From the foothills of Nepal’s snow-capped Himalayas to the beaches of the Timor Sea, the population of WHO’s South-East Asia Region is ageing. Eight percent of the Region, or around 142 million people, are currently over the age of 60, with estimates suggesting the proportion will rise to over 20 percent by 2050. The number of ‘old’ and ‘very old’ persons in most South-East Asia countries, meanwhile, is growing at a pace greater than any other age demographic.
Contrary to common assumptions, these facts hold great opportunity. Rather than being a ‘burden’ on younger generations, older persons can enhance the social, economic and cultural fabric of our societies, and pioneer ways to radically restructure 21st century living in South-East Asia and beyond. As highlighted by WHO’s World Report on Ageing and Health, the key to realizing this potential is promoting autonomy and emotional wellbeing in older persons, thereby achieving healthy ageing outcomes throughout the life course.
Understanding that there is no such thing as a typical older person is the first step to achieving these outcomes. Just as some 60-year-olds may have mental or physical limitations, there are many 80-year-olds that have the capacity to challenge those six decades their junior. Similarly, just as some older persons may require full-time care, others – particularly in the low and middle-income countries of South-East Asia contribute significantly to local and national economies. Alongside genetic and socioeconomic factors, urbanization, migration and changing social roles likewise affect the way ageing is experienced. As young people increasingly gain employment in urban centers, traditional forms of care in rural areas may be more difficult to access. Though 70 may not yet be the new 60, we have the opportunity to make this maxim a reality.
To facilitate healthy ageing, it is imperative that health care services are aligned with the diverse needs of older persons and responsive to their life course trajectories. As people age their health needs often become more chronic and complex and require health care services to address their multidimensional demands. These needn’t be expensive. For the Region’s more developed countries it is a matter of re-calibrating existing services. In the Region’s more resource-constrained settings it is about developing new approaches that can deliver adequate care to older persons while addressing the need for acute care at younger ages and promoting good health through the life-course.
Developing services for long-term care is similarly critical to facilitating healthy ageing. Quality long-term care services allow care-dependent older persons to maintain their dignity. They also help families avoid financial hardship. By spreading the burden associated with long-term care across a range of public and private stakeholders, governments allow those who may otherwise be compelled to provide unpaid 24-hour care to participate in the labor force. For the labor-intensive economies of the South-East Asia Region, increased access to long-term care provides a net benefit to older persons, as well as society.
Undergirding these policy innovations is the notion that maintaining the dignity and autonomy of older persons enhances mental wellbeing, thereby increasing the ability for older persons to contribute to and engage with society in ways hitherto unimagined. Older persons may wish to pursue higher education, start a second career, indulge a long-subdued passion, or – as is traditionally the case – enjoy time enriching the emotional lives of friends, family and/or grandchildren. Whatever the case, building the abilities of older persons to navigate their changing world and to offer new, more productive and fulfilling ways of living necessarily goes beyond public health policy, and involves the creation of age-friendly environments related to a range of areas, including transport, housing, labor, social protection and information and communication. Promoting healthy ageing involves an inter-sectoral approach to policymaking that combats ageism, enables autonomy, and discards staid, outdated social models and ways of thinking. In other words, it requires imagination and an ability to comprehend the opportunities ageing populations provide.
Countries in WHO’s South-East Asia Region are aware of this. In 2009, WHO introduced to Member States in the Region a strategic framework for healthy ageing followed by the provision of technical support to strengthen healthy ageing programs and identify constraints. In 2012, health ministers in the Region adopted the Yogyakarta Declaration on Ageing and Health, providing a clear, Region-wide acknowledgement of the public health challenge provided by ageing populations, as well as a commitment to implementing appropriate policies. This groundswell led to the adoption of WHO Regional Strategy for Healthy Ageing, a strategic plan with a five-year timeframe (2013-2018) that provides countries the tools to implement positive, forward-looking policy initiatives related to healthy ageing.
Within this context, the release of the World Report on Ageing and Health is to be celebrated. By combining cutting edge research with innovative policy solutions, the report promotes the importance of healthy ageing initiatives – both in a regional and global sense – and also creates the necessary dialogue to stimulate widespread engagement on the ways governments, private stakeholders and individual citizens can support healthy ageing throughout the life course. Though the ageing process may be irreversible, the attitudes and policies we adopt need not be.
Dr Poonam K. Singh
South-East Asia Region