The Global strategy and action plan on ageing and health 2016–2020: towards a world in which everyone can live a long and healthy life

SEVENTY-THIRD WORLD HEALTH ASSEMBLY

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Provisional agenda item 15.1

5 May 2020

Decade of Healthy Ageing

The Global strategy and action plan on ageing and health 2016–2020:

towards a world in which everyone can live a long and healthy life

Report by the Director-General

1. Pursuant to resolution WHA69.3 (2016), this global status report on healthy ageing provides data

and reviews progress made on actions for the proposed Decade of Healthy Ageing 2020–2030. It also

notes further work to be published in a forthcoming baseline report for the Decade of Healthy Ageing.

Global Status – Healthy Ageing

2. In 2019, the global population aged 60 years and over (older adults) was just over 1 billion people,

representing 13.2% of the world’s total population of 7.7 billion. That number is 2.5 times greater than

in 1980 (382 million) and is projected to reach nearly 2.1 billion by 2050. For the first time in history,

older adults outnumber children under five years of age; by 2050, United Nations projections estimate

that there will be more than twice as many older adults as children aged under five years. Most older

adults live in middle-income countries. In 2019, 5% of older adults worldwide lived in the African

Region, 16% in the Region of the Americas, 5% in the Eastern Mediterranean Region, 20% in the

European Region, 19% in the South-East Asia Region and 33% in the Western Pacific Region. WHO’s

response to population ageing and health is to optimize healthy ageing over the life course.

3. WHO defines healthy ageing as “the process of developing and maintaining the functional ability

that enables well-being in older age.”

Healthy ageing can be relevant to everyone, not just those who

are currently free of disease. Functional ability is determined by the intrinsic capacity of the individual

(that is, the combination of all the individual’s physical and mental capacities), the environments he or

she inhabits (understood in the broadest sense and including physical, social and policy environments),

and the interaction between these. There are three components to be measured using common standards

and metrics: functional ability, intrinsic capacity and environments.

Global strategy and action plan on ageing and health. Geneva: World Health Organization; 2017, paragraphs 17–20

(https://www.who.int/ageing/WHO-GSAP-2017.pdf?ua=1, accessed 20 February 2020).

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4. WHO’s normative language and framework for health,

tailored to older adults,

was applied to

the description of each component to obtain person-centred, multiple domain profiles that are relevant

to all older adults, as follows:

• Functional ability is defined as “all the health-related attributes that enable people to be and to

do what they have reason to value.” Five sub-domains are proposed: meeting basic needs,

learning and making decisions; mobility; building and maintaining relationships; and

contributing to families, communities or society.

• Intrinsic capacity at any point in time is “determined by many factors, including underlying

physiological and psychological changes, health-related behaviours and the presence or

absence of disease.” Five sub-domains are proposed: neuromusculoskeletal, sensory,

metabolic, cognitive and psychological.

• Environments “that people inhabit and their interaction with them are also major determinants

of what older people with a given level of intrinsic capacity can do. These environments provide

a range of resources or barriers that will ultimately decide whether older people can engage or

participate in activities that matter to them.” Five sub-domains are proposed: products and

technology, natural and built environment; support and relationships; attitudes; and services,

systems and policies.

5. Data from the greatest number of countries meeting the following criteria were collated to

measure each component and as many sub-domains as possible: (a) nationally representative,

cross-sectional studies of older adults between 2015 and 2017; (b) comparable questions or performance

tests for the same person, for functional ability, intrinsic capacity, and his or her environment, and (c) in

the public domain. Thirty countries had comparable data on intrinsic capacity and functional ability for

adults aged 60 years and over: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia,

Finland, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Latvia, Lithuania, Luxembourg,

Malta, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, United Kingdom

of Great Britain and Northern Ireland and United States of America.

6. Preliminary results combine data across these 30 countries with a population of 201.1 million

older adults, representing 24.1% of the total population in these 30 countries, and 21% of all older adults

worldwide, in 2017. Further details on data sources, methods, and pooled results, are found on WHO’s

website

and reflect the inputs of scientific and civil society partners, with a further peer review under

way.

The International Classification of Functioning, Disability and Health. Geneva: World Health Organization; 2001

(http://www.who.int/classifications/icf/en/, accessed 20 February 2020).

World Report on Ageing and Health. Geneva: World Health Organization; 2015

(http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf, accessed 20 February 2020).

