over the life course is a key factor in reaching overall health targets. Recent gains in life expectancy in the Region are increasingly attributable to better health and lower mortality among the oldest age groups, as documented in the Global Burden of Disease database. But an increase in life expectancy is not the same as an increase in life expectancy in good health. A significant proportion of older people live with disease and disability. Given the rapidly ageing population throughout the Region, healthy ageing therefore remains high on policy agendas. The current COVID-19 pandemic is affecting older people more than other age groups, but not in a uniform way due to differences in healthy ageing. This has reinforced the urgency to improve support and care for older people in need. 4. Since 2012, work on healthy ageing has been integrated as a cross-divisional issue in, and included in a broad range of activities by, the Regional Office. Ten regional strategies, action plans and frameworks include commitments that support healthy ageing policies. Another 10 programmes demonstrate synergies related to healthy ageing in their work and include a range of relevant outputs. More recently, a cross-divisional working group has addressed the needs of older people during the COVID-19 pandemic. The ongoing COVID-19 response activities and guidance development have benefited greatly from the established networks and workstreams, including those on long-term care, integrated care, age-friendly environments, and prevention and control of noncommunicable diseases. 5. The impetus for governments of the European Region to address healthy ageing was strengthened with the release of WHO’s World report on ageing and health in 2015 and the adoption of the Global strategy and action plan on ageing and health in 2016, which together establish a framework for achieving healthy ageing for all. The Global strategy and action plan includes strategic areas consistent with the European Region’s Strategy and Action Plan, which predated it. Data collected for 10 progress indicators show that the European Region had some of the highest implementation rates of all WHO regions. 6. The second global action plan, the Decade of Healthy Ageing 2020–2030, has been adopted by the World Health Assembly through written silent procedures. The Health Assembly also asked the WHO Director-General to transmit this decision to the Secretary- General of the United Nations for consideration of the proposal for the Decade by the United EUR/RC70/8(M) page 3 Nations General Assembly. The progress made on healthy ageing since 2012 means that the WHO Regional Office for Europe is in a good position to continue to lead in the implementation of the Decade, supported by increasing inter-programmatic cooperation at the Regional Office. Overview of progress and achievements 7. The key goal of the Strategy and Action Plan for Healthy Ageing in Europe was to allow more people to live longer in good health, remain active for longer, and counteract growing inequalities in old age. To achieve this goal, there was a focus on four objectives: to foster enabling environments; to take health-promoting and disease prevention action on risk factors for older people from a life-course and gender perspective; to strengthen health systems for healthy ageing and better quality and more equitable health and social care for older people; and to strengthen the evidence base for health and social care policies for ageing populations. The Strategy and Action Plan is organized into four strategic priority areas for action, five priority interventions and three supporting interventions. While these strategic areas were already very much in line with the action areas on which the Decade is built, the Decade adds the action area: Changing how we think, feel and act towards age and ageing, thus making this underlying principle of WHO work and the need for combatting ageism more explicit. 8. Around 60% of Member States have a strategy, policy or plan that supports healthy ageing, and most Member States have taken measures to promote healthy and active ageing. These measures include independent policies, or policies forming part of a broader national strategy or action plan on ageing, and involve either amending existing policies or embarking on new initiatives. 9. Since 2012, policy support for healthy ageing has been included in the biennial collaborative agreements of the following countries: Croatia, Czechia, Greece, Lithuania, Montenegro, North Macedonia, Republic of Moldova, Russian Federation, Serbia, Slovakia, Slovenia, Tajikistan, Turkey and Ukraine. Most other countries have been included in intercountry activities, such as regional workshops, in ageing-related activities under other programmes, or in ad hoc cooperation with the Regional Office. Among the most frequent activities were cooperation for the strengthening of health and long-term care for older people, support in the development of comprehensive national strategies and action plans, and the creation of plans to address the health of older migrants. Ageing has also been a recurrent topic of meetings under the South-eastern Europe Health Network and the WHO Regions for Health Network. For the current biennium, a record number of Member States (10) have requested support from the Regional Office, through their biennial collaborative agreements, for the design and implementation of healthy ageing policies. Healthy ageing over the life course 10. Greater investment in healthy ageing over the life course is essential to address the large and growing disparities in the health and well-being of older people, both within and between Member States. 11. With reference to the priority interventions to promote physical activity, older people are a priority population of the Physical Activity Strategy for the WHO European Region 2016–2025, and are a specific population included as an indicator in the Physical activity EUR/RC70/8(M) page 4 factsheets for the 28 European Union Member States of the WHO European Region of 2018. Physical activity needs to be addressed together with nutrition – another special concern for older people. The European Food and Nutrition Action Plan 2015–2020 tackles these issues, which are also highlighted in a policy brief on healthy nutrition for older people. The Regional Office has been preparing a policy brief on ageing, nutrition and physical activity for older people to be launched in September 2020. 