Ageing and health: updates from the Western Pacific Region

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WPR/DHS/HCF(01)/2013 English only Report Series No.: RS/2013/GE/16(PHL)

REPORT

INFORMAL EXPERTS’ CONSULTATION ON AGEING AND HEALTH IN THE WESTERN PACIFIC REGION

Convened by:

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC

Manila, Philippines 9–10 April 2013

Not for sale

Printed and distributed by:

World Health Organization Regional Office for the Western Pacific

Manila, Philippines August 2013

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NOTE

The views expressed in this report are those of the participants in the Informal Experts’ Consultation on Ageing and Health in the Western Pacific Region and do not necessarily reflect the policies of the World Health Organization.

This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Members States in the Region and for those who participated in the Informal Experts’ Consultation on Ageing and Health in the Western Pacific Region, which was held in Manila, Philippines from 9 to 10 April 2013.

KEY WORDS:

Healthy ageing, Older people, Health services, Health promotion, Life cycle, Framework for action

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SUMMARY

Ageing is a key public health challenge confronting Member States in the Western Pacific Region. In almost every country, the population aged 60 years and over is growing faster than any other age group as a result of longer life expectancies and declining fertility rates. Strengthening health systems to provide older persons with seamless access to needed services is an emerging need in developed and developing countries.

The WHO Regional Office for the Western Pacific has been strengthening its response to ageing and health. In October 2013, the sixty-fourth session of the Regional Committee for the Western Pacific will discuss ageing and health as an agenda item and in a panel. In preparation, the following analytical work was commissioned to strengthen the evidence base:

(1) a comparative study of the health of older people in selected countries in the Region, through secondary analysis of existing survey data; and

(2) a review and analysis of policies related to ageing and health in selected countries in the Region.

These activities have informed the development of a draft regional framework for action on ageing and health, to be discussed at a meeting of Member States from 9 to 11 July 2013.

The Informal Experts’ Consultation on Ageing and Health for Western Pacific Region brought together 12 temporary advisers and 11 secretariat staff from 9 to 10 April 2013 in Manila to discuss preliminary findings of these analytical studies and obtain advice on next steps with regard to the draft regional framework for action on ageing and health. The objectives of the consultation were:

(1) to discuss preliminary findings and recommendations from ongoing analytical work on ageing and health in the Region; and

(2) to identify priority actions WHO could take in cooperation with Member States to address the health aspects of population ageing.

Discussions took place according to three main themes, reflecting the three products described above: the health situation of older people in the Western Pacific Region; policies on ageing and health in the Western Pacific Region; and a regional framework for action on ageing and health. Overall, participants welcomed efforts by the WHO Regional Office for the Western Pacific to take forward and strengthen the work on ageing and health, including the development of a regional framework for action on ageing and health. Participants made suggestions during the consultation on core themes and issues to be considered for inclusion in these products. Moreover, participants expressed their appreciation and support of WHO's efforts in this field. Going forward, participants are ready to provide ongoing input in finalizing the regional framework for action on ageing and health and collaborating with Member States on this agenda more broadly.

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CONTENTS

1. INTRODUCTION ... 1

1.1 Background ... 1

1.2 Objectives ... 1

2. PROCEEDINGS ... 2

2.1 Opening session ... 2

2.2 Technical sessions ... 4

2.3.1 Health situation of older people in the Western Pacific Region ... 4

2.3.2 Policies on ageing and health in the Western Pacific Region ... 6

2.3.3 Regional framework for action on ageing and health ... 10

2.3 Closing session ... 12 ANNEXES:

ANNEX 1 - List of participants ANNEX 2 – Timetable

ANNEX 3 - Presentations

Key words:

Ageing and health, older people, health promotion, healthy and active ageing, life-course, age-friendly health system, framework for action

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1. INTRODUCTION

1.1 Background

Ageing is a key public health challenge confronting Member States in the Western Pacific Region of the World Health Organization (WHO). In almost every country, the population aged 60 years and over is growing faster than any other age group as a result of longer life expectancies and declining fertility rates. Strengthening health systems to provide older persons with seamless access to needed services is an emerging need in developed and developing countries.

Advancing health and well-being into old age is one of the three priority directions set forth in the Madrid International Plan of Action on Ageing, adopted in April 2002 at the second World Assembly on Ageing. In May 2012, the World Health Assembly requested the Director-General to support Member States on ageing by adopting Resolution WHA65.3 (Strengthening noncommunicable disease policies to promote active ageing).

