SIXTY-NINTH WORLD HEALTH ASSEMBLY
A69/17
Provisional agenda item 13.4
22 April 2016
Multisectoral action for a life course approach to
healthy ageing: draft global strategy and
plan of action on ageing and health
Report by the Secretariat
1. Populations around the world are ageing rapidly. Between 2000 and 2050, the proportion of the
world’s population aged 60 years or over will double from about 11% to 22%. The absolute number of
people aged 60 years or over is projected to increase from 900 million in 2015 to 1400 million by
2030 and 2100 million by 2050, and could rise to 3200 million in 2100. By 2050, Europe will have
about 34% of its population aged 60 years or over, while Latin America and the Caribbean and Asia
will have about 25%; although Africa has the youngest population structure of any major area, in
absolute terms it will see the number of people aged 60 years or over increase from 46 million in 2015
to 147 million in 2050.
2. These extra years of life and this reshaping of society have profound implications for each of us,
as well as for the communities we live in. Unlike most of the changes that society will experience in
the next 50 years, these trends are largely predictable. We know that the demographic transition to
older populations will occur, and we can plan to make the most of it.
3. Longer lives provide the opportunity for rethinking not just what older age might be but how
our whole life course might unfold. Yet the extent to which each of us as individuals, and society more
broadly, can benefit from this demographic transition will be heavily dependent on one key factor –
health. Unfortunately, while it is often assumed that increasing longevity is accompanied by an
extended period of good health, there is little evidence to suggest that older people today are
experiencing better health than their parents did at the same age. Furthermore, good health in older age
is not equally distributed, either between or within countries.
4. Most of the health problems of older age are linked to chronic conditions, particularly
noncommunicable diseases. Many of these can be prevented or delayed by healthy behaviours. Indeed,
even in very advanced years, physical activity and good nutrition can have powerful benefits on health
and well-being. Other health problems and declines in capacity can be effectively managed,
particularly if detected early enough. And even for people with declines in capacity, supportive
environments can ensure that they can live lives of dignity and continued personal growth. Yet the
world is very far from this ideal, particularly for poor older people and those from disadvantaged
social groups. Comprehensive public health action is urgently needed. These actions can be viewed
within the context of the Sustainable Development Goals, which provide a foundation for multicountry
and international action from 2015 to 2030, including Goal 3: “To ensure healthy lives and promote
well-being for all at all ages through universal health coverage including financial risk protection”.
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5. In May 2014, the Sixty-seventh World Health Assembly requested the Director-General to
develop, in consultation with Member States and other stakeholders and in coordination with the
regional offices, and within existing resources, a comprehensive global strategy and plan of action on
ageing and health, for consideration by the Executive Board in January 2016 and by the Sixty-ninth
World Health Assembly in May 2016.
1
6. This strategy was developed through an extensive consultative process. The starting point in its
development was the World report on ageing and health, which was released in 2015.
2
This drew on
19 background papers produced by experts in key areas relating to ageing and health, together with
input from representatives of key organizations of older people, civil society organizations working on
ageing, international organizations, professional bodies and numerous experts. The process included a
face-to-face consultation in April 2015 that considered key policy questions and potential actions to
address them.
7. A “zero draft” of the strategy was developed between May and August 2015, based on the
framework for public health action on ageing outlined in the report and further consultation with a
wide range of stakeholders, including staff from each Regional Office. Five of the six regions (the
Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific) have
strategies or frameworks for action on ageing and health; these also informed the zero draft.
8. Consultations for both the report and the zero draft of the strategy were also able to draw on the
mechanisms that have been established across WHO to ensure a “whole-of-organization” response to
population ageing. These include regular meetings of all departments engaged in ageing-related work
and regular electronic engagement with staff in regional and country offices. Both benefited from
inputs from the many experts and WHO collaborating centres contributing to this topic.
9. The zero draft, available in English and French, was widely distributed and reviewed through an
extensive consultation process that ran from the end of August to the end of October 2015, which
included: a web-based consultation that was open to all (20 August to 30 October); a regional
consultation organized by the Regional Office for Africa (Brazzaville, 23–24 September), reflecting
the fact that the Region is in the process of developing its first regional framework on ageing and
health, in parallel with the global strategy process; briefing and input from countries’ permanent
missions to the United Nations based in Geneva (28 September); and in-depth discussions with
interested Member States and nongovernmental organizations (September–October) and with regional
economic integration organizations and organizations in the United Nations system (October). More
than 500 comments from people or organizations in 55 countries were received through the structured
survey on the zero draft. Respondents included: Member States, i.e. ministries or government agencies
(22%), individuals, including older people (51%), civil society and other nongovernmental
organizations (24%), research and academic institutions (19%) and international organizations (9%).
10. This feedback led to a first draft of the strategy being completed in October 2015 and made
available in all six official WHO languages. The first draft was reviewed through a further
consultation process from mid-October to mid-November 2015. This included regional consultations
with Member States and other stakeholders prior to the global consultation, led by regional offices: for
the Eastern Mediterranean (Geneva, 28 October); Africa (Geneva, 28 October); South-East Asia
1
Decision WHA67(13) (2014).
2
World report on ageing and health. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/
10665/186463/1/9789240694811_eng.pdf, accessed 3 March 2016).
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(Geneva, 28 October); and the Americas (Geneva, 28 November). Within existing resources, further
consultations took place with key staff at the regional offices for Europe and the Western Pacific and
at WHO headquarters (October).
11. A face-to-face global consultation with 180 participants, including representatives of some
75 Member States, organizations in the United Nations system and international and national partners
such as development agencies, civil society organizations (including organizations of older persons)
and professional associations, was held on 29 and 30 October 2015. All six regional offices
contributed to identifying participants from all stakeholder groups and circulated the first draft widely.
An additional 100 comments on the text of the draft strategy were also received before the end of
October. A detailed timeline of the consultation programme, earlier drafts and informal reports,
including details of participants, are available on the WHO website.
1
12. The Secretariat used the comments made at these informal consultations in preparing the
updated draft global strategy and plan of action on ageing and health, a report on which was
considered and noted by the Executive Board at its 138th session.
2
During the Board’s discussions,
30 Member States covering all WHO regions together with five nongovernmental organizations in
official relations with WHO and one international organization, expressed their appreciation of the
draft strategy and action plan and the inclusive and transparent consultation process. All the strategic
themes and both goals received strong support and implementation was considered a priority in all
regions. The need for further emphasis in a few areas was highlighted, including strengthening gender-
sensitivity in actions, sharing policies and good practices, and being inclusive of dementia, food
security, sexual health and assistive technologies, as well as developing quantifiable indicators to
measure progress over the period 2016−2020 and assessing the resource requirements for work in this
area.
13. In response to Member States’ comments, the Secretariat has made some small adjustments to
the strategy and has strengthened the plan of action in strategic objectives 1.1, 1.3, 2.1, 3.1, 4.1, 4.3,
5.1 and 5.2. The draft strategy and plan of action are contained in the Annex.
14. The draft strategy renews the commitment to focus attention on the needs and rights of older
persons and expands on previous policy instruments, setting this commitment within the new context
of the Sustainable Development Goals. It provides clear objectives and actions for Member States, the
Secretariat, and international and national partners to foster that commitment by all stakeholders; to
create age-friendly environments; to align health systems to older persons’ needs; to develop long-
term care systems; and to advance measuring, monitoring and research for Healthy Ageing.
ACTION BY THE HEALTH ASSEMBLY
15. The Health Assembly is requested to consider the draft global strategy and plan of action on
ageing and health and to endorse it.
1
See http://www.who.int/ageing/global-strategy/en/ (accessed 3 March 2016).
2
See document EB138/16 and the summary record of the 138th session of the Executive Board, sixth meeting
(document EB138/2016/REC/2).
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ANNEX
DRAFT GLOBAL STRATEGY AND PLAN OF ACTION
ON AGEING AND HEALTH
PURPOSE
1. In 2014, the Sixty-seventh World Health Assembly requested the Director-General “to develop,
in consultation with Member States and other stakeholders and in coordination with the regional
offices, and within existing resources, a comprehensive global strategy and plan of action on ageing
and health, for consideration by the Executive Board in January 2016 and by the Sixty-ninth World
Health Assembly in May 2016”.
1
2. This global strategy and plan of action on ageing and health also responds to the recently
endorsed Sustainable Development Goals, an integrated, indivisible set of global priorities for
sustainable development. Ageing is an issue that is relevant to 15 of the 17 Goals, in particular:
• Goal 1. End poverty in all its forms everywhere – for all men and women;
• Goal 2. End hunger, achieve food security and improved nutrition and promote sustainable
agriculture including for older persons;
• Goal 3. Ensure healthy lives and promote well-being for all at all ages through universal
health coverage including financial risk protection;
• Goal 4. Ensure inclusive and equitable quality education and promote lifelong learning
opportunities for all;
• Goal 5. Achieve gender equality and empower all women and girls;
• Goal 8. Promote sustained, inclusive and sustainable economic growth, full and productive
employment and decent work for all;
• Goal 10. Reduce inequality within and among countries, by promoting the social, political and
economic inclusion of all, irrespective of age;
• Goal 11. Make cities and human settlements inclusive, safe, resilient and sustainable by
providing universal access to safe, inclusive and accessible green and public spaces, in
particular for older persons;
• Goal 16. Promote peaceful and inclusive societies for sustainable development, provide
access to justice for all and build effective, accountable and inclusive institutions at all levels.
1
Decision WHA67(13) (2014).
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3. Achieving these ambitious Goals will require concerted action both to harness the many
contributions that older people can make to sustainable development and to ensure they are not left
behind. The strategy frames how this can be achieved through a focus on the functional ability of older
people. This approach can be applied to each Goal, to ensure that the needs and rights of older people
are adequately addressed. For Goal 3, this represents a significant shift from previous global health
priorities, where the emphasis was often on reducing mortality at younger ages. Instead, the focus of
the strategy is on the quality of the extra years that these interventions now allow us to enjoy.
4. The strategy builds on two international policy instruments that have guided action on ageing
and health since 2002 – the Madrid international plan of action on ageing
1
and WHO’s policy
framework on active ageing.
2
Both refer to the right to health and its international legal framework,
highlight the skills and experience of older people and their potential contributions, regardless of
physical and cognitive limitations, and map a broad range of areas where policy action can enable
these contributions and ensure security in older age.
5. However, progress to improve the health of older people since 2002 has been uneven and
generally inadequate. Renewed commitment and more coordinated responses are required. This
strategy therefore expands on these previous instruments to address in detail the actions that are
needed to achieve this. In doing so, it maintains their rights-based approach and looks to tackle the
legal, social and structural barriers that limit health in older age, and to ensure the legal obligations of
State and non-State actors to respect, protect and fulfil these rights are met.
6. The strategy outlines a framework for action that can be taken by all relevant stakeholders
across the 15-year period of the Sustainable Development Goals. It also outlines concrete actions that
can be taken within this framework during the five-year period 2016–2020.
