Active Ageing: a Policy Framework was first published by the World Health Organisation (WHO) in 2002 to inform and to complement the Madrid International Plan of Action on Ageing (MIPAA), launched at the United Nation’s Second World Assembly on Ageing. It signalled a substantial change in paradigm. Breaking away from a narrow focus on disease prevention and health care, the document stood out as an international policy landmark. WHO championed the goal of Active Ageing which it defined as:
“the process of optimizing opportunities for health, participation and security in order to enhance the quality of life as people age”.
The concept was further refined in 2010 with the addition of opportunities for lifelong learning to the definition. The Active Ageing formula was intended to reference a continued participation in social, economic, spiritual, cultural and civic affairs; not simply physical activity or longer working lives. Additionally, it gave a fresh focus to ageing within a continuum or life-course. It was intended to apply to both individuals and population groups. The framework document was the culmination of a lengthy developmental process which began in 1999. It was formed out of multiple workshops and seminars involving academic, governmental and civil society bodies that were conducted in all regions of the world.
Active Ageing has informed ageing policy and research agendas in a wide range of settings – countries, states and municipalities as well as intergovernmental and non-governmental bodies. It additionally underpins the WHO Age-friendly Cities and Communities global project. In an international collaboration in 2015, ILC-Brazil comprehensively revised the Active Ageing philosophy in its publication, Active Ageing: a Policy Response to the Longevity Revolution. Active Ageing, both as a concept and a policy tool, has evolved and will continue to evolve in the context of shifting political and social landscapes. (See: Active Ageing: a Policy Framework, WHO Publications and Active Ageing: a Policy Response to the Longevity Revolution, ILC-BR Publications).
Real older people in the context of their lived experience should be the starting point and the driving force for all age-friendly design. There is no singular ownership of design but neither is there sufficient democratization of it. Too often, it is user-centred rather than user-led. Too often, it is design for the middle rather than design for the edges. Too often, it is design for personas or idealized persons rather than real people. Too often, it is uni-, multi- and inter-disciplinary rather than trans-disciplinary in nature. Too often, is emotion seen as a side product to design rather than its leitmotif or driving force. Too often, there is an impulse for big change rather than evolution. Too often, does design divide groups rather than unite them. (See: Toward Age-friendly Design, ILC-BR Publications).
AGE-FRIENDLY CITIES & COMMUNITIES
The physical environment presents variables of both risk and protection at all stages of the life-course. Environments need to compensate for declines in functional capacity and to facilitate participation and well-being in all ages, including older age. The WHO Age-friendly Cities & Communities movement grew out of the empowerment philosophy of the WHO Active Ageing Policy Framework (2002). The initiative was first promulgated by Dr Alexandre Kalache, in his role as Director of the WHO global programme on ageing, in his keynote speech at the Congress of the International Association of Geriatrics and Gerontology (IAGG) in 2005. Under Kalache’s direction, a research protocol was developed in the first 33 collaborating cities and a project formula was enunciated in 2007 with the publication of the WHO Age-friendly Cities Guide. The core WHO team that operationalised the AFC global initiative included Ina Voelcker (now Technical Director of ILC-Brazil) and Louise Plouffe (Associate of ILC-Brzil). The Age-friendly Cities and Communities movement forms a significant part of the design response to the two defining trends of the 21st century – population ageing and urbanisation.
Today there is a Global Network of Age-friendly Cities and Communities with hundreds of members from around the world. ILC-Brazil has taken a lead to engage Brazilian municipalities in the Network and developed a Brazilian-fit methodology, closely aligned to the principles established by the WHO.
Culture shapes every aspect of life – for instance, what and when people eat, how they perceive their bodies and the practices used to maintain health, to treat illness and provide care. It frames the roles of men and women and it informs their views on age, social class and other cultural or racial identities. Relationships, within both the family and the community; living arrangements; and expectations for care; are all defined through a cultural lens. In the Active Ageing Framework, culture (together with gender) is a cross-cutting determinant.
CULTURE OF CARE
There is a growing global crisis – one that has been termed “family insufficiency”. Smaller, more complex and more dispersed family networks are becoming less able to provide care. The response must be to create a new culture of care that includes, but goes beyond, family and public care and significantly addresses the gender imbalance in care provision. The culture of care must embrace employers, businesses, public community structures/services (such as housing, transportation) and voluntary groups, as well as family and friendship networks, in a broad intergenerational enterprise. There needs to be a shared solidarity with both the persons in need of care and the individuals involved in the provision of that care. It is imperative that men should increase their participation in providing care (See: Rio Declaration – Developing a Culture of Care, ILC-BR Publications).
