Decade of healthy ageing: development of a proposal for a decade of healthy ageing 2020–2030: report by the Director-General

EXECUTIVE BOARD EB146/23 146th session 11 December 2019 Provisional agenda item 17 Decade of Healthy Ageing Development of a proposal for a Decade of Healthy Ageing 2020–2030 Report by the Director-General BACKGROUND AND MANDATE FOR THE DECADE 1. In resolution WHA69.3 (2016), the Sixty-ninth World Health Assembly adopted the Global strategy and action plan on ageing and health, which comprises five strategic objectives; a framework for action across the 15-year period of the Sustainable Development Goals and the mandate to, inter alia, establish the global evidence and partnerships needed to set up a decade of concerted global action, the Decade of Healthy Ageing 2020–2030. Pursuant to the resolution, leveraging the experience and lessons learned from the implementation of the Global strategy and action plan on ageing and health, the Secretariat is developing a proposal for a Decade of Healthy Ageing 2020–2030 with Member States and with inputs from partners, including United Nations entities, other international organizations and non-State actors. A summary of the proposal for a Decade of Healthy Ageing, which extends the action plan from 2020 to 2030, is outlined in this document.1 The full draft proposal for the Decade is available at https://www.who.int/ageing/decade-of-healthy-ageing. PREPARATIONS FOR THE PROPOSAL Leveraging experience and lessons learned 2. In the first half of 2018, the Secretariat conducted a mid-term review of country progress on implementing the Global strategy and action plan on ageing and health against 10 indicators.2 The findings were later reported to the Seventy-first World Health Assembly in 2018.3 Some regional offices whose regional strategies are ending have reviewed progress, gaps and lesson learned. This information has been shared through regional meetings and formal reporting. 3. At the end of 2018, the Secretariat conducted an analysis of six past and current health-related Decades to ascertain factors for, and barriers to, successful Decades of action.4 1 In line with resolution WHA69.19 (2016) on the Global strategy on human resources for health: workforce 2030, a health workforce impact assessment was carried out for the draft Decade of Healthy Ageing (2020–2030) (see https://www.who.int/hrh/activities/HealthWorkforceImpactAssessment_Ageing_Oct2019.pdf, accessed 11 November 2019). 2 https://www.who.int/ageing/commit-action/measuring-progress/en/, (accessed 11 November 2019). 3 Document A71/41 Rev.2, section I. 4 https://www.who.int/docs/default-source/decade-of-healthy-ageing/analysis-report-decades-of-action.pdf, (accessed 11 November 2019). EB146/23 2 4. In January 2019, as part of Programme budget 2020–2021 planning, the Secretariat conducted an internal review of the contributions of WHO headquarters to the implementation of the Action plan on ageing and health (2016–2020). An independent evaluation is currently under way and will consider this review and other relevant documentation. The report of the independent evaluation will be available in January 2020. 5. The Secretariat is preparing a Global status report on healthy ageing reflecting agreed standards and metrics to provide baseline data for the Decade of Healthy Ageing 2020–2030. The draft global report will be submitted as information to the Seventy-third World Health Assembly and launched on 1 October 2020. Identifying priorities 6. From October to November 2018, with United Nations entities and partner organizations, the Secretariat ran a survey to determine country priorities for the Decade of Healthy Ageing. Responses were solicited from focal points for ageing in countries as well as a wide network of internal and external partners. A total of 160 people responded, from 82 countries spanning all WHO regions.1 7. When asked “what issues should the Decade focus on”, survey respondents prioritized: improved engagement with older people; better understanding of older peoples’ needs; developing and strengthening health and long-term care, specifically in communities; and improved multisectoral action. 8. When asked “what priority support options should be provided” survey respondents indicated: capacity-building; evidence-based guidance; support to connect, convene and exchange knowledge with relevant stakeholders; and data and innovation. On 15–16 November 2018, the support options were further discussed and refined in a meeting, held in partnership with the United Nations Population Fund, on developing a platform to support the Decade.2 9. When asked “what priority outcomes the Decade should promote”, respondents ranked highest: healthy life expectancy; age-friendly cities and communities; and reduced number of older people who are care dependent. Ten progress indicators related to the Global strategy have already been used to track progress.3 Other possible indicators were discussed during the process of consultation. From concept note to draft proposal 10. The proposal for the Decade of Healthy Ageing 2020–2030 has been developed through a broad consultative process led by Member States and engaging United Nations entities and international organizations, along with non-State actors including civil society organizations, representatives of older people’s associations, professional associations, academic institutions and the private sector. 