becomes the new 60 – in terms of physical and cognitive fitness, and anticipated further life expectancy – there is need for a profound reimagining of ageing and retirement. Healthy ageing This calls for a ‘life course approach’ that recognises that ‘healthy ageing’ is a legacy of many factors operating since conception and birth, across all the years of life that precede the ageing threshold. Unhealthy ageing is the result of cumulative inequities and behavioural indiscretions experienced over one’s lifetime. The continuity of the biological thread connects the nutritional exposure of the mother (preconception period and pregnancy) and of the child to health in later life. The epigenetic effects of early life nutrition are now known to cast a long shadow on adult life, through susceptibility to cardiovascular disease, diabetes and cancers. The Millennium Development Goals of improved maternal and child health are thus linked to the potential for healthy ageing, a relationship that reinforces the integrative nature of sustainable development. At the same time, we have also recognised that human biology, and hence health or illness, is profoundly affected by the social environment. Non-communicable diseases now constitute the dominant public health challenge of the 21st century and are propelled by social determinants that condition risk behaviours, which in turn alter biologic risk factors. Heart diseases, stroke, diabetes, cancers and chronic respiratory diseases are growing as a global threat, due to confluence of developmental and demographic transitions. Alongside the disabling effects of these non-communicable diseases, which extend their presence and perils from preceding adult life to the elderly years, the rise of mental illness in this age group poses a major threat to the quality of life (Prince et al., 2015). Alzheimer’s disease, vascular dementia, depression and a variety of neuropsychiatric disorders affect the elderly and call for an effective and empathetic response from the health system and the social environment. The imperative of the post-2015 sustainable development agenda is to minimise the influence of factors that impede the progress to healthy and active ageing by acting to promote good health at all stages of life, and create a positive legacy that benefits health in the later years. The health of the elderly does pose some distinct problems, such as a higher frequency of multiple co-morbidities, greater physical frailty and instability in advanced years, and impaired vision, hearing and memory. However, healthy living and H e a l t h y a g e i n g i s v i t a l t o s u s t a i n a b l e d e v e l o pme n t supportive health systems in earlier years can help people to cross the ageing threshold with a substantial credit balance of good health. Timely interventions can prevent or greatly limit disability and maintain functionality. It is an elemental desire of the elderly to age with grace, retaining their autonomy and remaining connected with a world that still values them, and to finally ease out of life without unduly prolonging their suffering through reflexive use of unfeeling and often unhelpful medical technologies. As one enters the ‘golden years’, there is increasing need for attention to structure (biological integrity of body parts and their co-ordination), function (physical and mental ability to carry on with daily living with minimal dependence on others) and participation (social engagement with family, friends and an external world that grows less familiar by the day). While healthy living in earlier years can make the elderly fit and functioning rather than frail and feeble, the reality of multiple physical and mental impairments falls to the lot of many as they age. A change of focus There is a need for a re-configuration of health systems, a re-focus from mere disease management to health promotion and risk reduction. Even in clinical care settings, recognition of multi- Action pathways Transform mindsets • Change the prevailing dogmas on ‘ageing’ and ‘retirement’ to accommodate contemporary concepts on fitness and productive potential • Promote awareness and understanding of the ‘life-course approach’ to healthy ageing • Counter the negative cultural stereotypes that generate inter-generational animosity and promote positive images that create harmony Transform institutional and regulatory frameworks • Create robust pension plans to provide financial security • Implement UHC with sensitivity to the needs of the elderly • Provide a safe physical environment through prescribed building standards, age-friendly urban design and transport systems • Legislate the social and economic rights of the elderly Transform support systems • Provide an enabling social and economic environment that supports healthy and happy ageing through healthpromoting influences across the life course (nutrition, formal and informal education for lifelong learning, productive work, financial security, clean environment) • Promote informed individual choices related to health, work and life transitions • Create dependable support systems to provide appropriate, empowering and empathetic health care in home or institutional settings Commonwealth Health Partnerships 2015 15 Key messages • Barriers to healthy and active ageing must be removed • Opportunities must be created for productive participation of the aged in all domains of human activity • Society must not only use these assets but also invest in them because of the high returns in social and even economic development • Needs of health care, social security and physical safety of the elderly must be recognised, along with gender- and povertyrelated specificities, for effective multi-sectoral responses • There is a need for ‘all of society’ engagement, with wideranging partnerships, to accomplish the above objectives
Commonwealth Health Partnerships 2015
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