The dependency threshold is the level of barrier in the environment that transforms a functional impairment (such as diminished vision or a knee stiff with osteoarthritis) into a dependency or disability. A high threshold increases dependency. Poor urban design, inadequate lighting/signage/ transportation, hard-to-access information, architectural barriers, lack of social support and financial obstacles are all features that contribute to this elevated threshold. Lowering the threshold by reducing barriers through age-friendly design, frees people with impairments to continue to function and to fully contribute to their families, communities and the economy. Two different people may have the exact same physical condition yet one, in a supportive (physical as well as social) environment, may permit a fully independent life while the other is effectively disabled by adverse surroundings. (See Fig. 8, p. 43, Active Ageing: a Policy Framework in Response to the Longevity Revolution, ILC-Brazil Publications).
DETERMINANTS OF ACTIVE AGEING
To clarify the multiple, interactive factors that shape whether a person ages actively over the life course, the World Health Organisation promulgated a set of Determinants of Active Ageing in 2002. Culture and gender were presented as overarching and cross-cutting determinants. Contextual determinants were shown to be the physical environment, the social environment, health/social services and the economic. Specific to the individual were the personal and the behavioural determinants. Active Ageing is presented as the dynamic, life-long interplay of these determinants both within the environment and within the person, with all their accompanying risks and protections. (See Fig. 9, p. 48, Active Ageing: a Policy Framework in Response to the Longevity Revolution, ILC-BR Publications)
FOURTH INDUSTRIAL REVOLUTION
The world is currently undergoing the Fourth Industrial Revolution. It is producing ultra-fast, profound systemic shocks that require imaginative and continually adaptive human responses. It is characterised by a hyper-connectivity between a vast range of components. It is creating an unprecedented fusion of seemingly disparate technologies across the digital, physical and biological domains. The speed and depth of the changes, the increased job insecurity, the imposed mobility, the growing need for multiple identities and the uneven ownership of the technologies necessitates that much more attention is given to the human and cultural disruptions. The 4th Industrial Revolution has profound implications for our much longer lives.
Human functional capacity increases to its peak in early adulthood. Beyond this point, that functional capacity will inevitably decline. Although the rate of that decline is clearly influenced by age, it is impacted to a much larger extent by lifestyle and external variables – all of which are modifiable. If the predominance of these personal and external conditions is favourable, the rate of decline will be gradual and the person will comfortably perform the requisite activities of life well into old age. This sustained functional capacity ideal leads to a compression of morbidity in which the eventual decline and disability is squeezed into a very short period of time immediately prior to death.
Assumptions about men and women from birth onwards determine the opportunities and the risks for Active Ageing in all areas of life. The accumulation of these disparities has a powerful impact on the health and well-being of older adults in multi-faceted ways – and it is enormously consequential to the wider society. Most social systems (labour protection, social assistance, pension and health care) are already being tested by the new demographic realities. There is an economic as well as a cultural pragmatism about the need for a strong gender focus. Fast-moving societal change requires a flexible citizenry. A failure to respond will mean unsustainable burdens and risk divisiveness between women, men and generations. In the Active Ageing Framework, gender (together with culture) is a cross-cutting determinant. (See: Gender & Ageing Charter, ILC-BR Publications).
Gerontolescence (from the Greek, “geron” meaning “old man” and the Latin “adolescere” meaning “to grow up”) is the period of early old age; a transitional phase between senior adulthood and senescence. It is the first chapter of old age. It is a new social construct reflecting a still emerging stage of human development that is marked more by functional and attitudinal markers than chronological ones. Gerontolescence is analogous to the social construct of adolescence which first emerged in developed regions of the world in the 1950s to describe the then new transition between childhood and adulthood.
It was the Baby-boomers who created adolescence and it is the Baby-boomers who are now creating gerontolescence. In their youth, they had the luxury of experiencing a new form of transition from childhood into adulthood – a time to experiment, to explore and to rebel. They have had a profound impact on every stage of their life course – sexual liberation, greater emancipation of women, the fight against racism and homophobia, the students’ movements of the 1960s, the activism for equality and human rights. They continue to impact society as they enter older age as gerontolescents. Their health status, expectations and aspirations are unlike previous generations. As more and more gerontolescents emerge, gerontolescence will be further defined.
Individuals who are ageing actively seize occasions throughout their lives to acquire and to maintain health, meaningful occupation, social relationships, new skills, knowledge and material necessity. These gathered resources constitute human capital. When accumulated throughout the life course, they become the foundations for physical, mental and social well-being at every point of age. All of them are interdependent and mutually reinforcing. The earlier that the accumulation of these capitals begin, the more beneficial are the likely outcomes.