Global status report on healthy ageing: data sources (SHARE), methods and results for 30 countries, Department of

Maternal, Newborn, Child, Adolescent Health and Ageing, WHO (https://www.who.int/docs/default-source/mca-

documents/healthy-ageing/data-methods-and-preliminary-results-for-the-73rd-wha-information-document-2020-04-08.pdf,

accessed 9 April 2020).

Bulletin of the World Health Organization. Metrics and evidence for healthy ageing. Geneva: World Health

Organization; 2019 (https://www.who.int/bulletin/volumes/97/12/19-246801.pdf, accessed 20 February 2020).

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7. Based on the data and methods applied for these estimates, the following messages emerge.

• The vast majority of older adults included in this analysis have high or sufficient functional

ability and intrinsic capacity, 81.0% and 85.2% respectively. While the estimated percentage

of older adults with significant loss of functional ability is 4%, those with significant loss of

intrinsic capacity is 0.7%. For those with significant loss of intrinsic capacity, supportive

environments, including health services and social care systems, could improve overall

functional ability. To promote healthy ageing and prevent significant loss, a life course

approach is needed to address the determinants of intrinsic capacity, including health-related

behaviours and the presence or absence of disease.

• The estimated proportion of older adults with significant and moderate loss of functional ability

was two times greater among adults aged 80 years and over than those aged 60 to 70 years. All

older adults, irrespective of the level of intrinsic capacity, should have opportunities to optimize

functional ability in order to enjoy what they value most. For example, WHO’s Integrated Care

for Older People (ICOPE) programme offers guidance to health and care workers, to assist

older adults to set person-centred goals and to develop a personalized care plan that addresses

cognitive declines, limited mobility, malnutrition, visual impairment, hearing loss and

depressive symptoms. The approach also supports self-management and supports caregivers.

• Overall, the estimated proportion of significant and moderate loss of functional ability and

intrinsic capacity is higher in older women than older men. Addressing this gender gap in

healthy ageing is vital to achieving the Sustainable Development Goals and the Thirteenth

General Programme of Work, 2019–2023.

PROGRESS ON ACTION AREAS ALIGNED TO THE PROPOSAL FOR A NEW ACTION

PLAN: THE DECADE OF HEALTHY AGEING

2020–2030

8. These four actions aim to support optimizing the levels and distribution of healthy ageing within

and across countries.

Changing how we think, feel and act towards age and ageing

9. WHO has advanced, in collaboration with others, a global campaign to combat ageism: in 2017,

its vision, goal, principles and values, theory of change and areas of work were defined. In 2018–2019,

WHO reviewed all evidence published on ageism in the past 50 years. Gaps were filled with original

research. The main outputs are: a global prevalence study, four systematic reviews (determinants of

ageism; consequences of ageism; strategies that are effective in reducing ageism; available metrics to

measure ageism), a detailed report on existing communication campaigns (local, national and regional),

analysis of 32 European Region country policies on ageism. These are being consolidated into a Global

report on ageism that is due to be launched in 2020.

https://www.who.int/docs/default-source/decade-of-healthy-ageing/full-decade-proposal/decade-proposal-fulldraft-

en.pdf?sfvrsn=8ad3385d_6 (accessed 20 February 2020).

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Developing communities in ways that foster the abilities of older people

10. WHO supports communities to foster healthy ageing through the WHO Global Network for

Age-Friendly Cities and Communities. Since May 2016, membership of the WHO Global Network has

quadrupled from 286 to 1100 regions, cities and communities in 42 countries covering 260 million older

adults. WHO has launched an interactive multilingual information platform called “Age-Friendly

World”;

a database of more than 300 age-friendly practices; an extensive resource library; and

opportunities for training and mentoring. The WHO Regional Office for Europe published guidance on

creating age-friendly initiatives and developed tools

for local policy-makers to help identify priority

areas of action, design action plans and monitor and evaluate age-friendly policies.

Delivering person-centred, integrated care and primary health services responsive to

older people

11. As noted, the WHO Integrated Care for Older People (ICOPE) programme

reflects a

community-based approach to reorient health and social services towards a more person-centred and

coordinated model of care in order to optimize functional ability for older people. In 2017, WHO

launched the Guidelines on Integrated Care for Older People, setting out community-level interventions

to manage declines in intrinsic capacity, and to assist health care workers in primary care settings to

detect declines in physical and mental capacities and deliver effective interventions to prevent and delay

care dependency. In 2019, WHO launched an associated package of tools to facilitate implementation

of the Integrated Care for Older People programme. The tools include a handbook and digital application

which provide guidance and pathways to respond to the health and social care needs of older people in

primary care. Integrated Care for Older People interventions are included in the UHC Intervention

Compendium under development by WHO.