RELATION TO EXISTING STRATEGIES AND PLANS
7. The strategy also draws on five WHO regional strategies and action plans addressing the health
of older people that reflect extensive consultation with Member States and other stakeholders. It adds
value by providing an overall vision and a public health framework for coordinated global action, and
by underlining the importance of Healthy Ageing as a public health priority and the need for Member
States to commit to a sustainable and evidence-informed public health response. The strategy also
reflects, and is complementary to, existing commitments, approaches and platforms such as universal
health coverage, social determinants of health, combatting noncommunicable diseases, disability,
violence and injury prevention, age-friendly cities and communities, strengthening human resources
for health, developing person-centred and integrated care, tackling dementia and ensuring the
provision of palliative care.
1
Political declaration and Madrid international plan of action on ageing. New York: United Nations; 2002
(http://www.un.org/en/events/pastevents/pdfs/Madrid_plan.pdf, accessed 3 March 2016).
2
Active ageing: a policy framework. Geneva: World Health Organization; 2002 (WHO/NMH/NPH/02.8;
http://apps.who.int/iris/bitstream/10665/67215/1/WHO_NMH_NPH_02.8.pdf, accessed 4 December 2015).
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8. The strategy builds on the World report on ageing and health.
1
This articulates a conceptual
model for Healthy Ageing and outlines a public health framework for action to foster it. This
framework was used as the starting point for the extensive consultations that led to the final draft
strategy.
GLOBAL SITUATION
9. Today, for the first time in history, most people can expect to live into their sixties and beyond.
This reflects our successes in dealing with fatal childhood disease, maternal mortality and, more
recently, mortality in older ages. When combined with marked falls in fertility rates, these increases in
life expectancy are leading to equally significant changes in population structure – population ageing.
10. Longer lives are an incredibly valuable resource, both for each of us as individuals and for
society more broadly. Older people participate in, and contribute to, society in many ways, including
as mentors, caregivers, artists, consumers, innovators, entrepreneurs and members of the workforce.
This social engagement may in turn reinforce the health and well-being of older people themselves.
11. Yet the extent of the opportunities that arise from increasing longevity will be heavily
dependent on one key factor – the health of these older populations. If people are experiencing these
extra years in good health and live in a supportive environment, their ability to do the things they
value will have few limits. However, if these added years are dominated by rapid declines in physical
and mental capacity, the implications for older people and for society as a whole are much more
negative. Ensuring the best possible health in older age is therefore crucial if we are to achieve
sustainable development.
12. Unfortunately, there is little evidence to suggest that older people today are experiencing better
health than their parents did at the same age. Furthermore, good health in older age is not equally
distributed, either between or within populations. For example, between countries there is a range of
38 years for life expectancy at birth, 37 years for healthy life expectancy at birth, and 13 years for life
expectancy at age 60 years. Furthermore, over the past two decades the gap in life expectancy at age
60 years between high-income countries and low- and middle-income countries, has grown. Moreover,
levels of capacity within a given population are generally distributed across a social gradient that
reflects the cumulative impact of various social and economic determinants of health experienced
throughout an individual’s life course. One crucial consequence is that in older age the people with the
greatest health needs tend to also be those with the least access to the resources that might help to meet
them. This association has major implications for policy, which will need to be crafted in ways that
overcome, rather than reinforce, these inequities.
13. The failure to ensure that extra years of life are enjoyed in the best possible health is avoidable.
Most of the health problems of older age are linked to chronic conditions, particularly
noncommunicable diseases. Many of these can be prevented or delayed by healthy behaviours and by
the environments that support them. Even if chronic diseases do emerge, their consequences can be
limited through integrated care to strengthen and maintain capacity or reverse declines. And for people
with significant declines in capacity, supportive environments can promote dignity, autonomy,
1
World report on ageing and health. Geneva: World Health Organization; 2015
(http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf, accessed 4 December 2015).
Annex A69/17
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functioning and continued personal growth. Yet the world is very far from this ideal, particularly for
poor older people and those from disadvantaged social groups.
14. A comprehensive response to foster Healthy Ageing is urgently needed.
Healthy Ageing
15. The changes that constitute and influence ageing are complex. At a biological level, the gradual
accumulation of a wide variety of molecular and cellular damage leads to a gradual decrease in
physiological reserves, an increased risk of many diseases and a general decline in capacity. But these
changes are neither linear nor consistent, and they are only loosely associated with age in years. Thus,
while some 70-year-olds may enjoy good physical and mental capacity, others may be frail and require
significant support to meet their basic needs.
16. Beyond these biological losses, older age frequently involves other significant changes,
including shifts in roles and social positions. Although some of these changes may be driven by
adaptation to loss, others reflect ongoing psychological growth in older age that may be associated
with the development of new viewpoints and social contexts. In developing a public health response to
ageing, it is therefore important to consider strategies that reinforce resilience and psychosocial
growth. Since cultural norms that cast older age as an inevitable period of decline can operate against
these efforts, it will also be important to challenge many of the stereotypes that currently define what it
is to be “old”.
17. This strategy frames this response through the concept of Healthy Ageing, which is described in
detail in the World report on ageing and health. This is defined as “the process of developing and
maintaining the functional ability that enables well-being in older age.” This functional ability is
determined by the intrinsic capacity of the individual (i.e. the combination of all the individual’s
physical and mental – including psychosocial – capacities), the environments he or she inhabits
(understood in the broadest sense and including physical, social and policy environments), and the
interaction between these.
18. Healthy Ageing is a process that spans the entire life course and that can be relevant to
everyone, not just those who are currently free of disease. 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. These in turn are strongly influenced by the
environments in which people have lived throughout their lives. Since the relationship that a person
has with these environments is itself strongly influenced by factors such as his or her gender and race,
these personal characteristics are also strongly associated with capacity at any point in time.
19. But intrinsic capacity is only one of the dimensions of older people’s functioning. The
environments they inhabit and their interaction with them are also major determinants of what older
people with a given level of capacity can do. These environments provide a range of resources or
barriers that will ultimately decide whether older people can engage in activities that matter to them.
Thus, while older people with severe osteoarthritis may have limited intrinsic capacity, they may still
be able to do the shopping if they have access to an assistive device (such as a walking stick,
wheelchair or scooter) and live close to affordable and accessible transport.
20. This conceptualization of Healthy Ageing reflects an individual’s accumulation of strengths or
deficits across the life course. Actions to improve trajectories of Healthy Ageing can thus take place at
any age and will be needed at multiple levels and in multiple sectors. Since much of the work of WHO
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addresses what can be done at younger ages, this strategy focuses on what can be done for people in
the second half of their lives.
21. In doing so, it pays particular attention to the significant influence of gender norms, both on
older people’s Healthy Ageing trajectories and on the impact their ageing may have on their families
and communities. For example, gender is a powerful influence on many health-related behaviours and
exposures across the life course. As a consequence, women tend to live longer than men but generally
experience poorer health throughout their lives and have higher rates of poverty. Moreover, when an
older person experiences significant losses of capacity, the family often plays a key role in providing
the care and support that are required. These unpaid and often under-respected caregiving roles are
frequently filled by women and can limit their participation in the workforce or in education. This can
be at a significant cost to their own well-being in older age, since it can limit the building of pension
entitlements and access to health insurance and increase the risk of poverty and other insecurity.
GUIDING PRINCIPLES
22. The strategy starts from an assumption that ageing is a valuable, if often challenging, process. It
considers that it is good to get old and that society is better off for having older populations. At the
same time, it acknowledges that many older people will experience very significant losses, whether of
physical or cognitive capacity or of family, friends and the roles they had earlier in life. Some of these
losses can be avoided, and we should do what we can to prevent them. But others will be inevitable.
Societal responses to ageing should not deny these challenges but seek to foster recovery, adaptation
and dignity.
23. This will require transformative approaches that recognize the rights of older people and enable
them to thrive in the complex, changing and unpredictable environment they are likely to live in now
and in the future. However, rather than being prescriptively designed around what older people should
do, the strategy aims to foster the ability of older people themselves to invent the future in ways that
we, and previous generations, might never have imagined.
24. These approaches must foster the ability of older people to make multiple contributions in an
environment that respects their dignity and human rights, free from gender- and age-based
discrimination. Principles that underpin the strategy therefore include:
• human rights, including the right that older people have to the best possible health and its
accountable, progressive realization;
• gender equality;
• equality and non-discrimination, particularly on the basis of age;
• equity (equal opportunity to the determinants of healthy ageing that does not reflect social or
economic status, place of birth or residence or other social determinants);
• intergenerational solidarity (enabling social cohesion between generations).
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VISION, GOALS AND STRATEGIC OBJECTIVES
25. The strategy’s vision is a world in which everyone can live a long and healthy life. This world
will be a place where functional ability is fostered across the life course and where older people
experience equal rights and opportunities and can live lives free from age-based discrimination.
VISION
A world in which everyone can live a long and healthy life
STRATEGIC OBJECTIVES
1. Commitment to action on Healthy Ageing in every country
2. Developing age-friendly environments
3. Aligning health systems to the needs of older populations
4. Developing sustainable and equitable systems for providing long-term care (home, communities and
institutions)
5. Improving measurement, monitoring and research on Healthy Ageing
PLAN OF ACTION 2016–2020
GOALS
1. Five years of evidence-based action to maximize functional ability that reaches every person.
2. By 2020, establish evidence and partnerships necessary to support a Decade of Healthy Ageing from
2020 to 2030
26. Five strategic objectives are identified. The first two, Commitment to action on Healthy Ageing
in every country and Developing age-friendly environments, reflect the multiple and intersectoral
influences that impact on Healthy Ageing. They also shape the broader context in which more focused
action can be taken by the health and social care sectors. This action is addressed in strategic
objectives 3 and 4, Aligning health systems to the needs of older populations, and Developing systems
for providing long-term care (home, communities and institutions). While the strategy identifies these
two objectives separately, to facilitate specific sectoral actions, they need to be considered as part of
an integrated continuum of care. The final strategic objective, Improving measurement, monitoring
and research on Healthy Ageing, addresses the actions that are needed to help build the evidence base,
which can ensure that all actions have the intended impacts, are equity-oriented and cost-effective.
Together the five strategic objectives are interlinked, interdependent and mutually supportive, and they
are aligned to this vision for Healthy Ageing. Each of the five strategic objectives comprises three
priority areas for action.
27. The proposed contributions that Member States, the Secretariat and other partners can make
towards this vision and these strategic objectives during the period 2016–2020 are outlined in
Appendix. They are framed under two goals. While there are many significant gaps in our
understanding of the factors that can foster Healthy Ageing, in many fields there is sufficient evidence
to identify action that can be taken now to help achieve this vision. The first goal, “Five years of
evidence-based action to maximize functional ability that reaches every person”, is therefore framed
around ensuring that this action is taken as widely as possible and in ways which ensure that particular
attention is paid to those with the least access to the resources they need to maintain their functional
ability.
