Prakash Tyagi
The proposal of observing a healthy ageing decade from 2021 to 2030 was endorsed by the 73rd World Health Assembly on August 3rd, 2020. It was also welcomed by the UN General Assembly on 14th December 2020 through a resolution, leading to the proclamation of a UN Decade of Healthy Ageing (2021-2030).
Population ageing and consequent demographic transition are a complex reality. As per the estimates, the global population of people over 60 years of age which is currently around 1.1 billion will grow to around 1.4 billion by 2030, and to about 2 billion by 2050. Between 2015 and 2050, the proportion of 60+ age population is expected to rise from 12% to a staggering 22%. Also by 2050, the older people above 60 years will outnumber younger people below the age of 15, which will happen for the first time in history.
In India, the transition has been taking place at a much rapid pace. The 104 million-population of older people from the 2011 national census is estimated to be tripled by 2050. While for a county like France, it took about 150 years for the aged population proportion to rise from 10% to 20%, a similar rise in India would occur in about 20 years.
Out of those older people, large numbers, particularly in lower and middle income countries, including in India, live under severe poverty and with poor health with no or limited access to basic health services and to social protection benefits. While older people living longer is an opportunity for themselves and for the society, there is not much evidence suggesting older people are currently living healthier lives than their previous generations did.
Inequity of access to healthcare for older people is mainly caused by attitudinal and behavioural reasons such as ageism and stigma, as well as by physical factors mainly remoteness of rural population settlements and with limited outreach of services in those areas. These pre-existing inequities have been growing rapidly and widely as the COVID-19 pandemic continues to spread across the world, and are clearly more stark in older women, in older people with disabilities and in older people living in remote and rural areas.
This significant demographic transition calls for an unprecedented need of an age-friendly and responsive healthcare system and a range of coordinated services to address the complex needs of ageing population.
The UN decade of healthy ageing is an initiative led by the World Health Organization (WHO) and is a global collaboration that will bring together Governments, civil society, international agencies, professionals, academia, the media, and the private sector, and will continue its interventions in alignment with the last 10 years of Sustainable Development Goals (SDGs) and of the 2030 agenda for Sustainable Development.
To foster healthy ageing and to improve the lives of older people, the decade of healthy ageing will focus on 4 action areas. The first is to create and strengthen age friendly environments by removing physical and social barriers and by converting environments into better places to live and to age. The second is to combat ageism. Older people, despite of their significant contributions to the society, are over-looked and neglected with an “ageism” bias. There is a need of addressing issues of stereotyping, prejudice and discrimination related to old age.
The third is to provide integrated care. All older people should have non-discriminatory access to integrated care which should include, but is not limited to, prevention, promotive, curative, rehabilitative, and palliative, and “end of life” care – which must be safe, affordable and of good quality. The fourth is to support long-term care. With significant decline in mental and physical capacities, many older people are unable to live an independent life or to actively participate in the society. Hence, access to good long-term care services is essential to maintain their functional ability, to ensure that they enjoy basic human rights and that they live a life with dignity.
The decade of healthy ageing action plan has been drafted by the WHO which has 10 years of concerted, catalytic and sustained collaboration. Older people themselves will be at the center of this plan, and it will bring together Governments and all other stakeholders together to improve the lives of older people, their families and their communities. It is the second action plan of the WHO Global strategy on ageing and health, building on the United Nations Madrid International Plan of Action on Ageing (2002), and is strongly aligned with the timing of the United Nations Agenda 2030 on Sustainable Development and the SDGs.
With a global framework for the decade of healthy ageing, country level mechanisms are being formed for direct implementation of planned interventions. WHO is working in that direction with global experts and in the country level stakeholders. It is recognized that a focus on some key areas would enable the progress of the healthy ageing decade. Those include – engaging older people and bringing out their voices, leadership development and capacity building among concerned stakeholders across all sectors, connecting various stakeholders, and strengthening research, data collection and innovation.
In India, several key initiatives have been taken up in the last couple of decades or so to address the challenges of population ageing, including – drafting a National Policy for Older Persons, introduction and adoption of the Maintenance and Welfare of Parents and Senior Citizens Act of 2007, and formulation of National Programme for Health and Care of the Elderly (NPHCE) and of National Old Age Pension Programme. Those national level initiatives will need to be scaled up across the country in the decade of healthy ageing, in partnerships with various stakeholders.
Civil Society Organizations (CSOs) are well placed to play an important role in the decade of healthy ageing action in India. There is a need of forming and strengthening multi-sectoral partnerships in which CSOs can play the last mile delivery roles. Initiatives of CSOs targeted at older people in the spheres of community based groups’ formation and capacity building, promotion of self-care and home based care, and on enhancing food, nutrition and water security may be scaled up. Civil society has both the credibility and capacity of bridging the inequities and to ensure that older people are not behind in health and social protection services.
SDG 3 intends to ensure healthy lives and to promote well-being for “all” at “all ages”, and to realize the progress on this goal; older people’s health needs must be addressed comprehensively. The decade of healthy ageing is a great opportunity.
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