The WHO Regional Office for the Western Pacific has been strengthening its response to ageing and health. In May 2011, it convened an informal experts’

consultation to advise on the Region’s work on population ageing. In April 2012, on World Health Day, the Regional Office undertook wider efforts to raise awareness on ageing and health, including by disseminating information and convening events at regional and country levels. In October 2013, the sixty-fourth session of the Regional Committee will discuss ageing and health. In preparation, the following analytical work was commissioned to strengthen the evidence base: (1) a comparative study of the health of older people in selected countries in the Region, through secondary analysis of existing survey datasets; and (2) a review and analysis of policies related to ageing and health in selected countries in the Region. These activities have informed the development of a draft regional framework for action on ageing and health, to be discussed at a meeting of Member States in July 2013.

An Informal Experts’ Consultation on Ageing and Health for the Western Pacific Region was held from 9 to 10 April 2013 in Manila, Philippines to present preliminary findings from the ongoing analytical work and to discuss their implications and recommendations for action. Twelve temporary advisers and 11 secretariat staff participated (see the list of participants in Annex 1). The informal experts' consultation included technical presentations and discussions. The timetable is attached as Annex 2.

1.2 Objectives

(1) To discuss preliminary findings and recommendations from ongoing analytical work on ageing and health in the Region.

(2) To identify priority actions WHO could take in cooperation with Member States to address the health aspects of population ageing.

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evidence base on ageing and health in other settings and countries.

In the discussions that followed, there was strong agreement that strengthening the evidence base on ageing and health to inform effective policy-making was a key priority. Participants highlighted the value of studies such as the WHO-commissioned comparative analysis on the health of older people. WHO has an important role in facilitating information sharing and supporting research and learning on ageing and health.

With regards to the content of the comparative analysis, participants suggested including social and mental health issues, including evidence on topics such as social isolation, depression and dementia. Several participants suggested including the issue of older people's expectations about health status, which are important but fluid, reflecting societal values and resources, such as the extent of availability of medicines and assistive devices. The availability and quality of health services in a given country are also relevant, since they vary substantially and could potentially distort a regional comparison of health data. Participants also noted the importance of NCDs and related co-morbidities in relation to the health of older people, which thus merits further analysis.

Participants felt that the planned country fact sheets will usefully stimulate policy-related discussions with Member States. Participants' recommendations included using the most up-to-date information available; incorporating policy implications in the comparative study report and country fact sheets; formulating key messages in policy-maker-friendly language; and moving beyond analysis to knowledge translation to informed policy-making.

Participants pointed out the various available sources and ongoing efforts by Member States to strengthen information on the health status of older people. Member States can learn from the examples of Japan and China as frontrunners. The group agreed strongly on the need to ensure appropriate disaggregation of data for effective policy-making. The lack of standardization of indicators across surveys and countries limits comparability and is a key priority for action.

2.3.2 Policies on ageing and health in the Western Pacific Region

Dr Gulin Gedik, Team Leader, Human Resources for Health, WHO Regional Office for the Western Pacific, chaired the first half of the session on policies on ageing and health in the Western Pacific Region. Dr Xu Ke, Team Leader, Health Care Financing, WHO Regional Office for the Western Pacific, facilitated the second half of the session.

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k review o ad set of gion as we lysis based erviews and ing visits hina, Fiji, t

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financial re rdination ac appropriate p ome countr ources, incl ancing arran milarly, serv

untries will ending on t In conc lysis, Profe elop and i areness abou

ving towar tainable and uld need to ween urban on conclud g-term care vice deliver ions for old he populatio

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ll as more d on key i d document in four the Philipp e summarize

rising dema nancial reso on leadersh ces for heal s have dev health issue

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need to bala their local co clusion, sum essor Kwon mplement ut ageing an rds univers d appropriat o be paid to n and rural p ded by com e, which cu ry and fina er people is on.

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(15)

population ageing, in particular increasing access to needed health technologies and medicine as well as engaging a range of stakeholders.

In the discussions that ensued, participants welcomed the review of ageing and health policies in the Region and its emphasis on health systems. Several stated that appropriately strengthening health systems and policies is as important as improving the evidence base on the health of older people to inform policy-making. Numerous countries in the Region have developed laws, policies and programmes on ageing and health. Other countries can learn from these examples and good practices. Participants urged the inclusion of a strong focus on age-friendly health systems in the planned regional framework for action on ageing and health. Participants also recognized the review's focus on four of WHO’s six health systems building blocks and suggested extending the analysis to include the remaining two. Participants emphasized the need to analyse the breadth of existing policies in the Region, which offer a diverse set of options on ageing and health. Further analysis of these policy options and their implementation and effectiveness is needed.