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28. However, the World report on ageing and health acknowledges the lack of evidence and
infrastructure in many crucial areas. The second goal, “By 2020, establish evidence and partnerships
necessary to support a Decade of Healthy Ageing from 2020 to 2030”, seeks to use the five-year
period 2016–2020 to fill these gaps and ensure that Member States and other stakeholders are
positioned to undertake a decade of evidence-informed, concerted action from 2020 to 2030.
STRATEGIC OBJECTIVE 1: COMMITMENT TO ACTION ON HEALTHY
AGEING IN EVERY COUNTRY
29. Fostering Healthy Ageing requires leadership and commitment. Investment in the well-being of
older people will have significant economic and social returns. In some cases, the return on these
investments is direct. For example, investment in health systems that are better aligned to the needs of
older people will result in them experiencing greater intrinsic capacity, which, in turn, will enable
them to participate and contribute more actively. Other returns may be less obvious but are no less
important. For example, investing in long-term care helps older people with a significant loss of
capacity to maintain lives of dignity and continued personal growth, but it can also protect families
from impoverishment, allow women to remain in the workforce and foster social cohesion through the
sharing of risk across a community. Much of the investment in infrastructure or policy to foster
Healthy Ageing will also have direct benefits for other sections of the population. For example,
improved access to transportation, public buildings and spaces, or assistive, information and
communication technologies can facilitate inclusion and participation of all people, including those
with disabilities and parents with young children. More integrated and person-centred health systems
will benefit everyone.
30. Enabling all people to live a long and healthy life requires a multisectoral approach with strong
engagement from diverse sectors and different levels of government. Collaboration is also needed
between government and nongovernmental actors, including service providers, product developers,
academics and older people themselves. A key step to fostering action must therefore be to build the
coalitions and shared understanding that can enable this multisectoral commitment.
31. However, this strategy does not propose that action on Healthy Ageing is necessarily undertaken
as an independent programme of work. In many cases, the most effective approach will be to integrate
evidence-based actions within the work of other health programmes and partnerships, or within other
sectors’ policies and laws, for example those dealing with housing, transportation, social protection,
education and employment. But action on Healthy Ageing will not happen by itself. It requires
leadership, coordination and a far greater understanding of the aspirations, potential and needs of an
increasingly large segment of all populations. This commitment can establish the broad political and
operational platform that enables, and gives legitimacy to, effective multidimensional action. A central
responsibility of this leadership and commitment will be to ensure that older people and their
representative organizations are informed, consulted and actively involved in formulating,
implementing and monitoring policies and laws that affect them.
32. The strategy does however propose that a fundamental step in fostering Healthy Ageing is to
combat ageism. Some of the most important barriers to action and effective public health policy on
Healthy Ageing are pervasive misconceptions, negative attitudes and assumptions about ageing and
older people. These can influence individual behaviour (including that of older people themselves),
social values and norms. They can also sway the focus of research and policy on ageing and health by
shaping the conceptualization of problems and potential solutions, and the way in which institutions
develop and implement rules and procedures. Unless ageism is tackled and these fundamental beliefs
and processes are changed, our capacity to seize innovative opportunities to foster Healthy Ageing
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will be limited. This will require diverse actions including legislation, interventions to shift social
norms, and education.
33. This strategic objective therefore focuses on creating national and regional frameworks for
action, enabling Member States to access and use existing evidence and making concrete efforts to
tackle ageism as an essential step in fostering Healthy Ageing.
Strategic objective 1.1: Establish national frameworks for action on Healthy Ageing
34. Governance is not just about government but extends to its relationship with the private sector,
nongovernmental organizations and civil society. However, as the ultimate guardian of ensuring that
people live long and healthy lives, governments, across their various administrative levels, have the
responsibility to put in place appropriate policies, financial arrangements and accountability
mechanisms. This needs to occur across all sectors and at different level of government.
35. Clear and evidence-informed national and regional strategies or policies that address ageing and
health are needed. Effective governance of Healthy Ageing also requires the development of
legislation, evidence-based policies and plans, whether as independent documents or integrated across
health and other sectors, that pay explicit attention to equity and the inherent dignity and human rights
of older people. These must adopt a rights-based approach to development and systematically
incorporate the views of older people. As such, these plans need to be linked to effective coordination
and accountability mechanisms, to ensure their implementation. They can be reinforced by a strong
civil society, particularly associations of older people and families and carers, which can help to create
more effective and accountable policies, laws and services for Healthy Ageing. Action will also
benefit from the evaluation and sharing of experiences to support Healthy Ageing across countries.
Strategic objective 1.2: Strengthen national capacities to formulate evidence-based
policy
36. Although there are major knowledge gaps, we have sufficient evidence to act now, and there is
something that every country can do irrespective of its current situation or level of development. To
ensure that action is informed by evidence, policy-makers need to be aware of key research findings
and be empowered to include them in policy development. This will require more effective
mechanisms to bridge the divide between how knowledge is generated and how it is used. These
mechanisms include: considering the policy context, such as the role of institutions, political will,
ideas, interests; facilitating evidence and knowledge creation that is relevant and timely, and
conducting relevant research on ageing and health for use in that policy context, including cost–
effective health system interventions applicable to the local setting; communicating better and making
research findings accessible to decision-makers, by synthesizing and packaging the evidence in a way
that policy-makers can use; and empowering decision-makers to use this information through a culture
that values evidence and its uptake.
37. One mechanism for fostering this translation of knowledge into policy and practice is policy
dialogues that draw together existing evidence and assess its relevance to national priorities. It will be
important to involve civil society, representing diverse age groups and interests, in these processes, to
shape policy development and implementation in line with social expectations.
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Strategic objective 1.3: Combat ageism and transform understanding of ageing and
health
38. Combating ageism must lie at the core of any public health response to population ageing.
While this will be challenging, experience of dealing with other widespread forms of discrimination
such as sexism and racism shows that attitudes and norms can be changed. Combating ageism
requires, at the institutional level, the adoption of laws to protect against age-based discrimination, the
modification or repeal of laws, customs or practices that discriminate directly or indirectly, as well as
the establishment of other appropriate administrative measures where needed. A key feature will be to
break down arbitrary age-based categorizations (such as labelling those over a certain age as old).
These overlook the great diversity of ability at any given age and can lead to simplistic responses
based on stereotypes of what that age implies. Removing these restrictive social constructs can
reinforce the view that, while older age will often entail losses, it can also be a period of personal
growth, creativity and productivity.
39. Combating ageism also requires a new way of understanding ageing and health that moves away
both from the conceptualization of older people as a burden and from unrealistic assumptions that
older people today have somehow avoided the health challenges of their parents and grandparents.
More accurate portrayals of ageing and health will adopt a life course perspective and seek to increase
trust and break down barriers between generations, while providing a sense of common identity and
respect for differences. Core strategies include communication campaigns that directly challenge
ageism and concerted efforts in the media and entertainment to present a balanced view of ageing.
40. Another key step in challenging ageism will be to consolidate evidence on the current roles and
needs of older people. New economic models are required that comprehensively assess the total
contributions of older people; the cost of care provision (not just to public services but to the informal
carers who often provide it); and the benefits of interventions to foster Healthy Ageing on older
people’s functioning, on their contributions and on society more broadly (for example on the need for
care). The evidence generated will provide an ongoing reference for subsequent public discourse.
STRATEGIC OBJECTIVE 2: DEVELOPING AGE-FRIENDLY ENVIRONMENTS
41. Environments are the contexts in which people live their lives. Environments that are age-
friendly help to foster Healthy Ageing in two ways: by supporting the building and maintenance of
intrinsic capacity across the life course, and by enabling greater functional ability so that people with
varying levels of capacity can do the things they value.
42. Actions to create age-friendly environments can target different contexts (the home or
community, for example) or specific environmental factors (such as transport, housing, social
protection, streets and parks, social facilities, health and long-term care, social attitudes and values),
and they can be influenced at different levels of government (national, regional or local). When actions
also take into consideration social exclusion and barriers to opportunity, these efforts to build and
maintain functional ability can also serve to overcome inequities between groups of older adults.
43. The WHO global network of age-friendly cities and communities provides a good example of
how age-friendly environments can be successfully implemented at local level. The network brings
together municipalities from across the world that, through multisectoral action, are making their
environments better places for older people to live. By taking the needs and preferences of older
people as a starting point for shaping age-friendly environments, rather than looking only at a service
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or adopting a supply-side perspective, they ensure that specific approaches are relevant to local
populations.
44. When age-friendly actions are coordinated across multiple sectors and levels, they can enhance
a range of domains of functional ability, including the “abilities” to meet basic needs; to be mobile; to
continue to learn, grow and make decisions; to build and maintain relationships; and to contribute.
When multiple sectors and stakeholders share a common goal of fostering functional ability and shape
development in ways that foster these specific abilities, this can help ensure that older people age
safely in a place that is right for them, are free from poverty, can continue to develop personally and
can contribute to their communities while retaining autonomy and health. This approach is equally
relevant in emergency situations.
45. However, while population-level interventions such as accessible transportation may provide a
resource for all older people, some will not be able to benefit fully without individually tailored
supports that foster their autonomy and engagement. For example an older woman’s ability to be
mobile may be determined by her desire to get out and about, and the availability of specific mobility
devices which correlate to her need (walker, wheelchair, etc.), as well as the level of accessibility and
safety of footpaths, buildings, lighting, and the kindness of the bus driver or other passengers to help
her get on or off the bus.
46. This strategic objective outlines approaches to maximize older people’s participation, with a
focus on fostering autonomy and enabling their engagement. Because multisectoral action is required
to achieve these, the third approach suggests how sectors can efficiently work together for the greatest
impact.
Strategic objective 2.1: Foster older people’s autonomy
47. Autonomy has been repeatedly identified by older adults as a core component of their well-
being and has a powerful influence on their dignity, integrity, freedom and independence. Older adults
have the right to make choices and take control over a range of issues, including where they live, the
relationships they have, what they wear, how they spend their time, and whether they embark on a
treatment. Nevertheless, many older adults – particularly women − do not yet enjoy these
opportunities across the life course. These fundamental rights and freedoms must exist regardless of
age, sex or level of intrinsic capacity, including in emergency situations and institutional care, and
need to be enshrined in law (addressed in strategic objective 1).
48. Autonomy is shaped by many factors, including the capacity of older people; the environments
they inhabit; the personal resources (such as relationships with children and other family members,
friends, neighbours and broader social networks) and financial resources they can draw on; and the
opportunities available to them. Autonomy is heavily dependent both on an older person’s basic needs
being met and on access to a range of services, such as transport and lifelong learning (addressed in
strategic objective 2.3). Older people’s autonomy can be particularly compromised in emergency
situations, if appropriate action is not taken.
