UN Decade of Healthy Ageing 2021-2023 — Comprehensive Bullet-Point Study Notes

Foreword & Context

• WHO celebrates 75 years; global life expectancy increased from $46 \rightarrow 73\text{ years}$
• Extra years must be spent in good health, dignity and with human rights protected.
• UN Decade of Healthy Ageing (2021–2030) seeks to “add life to years, and years to life”.
• First phase overlapped with COVID-19, economic crisis, humanitarian emergencies → disproportionate impacts on older people (mortality, income, food security, social connection, human rights).
• Dr Tedros: progress recognised, yet calls for greater political will and resources.

Acknowledgements Snapshot

• Report led by WHO Ageing & Health Unit (Rachel Albone, Yuka Sumi, Christopher Mikton).
• Wide collaboration: six WHO regional offices, UNFPA, UNDESA, OHCHR, ESCAP, World Bank, UN-Habitat, ILO, UN-Women.

Acronyms to Know

• COVID-19, ICOPE, MIPAA, TAG4MHA, SDGs, etc.

Executive Summary Highlights

• Purpose: assess 2021–mid-2023 progress, showcase stakeholder contributions, inspire collaboration.
• Progress metric = increase in proportion of countries with supportive policies/programmes (10 national indicators).
• ≥ $20\%$ absolute growth (2020→2022) in 4 indicators:
  • anti-age discrimination laws
  • assistive-product legislation
  • age-friendly cities programmes
  • comprehensive health/social assessment policies
• Political support/resources still limited (< 33 % countries report adequate funding).
• Engagement of diverse older people growing but not yet systematic.

Chapter 1 – Introduction

Why the Decade?

• By 2030 older population (≥60 yrs) rises $1.1\,\text{bn} \rightarrow 1.4\,\text{bn}$.
• Gap between life expectancy & healthy life expectancy widening:
  • Men $7.3 \rightarrow 8.3\text{ yrs}$ (2000–2019)
  • Women $9.7 \rightarrow 11\text{ yrs}$.
• Systems/policies unprepared → older people “left behind”.

UN Response

• Decade endorsed by WHA 73 (Aug 2020) & UNGA 75 (Dec 2020); WHO acts as Secretariat.
• Builds on:
  • WHO Global Strategy & Action Plan on Ageing & Health (2016–2030).
  • Madrid International Plan of Action on Ageing (2002).

Key Definitions (Box 1)

• Healthy Ageing: “process of developing & maintaining functional ability that enables well-being in older age”.
• Functional Ability = Intrinsic Capacity + Environment + interaction.
• Intrinsic Capacity = physical & mental capacities composite.

Four Action Areas

1. Change how we think, feel, act on age.
2. Communities foster abilities (age-friendly env.).
3. Person-centred integrated care & PHC responsive to older people.
4. Access to long-term care.

Four Enablers

• Meaningful engagement of diverse voices.
• Leadership & capacity-building across sectors.
• Connecting stakeholders globally to share/learn.
• Strengthen data, research, innovation.

Monitoring Framework

• TAG4MHA (20 experts) guides measurement.
• 10 National Progress Indicators (Box 3) covering focal point, plans, forums, anti-discrimination, assistive devices, age-friendly programme, comprehensive assessment, LTC policy, surveys (cross-sectional & longitudinal).

2023 Report Methods

• WHO online Process-Evaluation Survey (Sept 2022–Apr 2023), 136/194 countries (70 %) responded. Only those with 2020 baseline used for comparisons.
• Case-study call via Decade Platform; quality-screened.