On the scope of the review, participants suggested further analysis of certain

“grey areas” in health systems, as a stronger basis for the development of the regional framework. For example, clearly differentiating the health and social components of care could strengthen the policy analysis as well as the regional framework for action.

Older people typically experience co-morbidities that many health systems are weakly equipped to handle. On service delivery, participants stressed the need to ensure a continuum of care for older people. This requires appropriate coordination and integration of care based on improved understanding of service delivery from the patients’ perspective, as well as from the supply side. Home- and self-care also need to be integrated into the care continuum. OPAs can potentially meet some of these care needs. Further attention is needed to explore community-based care models, given changing dynamics in families, which have traditionally performed this function.

On health workforce, participants noted the wide range of health professionals engaged in care, including clinical service providers, those working in health promotion and disease prevention, social care workers and informal careers. Changing demands for different types of health workers would require efforts to strengthen the competencies of all workers in meeting the health needs of older people, including at the primary care level. In addition, increased investment is needed in certain specialities relevant to the health needs of older people. This would require changes in health worker education in terms of technical specialities as well as competencies of health workers. Health worker migration needs attention, given the expected increase in demand for health workers.

On health financing, participants agreed that the policy review could highlight examples of effective health financing policies and practices, given the importance of this topic for population ageing. The potential involvement of the private sector is an area that deserves further analysis. Discussions also highlighted the policy links between financial accessibility of health care for older people and broader policy issues related to the retirement age, pensions and social security. In many countries, older people—especially those from low-income households—had little choice but to continue to work, often in the informal sector, due to limited social protection. Society

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traditional backbones. It also has important implications for health systems elements, such as the health workforce.

Dr Megumi Kano, Technical Officer, WHO Centre for Health Development, presented an overview of the centre's work. The centre has worked extensively on urban health, including development of the Urban Health Equity Assessment and Response Tool (Urban HEART), to enable local and national officials to identify health inequities and identify appropriate actions to reduce them. The centre's work on metrics for ageing and health equity includes exploratory analyses of intra-urban health inequalities by socioeconomic status among older people in Japan. With the Centre for Well-being and Society at Nihon Fukushi University in Nagoya, Japan, the WHO Centre for Health Development has developed benchmarks to align JAGES with Urban HEART. The centre has also led the development of indicators for age-friendly cities. Innovation for healthy ageing is a new area of focus. A Consultation on Advancing Technological Innovation for Older Populations in Asia, held in February 2013, considered the role of medical and assistive devices in relation to ageing and health. A WHO Global Forum on Innovation for Healthy Ageing is planned for December 2013.

In the discussions that followed, participants welcomed the development of the regional framework for action on ageing and health. Participants supported the overall objectives and several suggested including a vision statement, emphasizing older people's experience, skills and wisdom as a resource to society, especially if they are enabled to retain their health and live in environments that promote their active participation. Participants also welcomed the framework's emphasis on the cross- cutting issues of gender, equity and human rights, including the participation of older people.

On the framework's structure and content, participants generally supported the proposed components as appropriate, especially the focus on promoting age-friendly health systems. WHO could play a valuable role in supporting Member States in this area. They suggested highlighting key health systems challenges with regard to ageing and outlining some suggested actions.

Participants also agreed that adequate data collection and knowledge translation are important inputs to inform appropriate policy development and action on ageing and health. The relevant section of the framework should highlight the current situation, potential challenges such as the lack of standardization, and suggested actions.

Participants suggested dealing with “promoting healthy ageing across the life course”, in two sections: the first on ageing and health across sectors, stressing the importance of fostering age-friendly environments and the leadership role of the health sector to engage in multisectoral action on ageing and health; and the second on promoting healthy ageing across the life course, recognizing the need for policies and actions to reduce exposure to risk factors for NCDs.

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Four pillars of action were proposed for the regional framework for action:

(1) foster age-friendly environments through action across sectors;

(2) promote healthy ageing across the life course and prevent functional decline and disease among older people;

(3) promote universal health coverage through age-friendly health systems;

and

(4) strengthen the evidence base on ageing and health.