The life course is the trajectory of lived events that define a person at any age. Longevity, in combination with other major trends, is reshaping the life course in complex and multifarious ways. The traditional life-course model of three distinct phases – preparation, productivity and retirement – is undergoing a process of necessary change. The demarcations between learning, working, caring and resting are inevitably going to become even less defined and more overlapping across a greater number of years.
The world is rapidly ageing. The main legacy of the last century was arguably the gift of longer life. There has been a rapid reduction of mortality in all countries, including those with low and middle income. This factor, compounded by high birth rates in the two decades after World War II (the Baby-boom), has meant that by 2015 there were already 810 million people aged 60 and older in the world. This will increase to over 2 billion by 2050. Two people in the world celebrate their 60th birthday every second. These extra years of life are an unprecedented privilege. What is occurring is nothing short of a revolution – a longevity revolution. By 2050, 30% of the populations of 64 countries will be aged 60 and older. Most developed countries will be on that list but so too will be many countries in Latin America and Asia, including China. Recent analyses reveal that the longevity revolution is not the macro-economic catastrophe that some have predicted, but they also show that outdated ideas about the life course must be discarded and that policies that respond to the new demographic reality must be embraced. (See Fig 1: p 15, Active Ageing: a Policy Framework in Response to the Longevity Revolution, ILC-BR Publications).
PILLARS OF ACTIVE AGEING
The components of health, life-long learning, participation and security are the Active Ageing policy pillars or key areas for strategic action. Effective policies that address these four pillars will greatly improve the capacity of individuals to assemble the necessary resources during their life-courses for their personal resilience and well-being. (See Fig. 12, p. 79, Active Ageing: a Policy Response to the Longevity Revolution, ILC-BR Publications).
PILLAR OF HEALTH
Active Ageing embraces the goal of enhancing the health of populations and reducing health inequalities. It seeks to enable the achievement of the fullest health potential across the life course. The Active Ageing vision of health is firmly rooted in the concepts and strategies for health articulated over decades by WHO and universally regarded as normative. Health is “a state of complete physical, mental and social well-being and not merely the absence of disease” (Constitution of WHO 1946). It is a resource for everyday life. It is “an important dimension of quality of life that must be achieved not solely by health services, but also by assuring security and learning”, through “peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity”.
PILLAR OF LIFE-LONG LEARNING
Globalization, the exponential expansion of the knowledge economy and increasing highly disruptive change means that on-going life-long learning is key to well-being at all ages. It is a pillar that underpins all the other pillars of Active Ageing. It equips us to remain healthy, relevant and engaged in society. The OECD considers continuous learning to be one of the most important components of human capital in an ageing world. Access to information is fundamental, but so too is the development of the skills and the imagination to be discerning and selective with that information.
PILLAR OF PARTICIPATION
Participation goes far beyond involvement in paid work. It means engagement in any social, civic, recreational, cultural, intellectual or spiritual pursuit that brings a sense of meaning, fulfilment and belonging. Participation supports positive health, it provides engagement or flow experiences that are intrinsically satisfying, it imparts a sense of purpose and gives opportunity for positive social relationships. The active participation of all citizens at all levels of decision-making keeps democracies robust, makes policies more responsive and empowers individuals. Full participation in society requires a strong focus on the human rights of older persons.
PILLAR OF SECURITY
Security is the most fundamental of human needs. It provides an individual with the feeling of being protected at all stages of one’s life. In the absence of it, we cannot fully develop our potential and age actively. Insecurity has a corrosive effect on our physical health, emotional well-being and social fabric. Threats to security at a societal level include conflict, effects of climate change, natural disasters, disease epidemics, organized crime, human trafficking, criminal victimization, interpersonal violence, abuse and discrimination as well as sudden and/or prolonged economic and financial downturns. At the individual level, risks to security include illness, deaths in the family, poverty, periods of unemployment or incapacity and moving far away from one’s homeland.
Active Ageing is framed within the current theoretical perspective of resilience – defined as having access to the reserves needed to adapt to, endure, and grow from, the challenges encountered in life. Biological make-up, personal behaviours and psychological dispositions greatly influence the development of resilience. These in turn however, are strongly influenced by external determinants – most of which are highly affected by policy decisions. A truly resilient society promotes the development of an individual resilience, of Active Ageing throughout the life course. (See: Building Resilience Throughout our Increasingly Longer Lives, ILC-BR Publications).