Chapter 2 – Implementation Progress

Global Indicator Results 2020→2022 (Fig. 1)

• Focal point: $84.6 \rightarrow 86.4\%$ (+1.8 pp)
• National plan: $66.7 \rightarrow 73.7\%$ (+7.0 pp)
• Multistakeholder forum: $59.6 \rightarrow 82.6\%$ (+23.0 pp)
• Anti-ageism law: $47.1 \rightarrow 72.9\%$ (+25.8 pp)
• Assistive devices law: $52.2 \rightarrow 77.2\%$ (+25.0 pp)
• Age-friendly programme: $48.0 \rightarrow 70.6\%$ (+22.6 pp)
• Comprehensive assessment policy: $67.3 \rightarrow 78.2\%$ (+10.9 pp)
• LTC policy: $43.3 \rightarrow 56.7\%$ (+13.4 pp)
• Cross-sectional survey: $36.5 \rightarrow 46.2\%$ (+9.7 pp)
• Longitudinal survey: $43.3 \rightarrow 56.7\%$ (+13.4 pp)

Older People Central

• 74 % countries now have ageing & health forums; yet 1/3 exclude older people.
• Participatory video toolkit (WHO) empowers elders (Canada/Jordan/Togo).
• Aged Care Council of Elders (Australia) advises govt.
• Initiatives targeting:
  • Women (Uncertain Futures; workshops Mexico; gendered COVID impact Thailand).
  • LGBTQ+ elders (Equity by Design cases).
  • Indigenous (Canada Elsipogtog).
  • Refugees (Lebanon Syrian elders; Venezuelan migrants in Spain).
  • Centenarian care model (Colombia).
  • Mid-life prep (Seoul Learn 4050).

Key lesson

• Terminology (“old”, “ageing”) may deter participation → address self-ageism.

Action Area 1 — Combatting Ageism

• Anti-discrimination legislation up to $83\%$ of countries.
• >60 % have mechanisms for rights promotion & redress.
• Effective strategies (Global report on ageism 2021):
  • Policy & law
  • Education
  • Intergenerational interventions.
• Examples: #StopIdadismo (Ibero-Am.), Belarus IS65+ media strategy, Singapore Youth Action Challenge, Tanzania youth theatre, Argentina gender-based violence centre.
• Abuse of older people: $1/6$ victims yearly; WHO 5-priority brief (2022). New global survey tool & “intervention accelerator”.

Action Area 2 — Age-Friendly Environments

• National AFCC programme: $52\%\rightarrow77\%$.
• GNAFCC membership rising (2010→2022 >1400 members).
• National exemplars:
  • Ireland – Age Friendly Ireland + Healthy Age Friendly Homes (extra €5 m).
  • Philippines – Plan of Action for Senior Citizens, local govt pilots.
• WHO “National programmes for AFCC guide” (2023); World Bank “Silver Hues” (2022).
• Social/financial protection: 59 % countries support income generation; but only 39 % in Africa & 32 % low-income.
• ILO World Social Protection Report 2020-22: $78\%$ global pension coverage; <$20\%$ in 48 countries.
• Isolation/Loneliness brief (WHO/ITU/UNDESA 2021); ministers for loneliness in JP & UK; data from Tamil Nadu study (loneliness >$60\%$ among seniors living alone).
• Emergencies: HelpAge in Ukraine (77 000 reached); S Africa flood elders volunteering.

Action Area 3 — Integrated, Person-Centred Care

• Comprehensive assessment policy: $48\%\rightarrow71\%$.
• ICOPE tools: guidelines (2017), framework (2019), handbook + app.
  • Pilots in Sri Lanka, China (>22 700 workers reached), Qatar (EHR integration), Argentina (self-care programme).
• Workforce indicators 2022:
  • 64 % have geriatric workforce plan
  • 57 % organising guidelines
  • 53 % competency framework; only 11 % low-income.
• Assistive products: legislation 77 %; 66 % countries provide free devices (only 37 % low-income).
• Access to outpatient care free for 80 % countries.
• Vaccine equity programmes (Tanzania 6 899 seniors jabbed; Cambodia 95 % seniors 1st-dose).
• Other innovations:
  • Johns Hopkins menopause clinic;
  • NZ Dementia Learning Centre;
  • UK Sexual Rights Charter;
  • Cameroon/Senegal HIV+ elders integrated screening.