Participants agreed on the usefulness of including a section in the framework on implementation, offering suggestions on advocacy, political commitment and partnerships, and highlighting the importance of engaging with different stakeholders, including older people themselves.

2.3 Closing session

Dr Henk Bekedam concluded the consultation by warmly thanking the experts for their active participation. Their helpful advice would inform finalization of the regional framework for action on ageing and health. The framework would then be presented for further review and input from Member States at a meeting scheduled for July 2013. The final draft would be presented to the Regional Committee at its sixty- fourth session in October 2013. Its endorsement by the Regional Committee would strengthen political commitment and enable WHO to move forward on ageing and health. Dr Bekedam assured participants that WHO stood ready to advance this area of work, in collaboration with Member States and other partners, including the experts participating in this informal consultation.

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ANNEX 1: List of participants

1. Temporary advisers

Professor Julie Byles, Director, Research Centre for Gender, Health and Ageing University of Newcastle

University Drive, Callaghan, New South Wales 2308, Australia

Tel.: +61 2 4042 0668; Fax: +612 4042 0044; E-mail: Julie.Byles@newcastle.edu.au Dr Aparajit B. Dey, Professor and Head, Department of Geriatric Medicine, All India Institute of Medical Sciences

Room No. 3091, Teaching Block, Ansari Nagar, New Delhi 110029, India Tel. + 91 11 2659 3639; Fax: +91 11 2658 8663; E-mail: abdey@hotmail.com Professor Catherine D'Este, Director, Centre for Clinical Epidemiology and Biostatistics and Deputy Head of School (Public Health), University of Newcastle University Drive, Callaghan, New South Wales 2308, Australia

Tel.: +61 2 4042 0517; Fax: +61 2 4042 0044; E-mail:

Catherine.DEste@newcastle.edu.au

Professor Hal Kendig, Professor of Ageing and Public Policy, Center for Research on Ageing, Health and Wellbeing, Australian National University, CMBE/RSPH,

Building 62A, Canberra, ACT 0200, Australia

Tel.: +61 2 6125 5625; Fax: +61 2 9351 9566; E-mail: hal.kendig@anu.edu.au Mr Eduardo Klien, Regional Director, HelpAge International East-Asia/Pacific Regional Development Centre

6 Soi 17, Nimmanhaemin Road, Suthep, Muang, Chiang Mai, Thailand 50200 Tel.: +66 53 225 440; Fax: +66 53 225 441; E-mail: eduardo@helpageasia.org Professor Josefina Natividad, Director and Professor of Demography, Population Institute

3^rd Floor, Palma Hall, University of the Philippines, Diliman 1101, Quezon City, Philippines

Tel.: +63 2 920 5402; Fax: +63 2 920 5402; E-mail: jnatividad55@yahoo.com Dr Katsunori Kondo, Professor, Faculty of Social Welfare, Graduate School of Health and Social Services Management, Nihon Fukushi University

5-22-35 Chiyoda, Naka-ku, Nagoya-shi, Aichi 460-0012, Japan

Tel.: +81-52-776-5170; Fax: +81-52-776-5170; E-mail: kkondo@n-fukushi.ac.jp Professor David Phillips, Chair Professor of Social Policy, Department of Sociology and Social Policy

WYL323, Dorothy Y L Wong Building, Lingnan University, Tuen Mun, N.T., Hong Kong, China

Tel.: +85 2 2616 7179; Fax: +85 2 2616 5599; E-mail: phillips@LN.edu.hk

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Annex 1

Professor Soonman Kwon, Dean, School of Public Health, Seoul National University 1 Kwanak-ro, Kwanak-gu, Seoul 151-742, Republic of Korea

Tel.: +82 2 880 2721; Fax: +82 2 762 2888; E-mail: kwons@snu.ac.kr

Dr Srinivas Tata, Chief, Social Policy and Population Section,Social Development Division, United Nations Economic and Social Commission for Asia and the Pacific, United Nations Building, Rajadamnern Nok Avenue, Bangkok 10200, Thailand Tel: +66 2 -288-1667; Fax: +66 2 288 1030; Email: tatas@un.org

Ms Yuki Murakami, Health Economist/Policy Analyst, Health Division, Directorate for Employment, Labour and Social Affairs, Organisation for Economic Co-operation and Development

2, rue André Pascal, 75775 Paris Cedex 16, France

Tel.: +33 1 45 24 93 23, Fax: +33 1 44 30 63 61, E-mail: Yuki.murakami@oecd.org Dr Wang Limin, Professor and Acting Deputy Director of Department of Disease Surveillance, National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention

27 Nanwei Road, Xicheng District, Beijing, China, Tel.: +86 10 8313 6482;

+8615010927830; Fax: +86 10 8313 6481, E-mail: wlm65@126.com 2. Secretariat

WHO Western Pacific Regional Office

Dr Henk Bekedam, Director, Division for Health Sector Development World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000, Philippines

Tel.: +63 2 528 9802; Fax: +63 2 521 1036; E-mail: bekedamh@wpro.who.int Dr Susan Mercado, Director, Building Healthy Populations and Communities World Health Organization Regional Office for the Western Pacific

P.O. Box 2932, Manila 1000, Philippines

Tel.: +6 32 528 9852, Fax.: +63 2 521 1036; E-mail: mercados@wpro.who.int Dr Dale Huntington, Director, Asia Pacific Observatory on Health Policy and Systems, World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000, Philippines

Tel.: +63 2 528 9820; Fax: +63 2 521 1036; E-mail: huntingtond@wpro.who.int Mr Sjoerd Postma, Team Leader in Health Services Development, Division for Health Sector Development, World Health Organization Regional Office for the Western Pacific, P.O. Box 2932, Manila 1000, Philippines

Tel: +63 2 528 9806, Fax: +63 2 521 1036; Email: postmas@wpro.who.int

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Annex 1

Dr Gulin Gedik, Team Leader, Human Resources for Health, Division for Health Sector Development, World Health Organization Regional Office for the Western Pacific

Tel.: +63 2 528 9816; Fax.: +63 2 521 1036; E-mail: gedikg@wpro.who.int Dr Xu Ke, Team Leader, Health Care Financing, Division for Health Sector Development, World Health Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000, Philippines

Tel: +63 2 528 9711; Fax.: +63 2 521 1036; E-mail: xuk@wpro.who.int Dr Manju Rani, Senior Technical Officer, Health Research Policy, Division for Health Sector Development, World Health Organization Regional Office for the Western Pacific

Tel.: +63 2 528 9048, Fax.: +63 2 521 1036; E-mail: ranim@wpro.who.int

Dr Hai-Rim Shin, Team Leader, (Noncommunicable Diseases and Health Promotion), Division for Building Healthy Populations and Communities, World Health

Organization Regional Office for the Western Pacific P.O. Box 2932, Manila 1000, Philippines

Tel.: +63 2 528 9860; Fax.: +63 2 521 1036; E-mail: shinh@wpro.who.int Dr Cherian Varghese, Senior Medical Officer (Noncommunicable Diseases), Division for Building Healthy Populations and Communities, World Health Organization Regional Office for the Western Pacific

Tel. No.: +63 2 528 9866; Fax.: +63 2 521 1036; E-mail: varghesec@wpro.who.int Ms Anjana Bhushan (Responsible Officer), Technical Officer (Health in

Development), Division for Health Sector Development, World Health Organization Regional Office for the Western Pacific

Tel.: +63 2 528 9814; Fax: +63 2 528 9072; E-mail: bhushana@wpro.who.int

Ms Britta Baer, Technical Officer (Gender, Equity and Human Rights), Division for Health Sector Development, World Health Organization Regional Office for the Western Pacific

Tel.: +63 2 528 9084; Fax: +63 2 528 9072; E-mail: baerb@wpro.who.int WHO Geneva

Dr Ritu Sadana, Lead Specialist, Department of Ageing and Life Course, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland Tel.: +41 22 791 3250; Fax: +41 22 791 0746; E-mail: sadanar@who.int

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Annex 1

WHO Centre for Health Development

Dr Megumi Kano, Technical Officer, WHO Centre for Health Development I.H.D. Centre Building 9F, 5-1, 1-chome, Wakinohama-Kaigandori, Chuo-ko, Kobe 651-0073, Japan

Tel.: +81 78 230 3105; Fax: +8178 230 3178; E-mail: kanom@who.int

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ANNEX 2: Timetable

INFORMAL EXPERTS’ CONSULTATION ON AGEING AND HEALTH IN THE WESTERN PACIFIC REGION Time DAY 1 - Tuesday, 9 April 2013

8:00 Registration 08:30-

10:00

Opening session Opening remarks:

 Dr Henk Bekedam, Director (Health Sector Development)