49. Enhancing autonomy regardless of an older person’s level of capacity can be achieved through a
range of mechanisms, including advanced care planning, supported decision-making and access to
appropriate assistive devices. When adapted to the individual and his or her environments, both of
which may change over time, these mechanisms can enable older people to retain the maximum level
of control over their lives. Other actions that impact directly on older peoples’ autonomy include
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protecting and ensuring their human rights through awareness-raising, legislation and mechanisms to
address breaches of these rights.
50. As outlined in the World report on ageing and health, one key threat to autonomy is elder
abuse, which currently affects 1 in 10 older people living in the community and an even higher
proportion living in institutions. Another threat to autonomy is falls. Some 30% of people older than
age 65, and 50% of people older than age 85, living in the community will fall at least once each year.
Specific actions are therefore required to protect older people’s rights to freedom from injury, violence
and abuse.
Strategic objective 2.2: Enable older people’s engagement
51. Engaging older people in development processes can help to build societies that are cohesive,
peaceful, equitable and secure. Excluding them from these processes not only undermines their well-
being and contributions, it can also impact heavily on the well-being and productivity of other
generations. For example, older people make numerous social and economic contributions to their
families, communities and society such as assisting friends and neighbours, mentoring peers and
younger people, caring for family members and the wider community, and as consumers, workers and
volunteers. Enabling the participation of older people must therefore be a central goal of
socioeconomic development, and ensuring that they can engage in and benefit from these processes is
essential.
52. Investing in older people through community groups, organizations of older people and self-
help groups, for example, can facilitate older people’s engagement. When these organizations are
suitably developed and funded, they can also play an important role in service delivery, including in
emergency situations, by for instance identifying older people at risk of isolation and loneliness,
providing information, peer support and long-term care, and ensuring that older people have the
opportunity to continually build and maintain the skills they need to navigate, benefit from and
influence a changing world.
Strategic objective 2.3: Promote multisectoral action
53. Most policies, systems or services have a direct impact on older people’s ability to experience
Healthy Ageing. The way in which these are delivered is also likely to have differential impacts on
older people and their families.
54. No sector alone can foster the functional ability of older people. The ability to be mobile, for
instance, is influenced directly by sectors responsible for transportation, urban planning, housing,
information, health and social welfare. Working together can have important efficiency gains, as
action in one arena may reduce the need for others. Making housing modifications or providing
assistive technologies, for example, may reduce the need for long-term care.
55. National or regional strategies and action plans on Healthy Ageing, as outlined in strategic
objective 1, can provide a framework for action by relevant stakeholders. However, concrete and
concerted actions need to be taken within and across sectors, if these frameworks are to have a positive
impact on the functional ability of older people. Furthermore, these efforts need to encompass the
diverse multisectoral programmes and initiatives that are required to foster functional ability,
including developing and sustaining social protection systems, improving access to adequate housing,
enabling lifelong learning, delivering effective health and long-term care, and fostering older people’s
contributions in the labour force, through volunteering and other social roles. Implementation of these
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programmes and initiatives will naturally vary from setting to setting, between levels of government
and depending on the situation (for example, in contexts affected by disasters or not).
56. Collecting and using age- and socioeconomic-disaggregated information on older people’s
functional abilities is important to document inequalities and address inequities, and to assess the
effectiveness of and gaps in existing policies, systems, and services in meeting the needs and rights of
all older people. Having access to information and good practice are also important for governments
and other key stakeholders to support the implementation of action plans, advocate for action and
generate political and technical support for implementation.
STRATEGIC OBJECTIVE 3: ALIGNING HEALTH SYSTEMS TO THE NEEDS OF
OLDER POPULATIONS
57. As people age, their health needs tend to become more chronic and complex. Health systems
and services that address these multidimensional needs in an integrated way have been shown to be
more effective than services that simply react to specific diseases independently. Yet many existing
systems are better designed to cure acute conditions, continue to manage health issues in disconnected
and fragmented ways, and lack coordination across care providers, settings and time. This results in
health care and other services that not only fail to adequately meet the needs of older people but also
lead to significant and avoidable costs, both for older people and for the health system. Where services
do exist, there are frequently barriers that limit older people’s access to them, such as lack of transport,
unaffordability and ageism in health care delivery.
58. Problems that matter for older people, such as pressure ulcers, chronic pain and difficulties with
hearing, seeing, walking or performing daily or social activities, are often overlooked by health
professionals. In primary health care, the clinical focus still generally remains on detection and
treatment of diseases; because these problems are not framed as diseases, health care providers may
not be aware how to deal with them, and frequently lack guidance or training in recognizing and
managing impairments and geriatric syndromes. This leads to older people disengaging from services,
not adhering to treatment or not admitting themselves to primary health care clinics, based on the
belief that there is no treatment available for their problems. Further early markers of functional
decline, such as decreases in gait speed or muscle strength, are often not identified, treated or
monitored, which is crucial for delaying and reversing declines in capacity. New approaches and
clinical intervention models need to be introduced at primary health care level, if the aim is to prevent
care dependence and maintain intrinsic capacity.
59. A transformation is needed in the way that health systems are designed, to ensure affordable
access to integrated services that are centred on the needs and rights of older people. These systems
will need to respond to the diverse needs of older people, including those who are experiencing high
and stable levels of intrinsic capacity, those in whom capacity is declining, and those whose capacity
has fallen to the point where they require the care and support of others.
60. This can be achieved through the common goal of helping older people to build and maintain
the best possible functional ability at all stages of life. It will require coordination between a wide
range of services, including health promotion and disease prevention; screening, early detection and
acute care; ongoing management of chronic conditions; rehabilitation and palliative care. Coordination
between different service levels and between health and social services will be crucial. Where an older
person’s capacity has fallen, provision of assistive technologies is also likely to be important.
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61. As a first step, services will need to be designed around older people’s needs and preferences.
This can best be achieved by involving older people themselves in service planning. Many practical
issues will need to be considered, including the difficulty that older people may have waiting in a
queue or standing for prolonged periods, as well as the need for adequate toilets. Furthermore, services
and staff need to treat older people with the respect they deserve, and this will include communicating
in ways that are effective and that take account of common visual and hearing impairments.
Strategic objective 3.1: Orient health systems around intrinsic capacity and functional
ability
62. Building systems that enable the best possible trajectories of functional ability across the life
course will require the fundamental drivers of systems to be aligned to this shared goal. This will
require significant changes to the collection, recording and linkage of health and administrative
information, which is currently often condition- or intervention-based. Information on trajectories of
functioning can be readily drawn from the assessments of ability and capacity that are the starting
point for older person-centred and integrated care and should be routinely collected at each encounter
with the system. Mechanisms are needed to automate the storage of this information, to allow trends in
functioning over time to be routinely determined. This can benefit clinical practice, but in the future it
could also form the basis for performance management and financing mechanisms. For example, the
remuneration of and incentives for care providers could be oriented towards enabling the best possible
trajectories of functioning, rather than the provision of specific interventions.
63. In many settings, other fundamental building blocks of services will also need to be reviewed, to
ensure that older people have access to the care they need. For example, the medical products and
assistive devices that are necessary to optimize older people’s intrinsic capacities and functional ability
will need to be identified and made accessible. While intraocular lenses that are used in surgery for
cataracts may seem a luxury in low-resource settings, surgery can be completed in a few minutes
under local anaesthetic and can make the difference between older people retaining their autonomy or
becoming dependent on the care of others.
64. Harnessing technological innovations (including assistive technologies and information and
communication technologies) may be particularly useful, and this is true in clinical, home and
community settings. Technological innovation, or the convergence of existing technologies, may also
help lower-resource countries to develop service models that “leapfrog” models delivered in other
settings.
65. Since many of the disorders of older age are preventable, and many of their determinants begin
earlier in life, systems will need to include effective strategies for the prevention of disease and
declines in capacity. At younger ages, and when capacity is high, the priority will be on preventing the
common noncommunicable diseases by enabling physical activity and good nutrition, avoiding
tobacco and fostering the responsible use of alcohol. These factors remain important throughout life,
but if capacity starts to decline, other approaches that help older people to avoid or delay care
dependence begin to emerge. New models of health promotion and disease prevention in older age are
needed, to ensure these strategies are evidence-based. Much of the resulting action will be situated in
the environments that an older person inhabits.
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Strategic objective 3.2: Develop and ensure affordable access to quality older person-
centred and integrated clinical care
66. The entry point to older person-centred and integrated care is a strong case management system,
in which individual needs are assessed and a comprehensive personalized care plan is developed
around the single goal of maintaining functional ability. These plans should be designed to consider
the older person’s preferences and objectives, how they can best be addressed and how progress will
be followed up. A key aim will be to foster self-management by providing peer support, training,
information and advice, both to older people and to their caregivers.
67. Mechanisms to ensure that older people can access services without financial burden will be
crucial. Sustainable financing models are urgently needed to underpin the comprehensive and
integrated services that older people require. These should consider the need to minimize out-of-
pocket spending and fragmentation within the health system.
68. Integration and a focus on ability do not mean that services and interventions for the key
conditions of older age should be neglected. These include musculoskeletal and sensory impairments;
cardiovascular disease and risk factors such as hypertension and diabetes; mental disorders, dementia
and cognitive declines; cancer, oral health and geriatric syndromes such as frailty, urinary
incontinence, delirium and falls. Continued research is needed to improve the treatments available for
each of these conditions, and processes should be established to ensure that research findings are
translated into practice. But the management of each of these conditions will need to be coordinated
around the functional ability of the older person. It will also need to take account of the comorbidities
common in older age, the associated risk of polypharmacy, and the combined impacts that they have
on functioning. This may require the development of new clinical guidelines on how to optimize
trajectories of intrinsic capacity, or the updating of existing guidelines on specific conditions to
consider their impact on capacity. Services that enable recovery from declines in capacity will also be
important, as will ensuring that all older people who need it have access to palliative care.
69. Furthermore, not all the health challenges experienced in older age are chronic. Older people
can suffer rapid deteriorations in health as a result of a minor acute illness or exacerbation of an
existing condition. Frail older people in particular thus require timely access to acute and specialist
geriatric care. Moreover, older people in general retain the need for mental health and sexual health
services, including the prevention and treatment of sexually transmitted infections, and as part of
wider efforts to ensure and promote and protect rights and freedoms for all.
70. To enable older people to age in a place that is right for them, services should be situated as
close as possible to where they live, including delivering services in their homes and providing
community-based care.
Strategic objective 3.3: Ensure a sustainable and appropriately trained, deployed and
managed health workforce
71. All service providers require the competencies appropriate to addressing older people’s needs.
These include gerontological and geriatric skills, as well as the more general competencies that are
needed to provide integrated care, such as the ability to share information using information and
communication technologies, combat ageism and provide self-management support. By its nature, the
clinical care of older people requires the involvement of multidisciplinary teams, and competencies in
working in this environment will also be essential, whether providers work in hospital or community
settings.
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72. Ensuring an adequately trained workforce will first require the nature, quantity and
characteristics of these competencies to be defined. They should then be included in the curricula of all
health professionals. Existing service providers are likely to require professional development to
achieve them.