12. Regarding the priority intervention of falls prevention, many Member States have a national policy and/or guidance document on the prevention of accidental falls, and they also address prevention in the design of accessible urban space and in standards for housing and other settings in which older people live, such as nursing homes. Despite a reduction in overall mortality from falls in people of all ages in the Region between 2000 and 2016, the rate in people aged 70 years and over increased by 25% during the same period. Sixty-seven per cent of all deaths from falls in the Region were in the age group 70 and older, and such deaths were more common in women. The WHO guidelines on integrated care for older people (2017) propose evidence-based recommendations to reduce the risks of falls – such as strength and balance exercises, physical therapy, and the withdrawal of unnecessary or harmful medication – as well as to carry out home-hazard assessments and create barrier-free living environments. There is, however, evidence to suggest that more can be done to prevent falls in institutional settings by adapting the built environment more effectively and implementing other more general measures to prevent falls, including providing access to high-quality, affordable assistive devices. 13. Fostering physical activity, ensuring good nutrition and preventing falls are important interventions that can help prevent or postpone the onset of frailty and mitigate decline in functional capacity among older people. The Regional Office has worked with the European Commission and European Union Member States initiative ADVANTAGE Joint Action on the Prevention of Frailty to address this topic. 14. With reference to the supporting intervention on prevention of elder maltreatment, the Global status report on violence prevention 2014 documented the growing awareness of and political commitment to addressing elder abuse in the European Region. The report provides evidence based on a global survey on violence and injury prevention, which also constitutes a useful tool for future monitoring of progress in this area in the European Region. It has been estimated that 15.4% of older people living in the community and up to 33.4% of older people residing in institutions experienced some form of abuse in the past 12 months. Elder abuse has not received the attention it deserves: only approximately half of the countries in the European Region report having national action plans to combat it. Moreover, over half of elder abuse prevention action plans were developed without being informed by a population- based survey. 15. Many countries are investing in prevention and have public and professional awareness campaigns about elder abuse at either national, regional or subregional levels. Most countries report that they already have laws against elder abuse, including abuse of elderly people in institutions. Country reports suggest that there is a need for more reporting systems for elder abuse, with many countries reporting that such systems are not in place. 16. Gender aspects of healthy ageing are being addressed by improving public support for long-term care provided by family caregivers and improving the coverage and quality of care provided for older people with functional limitations. Women are predominantly both the caregivers for elderly relatives and the recipients of care for those with functional limitations. These and other aspects of gender and health among older people are discussed in two EUR/RC70/8(M) page 5 Regional Office publications: Women’s health and well-being in Europe: beyond the mortality advantage (2016) and The health and well-being of men in the WHO European Region: better health through a gender approach (2018). 17. Although progress has been made on addressing gender in relation to the health of older people in the Region, there is a need for greater incorporation of gender perspectives, since close to half of countries reporting that they have current strategies, policies and plans for ageing and health say that these do not incorporate a gender perspective to account for important differences between men and women in roles and experiences at an older age. Supportive environments 18. The number of cities and communities planning activities to create age-friendly environments using WHO guidance continues to grow. Since 2012, this movement has received increasing government support at higher – including national – levels in countries such as Finland, France, Ireland and the United Kingdom of Great Britain and Northern Ireland. Local action has been central to efforts to promote physical activity and address social isolation. 19. In the work of the WHO European Healthy Cities Network, age-friendly policy development was one of the most frequently addressed policy issues at the municipal level. Twelve cities have joined forces to work with the Regional Office through the Healthy Ageing Task Force for the purpose of mutual learning and to support the Regional Office in developing tools for age-friendly environments for use by other cities and communities. Healthy ageing has been discussed regularly during the annual meetings of the Network, covering a broad range of topics, from policy issues such as social participation, physical activity and age-friendly built environments to multilevel governance, monitoring, indicators and rapid assessment of progress in implementation. 20. An important task for the Regional Office was to expand the toolkit for guidance that is needed for age-friendly policy implementation in countries. This work has been supported by funding from the European Commission and the Government of Germany. The 2017 publication, Age-friendly environments in Europe: a handbook of domains for policy action, complemented by a policy tool and a guide to choosing indicators, supports the development by local governments of policies for healthy ageing. The Age-friendly environments in Europe framework covers eight domains for policy action: outdoor environment, transport and mobility, housing, social participation, social inclusion and non-discrimination, civic engagement and employment, communication and information, and community and health services. European cities form the largest group within the WHO Global Network for Age- friendly Cities and Communities, with some 380 member cities in 22 European countries – almost 40% of the global membership. 21. For the supporting intervention in the Strategy and Action Plan, prevention of social isolation and social exclusion, most countries report that the prevention of social isolation and social exclusion is included in national-level policy or addressed in a separate strategy. Community-level action in this policy area is one of eight action areas of the Age-friendly environments in Europe framework. 