1 African Region, n=46 from 32 countries; Region of the Americas, n=13 from 3 countries; South-East Asia Region, n=19 from 10 countries; European Region, n=45 from 25 countries; Eastern Mediterranean Region, n=9 from 6 countries; Western Pacific Region, n=28 from 6 countries. 2 The meeting was attended by 42 international multidisciplinary stakeholders, including from national governments, United Nations and international organizations, WHO regional offices and non-State actors. 3 https://www.who.int/ageing/commit-action/measuring-progress/en/, (accessed 11 November 2019). EB146/23 3 11. An initial concept note for the Decade was drafted by the Secretariat based on progress on the priorities identified and inputs received through stakeholder meetings.1 Consultations on the concept note were held within WHO headquarters, with WHO regional offices, during global and regional meetings hosted between November 2018 and February 2019,2 at an information session for Member States (6 May), and during an informal United Nations Inter-Agency Group on Ageing convened by the United Nations Department for Economic and Social Affairs on 17 May 2019. 12. Building on the concept note, the results from the survey and the meeting on developing a platform to support the Decade, a preliminary draft proposal for the Decade of Healthy Ageing was developed by the Secretariat. The draft was further refined through an iterative process through a series of consultations with Member States3 and United Nations entities4 and a global public online survey5 during the period from May to October 2019. 13. A summary of the draft proposal was also referred to the regions for discussion by the regional committees. 14. A revised draft was prepared by the Secretariat based on the feedback received through all channels. This refined proposal for the Decade of Healthy Ageing is for consideration by the Executive Board. Stakeholder participation in the development of the proposal 15. As of September 2019, a total of 89 Member States,6 across all six regions and at different administrative levels, and the European Union have provided inputs to one or more of the following: the survey; the side event of the World Health Assembly; informal consultations on the concept note or subsequent drafts, online consultations and regional committee meetings. 1 2 February, in New York, United States of America, during a side event hosted jointly by WHO and the United Nations Department of Economic and Social Affairs “MIPAA Meets SDG3 – A Decade of Healthy Ageing” at the 56th Commission on Social Development; 11 August, in Toronto, Canada, during the meeting of affiliates to the Global Network for Age Friendly Cities and Communities. 2 15–16 November 2018 in Geneva, Switzerland, at the stakeholder meeting on the platform for population ageing; 21–23 November 2018 in Santiago, Chile, during a regional meeting entitled “Integrated care for elder people. Are we prepared?”; 11–12 December 2018 in Geneva, Switzerland, during the Clinical Consortium on Healthy Ageing; and 26–27 February 2019, Moscow, Russia, Regional workshop for national policy experts on healthy ageing. 3 5 July 2019 and 12 September 2019. 4 23 May 2019 and 30 July 2019. 5 9 July–8 September 2019. 6 Algeria, Angola, Argentina, Armenia, Australia, Austria, Azerbaijan, Belarus, Belgium, Bhutan, Bosnia and Herzegovina, Botswana, Brazil, Bulgaria, Burkina Faso, Canada, Chile, Costa Rica, Croatia, Cyprus, Czech Republic, Dominican Republic, Ecuador, Estonia, Finland, France, Georgia, Germany, Greece, Honduras, Hungary, Iceland, India, Indonesia, Iraq, Ireland, Islamic Republic of Iran, Israel, Italy, Japan, Kazakhstan, Kenya, Kyrgyzstan, Latvia, Lithuania, Libya, Lao People’s Democratic Republic, Lesotho, Luxembourg, Maldives, Mauritius, Mexico, Monaco, Morocco, Myanmar, Nepal, Netherlands, Nigeria, North Macedonia, Norway, Pakistan, Panama, Peru, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, Saudi Arabia, Serbia, Singapore, Slovenia, Spain, South Africa, Sri Lanka, Sweden, Switzerland, Syrian Arab Republic, Tajikistan, Thailand, Timor-Leste, Trinidad and Tobago, Tunisia, Turkey, Turkmenistan, United Kingdom of Great Britain and Northern Ireland, United States of America, Uzbekistan, Zimbabwe. EB146/23 4 16. Some Member States leveraged international and regional forums to discuss ageing including the proposal for a Decade of Healthy Ageing. For example, Chile, hosted a side event (with 11 cosponsors)1 at the Seventy-second World Health Assembly and meetings of Asia-Pacific Economic Cooperation, as did Japan at the G20 and Finland under its Presidency of the Council of the European Union. Chile, Japan and Slovenia also co-hosted a side event on the Decade of Healthy Ageing, with the United Nations Department of Economic and Social Affairs, the Office of the United Nations High Commissioner for Human Rights and WHO, at a meeting of the Open-ended Working Group on Ageing. 