73. Ensuring that the supply of geriatricians meets population needs and encouraging the
development of specialized units for the management of complex cases will also be important. This
can ensure the appropriate treatment of more complex cases and can be a vehicle for research to
identify better models of care.
74. New workforce cadres (such as care coordinators and self-management counsellors) and career
paths will also need to be considered, as will options for extending the roles of existing health
workers, whether paid or unpaid, working in institutions or in communities. In many countries, one
challenge that will need to be faced will be the ageing of the health workforce. Employment models
that foster retention of these skilled workers will need to be explored.
STRATEGIC OBJECTIVE 4: DEVELOPING SUSTAINABLE AND EQUITABLE
SYSTEMS FOR LONG-TERM CARE
75. In many people’s lives there will come a stage when they experience a significant loss of
capacity. This is particularly true in older age. As part of the right to health, older people with, or at
high risk of, a loss of capacity have a right to receive care and support that maintains the best possible
level of functional ability and that is consistent with their human rights, fundamental freedoms and
human dignity.
76. Worldwide, the number of older people requiring care and support is increasing rapidly. At the
same time, the proportion of younger people who might be able to provide this care is falling, and
women, the traditional caregivers within many families, are already filling, or aspiring to, other social
and economic roles. As a result, the assumption that families alone can meet the needs of older people
with significant losses of capacity is outdated and neither sustainable nor equitable.
77. In the 21st century, therefore, every country needs to have a comprehensive system for long-
term care that can be provided at home, in communities or within institutions. These systems have
many benefits beyond enabling care-dependent older people to continue to do what they value and to
live lives of dignity. These include freeing women to pursue what they value, reducing inappropriate
use of acute health services and helping families avoid poverty and catastrophic care expenditures. By
sharing the risks and costs associated with care dependence across generations, long-term care systems
can thus help foster social cohesion.
78. In framing how this can be achieved, the strategy adopts the definition of long-term care used in
the World report on ageing and health – “The activities undertaken by others to ensure that people
with or at risk of a significant ongoing loss of intrinsic capacity can maintain a level of functional
ability consistent with their basic rights, fundamental freedoms and human dignity”.
79. Two key principles underpin this definition. First, even in circumstances of significant loss of
functioning, older people still “have a life”. They have the right and deserve the freedom to realize
their continuing aspirations to well-being, meaning, and respect. Second, as with other phases of life,
intrinsic capacity during this period is not static. Rather, declines in capacity are part of a continuum
and in some cases may be preventable or reversible. Fully meeting the needs of someone at this stage
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of life therefore demands that efforts be made to optimize these trajectories of capacity, thus reducing
the deficits that will need to be compensated for through other mechanisms of care.
80. Each country needs to develop a system that takes account of its economic and cultural context,
and which can take advantage of existing health and social care delivery systems in ways that foster
intergenerational equity. There is no single system of long-term care that can be applied in every
setting, nor even in countries with similar resource constraints. Long-term care systems should be
based on an explicit partnership between older people, families, communities, other care providers,
and both the public and private sectors.
81. A key role of government is to steward these partnerships and to build a consensus on the
system that is most appropriate. Furthermore, governments in all settings also have a role to play in
ensuring that the numerous components of the system are in place, including a sound regulatory
framework, training and support for caregivers, coordination and integration across various sectors
(including with the health system), and mechanisms such as accreditation and monitoring to ensure
quality. In many countries, the public sector will also directly provide services, particularly to those
most in need (either because of their loss of capacity, their socioeconomic status or marginalization).
Strategic objective 4.1: Establish and continually improve a sustainable and equitable
long-term-care system
82. Establishing a sustainable system requires a governance structure that can guide and oversee
development and assign responsibility for making progress. This can help define the key services and
roles, their expected benefits and who should deliver them, as well as the barriers that may exist to
their being fulfilled. A key focus would be on developing the system in ways that help older people to
age in a place that is right for them and to maintain connection with their community and social
networks, and that are aligned to people’s needs through the provision of person-centred, integrated
care (including with the health system). As a part of universal health coverage, ensuring access to this
care without the risk of financial hardship for the older person, caregiver or family, will require
resourcing and a commitment to prioritize support for those with the greatest health and financial
needs.
83. A number of actions may help in achieving these aims. A clear recognition that long-term care
is an important public health priority will be central. This can be linked to acknowledging the right of
older people with significant losses of capacity to appropriate care and support, and anchoring this in
national legislation to ensure access to quality services, with special attention to poor and marginalized
older people. It will also be crucial to identify responsibility for system development and to initiate or
review planning, defining the roles of government and other stakeholders and identifying the
approaches that will be necessary to fulfil these roles, such as regulation, incentives and monitoring.
Finally, sustainable and equitable mechanisms for resourcing and support will need to underpin any
system, and these will need to be identified and developed.
Strategic objective 4.2: Build workforce capacity and support caregivers
84. A comprehensive long-term care system will require all who contribute to it to be adequately
skilled and appropriately supported. Many of the actions outlined under strategic objective 3.5 will be
relevant for training providers of long-term care services. However, because the field of long-term
care is undervalued in most countries, a crucial action will be to ensure that paid caregivers are
accorded the status and recognition that their contribution deserves. Furthermore, unlike in the health
system, the majority of caregivers in the long-term care system are currently family members,
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volunteers, members of community organizations, or paid but often untrained workers. Many of them
are, themselves, older people and most are women. Special efforts will be needed to ensure that all
these caregivers have access to the resources, information and/or training they need to perform their
role. This will ensure that older people receive the best possible care and relieve caregivers of the
stress that arises from being insufficiently informed and skilled in how to deal with challenging
situations. Other mechanisms that can ease the load on caregivers include the provision of respite care
and of flexible working arrangements or leaves of absence for members of the workforce.
85. Extending the current workforce will also be important. An adequately skilled and appropriately
supported workforce will help retain care workers. One important possibility lies in the greater
engagement of men and younger people, as well as of non-family members such as peers. Another is
to draw on older volunteers who have been empowered through older people’s associations. Good
examples exist in many low- and middle-income countries, and these concepts and good practices may
be transferrable across countries and settings.
Strategic objective 4.3: Ensure the quality of person-centred and integrated long-term
care
86. Long-term care services need to be oriented around the functional ability and well-being of
older people. This requires systems and caregivers to provide care in a way that both supports the best
attainable trajectory of intrinsic capacity and compensates for loss of capacity through support, care
and environmental action to maintain functional ability at a level that ensures well-being and allows an
older person to age in a place that is right for them. This can be achieved through care that is
integrated across many professions and settings, as well as condition- and care-specific services
(dementia and palliative care, for example). Using innovative assistive health technologies or drawing
on existing technologies in innovative ways for coordination, support and monitoring may be
particularly important.
87. Ensuring the quality and effectiveness of this care requires appropriate guidelines, protocols and
standards. It will also need mechanisms to accredit care providers (both institutional and professional),
protect the rights of recipients, and monitor and evaluate the impact of long-term care provision on
recipients’ functional ability and well-being.
88. A key step will be to identify models of long-term care in different settings that have the
greatest impact on Healthy Ageing trajectories. Coordination across and between services (including
between long-term care and health care services) can be facilitated through case management. Quality
management systems that identify critical care points, with a focus on optimizing functional ability
and well-being, will also be required. These will need to be underpinned by mechanisms to protect the
rights and autonomy of care recipients.
STRATEGIC OBJECTIVE 5: IMPROVING MEASUREMENT, MONITORING AND
RESEARCH FOR HEALTHY AGEING
89. Progress on Healthy Ageing will require more research and evidence on age-related issues,
trends and distributions, and on what can be done to promote Healthy Ageing across the life course.
Many basic questions remain to be answered. These include:
What are older people’s needs and preferences? How diverse are these? What are the Healthy
Ageing outcomes that people value and want societies to contribute to?
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What are current patterns of Healthy Ageing? Is increasing life expectancy associated with
added years of health?
What are the determinants of a long and healthy life, including structural, biological, social,
individual or systems-related determinants? For example, what environmental features make a
difference for Healthy Ageing outcomes? What biological or cellular advances can be made
accessible and relevant to the widest range of people, particularly those with least resources?
What are the current needs of older people for health care and long-term care, and are they
being appropriately met? How do we know whether someone has retained their autonomy?
How should differences in Healthy Ageing be measured, especially differences that are relevant
for policy and action?
Are inequalities increasing or narrowing? For each context, what inequalities are inequities?
Which interventions improve trajectories of Healthy Ageing, and in which contexts and
population subgroups do they work?
Are the availability, effectiveness and coverage of these interventions improving?
What is the appropriate timing and sequencing of these interventions in diverse contexts?
How can clinical research approaches be improved to generate information on the effectiveness
and cost–effectiveness of therapies in older people or people with comorbidities?
What are the attributes of an age-friendly environment? Which interventions work to create
more age-friendly environments?
What are the economic and other contributions of older people? What are the total costs of
losses of functional ability in older age on the individual older person, his or her family and
community? What is the return on investments in health services, social care and other forms of
social protection for older people?
What are the best and most sustainable investments to foster Healthy Ageing across the life
course?
90. Addressing these and other questions requires research in a range of disciplines that will be
relevant to multiple sectors, with evidence produced in a way that can inform policy choices. It will
require thorough evaluations of policies and interventions that are put in place. One fundamental step
will be to understand the needs, rights and expectations of older people and their families. Another
will be to better understand the interactions that older men and women have with their communities,
social networks, the health and social sectors, and the broader environment. This will require
qualitative and quantitative studies that document how these differ by socioeconomic or other
characteristics, including gender and place of residence, and how these relationships have changed
over time.
91. Historically, many data collection efforts have excluded older people or aggregated data above a
certain age, for example 60 or 65 years. National statistics and surveillance approaches will need to
become inclusive of older people, to the oldest age groups, and in sufficient numbers to document
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their experiences and diverse contexts. Information resources will need to be disaggregated by age, sex
and other characteristics, including civil status. This must be integrated in the design, collection and
reporting of vital statistics and general population surveys, and approaches will be needed to link and
analyse data across sectors. At present, when data on older people and functioning are collected, the
instruments used are limited to identifying only those with disease or advanced losses of capacity.
New methods and instruments are needed that can capture trajectories of Healthy Ageing and their
determinants, outcomes and distributions across the life course, and these will need to be incorporated
in routine data collection and other periodic population surveys.
92. To gauge the degree to which health and social systems are aligned to the needs of older adults,
studies will need to consider not just the presence or absence of chronic and acute diseases, but also
the presence of comorbidities and the impact that they have on older people’s capacity and functional
ability. This must be supplemented by better information on how the needs arising from these
conditions are being met, either by services spanning health promotion, disease prevention, treatment,
rehabilitation and palliative care, or broader social systems. Research will also be needed to consider
to what extent the full range of services that older people require are available, effective and do not
impose a financial burden on individuals or their families. The involvement and contribution of older
people in setting priorities and developing methods, as study respondents and as stakeholders in
reviewing results, are likely to lead to more relevant and more innovative study designs and
interventions, whether in terms of policies, services, devices or products.
