The World Health Organization has long been a leader in matters of public health, from its successes against such dreaded diseases as smallpox to its campaign to control tobacco use. So the passage of its new Health and Ageing strategy last week in Geneva at the 69th World Health Assembly follows an admirable tradition.
However, the latest strategy goes beyond a current and easily observable health crisis. It is based on one of the mega-trends of our time – 21st century longevity. It reflects the goals of a healthier population and more active ageing through enabling “functional ability” over time.
The 194 health ministers in the Geneva Assembly Hall were given an execution plan to take home. They will report back progress the next five years and then gather in 2020 to launch the decade of Healthy Aging: “The aim of the strategy is for every country to commit to action on healthy ageing. It calls for the development of age-friendly environments and the alignment of health systems to the needs of older populations. It envisages the development of sustainable and equitable systems of long-term care, and improved measurement, monitoring and research. It emphasizes equity and human rights, including the important role of involving older adults in all decisions that concern them.”
The newly minted strategy impressively builds on a year of direct work by the WHO’s Aging and Life Course unit, headed by Dr. John Beard and ably supported by Dr. Alana Officer. They issued their report last October, informing the strategy the WHO Director General, Dr. Margaret Chan, just got approved. As Dr. Chan said last fall, “The greatest costs to society are not the expenditures made to foster this functional ability, but the benefits that might be missed if we fail to make the appropriate adaptations and investments.” The report and the strategy are well supported by the medical, health and scientific leaders in the Gerontologist supplement on healthy aging.
While it’s understandable the headline-grabbers of public health will still be emergencies like Ebola or Zika, don’t for a second underestimate the importance and impact of what just happened in Geneva. Here’s the WHO summary:
- commitment to action on Healthy Ageing in every country;
- developing age-friendly environments;
- aligning health systems to the needs of older populations;
- developing sustainable and equitable systems for providing long-term care (home, communities, institutions); and
- improving measurement, monitoring and research on healthy aging.
The broader impact is huge, along the following lines:
Culture shift. As with any social or economic revolution, those living through it often miss the really big idea. Drs. Chan and Beard and their team got it exactly right in identifying the subtle shift that must take place to truly appreciate that public health is an essential and defining partner for 21st century society. A global society that will soon have more old than young; a world where over 80 is the fastest growing demographic; a world where planning for 100 years of life is for the first time in history the norm. It is essential to break down the barriers to how we think about and treat our older population, no longer an afterthought to public health needs -- the 60+ population reaching 2 billion by mid-century and comprising 25 percent or more of most nations on the planet changes everything.
How could we not consider in our time an “adult immunization campaign” parallel to the childhood immunization program we have so brilliantly embedded in every aspect of public health thinking, everywhere? Or dedicate the kind of funds that will be required to better manage today and ultimately cure Alzheimer’s, the disease of aging? This new strategy will do much for the essential re-imagination and re-shaping of public health in alignment with 21st century longevity.
Longevity and functional ability. Perhaps the greatest contribution of the new strategy will be its shift from defining health as the absence of disease to the metric of functional ability. With 20, 30 and 40 percent of national populations being old, it will not only be nice for as many of us to be healthy and active, it will be essential if we are to contemplate economic growth and prosperity.
This leads to different considerations that, done right, will also substantially reduce the expected cost burdens on health systems. Skin, oral and nutritional health are examples the new strategy contemplates which are today virtually ignored. It simply didn’t matter as much when we died younger. But living to 100 with especially deteriorated skin has an impact on mental health, increased infections and wounds and a growing prevalence of melanoma. What if prevention strategies across the life course kept us aging more functionally and actively?
Caring differently. It was fine for public health to arrange long term care for 20th century aging. But in the 21st century, how we care for those in need as we age creates brand new paradigms and possibilities. Aging at home; effective and efficient uses of innovative technology wherever the care is delivered; the type and quality of care aligned with wellness, functional ability, especially in old age – all would represent the sea change the new strategy envisions.
Here’s what we need to achieve these changes: “Multiple actors and agents will need to align, collaborate and coproduce Healthy Aging … 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.”
Bravo, WHO! Now, let’s kindly thank and encourage the 194 health leaders to go home and start working with the rest of us for a healthier and more active aging.