17. Nineteen2 United Nations entities and international organizations provided comments and inputs, including as part of a special consultation organized under the Inter-Agency Group on Ageing.3 18. An estimated 300 non-State actors working on ageing and with older people engaged in the development of the proposal for the Decade of Healthy Ageing. This included organizations in official relations with WHO,4 and networks such as the NGO committees on ageing in Geneva and New York. This has been through bilateral meetings, global webinars (30 April and 2 August 2019), public global online survey, participation in side events during sessions of the World Health Assembly and the Open- Ended Working Group on Ageing, observer remarks at consultations with Member States and United Nations and international organizations, and emailed comments. 19. Starting in March 2019, the Secretariat has produced, translated and disseminated updates on the proposal for the Decade of Healthy Ageing,5 in collaboration with Member States holding current leadership roles in political and policy setting forums (such as the G20 and Asia-Pacific Economic Cooperation). These updates share news and highlight progress by Member States championing healthy ageing. Throughout 2019, this has helped spread awareness on the proposal for a Decade of Healthy Ageing and catalysed the expansion of countries engaged in its development. THE DRAFT PROPOSAL FOR A DECADE OF HEALTHY AGEING 2020–2030 Vision 20. The vision for the Decade of Healthy Ageing is a world in which everyone can live a longer and healthier life. This is the vision of the Global strategy and action plan on ageing and health;6 it is linked 1 Argentina, Canada, Costa Rica, Ecuador, Finland, France, Japan, Panama, Slovenia, Singapore and Turkey. 2 United Nations system: Economic Commission for Latin America and the Caribbean, Economic and Social Commission for Asia and the Pacific, International Labour Organization, International Organization for Migration, International Telecommunications Union, Office for the Coordination of Humanitarian Affairs, Office of the United Nations High Commissioner for Human Rights, Office of the United Nations High Commissioner on Refugees, United Nations Department of Economic and Social Affairs, United Nations Development Programme, United Nations Economic Commission for Europe, United Nations Population Fund, UN Habitat, UN Women, World Bank. International organizations: International Federation of the Red Cross and Red Crescent Societies, Ibero-American Secretariat General, Organisation for Economic Co-operation and Development, and the World Economic Forum. 3 See paragraph 54 of the Secretary-General report of the 74th session of the General Assembly https://undocs.org/A/74/170. 4 Help Age International, The International Federation on Ageing. 5 https://who.us3.list-manage.com/subscribe?u=c7943277461ee4157547221f2&id=4488fab1b7, (accessed 11 November 2019). 6 See document WHA69/2016/REC/1, Annex 1. The proposal for a Decade of Healthy Ageing would extend the action plan from 2020 to 2030. EB146/23 5 to the three priority directions of the Madrid International Plan of Action on Ageing and reflects the pledge in the 2030 Agenda for Sustainable Development to leave no one behind. Action areas 21. The Decade of Healthy Ageing is proposed as a global collaboration that will bring together diverse sectors and stakeholders including governments, civil society, international organizations, professionals, academic institutions, the media and the private sector. This global collaboration has the potential to build on and strengthen existing synergies, align with United Nations reform, contribute to the progressive realization of the rights of all older people everywhere to the enjoyment of the highest attainable standard of health, and harness the social and economic opportunities that population ageing provides. 22. The collaboration focuses on four action areas that are intended to improve the lives of older people, their families and their communities: • changing how we think, feel and act towards age and ageing; • developing communities in ways that foster the abilities of older people; • delivering person centred integrated care and primary health services responsive to older people; • providing older people who need it with access to long-term care. 23. These four action areas are strongly interconnected. For example, health systems that are responsive to older adults’ needs are essential to ensure long-term care; person centred integrated health and social care are key for developing communities in ways that foster the abilities of older people. Multisectoral action is important to promote health and address the environmental and social determinants of healthy ageing. Combating ageism needs to take place across all policies, settings and practices. Activities 24. The activities will: • take place at the local, national, regional and global levels, with a focus on improving the lives of older people, their families and their communities; • tackle the current challenges that older people face, while anticipating the future for those who will journey into older age; • take a life course approach, which recognizes the importance of multisectoral actions that focus on a healthy start to life, in each life stage and also target the needs of people at critical periods throughout their life, but focuses on the second half of life, given the unique issues that arise in older age, and the limited attention this period has received compared with other age groups; EB146/23 6 • be crafted in ways that overcome, rather than reinforce, inequities linked to individual and social factors and to specific, multiple or complex health conditions;1 without doing so, policies and programmes would risk widening the gaps and leaving some older people behind. 