93. Multicountry and multidisciplinary studies that are representative of population diversity and
the distinct contexts of older men and women will also be important. These can help identify what
works in different contexts and among diverse populations. Global and local mechanisms will also be
needed to ensure synthesis and rapid translation of knowledge and evidence into policy and practice.
This will include the communication of information to decision-makers in forms that are most relevant
to them, such as “best practices” or “best buys” in health promotion and clinical practice, population-
based health interventions, age-friendly homes and communities, and health in all policies. But it will
also require researchers to be engaged in processes that allow them to better understand the knowledge
gaps that limit policy development and to be encouraged to fill these.
94. As evidence builds, accountability frameworks and mechanisms will be needed to monitor
progress. These should incorporate the values enshrined in this strategy, spanning global targets,
universal periodic reviews of human rights, health system performance evaluations, and commitments
to age-friendly cities and communities, among others.
Strategic objective 5.1: Agree on ways to measure, analyse, describe and monitor
Healthy Ageing
95. The current metrics and methods used in the field of ageing are limited, preventing a
comprehensive understanding of the health issues experienced by older people and the usefulness of
interventions to address them. Transparent discussions on values and priorities are needed, involving
older people and other stakeholders, to inform how operational definitions and metrics on a long and
healthy life can be constructed and implemented within monitoring, surveillance and research.
Consensus should be reached on common terminology and on which metrics, biological or other
markers, data collection measures and reporting approaches are most appropriate. Improvements will
draw on a range of disciplines and fields, and should meet clear criteria.
96. Among other priorities, these new approaches will need to measure and analyse trajectories of
intrinsic capacity and functional ability across the life course, distinguish between the capacity of the
Annex A69/17
23
individual and the impact of the broader environment, take account of the different physiology of older
people and the high prevalence of multimorbidity when assessing the impact of clinical interventions,
and capture the unique views of older people on what constitutes health and well-being. New
analytical approaches are also needed to obtain more robust and comprehensive economic assessments
of the impact of poor health on older people and the benefits of population-wide and clinical
interventions.
Strategic objective 5.2: Strengthen research capacities and incentives for innovation
97. For all countries, fostering Healthy Ageing also requires promoting innovation, voluntary
knowledge exchange and technology transfer, and attracting resources (people, institutions and
financing) to address the major challenges faced. Development of innovations (in areas ranging from
assistive technologies and pharmaceuticals to care models and forecasting of scenarios) must be
inclusive of older people well into the oldest age groups, in terms of design and evaluation that
recognize the different physiology of older men and women. This will require significant
strengthening of capacity at system, institutional and individual levels. It will also need greater
collaboration across organizations, disciplines and countries.
98. Multidisciplinary research, incorporating gender-sensitive and equity-oriented analyses
involving older people at every stage, is needed to produce evidence that can inform new policies and
evaluate existing ones. Ethical guidelines are needed to guide governments and stakeholders at all
levels, to address competing demands for resources, and to develop more inclusive approaches that
optimize the functional ability of every person.
99. Much innovation relevant to older people will occur in disciplines other than gerontology and
geriatrics. Yet outdated stereotypes of older age often limit the capacity of researchers in many fields
to consider and identify opportunities for intervention. Even in health disciplines, ageist attitudes can
limit research progress.
100. Global research priorities that enable a better understanding of population ageing and health in
the 21st century are needed, to address the determinants of healthy ageing and evaluate interventions
to improve them. Researchers and other knowledge producers should be well informed and equipped.
Resources will also need to be shifted to emerging areas or to address fundamental gaps, and findings
must be easily accessible worldwide.
Strategic objective 5.3: Research and synthesize evidence on Healthy Ageing
101. In order to mount an effective and sustainable public health response to population ageing,
much better information is required on the needs and preferences of older people; whether these are
currently being met; what influences trajectories of Healthy Ageing; what works to improve them; and
the cost–effectiveness of these interventions. Research and evaluation studies should identify what can
be done to enable every person to reach relatively high and stable capacity, to support those with
declining capacity, and to support those with significant losses of capacity.
102. As a start, population-based studies of older people at home, in communities and in institutions
can identify the levels and distribution of intrinsic capacity and functional ability, how these are
changing over time, and to what extent older people’s needs for and expectations of health services
and care are being met. This information should be collected in ways that allow valid and reliable
comparison between settings and over time.
A69/17 Annex
24
103. More evidence is also required on how to shape underlying political, social, biological and
environmental conditions and determinants, as these contribute to and differentially affect Healthy
Ageing trajectories across the life course within a given society and across countries. Another priority
will be to determine ways to regulate, select and integrate medical, health and social services to best
support older adults at home, in the community or in institutions. This would need to include
consideration of their governance and organization, access and financing, and their delivery by health
professionals and informal care givers, as well as assessment of system performance. Research is also
urgently needed on ways to improve the broader environmental context and multisectoral mechanisms
that influence Healthy Ageing and to identify action that might be taken in the household, community,
workplace or other locations to improve these impacts.
104. Increasing recognition that many of the determinants of Healthy Ageing lie earlier in life has
prompted interest in how life course approaches might be used to identify critical periods for action.
This analysis should include how inequities and vulnerabilities (or strengths and resilience) are
accumulated and determined. Greater use of longitudinal cohort studies can clarify cause-and-effect
relationships and consider what development processes shape initial and lasting differences in health.
Such studies, combined with natural experiments and evaluations, may also clarify the sequencing and
effectiveness of interventions that can mitigate and overcome vulnerabilities, or further support desired
outcomes.
105. Finally, better clinical research is urgently needed on the etiology of, and treatments for, the key
health conditions of older age, including musculoskeletal and sensory impairments, cardiovascular
disease and risk factors such as hypertension and diabetes, mental disorders, dementia and cognitive
declines, cancer, and geriatric syndromes such as frailty. This must include much better consideration
of the specific physiological differences of older men and women and the high likelihood that they
will be experiencing mutimorbidities. This could also be extended to include possible interventions to
modify the underlying physiological and psychological changes associated with ageing.
RESOURCES
106. Multiple actors and agents will need to align, collaborate and coproduce Healthy Ageing. These
include formal tiers of government, individuals in communities and as patients and caregivers, and a
wide spectrum of networks, associations, businesses and organizations in diverse sectors. The
Programme budget 2016–2017 describes the financial resources required by the Secretariat for work to
meet the Organization-wide strategic objective on ageing and health; however, the resources allocated
to the area of Ageing and health are less than adequate to meet expectations. For future biennia,
additional resources will be required, given the pace of population ageing and the increasing
opportunities to foster Healthy Ageing. Further progress towards Healthy Ageing, regionally and
nationally is dependent on the amount of additional resources available and allocated to this area, and
on effective, joined-up actions across all programmes, departments and levels of the Organization. All
partners – including intergovernmental and nongovernmental organizations, academic and research
institutions and the private sector – will need to do more to mobilize resources at all levels.
MILESTONES 2016–2020
107. Working together to implement the global strategy requires a whole-of-government and whole-
of-society response. Moreover, the specific actions identified in Appendix for the period 2016–2020
require a timetable and milestones to which Member States and key stakeholders and development
partners can commit themselves. This is part of the process of accountability for and commitment to
Annex A69/17
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collaboration across governments, nongovernmental organizations, countries and other stakeholders.
One of the first milestones identified for this five-year period is therefore the development of a set of
core quantifiable process indicators related to the action plan’s objectives by the end of December
2016. These will be used to measure subsequent progress and contribute to accountability. They would
mostly focus on action taken by Member States and by the Secretariat, with an investment case for this
work, also prepared. Together, they will help monitor whether overall implementation is on track,
whether resources and collaborations are in place, and whether course correction is required, towards
the vision of Healthy Ageing. The indicators will also be used to gauge the extent to which
preparations have advanced towards planning for a Decade of Healthy Ageing during 2020–2030,
including establishing baseline values for health and other outcome indicators of interest.
2016
May: Adoption of finalized global strategy and plan of action on ageing and health by the World
Health Assembly
December: Identification of quantifiable progress indicators for each strategic objective in strategy
2017
February: Contribution to 15-year review of Madrid International Plan of Action on Ageing
June: Agreement on metrics and methods to assess Healthy Ageing – whether existing or new
2018
June: Mid-term report on implementation of strategy, including progress on evidence synthesis on
key themes, monitoring, norms and “best buys”. Refine direction of strategy based on learning to
date.
2019
May – September: Proposal for Decade of Healthy Ageing discussed in open consultation with
Member States, entities representing older people, bodies of United Nations system and other key
partners and stakeholders
2020
January: Proposal for Decade of Healthy Ageing, extending the plan of action from 2020 to 2030,
discussed at WHO Executive Board
October: Final report on review of strategy, with baseline for Decade on Healthy Ageing
A69/17 Annex
26
Appendix
PLAN OF ACTION 2016–2020
The following table outlines the contributions to each strategic objective that can be made by
Member States, the Secretariat of WHO and other bodies of the United Nations system, and national
and international partners. Each country will vary in its preparedness to take the actions identified.
What needs to be done, and in what order, will depend very much on the national context and
priorities.