 Dr Susy Mercado, Director (Building Healthy Communities and Populations)

Introduction of participants

Presentation: Global update on ageing and health (15’)

 Dr Ritu Sadana, Lead Specialist (Ageing & Life Course), WHO Headquarters

Presentation: Regional update on ageing and health (15’)

 Ms Anjana Bhushan, Technical Officer (Health in Development)

Group photo 10:00 Break 10:30-

12:00

Session 1a: Health situation of older people in the Western Pacific Region Facilitator: Dr Hai-Rim Shin, Team Leader (NCDs and Health Promotion)

Presentation: Health situation of older people in the Western Pacific Region – quantitative analysis (15’)

 Professor Julie Byles, Director, Research Centre for Gender, Health and Ageing, University of Newcastle (WHO CC), Australia

Presentation: Health situation of older people in China (10’)

 Dr Wang Limin, Director, Division of Disease Surveillance, Chronic Disease Control Center, China CDC, Beijing, China

Presentation: Health situation of older people in Japan (10’)

 Dr Katsunori Kondo, Professor, Faculty of Social Welfare, Graduate School of Health and Social Services Management, Nihon Fukushi University, Japan

Discussion 12:00 Lunch 13:30-

15:00

Session 1b: Health situation of older people in the Western Pacific Region Facilitator: Dr Cherian Varghese, Senior Medical Officer (NCDs)

Facilitated discussion based on guided questions:

1. What are the most important conclusions from the information presented?

2. What further information needs to be collected [what are the gaps] to enable the development of appropriate policy or programmatic recommendations?

3. What are the potential policy/programmatic options based on the report findings?

15:00 Break 15:30-

17:00

Session 2a: Policies on ageing and health in the Western Pacific Region Facilitator: Dr Gulin Gedik, Team Leader (Human Resources for Health)

Presentation: Policies on ageing and health in the Western Pacific Region (15’)

 Professor Soonman Kwon, Dean, School of Public Health, Seoul National University, Republic of Korea

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Presentation: Comments and overview of work by HelpAge International (10’)

 Mr Eduardo Klien, Regional Representative, HelpAge International, East-Asia/Pacific Regional Development Centre, Thailand

Presentation: Comments and overview of work by UNESCAP (10’)

 Mr Srinivas Tata, Chief, Social Policy and Population Section, Social Development Division, UNESCAP, Thailand

Discussion 18:00-

19:30

Informal get-together to welcome participants Time DAY 2 - Wednesday, 10 April 2013

8:30- 10:00

Session 2b: Policies on ageing and health in the Western Pacific Region Facilitator: Dr. Ke Xu, Team Leader (Health Care Financing)

Facilitated discussion based on guided questions

1. What key areas regarding ageing and health are not addressed by the policy review?

2. What is the ‘adequacy’ and ‘appropriateness’ of existing policies (in developed and developing countries)? Are policy gaps the major issue, or policy implementation the major issue, or both?

3. Which are the areas where appropriate policy and programmatic action will lead to maximum gains?

10:00 Break 10:30-

12:00

Session 3a: Regional framework of action on ageing and health

Facilitator: Mr Sjoerd Postma, Team Leader (Health Services Development)

Presentation: Overview of the Draft Regional framework of action on ageing and health (15’)

 Professor A.B. Dey, Professor, Department of Medicine & Nodal Officer, National Institute of Ageing, All India Institute of Medical Sciences, India

Presentation: Comments and overview of work by OECD (10’)

 Ms Yuki Murakami, Health Policy Analyst, OECD, France

Presentation: Comments and overview of work by the WHO Kobe Centre (10’)

 Dr Megumi Kano, Technical Officer, WHO Kobe Centre for Health Development, Japan Discussion

12:00 Lunch 13:30-

15:00

Session 3b: Regional framework for action on ageing and health

Facilitator: Ms Anjana Bhushan, Technical Officer (Health in Development) Facilitated discussion based on guided questions:

1. Does the draft framework adequately reflect the available evidence on ageing and health?

2. How should the Regional framework for action be used in countries (—as an advocacy tool, helping to inform policy/programmatic options, mobilizing financing)? Does the draft fulfil those expectations?