25. The proposal for the Decade of Healthy Ageing promotes multisectoral and multistakeholder engagement and collaboration. A platform established to support the development of the proposal will be further expanded to support collaboration and to strengthen existing alliances such as the WHO Clinical Consortium on Healthy Ageing,2 the WHO Global Network for Age-friendly Cities and Communities,3 WHO Consortium on Metrics and Evidence for Healthy Ageing,4 and the Titchfield City Group on Ageing.5 The platform will also build on and complement other WHO initiatives, such as the WHO Academy and Innovation Hub, with a focus on four enablers across the four action areas of the Decade of Healthy Ageing. These are: • hearing diverse voices and enabling the meaningful engagement of older people, family members, caregivers and communities; • nurturing leadership and building capacity at all levels to take appropriate action that is integrated across sectors; • connecting diverse stakeholders around the world to share and learn from the experience of others; • strengthening data research and innovation to accelerate implementation. 26. Underpinning this work is a framework to track progress in implementing the Decade of Healthy Ageing that: • takes stock of the vision, action areas and enablers of the Decade; • builds on progress indicators used for the Global strategy and action plan on ageing and health; • uses existing indicators (such as those of the Sustainable Development Goals), where possible, by disaggregation of data by age. 27. This framework to track progress prioritizes: the role of national and subnational leadership and ownership of results; building strong capacity including to monitor and evaluate; and a reduction in reporting burden by aligning multistakeholder efforts with the systems countries use to monitor and 1 Individual factors include gender, ethnicity, level of education, civil status or where a person lives. 2 For more information, see the WHO Clinical Consortium on Healthy Ageing webpage (https://www.who.int/ageing/health-systems/clinical-consortium/en/, accessed 11 November 2019). 3 For more information, see the WHO Global Network for Age-friendly Cities and Communities (https://www.who.int/ageing/projects/age_friendly_cities_network/en/, accessed 11 November 2019). 4 For more information, see https://www.who.int/ageing/data-research/metrics-standards/en/ (accessed 3 December 2019). 5 For more information on the Titchfield City Group on Ageing, see https://www.un.org/development/desa/ageing/news/2018/03/title-statistics-commission-endorses-new-titchfield-city-group- on-ageing/, (accessed 11 November 2019). EB146/23 7 evaluate their national policies and strategies on ageing. For example, by drawing on existing reporting mechanism for the Madrid International Plan of Action on Ageing,1 and voluntary national reviews2 on progress on the Sustainable Development Goals. The framework also recognizes that, along with traditional forms of support to develop state systems and institutions, strengthening people’s voice and the engagement of civil society is critical to responsive governance and service delivery. 28. A detailed draft proposal for the Decade of Healthy Ageing 2020–2030 has been developed through a broad multistakeholder consultative and iterative process. Mechanisms to manage the Decade of Healthy Ageing will initially be led by WHO with support from key United Nations entities (such as the International Labour Organization, Office of the United Nations High Commissioner for Human Rights, United Nations Department of Economic and Social Affairs, United Nations Development Programme, United Nations Human Settlements Programme, United Nations Population Fund and UN Women). These mechanisms are expected to evolve to ensure that actions remain country led, drawing on the leadership of governments at different levels and across sectors, in partnership with civil society and continue to strengthen the United Nations system delivering as one on ageing. ACTION BY THE EXECUTIVE BOARD 29. The Executive Board is invited to note the report and to consider the following draft decision: The Executive Board, having considered the report on the proposal for a Decade of Healthy Ageing 2020–2030,3 decided to recommend to the Seventy-third World Health Assembly the adoption of the following decision: The Seventy-third World Health Assembly, having considered the report on the proposal for a Decade of Healthy Ageing 2020–2030 decided: (1) to endorse the proposal for a Decade of Healthy Ageing 2020–2030; and (2) to request the Director-General to report back on progress in the implementation of the Decade of Healthy Ageing to the Seventy-sixth World Health Assembly, the Seventy-ninth and the Eighty-second World Health Assembly. = = = 1 https://www.un.org/development/desa/ageing/3rdreview-mipaa/3rdreview-mipaa-globalreview.html, (accessed 11 November 2019). 2 https://sustainabledevelopment.un.org/vnrs/, (accessed 11 November 2019). 3 Document EB146/23.