Strategic objective 1: Commitment to action on Healthy Ageing in every country
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and
international partners
1.1 Establish
national frameworks for
action on Healthy
Ageing
Identify government focal
points for Healthy Ageing
Systematically involve
older people in the
development,
implementation
monitoring and
evaluation of all laws,
polices and plans on
ageing and health
Develop, in collaboration
with all relevant
stakeholders national and
regional plans to foster
Healthy Ageing,
establishing clear lines of
responsibility and
mechanisms for
coordination,
accountability,
monitoring and reporting
across all relevant sectors
Allocate adequate
resources to implement
action plans while
ensuring that public
resources are effectively
managed to facilitate
Healthy Ageing
Revise mainstream and
ageing-specific laws and
policies to foster Healthy
Ageing, and revise
compliance and
enforcement mechanisms
Support policy dialogues
on the World report on
ageing and health and the
global strategy and plan
of action
Develop an investment
case and budget to
resource the overall
action plan in this area
Strengthen intersectoral
collaboration on Healthy
Ageing
Conduct a situation
analysis of existing
frameworks and share
globally
Include Healthy Ageing
throughout the life course
in the agendas of
governing body meetings
at all levels and in other
social, health and
economic fora
Engage older people in
policy-making at
international, regional and
national levels within
WHO’s own structures
Include Healthy Ageing
in all dialogues and
polices on health, human
rights and development
Exchange information,
coordinate actions and
share lessons learnt to
support the development
of policies and plans to
foster Healthy Ageing
Support the participation
of older people and their
representative
organizations in revising
and developing laws,
policies and plans that
impact on Healthy
Ageing
Annex A69/17
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Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and
international partners
1.2 Strengthen
national capacities to
formulate evidence-
based policy
Create a decision making
culture that values
evidence and its uptake
Create formal structures
and make available
opportunities, capacity
and activities for
translation of research
and evidence, to inform
policy-making
Identify research gaps and
encourage research in
these areas
Create mechanisms to
enable effective
communication flows
between researchers and
decision-makers
Provide technical support
towards knowledge
translation activities that
enable evidence-based
policy development on
Healthy Ageing
Facilitate exchanges
across countries
addressing innovations
and good practices
Ensure that evidence is
communicated in ways
that are accessible to and
useable by policy-makers
Carry out research in
areas where there are
identified gaps for policy
and practice
Facilitate relationships
among researchers,
knowledge users, funders,
older people, families and
caregivers, and
professional bodies in
support of Healthy
Ageing policy-making,
including creating
regional forums and peer-
to-peer exchanges of
information, good
practice and tools
1.3 Combat ageism
and transform
understanding of ageing
and health
Support the collection and
dissemination of
evidence-based and age
and sex-disaggregated
information about ageing
and health and the
contribution of older
people
Adopt legislation against
age-based discrimination
and put in place related
enforcement mechanisms
Modify or repeal existing
laws, policies or
programmes, in particular
on health, employment
and life-long learning,
that discriminate directly
or indirectly and prevent
older people’s
participation in and
access to benefits that
would address their needs
and rights
Undertake
communication
campaigns, based on
research into attitudes,
beliefs and implications
Synthesize current
evidence and provide
guidance on
understanding and acting
on ageism for better
policy
Develop improved
economic models for
assessing the
contributions of older
people, and the costs and
benefits of investments in
Healthy Ageing
Ensure WHO policies,
guidance and
communication are free
from age-based and
gender-based
discrimination
Collect and disseminate
evidence about ageing,
the role and contribution
of older people and the
social and economic
implications of ageism
Ensure that a balanced
view of ageing is
presented in the media
and entertainment, for
example by minimizing
sensationalist reporting of
crimes against older
people, and including
older adults as role
models
A69/17 Annex
28
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and
international partners
of ageism, to increase
public knowledge and
understanding of Healthy
Ageing
Strategic objective 2: Developing age-friendly environments
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and
international partners
2.1 Foster
older people’s
autonomy
Raise awareness about the rights of
older people and create mechanisms
to address breaches of their rights,
including in long-term care and
emergency situations
Provide mechanisms for advanced
care planning (including long-term
care provision), appropriate assistive
technologies and supported decision-
making that enable older people to
retain the maximum level of control
over their lives despite significant loss
of capacity
Provide information in formats such
as large print, “easy read” and pictures
that meet the needs of older people to
make free and informed decisions
Implement evidence-based falls
prevention and elder abuse prevention
and response programmes
Promote awareness and
understanding of the
rights of older people
Develop technical
guidance on maximizing
autonomy covering a
range of key issues such
as food security,
preventing and
responding to elder
abuse and preventing
falls
Provide a database of
available evidence on
prevalence, risk factors,
consequences and
interventions in elder
abuse, including
violence against older
women
Provide a list of essential
assistive devices
Raise older people’s
awareness of their
human rights
Support the provision of
assistive technologies
Provide technical and
financial support to
implement policies and
programmes that
enhance older people’s
autonomy
Create and support
platforms for sharing
information about what
works in fostering older
people’s autonomy
2.2 Enable
older people’s
engagement
Ensure formal participation of older
people in decision-making on policies,
programmes and services that concern
them
Support the development of older
people’s organizations
Promote awareness and
understanding of the
contributions of older
people and the value of
working with different
generations
Provide technical
guidance and support to
enable older people’s
engagement in
development
Engage older people in
decision-making within
WHO’s own processes
and on issues that
concern them
Build the capacity of
organizations of older
people to participate
effectively in policy
development and
planning
Develop the capacity of
older people’s
organizations to provide
information, training,
peer support and long-
term care
Support and create
platforms for sharing the
diverse voices of older
people
Annex A69/17
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Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and
international partners
2.3 Promote
multisectoral
action
Tailor advocacy messages to
particular sectors about how they can
contribute to Healthy Ageing
Encourage and support municipalities
to take action to become more age-
friendly
Take action at all levels and in all
sectors to foster functional ability,
including to:
– protect older people from poverty,
ensuring that older women who are
most commonly affected are
supported
– expand housing options and assist
with home modifications that
enable older people to age in a
place that is right for them without
financial burden
– develop and ensure compliance
with accessibility standards in
buildings, transport, information
and communication technologies
and other assistive technologies
– provide community places where
older people can meet, such as
seniors’ centres and public parks
– provide social opportunities as well
as accessible information on leisure
and social activities
– deliver older people’s health
literacy programmes
– provide opportunities for lifelong
learning
– promote collaboration, age diversity
and inclusion in working
environments
Ensure effective coordination of
implementation and monitoring, for
example through task forces (linked
with the overall coordination
mechanisms outlined in strategic
objective 1)
Expand and develop the
WHO global network of
age-friendly cities and
communities to connect
cities and communities
worldwide
Provide an interactive
platform to facilitate
learning and exchange of
information and
experience on creating
age-friendly
environments that foster
Healthy Ageing
Provide technical
support to countries to
support the development
of age-friendly
environments
Document, support and
disseminate evaluations
of existing age-friendly
initiatives, to identify
evidence of what works
in different contexts
Suggest indicators that
can inform policy-
makers on progress on
age-friendly
environments
Provide technical
guidance and support on
addressing the needs and
rights of older people in
emergencies
Promote the concept of
age-friendly
environments
Support the development
of age-friendly cities,
communities and
countries by connecting
actors, facilitating
information exchange
and sharing good
practice
Provide technical and
financial assistance to
Member States in order
to ensure that public
services enable
functional ability
Provide guidance to
Member States on a
range of issues, such as
establishing and
maintaining nationally
defined social protection
floors; ensuring decent
work for all ages and
providing adequate
housing
Support older people and
their organizations to
access information on
mainstream programmes
A69/17 Annex
30
Strategic objective 3: Aligning health systems to the needs of older populations
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and
international partners
3.1 Orient
health systems
around
intrinsic
capacity and
functional
ability
Assess national health system
responses to ageing populations and
develop plans for realignment
Sustainably finance the programmes,
services and systems realignment
necessary to foster Healthy Ageing
Adapt information systems to collect,
analyse and report data on intrinsic
capacity and trends in capacity
Ensure availability of medical
products, vaccines and technologies
that are necessary to optimize older
people’s intrinsic capacities and
functional abilities
Ensure collaboration between sectors,
most importantly between health and
social services, to address the needs
of older people including those
arising from mental disorders,
dementia and cognitive declines and
geriatric syndromes such as frailty,
urinary incontinence, delirium and
falls
Provide technical
assistance and guidance
on integrating health
system responses to
ageing populations into
national healthy ageing
policies and plans
Provide technical advice
and develop standardized
approaches to enable
regional and national
assessments of health
system alignment to
needs of older people
Provide technical
assistance to enable
health system change,
including with regard to
the health workforce,
health information
systems, medical
products and
technologies
Document best practices
and develop evidence-
based service delivery
models for integrated
care in high, medium,
and less resourced health
care settings, and share
models of care that have
been shown to be
effective in supporting
intrinsic capacity
Advocate and support
older people, their
families and
communities to
participate in policy and
planning decisions
Support older people’s
engagement with health
systems
Promote older people’s
sexual health and rights
Contribute with
evidence and research
on health system change
for the older population
3.2 Develop
and ensure
affordable
access to
quality older
person
centred and
integrated
clinical care
Ensure that older people are provided
with comprehensive assessments at
the time of their engagement with the
health system and periodically
thereafter
Design systems to foster the self-
management of older people
Identify and implement evidence-
based models of integrated care
Establish age-friendly infrastructure,
service designs and processes
Develop services as close as possible
to where older people live
Provide technical support
on the development of
integrated services,
including strategies to
ensure service coverage
and to reduce
catastrophic health
expenditure
Develop evidence-based
recommendations and
clinical guidelines on
prevention and
management of
functional decline and
Participate in advocacy
campaigns and partner
in existing initiatives to
encourage the adoption
of integrated care
models
Build awareness of the
health needs of ageing
populations and older
people, and support
self-management and
engagement of older
people, family and
communities
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Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and
international partners
Implement universal health coverage
Strategies to reduce out-of-pocket
payments, wherever possible by
extending population coverage, and
widening the package of services that
older people often need
Deliver community-based
interventions to prevent functional
decline and care dependency
Adopt and implement WHO
guidelines on integrated care for
older people
Ensure the continuum of care,
including linkages with sexual health
programmes, and availability of acute
care, rehabilitation and palliative care
care dependence in older
age, and disseminate and
pilot these guidelines at
country level
Produce evidence and
guidance on clinical
management of specific
conditions relevant to
older people, including
musculoskeletal and
sensory impairments,
multimorbidities,
cardiovascular disease
and risk factors such as
hypertension and
diabetes, mental health
illness and dementia, and
cancer
Develop tools and
guidance to facilitate
implementation of case
management
3.3 Ensure
a sustainable
and
appropriately
trained,
deployed and
managed
health
workforce
Ensure competencies on ageing and
health are included in the curricula of
all health professionals
Ensure competencies in ageing
(including those required for
comprehensive Healthy Ageing
assessments and integrated
management of complex health care
needs) of existing health
professionals through pre- and in-
service training
Ensure capacity of training
institutions to establish/expand
geriatric education
Ensure balanced distribution of
workforce within countries and
development of workforce to match
demand for services
Promote new workforce cadres (such
as care coordinators, case managers,
and community care workers)
Provide opportunities for extending
the roles of existing staff for
delivering care for older people
Provide technical support
and guidance on
competencies required to
meet the needs of older
populations
Report on the impact of
population ageing on the
health workforce and on
the adequacy of the
current workforce to
meet the needs of older
populations
Provide technical
assistance to countries to
develop evidence-
informed strategies on
the health workforce
Support the development