3. How can WHO support implementation in countries and monitor progress on the Regional Framework for action?

15:00 Break 15:30-

16:30

Closing session: Way forward and next steps

Facilitator: Dr Henk Bekedam, Director, Health Sector Development

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ANNEX 3: Presentations

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Global Update on Ageing and Health

Informal Experts' Consultation 9 - 10 April 2013

Manila

Dr Ritu Sadana, Lead Specialist Dr John Beard, Director

Department of Ageing and Life Course WHO Geneva

Global Conference on Ageing 2010 2^|

Proportion of Population Over Age 60, 2012

Global Conference on Ageing 2010 3|

Proportion of Population Over Age 60, 2050

Pace of Ageing - Accelerated Pace of Ageing - Accelerated

WPRO Informal Experts' Consultation, 9 to 10 April 2013, Manila 5|

Hypertension in people 50 plus - Untreated Hypertension in people 50 plus - Untreated

Source: SAGE wave1 2007 – 2010, n = 34,124

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3 Approaches to the Challenges of Population Ageing 3 Approaches to the Challenges

of Population Ageing

INACTION REACTION ACTION

INACTION INACTION

Pretend there is no demographic change and continue with current approaches

CONSEQUENCES

More developed countries or sub areas

–Increasing health and social protection costs with questionable benefit

–Marginalisation of older adults and loss of human and social capital

Less developed countries or sub areas

–Increasing inequity, reduced productivity due to family burden

REACTION REACTION

Respond by addressing the symptom (e.g. current model yet with reduced health and social benefits)

CONSEQUENCES

More developed countries

–Initial fall in direct commitments, long term increase in indirect costs

Less developed countries

–Entrench unproductive systems (inefficient, inequitable, injust)

ACTION ACTION

Invest in sustainable health and social systems that liberate the human resource of older populations and enhance socioeconomic

development, while also building social protection and responding to health needs.

Taking Action on Ageing and Health Taking Action on Ageing and Health

Promoting good health and healthy behaviours at all ages – life course approach

Equipping health systems to minimize the consequences of chronic diseases

Creating physical and social environments that foster health and participation

Reinventing ageing WHO 2012

Linear Lifeplan

Education Work/Family Leisure

Age

0 10 20 30 40 50 60 70 80 85

Thanks to Ken Dychtwald

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Linear Lifeplan

“Longevity Bonus”

Age

0 10 20 30 40 50 60 70 80 85

Age

0 10 20 30 40 50 60 70 80 85

Cyclic Lifeplan

Thanks to Ken Dychtwald

WPRO Informal Experts' Consultation, 9 to 10 April 2013, Manila 17^|

TAKING ACTION TAKING ACTION

Health policy implications What can the health sector

do?

What can each health system function do?

What can major public health programmes do?

What can universal health coverage do?

Broader policy implications

What can government do?

What can civil society do?

What can regional and global institutions do?

What can be done together?

What level of policy implication?

What specifically can I do about it?

Legislationcan help protect from discrimination, ageism and social exclusion.

Health policies should remove barriersto health care access and integrate social services.

Labour market, education and family welfare policies should aim to sustain intergenerational solidarity.

Interventions tomaintain independence and social participationare needed at the individual and the community levels

Policy implications: ageing and health

How would they do this?

How would they do this?

What sort of interventions?

What sort of legislation?

Implied questions

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IFMSA August 2009 19|

General Programme of Work 2014-19

Ageing and health work 2014-2015 Ageing and health work 2014-2015

Support countriesto strengthen their own capacities and articulate their own policies

Global report on ageing and health, leading to a global plan of action on ageing and health

Model and measures for monitoringand quantifying the diverse health needs of older people and whether these needs are met

WHO Global and Regional Networks of Age-friendly Cities and Communities strengthened

WHO global network of age-friendly cities and communities

Ageing and health work 2014-2015 Ageing and health work 2014-2015

Technical guidelines on management of frailty, with a focus on low- and middle-income countries

Policy options on long-term care– to maintain independence as long as possible, integrate health and social care, offer assistive devices and palliative care Policy options on workforce development– pre

service and in service training, not only for chronic diseases

Policy options on the health of womenacross the life course beyond the reproductive age

Need a framework – WHO has some Need a framework – WHO has some

Classifications & Measures Broader policy Health policy

Catalyzing action on ageing and health Catalyzing action on ageing and health

Knowledge generation with collaborators(data, analysis, research, guidelines, evidence synthesis) – global public goods

Knowledge translation in countries (evidence- informed policy dialogues, identification and

implementation of policy options, monitoring impact) – learning and accountability

Strengthen expert and institutional networks and collaborations(channel expertise, evidence, experience for Member States) –increasing capacities