22. Despite the great contributions that many older people make to society, negative attitudes and ageism are still common in societies, and this is a key barrier to healthy ageing. More national legislation and enforcement mechanisms against ageism need to be put in EUR/RC70/8(M) page 6 place, and more awareness campaigns and guidance on media reporting and public image campaigns are required to foster intergenerational relations. People-centred health and long-term care systems fit for ageing populations 23. Investment in long-term care has increased in countries of the Region, both through explicit long-term care policies and as part of overall health and social expenditure. Almost all countries report that they have a national or subnational long-term care policy, strategy, plan or framework in place or under development. Over 70% of countries have undertaken action that aims at improving long-term care for older people. However, progress has been uneven in this respect, and long-term care remains fragmented, under-funded and under-staffed in many countries. The lack of resources and limited preparedness of nursing homes during the COVID-19 pandemic illustrate the scope of under-investment in the care of older people. One focus of the COVID-19 response is to support countries by providing technical guidance to address the acute challenges of nursing-home care. 24. To improve the model of long-term care, a new tool, the Country assessment framework for the integrated delivery of long-term care (2019), has been developed and applied in six country studies in cooperation with the WHO European Centre for Primary Health Care. This guidance also covers important aspects of the priority interventions on public support for informal caregiving – with a focus on home care including self-care – and of the supporting intervention on quality-of-care strategies for older people, including dementia care and palliative care for long-term care patients. Most countries report that initiatives have been implemented at the national or subnational level to improve and monitor the quality of long- term care. New guidance has been developed to respond to the needs of vulnerable older people receiving care in various settings. 25. With reference to the priority interventions on vaccination of older people and infectious disease prevention in health care settings, the European Vaccine Action Plan 2015–2020 (document EUR/RC64/15 Rev.1) promotes a life-course approach to vaccination. Special advocacy and awareness-raising campaigns were launched on the influenza vaccination for older people. The European Region is still a long way from the WHO target of uptake by 75% of older people of the influenza vaccine. Seasonal influenza vaccination coverage among older people varies considerably between countries in the Region, from below 1% to over 75%, the latter achieved by only a very few countries. Greater awareness of the benefits of vaccination for older people is needed in order to reverse some of the recent decline that has been observed in influenza vaccination rates. 26. The guidance document Prevention and control of outbreaks of seasonal influenza in long-term care facilities: a review of the evidence and best-practice guidance (2017) focuses on the prevention and control of health-care-associated influenza infection and influenza outbreaks in long-term care facilities where residents are older and frequently live with frailty. Much of this guidance is also of high relevance during the COVID-19 pandemic. 27. With reference to the priority intervention of geriatric and gerontological capacity- building among the health and social care workforce, most countries report that they perform geriatric and gerontological capacity planning as part of overall health and social workforce planning for ageing populations. However, the COVID-19 pandemic illustrates the extent of shortages of staff to provide care for older people in various settings and situations. Drawing EUR/RC70/8(M) page 7 the right lessons from the pandemic will help countries make more effective progress in this area in the future. Strengthening the evidence base and research 28. Most countries report having a public health institute or centre of excellence for research that is specialized in health and ageing research. However, many countries do not compile national reports at regular intervals about older people and their health and well- being. More than half of all countries have established cross-sectional, nationally representative, publicly available (anonymous) individual-level data on older people and their health status and needs, and nearly half of all countries have established longitudinal, nationally representative surveys (cohort or panel) of older people and their health status and needs that are available in the public domain. There are gaps in basic information about the health and well-being of older people. This is also the case for the health and social services that they need or receive. For example, standardized, comparable information is lacking on long-term care, both at home and in institutions. The COVID-19 pandemic has highlighted the shortcomings in these reporting systems, including those for mortality data. Moving towards the Decade of Healthy Ageing 29. The development of an implementation plan for the Decade of Healthy Ageing in the WHO European Region, 2021–2030 – to be adopted in 2021 at the 71st session of the WHO Regional Committee for Europe – provides an opportunity to address some of the remaining and emerging challenges of policies for healthy ageing and the health and well-being of older people, including those in vulnerable situations. The Decade will address four areas for action: change how we think, feel and act towards age and ageing; ensure that communities foster the abilities of older people; deliver person-centred integrated care and primary health services responsive to older people; and provide access to long-term care for older people who need it. 30. The proposed implementation plan for the Decade of Healthy Ageing in the WHO European Region will outline recommended ways of implementing the action plan of the global Decade, while maintaining full alignment with the European Programme of Work (2020–2025). Due to the importance that disease prevention and health promotion, as well as the promotion of age-friendly environments, has in older age groups, the WHO Regional Office for Europe will give it special attention in drafting its implementation plan.