Accelerating Progress on the UN Decade of Healthy Ageing

The vision of the UN Decade is a world in which all people live long and healthy lives. The UN Decade calls for action around four areas:

• Changing how we think, feel and act towards age and ageing;
• Ensuring that communities foster the abilities of older people;
• Delivering person-centred integrated care and primary health services that are responsive to older people; and
• Providing access to long-term care for older people who need it.

These action areas are interconnected and mutually reinforcing, and their achievement will foster healthy ageing and improve the well-being of current and future generations of older people around the world.

The adoption of the UN Decade recognized population ageing as a global megatrend of the 21^st century, and the right of older people to the highest attainable standard of health. It is projected that the number of people aged 60 and over worldwide will increase from 1.1 bn in 2021 to 1.4 bn in 2030 (World Population Prospects, 2022). However, data presented in WHO’s baseline report for the UN Decade (WHO, 2020) shows that while life expectancy is increasing, healthy life expectancy is not keeping pace, resulting in an increase in the number of years people spend in ill health.

A further key finding from the Baseline report was that 14% of older people − at least 142 million people aged 60 years and over globally − are not able to meet some of their basic needs. This presents a major challenge for older people that should be addressed during the UN Decade.

The adoption of the UN Decade recognized population ageing as a global megatrend of the 21st century, and the right of older people to the highest attainable standard of health.

A further key finding from the Baseline report was that 14% of older people − at least 142 million people aged 60 years and over globally − are not able to meet some of their basic needs.

The UN Decade was adopted in the midst of the COVID-19 pandemic. The pandemic disproportionately impacted older people, in terms of mortality and income and food security (WHO, 2023a). Evidence of threats to older people’s human rights, with some countries imposing restrictions on people’s movement and denying health services on the basis of age, made clear the scale of ageism around the world (WHO, 2021). Older people living in long-term care facilities were particularly affected. Yet older people were also active in the response to the pandemic, supporting their communities. The pandemic provided a renewed sense of urgency to take action towards healthy ageing, with the UN Decade providing a critical mandate through which to drive action.

Evidence of threats to older people’s human rights, with some countries imposing restrictions on people’s movement and denying health services on the basis of age, made clear the scale of ageism around the world.

Progress to date

In 2023, the World Health Organization (WHO) worked with UN partners[2] to develop the first progress report on the UN Decade (WHO, 2023b) this first round of reporting, focus was on progress in relation to process, with an outcome and impact evaluation planned for the next report in 2026. A process evaluation survey was conducted with Member States, focused on 10 national progress indicators (WHO, 2023c). Between September 2022 and April 2023, WHO conducted the survey and received responses from 136 of 194 Member States (70%).

Global and regional progress was defined in the report, using the data from countries that participated in both baseline survey and follow up survey in 2022, as an increase from the 2020 baseline in the proportion of countries with policies, strategies, action plans, programmes and data to support implementation of the UN Decade at national level.

Findings from the survey showed progress had been made in the first three years of the UN Decade in all 10 national indicators despite the challenges of the COVID-19 pandemic (Fig 1).

For four indicators, the absolute increase was > 20%: legislation or regulations to ensure that older people access assistive devices (26%); a national programme to support activities of the WHO Global Network for Age-friendly Cities and Communities (25%); national legislation and enforcement of strategies against age-based discrimination (23%); and a national policy on comprehensive assessments of health and social care needs (22%).

Fig. 2 shows the full range of responses to the 10 national progress indicators in 2022. For three indicators, more than 100 countries reported having policies, mechanisms or legislation in place: 112 countries had a focal point on ageing and health; 108 had a national policy, strategy or plan aligned to healthy ageing; and 105 had national legislation and enforcement strategies against age-based discrimination.

Alongside the national level data collected through the process evaluation survey, WHO also undertook an exercise to identify and share examples of contributions being made to the UN Decade and its call to foster healthy ageing by diverse stakeholders from around the world. A call for case studies resulted in over 150 being submitted by governments, NGOs, older people’s groups, UN agencies, academics and private sector actors.

These case studies, included in both the 2023 progress report and on the UN Decade’s knowledge platform, highlighted the breadth of activity being undertaken by, with and for older people. They demonstrate older people’s diversity with programmes targeting older women, people of different older ages, LGBTQ+ people, refugees and indigenous peoples, among others. Through these case studies, the report highlights work on healthy ageing happening in 60 countries in all WHO and SDG regions.

Where accelerated action is needed

While progress has been made since the UN Decade began, accelerated action is needed. A key area of concern is the adequacy of political commitment and financial resources. Only up to a third of countries reported having adequate or substantial resources available to implement the four action areas, ranging from 34% for long-term care to 27% for integrated primary health care, 26% for age-friendly environments and 22% for combatting ageism. For each area, some countries reported having no resources (Fig 3.).