of guidance and training
programmes to improve
the skills and knowledge
of health professionals in
low- and middle-income
countries
Support teaching
institutions in revising
their curricula to
address ageing and
health issues
Provide technical
support and expertise to
conduct training,
especially in countries
where there is shortage
of health care
professionals working
in the field of ageing
Become familiar with,
and help to implement,
WHO norms and
guidelines on integrated
care for older people
A69/17 Annex
32
Strategic Objective 4: Developing sustainable and equitable systems for providing long-term care (home,
communities, institutions)
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and international
partners
4.1 Establish
and continually
improve a
sustainable and
equitable long-
term care system
Identify access to long-term
care as a public health
priority and a human right
Steward development of the
infrastructure and support
needed to ensure that long-
term care is addressed under
universal health coverage
Define appropriate systems of
care to improve the functional
ability and well-being of older
people with, or at risk of, a
loss of capacity
Identify and put in place
sustainable mechanisms for
resourcing long-term care
Convene relevant
stakeholders, including older
people and caregivers, and
plan for sustainable and
equitable long-term care,
including provision,
resourcing, regulation and
monitoring, and define roles
and responsibilities (linked
with strategic objective 1)
Foster collaboration between
key stakeholders, including
care-dependent people and
their caregivers,
nongovernmental
organizations, and the public
and private sectors, to
provide long-term care
Provide guidance on
appropriate and
sustainable systems of
long-term care relevant to
different resource settings
Provide technical support
to Member States to
identify sustainable
mechanisms for
resourcing long-term care
Provide technical support
for national situation
analysis and the
development,
implementation and
monitoring of legislation,
services, policies and
plans on long-term care
Contribute evidence to
develop and implement
appropriate systems and
sustainable mechanisms for
resourcing long-term care in
diverse resource settings
Contribute to the
development and
implementation of an
integrated, sustainable,
equitable, and ability-
oriented, system of long-
term care
4.2 Build
workforce
capacity and
support
caregivers
Develop and implement
strategies for the provision of
information, training and
respite care for unpaid
caregivers, and flexible
working arrangements or
leaves of absence for those
who (want to) participate in
the workforce
Produce national standards
for training of professional
caregivers
Provide guidance on
training and task-shifting
for long-term care
provision
Provide online resources
on long-term care
provision for unpaid
caregivers
Contribute to the
development and
implementation of training,
continuing education and
supervision for the long-term
care workforce
Ensure pay, benefits and
working conditions for care
workers
Provide flexible working
arrangements or leaves of
absence for unpaid
caregivers
Annex A69/17
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Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and international
partners
Develop – through training
and task-shifting – the long-
term care workforce (also
including men, younger
people and non-family
members such as older
volunteers and peers)
Improve working conditions,
remuneration and career
opportunities in order to
attract and retain paid
caregivers
Provide continuing
education, supervision and
other support for existing
paid caregivers
Create and support platforms
for the development and
evaluation of cost-effective
interventions to support the
long-term care workforce
Contribute with research and
evidence to the development
and evaluation of cost-
effective interventions to
support the long-term care
workforce
4.3 Ensure
the quality of
person-centred
and integrated
long-term care
Ensure the development and
implementation of national
care standards, guidelines,
protocols and accreditation
mechanisms for ability-
oriented, person-centred
integrated long-term care
provision
Ensure the establishment of
formal mechanisms for
ability-oriented, person-
centred integrated long-term
care, for example through
case management, advance
care planning and
collaboration between paid
and unpaid caregivers
Ensure the appropriate use of
and affordable access to
innovative assistive health
technologies to improve the
functional ability and well-
being of people in need of
long-term care
Ensure that long-term care
services are age-friendly,
ethical and promote the
rights of older people and
their caregivers
Ensure the monitoring of
long-term care in terms of
functional ability and well-
being, and the continuous
improvement of long-term
care based on the outcomes
Provide technical support
to Member States on
ability-oriented, person-
centred integrated long-
term care provision
Develop guidance on
specific approaches to
ensure the quality and
appropriateness of long-
term care in different
resource settings
Follow national care
standards, guidelines,
protocols, accreditation and
monitoring mechanisms
Provide quality long-term
care services in line with
national care standards,
guidelines and protocols in
an age-friendly and equitable
way promoting the rights of
older people
Provide mechanisms for care
providers to share and learn
from experiences
Develop and implement
innovative long-term care
services, including through
the use of technology for
coordination, care, support
and monitoring
A69/17 Annex
34
Strategic objective 5: Improving measurement, monitoring and research on Healthy Ageing
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and international
partners
5.1 Agree on
ways to
measure,
analyse,
describe and
monitor Healthy
Ageing
Ensure national vital
registration and statistics are
disaggregated by age and
sex throughout the life
course, and by important
social and economic
characteristics
Encourage monitoring,
surveillance and reporting in
line with agreed global
metrics
Encourage data-sharing and
linkages across sectors (such
as health, social welfare,
labour, education,
environment, transportation)
Conduct periodic,
population-based monitoring
of older people, including
those in long-term care
institutions
Link the monitoring of
Healthy Ageing metrics to
the evaluation of national
sectoral, intersectoral and
multisectoral policies and
programmes, and link to
other international efforts
(such as the Sustainable
Development Goals)
Convene and liaise
across specialized
agencies of the United
Nations system and other
development partners to
foster a consensus on
metrics and methods
Review existing data
sources, methods and
indicators and promote
the sharing of data and
methods for global,
regional, national and
community-based
monitoring and
surveillance of Healthy
Ageing
Develop norms, metrics
and new analytical
approaches to describe
and monitor Healthy
Ageing, including levels
and distributions, and
ways to combine and
report information on
intrinsic capacity,
functional ability and
length of life
Develop resources,
including standardized
survey modules, data and
biomarker collection
instruments and analysis
programmes
Prepare a global situation
report on Healthy Ageing
by 2020 reflecting
metrics, data availability
and distribution within
and across countries, and
new evidence on what
can be done to support
Healthy Ageing
Empower older people to
participate and share best
practices to experience
Healthy Ageing
Provide qualitative and
quantitative information to
track progress towards
Healthy Ageing and
advocate for accountability
by all stakeholders
Work with partners to
improve measuring,
monitoring and reporting
systems, including enabling
age- and gender-sensitive
analysis
Support policy development
by reporting on trends and
emerging issues
5.2 Strengthen
research
capacities and
incentives for
innovation
Incorporate older people in
all stages of research and
innovation, including their
needs and preferences
Advocate for strengthened
research funding,
capacities, methods and
collaboration to foster
Healthy Ageing and
Encourage older people to
participate in research and
identify research questions
and the need for innovation,
including developing study
designs
Annex A69/17
35
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and international
partners
Ensure older people are
meaningfully and
statistically represented in
population-based studies
with sufficient power to
analyse data, and included in
clinical trials
Strengthen research funding,
capacities and collaborations
to address Healthy Ageing
Create incentives and
support innovation that meet
the needs of different age
groups, including older
people, through
multisectoral and
intersectoral actions,
including technological and
social innovations for home-
and community-based
services for older
populations
Support voluntary and
mutually agreed technology
transfer that includes
services, innovations,
knowledge and best
practices
Guide research and
innovation to ensure public
and private sector
developers and providers
(including health and care
services, devices, and drugs)
meet the specific needs of all
older people, including those
with limited resources
Build national capacity to
synthesize research, as
inputs to knowledge
translation and evidence
based policies (link to SO 1)
combat ageism, including
through a network of
WHO collaborating
centres on ageing and
health, pilot countries
from all WHO regions,
and civil society
organizations
Support international
cooperation to foster
technological innovation,
including by facilitating
the transfer of expertise
and technologies such as
assistive devices,
information and
communication
technology and scientific
data, and the exchange of
good practices
Develop ethical
frameworks to identify
health and social services
that respond to the needs
and rights of older
people and to prioritize
what is included within
national benefit packages
and universal health
coverage
Contribute to
development and sharing
of new methods and
approaches to:
– deliver integrated
person-centred health
care and long-term
care services
– shape clinical research
to be more relevant to
older people
– finance health services
and long-term care
within universal
schemes
– meet older peoples’
needs and expectations
in communities, cities
and rural areas that
facilitate ageing in
place, with regard to
Support training and
capacity development
efforts, including networks
of academics, researchers
and trainers that incorporate
low- and middle-income
countries
Ensure that older people
participate in clinical trials
and evaluation of new
technologies that take
account of the different
physiology and needs of
older men and women
Support small- and large-
scale innovations
Encourage the participation
of older people in the
development, design and
evaluation of services,
technologies or products
Promote innovation to
accelerate the development
of new and improved
assistive technologies and
interventions to support
older people
Collaborate to shape the
global research and
innovation agenda on
Healthy Ageing, and
advocate and support
funding and capacity
strengthening
A69/17 Annex
36
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and international
partners
issues such as health,
land use, housing,
transportation and
broadband
– establish the
prevalence and
prevention of elder
abuse
– quantify the
contributions of older
people and the
investments required to
provide services they
need
– combine multiple
disciplines and
qualitative and
quantitative data to
communicate older
peoples’ diverse needs
and expectations
Convene and work with
partners to develop and
communicate a global
research agenda on
healthy ageing
5.3 Research
and synthesize
evidence on
Healthy Ageing
Establish regular
longitudinal population
surveys, measuring health
status and related needs of
older people and to what
extent needs are being met
Reflecting older peoples’
needs and expectations,
shape, fund and implement
national research and
innovation priorities on
Healthy Ageing
Promote and support
research to identify the
determinants of Healthy
Ageing and to evaluate
interventions that can foster
functional ability
Promote and support
multisectoral and
intersectoral collaboration
with diverse stakeholders to
design and evaluate actions
to foster functional ability
Organize and participate
in international forums to
raise awareness of
research priorities for
Healthy Ageing
Coordinate priority
multicountry research
and evaluation efforts,
for example building on
the WHO study on
global ageing and adult
health or extending other
existing efforts
Collaborate with
stakeholders to identify
the range and potentially
common trajectories of
intrinsic capacity and
functional ability, and
their broader social,
economic and
environmental
determinants in different
populations and contexts
Advocate for and enable
research to scale up
Collaborate and participate
in research design and
implementation, including
evaluation of what works in
different settings
Contribute learning gained
from associations and
organizations addressing risk
factor-, disease- or
condition-specific issues,
that are inclusive of older
people (including dementia,
elder abuse and self-help
approaches)
Develop and test innovative
approaches to strengthening
institution-, community- and
home-based care to
implement the most
appropriate interventions
and increase access to
essential medicines for older
people, including pain relief
medicines such as opioids
Support research and
dissemination of evidence
Annex A69/17
37
Member States
Secretariat (WHO and
other bodies of the
United Nations system)
National and international
partners
Provide forums for the
exchange of experiences,
good practices and lessons
learned
Promote research into
innovations that contribute
to age-friendly
environments, including at
the workplace
Synthesize research and
disseminate evidence on
Healthy Ageing that
addresses important policy
questions and older people’s
expectations
interventions and
strengthen national
health systems, including
health workers, informal
caregivers and long-term
care (home-, community-
and institution-based)
towards meeting the
needs of older people
Review and share models
of care that have been
shown to be effective in
supporting intrinsic
capacity
on the impact of health
services, long-term care and
environmental interventions
on trajectories of healthy
ageing
Engage in dialogue within
communities and the media,
and use effective
communication techniques
to convey messages about
Healthy Ageing
Reflecting global evidence
on what works in diverse
contexts and basic standards,
encourage testing of
approaches to further
develop systems of long-
term care (home-,
community- or institution-
based)
Develop and identify
evidence-based
approaches to
intersectoral action to
maximize functional
ability, particularly in
resource-poor settings
Document health
inequalities and
inequities, and their
impacts across the life
course on Healthy
Ageing, and report how
these can be mitigated by
health and social
interventions and by
multisectoral and
intersectoral actions
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