Providing older people who need it with access to long-term care

12. With significant loss of intrinsic capacity, access to good-quality long-term care is essential to

maintain functional ability, enjoy basic human rights and live with dignity. In 2017, WHO launched the

first report in the WHO series on long-term care that aims to catalyse change and guide the development

of sustainable and equitable long-term care systems in different regions of the world. In 2019, the WHO

Regional Office for Europe released a country assessment framework to provide technical guidance on

assessing the integrated delivery of health and social services for long-term care. The Organization also

developed iSupport for dementia, an online support and training programme for caregivers of those with

dementia.

ADDITIONAL ANALYSIS AND EVIDENCE SYNTHESES

Building on this global status report, the Secretariat will publish a baseline report for the

Decade of Healthy Ageing 2020–2030 in October 2020

13. In order to further document the current status, the baseline report will include:

https://www.who.int/ageing/age-friendly-world/en/ (accessed 20 February 2020).

.https://www.who.int/ageing/health-systems/icope/en/ (accessed 20 February 2020).

https://www.isupportfordementia.org/en (accessed 20 February 2020).

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(a) finalized estimates of functional ability and intrinsic capacity for the 30 countries, and for

an additional 20 countries drawn from all WHO regions; it will also include analysis by

socioeconomic characteristics, such as, place of residence, years of education and household

wealth; for a subset of countries, nationally representative longitudinal data will track trends over

time; and with inputs from the WHO Consortium on Metrics and Evidence for Healthy Ageing,

results from a multi-country study testing personalized devices to measure real time functional

ability;

(b) an analysis of the third component of healthy ageing, environments, aligned to the domains

of functional ability and indicators of age-friendly cities and communities, for example, proximity

of health services, transportation and social clubs; and to increase global reach, methods are being

tested to extract information from satellite and web mapping services in the public domain;

for loss of capacity are under review; for example, years lived with disability distributed by age

and sex groups.

14. In order to support monitoring of Member States’ progress on their existing commitments

between 2020–2030, the baseline report will include:

(a) an updated review of the 10 progress indicators

agreed on by Member States to monitor

the first action plan of the global strategy on ageing and health, (2016–2020), also proposed to

monitor the Decade of Healthy Ageing 2020–2030 (second action plan);

(b) calculated projections to 2030 of healthy ageing, and Sustainable Development Goal

indicators relevant to older adults,

under different scenarios, including an optimal approach; this

is in collaboration with organizations of the United Nations system, including the United Nations

Statistical Commission’s Titchfield City Group on Ageing and Age Disaggregated Data, and civil

society partners, including HelpAge International.

15. In order to support evidence for impact and delivery on priorities, the baseline report will include:

(a) new evidence synthesis and mapping on what can be done to optimize intrinsic capacity

and functional ability among older adults, in collaboration with the WHO Ageing and Health

Forum

and scientific partners, including Cochrane Campbell Global Ageing; this includes the

mapping of existing WHO guideline recommendations across life course stages; interventions for

prevention and management of cardiovascular disease; promotion of sexual health and prevention

of sexually transmitted diseases; and life-long learning programmes evaluating impact on healthy

ageing;

https://www.who.int/ageing/commit-action/measuring-progress/en/ reporting 2018 mid-term progress on the Global

Strategy and Action Plan on Ageing and Health (accessed 20 February 2020).

These indicators are listed in the Proposal for the Decade of Healthy Ageing. Table 2

https://www.who.int/docs/default-source/decade-of-healthy-ageing/full-decade-proposal/decade-proposal-fulldraft-

en.pdf?sfvrsn=8ad3385d_6 (accessed 20 February 2020).

The Forum enables staff across the Secretariat to work together on ageing and health, drawing on all regional

offices and headquarters departments, including those addressing risk factors, diseases and conditions relevant to older adults.

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(b) Member States’ experiences in examining how evidence is being used by stakeholders to

inform policy, make programmatic decisions and identify interventions that can improve the lives

of older persons; specifically, eight national case studies led by the Ministries of Health in Chile,

China, Finland, Ghana, India, Qatar, Singapore and Thailand, representing all WHO regions, in

close collaboration with WHO country and regional offices;

on what can be done to support healthy ageing, with diverse partners, including national medical

and health research councils and the European Union’s Joint Programming Initiative “More Years

Better Life”.

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