Action Area 4 — Long-Term Care (LTC)

• LTC policy presence: $67\%\rightarrow78\%$.
• Only 34 % countries report adequate resources.
• Care workforce: 61 % have caregiver programmes, but just 16 % in low-income.
• Regional moves: EU Care Strategy (2022); African Union Protocol ratifications; WHO Continuum of LTC framework 2021; ILO–ISSA working paper on social protection.
• Palliative care: 65 % include in policy; only 25 % low-income.
• Country examples:
  • Canada national LTC standards (HSO 21001:2023).
  • Dominican Republic – UNFPA revamps 3 facilities.
  • Romania Care Hub engages retired nurses (25 000 hours care).
  • Chile e-learning for LTC staff (mental health/dementia).
  • UK early-warning tech reduced hospitalisations.
  • Maldives short course for bedridden care.

Doing Things Differently

• Decade Platform: 894 items uploaded; ~1500 users/week; >400 orgs listed.
• Healthy Ageing 50 (WHO/ITU/ILO/OHCHR/UNDESA/WEF) – showcases leadership.
• Healthy Ageing Collaborative (launched 2022) to mobilise multisector partnerships.
• National policy progress: focal points 86 %; healthy-ageing strategy 87 % (up from 73 %).
• New strategies: Chile (2020-30), Kenya (2022-26), Mauritius ICOPE (2022-26), Nepal Geriatric Strategy (2021-30), Palau policy 2023.

Data & Monitoring

• Cross-sectional survey inclusion only 57 %; longitudinal 46 % (lowest indicators).
• WHO Ageing Data Portal + indicator short-list; guidance for national situation analyses; Titchfield City Group to enhance SDG disaggregation.

Chapter 3 – Accelerating Action

1. Indicators show progress, but resources lag (≤ 34 % adequate across areas; 8–10 % no resources).
2. Diverse stakeholder programmes exist → need scaling, coordination.
3. Low-income countries require urgent focus (by 2050, 80 % elders in LMICs).
4. Decade legitimises ageing agenda; use momentum to raise priority.
5. Strengthen data/evaluation; TAG4MHA to finalise 20 outcome indicators; impact surveys in 2026 & 2029.
6. Must “walk the talk” on meaningful engagement of older people.
7. Leverage Healthy Ageing Collaborative & Platform for knowledge diffusion.

Numerical/Statistical Nuggets

• $1.4 \text{ billion}$ people ≥60 yrs by 2030.
• Four indicators improved >$20\%$ between 2020–22.
• COVID-19: 80 % deaths in ≥60; 82 % of 15 million excess deaths (to 2021).
• LTC global workforce: $130.2\text{ million}$ jobs; ≈ $80\%$ female.
• Isolation study India: >$60\%$ seniors living alone feel lonely.

Ethical & Practical Implications

• Rights-based approach central: anti-discrimination, autonomy, participation.
• Intersectionality (age+gender+disability+LGBTQ+status) must inform policy.
• Informal carers (mainly women) need recognition, respite, remuneration (ILO 5R framework).
• Emergencies & climate disasters expose neglect; age & disability inclusive humanitarian action needed.

Exam Tips / Connections

• Link Decade action areas to SDGs:
  • SDG 3 (Good Health), SDG 11 (Sustainable Cities), SDG 10 (Reduce Inequalities), SDG 8 (Decent Work), SDG 5 (Gender Equality).
• Remember 4 Enablers & 4 Action Areas → scenario questions.
• Know TAG4MHA role and 10 progress indicators list.
• Be ready to cite ICOPE as the flagship integrated-care model.
• Contrast high vs low-income country statistics for pensions, caregiver programmes, palliative inclusion.
• Recognise ageism triad: stereotype (think), prejudice (feel), discrimination (act).