A key area of concern is the adequacy of political commitment and financial resources. Only up to a third of countries reported having adequate or substantial resources available to implement the four action areas.

Increasing resource availability is particularly important in low- and middle-income countries where over 80% of older people will live by 2030 (UN, 2020). A consistent finding from the process evaluation survey, was less national engagement in lower income countries. This is a particular challenge in relation to the provision of an integrated continuum of care. Only 11% of low-income countries had national guidelines for organizing geriatric care and training, 16% had programmes for carers, and 25% had policies for palliative care.

Another area requiring increased attention is the meaningful engagement of older people. While older people are involved in the design and implementation of many initiatives that contribute to the UN Decade, more work is required to ensure that older people are meaningfully engaged at all stages. This is clearly highlighted by the fact that one third of countries with a multistakeholder forum on healthy ageing do not currently include older people within that forum.

Another area requiring increased attention is the meaningful engagement of older people. While older people are involved in the design and implementation of many initiatives that contribute to the UN Decade, more work is required to ensure that older people are meaningfully engaged at all stages.

WHO’s work on the UN Decade of Healthy Ageing

As the UN Decade progresses, so does WHO’s work to contribute to the achievement of healthy ageing, in collaboration with diverse stakeholders. At the global level, in 2024 WHO published its Long-term care for older people, package for universal health coverage which includes a list of long-term care interventions that all countries could provide and integrate within health and social care sectors. WHO also continued to support the capacity building of health workers around the world, including through the launch of a field test version of the integrated care for older people training programme.

WHO also released Making older persons visible in the sustainable development goals’ monitoring framework and indicators. The report provides examples from National Statistical Offices of SDG indicators relevant for older people that are already being collected and used for decision making, demonstrating that disaggregation of data is possible and useful.

WHO has published Connecting Generations, a practical ‘how-to’ guide that supports stakeholders to do intergenerational practice well.

At the global level, in 2024 WHO published its "Long-term care for older people, package for universal health coverage" which includes a list of long-term care interventions that all countries could provide and integrate within health and social care sectors.

Together with the Pan American Health Organization (PAHO), WHO launched a new multilingual online course on age-friendly environments highlighting the importance of developing cities and communities that foster the abilities of older people and welcomed new members to WHO’s Global Network for Age-friendly Cities and Communities.

To mark World Elder Abuse Awareness Day 2024, WHO released an interactive database of interventions that show promise in preventing and responding to the abuse of older people.

With the mid point of the UN Decade approaching, focus must be maintained and efforts increased to achieve a world in which all of us can live long and healthy lives, no matter where or who we are. This edition of the Medicus Mundi Switzerland Bulletin, focused on ageing and international health cooperation is a great contribution to this effort, supporting increased learning on healthy ageing, strengthened networking for collaboration during the UN Decade and the promotion of older people’s right to health.

This edition of the Medicus Mundi Switzerland Bulletin, focused on ageing and international health cooperation is a great contribution to this effort, supporting increased learning on healthy ageing, strengthened networking for collaboration during the UN Decade and the promotion of older people’s right to health.

1. 1 Defined by WHO as the process of developing and maintaining the functional ability that enables well-being in older age.

2. United Nations Department of Economic and Social Affairs, UN Habitat, United Nations Population Fund, United Nations Human Rights Office of the High Commissioner, UN Women.

References

• UN, 2020. United Nations Department of Economic and Social Affairs World Population Ageing 2019 United Nations, New York, 2020 (https://www.un-ilibrary.org/content/books/9789210045544)
• United Nations Decade of Healthy Ageing (2021–2030). In: United Nations General Assembly Seventy-Fifth session. Agenda item 131: Global health and foreign policy. New York(NY): The United Nations; 2020 (https://documents.un.org/doc/undoc/gen/n20/363/87/pdf/n2036387.pdf)
• WHA, 2020. Decade of Healthy Ageing 2020-2030. In Seventy-Third World Health Assembly. Agenda item 15.1. Geneva: World Health Organization; 2020 (https://apps.who.int/gb/ebwha/pdf_files/WHA73/A73(12)-en.pdf)
• WHO, 2020. The WHO baseline report for the Decade of Healthy Ageing. Geneva: World Health Organization; 2020 (https://iris.who.int/handle/10665/338677)
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• WHO, 2023c. Maternal, newborn, child and adolescent health and ageing. Data portal. Geneva: World Health Organization; 2023 (https://platform.who.int/data/maternal-newborn-child-adolescent-ageing/ageing-data)
• World Population Prospects 2022. New York: United Nations, Department of Economic and Social Affairs; 2022 (https://www.un.org/development/desa/pd/sites/www.u...)