International Frameworks Guide Government Policymaking and Resource Allocation Around Aging

National strategies, plans, and policies that support population aging are, together, helping to mainstream government action and guide the allocation of resources over time. The mainstreaming aging concept was first introduced by the Madrid International Plan of Action on Ageing (MIPAA) in 2002. MIPAA is a nonbinding global agreement that succeeded the Vienna International Plan of Action on Ageing (1982), the world’s first international policy framework on aging. Although MIPAA builds upon the commitments of the Vienna Plan, MIPAA departs from its predecessor, recommending that countries integrate older people’s issues into national policymaking by linking “aging to other frameworks for social and economic development and human rights.” As a result, MIPAA continues to serve as a foundational norm-building framework that guides age-related policy around the world.

Mainstreaming Aging

Mainstreaming aging, similar to the movement to mainstream gender, is a multi-dimensional strategy or plan that seeks to incorporate the concerns and needs of older people across a wide range of policy areas, such as transportation infrastructure or emergency planning. Mainstreaming aging encourages a holistic, coherent, gender-responsive, and rights-based policy approach to aging, with a goal to achieve an equitable society for all age groups

Figure 1

Breakdown of Policies, Plan, and Laws on Older Persons Globally (2022)

While a growing number of countries have aging strategies, much more needs to be done to define specific plans or legally binding instruments that address population aging.

In 2016, the unanimous adoption of a five-year Global Strategy and Action Plan on Ageing and Health (GSAP) by the World Health Assembly reinvigorated efforts to mainstream aging, urging Member States to adopt national plans to support older populations - and a range of national and sub-jurisdictional plans have developed since. Following the expiration of GSAP in 2020, the United Nations (UN) General Assembly proclaimed 2021–2030 as the UN Decade of Healthy Ageing – a global initiative to catalyze actions that meaningfully improve the lives of older people through a whole-of-government, whole-of-society approach. The Decade provides a ten-indicator framework to track country progress toward its goals, which includes the presence of national plans on healthy aging.

According to the Decade of Healthy Ageing Baseline Report, in 2020, 105 United Nations Member States (54 percent) had reported a national plan that aligned with healthy aging principles. As of February 2022, FP Analytics research found that 128 United Nations Member States - 66.3 percent of total Member States - had developed at least one targeted national or subnational law, policy, or plan related to aging. In at least six countries, one or more subnational jurisdictions have formulated plans of their own. These subnational plans exist at the state or province level in Belgium, Canada, Italy, the Netherland, the United Kingdom, and the United States.

Figure 2

128 Countries have National or Subnational Plans on Aging

While most countries have at least one plan or strategy,
65 countries have no plan or strategy that directly addresses aging.

Demographic and Development Trends Influencing Plan Advancement

Population aging - the increasing share of older persons, resulting from a decline in fertility rates and increase in life expectancy - is a clear factor driving the development and adoption of action plans on aging. In 2019, the number of people aged 60 years and older reached 1 billion globally; this number is projected to increase to 1.4 billion by 2030 and 2.1 billion by 2050. The following trends are emerging within each World Health Organization (WHO) region, which are presented in descending order of percentage with national plans:

  • Southeast Asia: Across the six WHO regions, Southeast Asia, which accounts for over 25 percent of the global population, is the region with the highest percentage of strategies, policies, and laws on aging, with 10 of 11 countries, or 91 percent, possessing some sort of mainstreaming mechanism. By 2050, these 11 countries will account for more than 22 percent of the world’s population aged over 65, according to the UN Department of Economic and Social Affairs’ World Population Ageing 2019 report.

  • The Americas: 71 percent of countries in the region have developed national plans - a total of 24 out of 35 countries. The Americas region is quickly aging, with the Pan-American Health Organization (PAHO) projecting that one in six people will be aged over 60 by 2030. However, the rate of aging is not consistent across the region. While Canada and the U.S. are rapidly becoming “super-aged” societies, Latin America and the Caribbean are aging at slower paces, with only 13 percent of Latin America’s population currently aged 60 years or older. 

  • Europe: The WHO Europe region, which includes EU and non-EU countries in Europe and Central Asia, has the oldest regional population in the world and the longest history of developing policies and plans to support older persons. As of 2022, 66 percent of Europe’s 53 countries have adopted a national plan, for a total of 33 plans. By 2100, the population over age 80 in the EU is predicted to more than double, from 5.9 percent to 14.6 percent. 

  • Eastern Mediterranean: The Eastern Mediterranean region is young, compared to the rest of the world, with approximately two-thirds of the region’s population under the age of 35. Governments in the region are increasingly identifying aging as policy priority: 13 of the region’s 20 countries or 65 percent have at least one strategy, policy, or law on aging.

  • Africa: The Africa region, which is the second-largest region at 47 countries, has the second-lowest percentage of national plans, with 22 countries (47 percent) possessing a plan on aging. Similar to the Eastern Mediterranean, Africa has a relatively young population: in Sub-Saharan Africa, approximately 70 percent of people are younger than 30.

  • Western Pacific: Although 34 percent of the world’s older people currently live in the Western Pacific region - a figure that is expected to double in the next three decades - only nine of the region’s 27 countries, or around 33 percent, have developed a plan on aging. While globally there seems to be a correlation between demographic trends and development of plans on aging, this does not appear to be true for the Western Pacific region.

Countries’ income levels are also associated with the development and adoption of plans around population aging. A comparison of the World Bank’s Income Classification for 2022 against countries with plans on aging reveals that countries with higher incomes are more likely to possess a national plan, policy, or strategy on aging. According to data collected for this report, 76 percent of higher-income countries, 67 percent of upper-middle-income countries, 62 percent of lower-middle-income countries, and 40 percent of lower-income countries possess a national plan, policy, or strategy on aging. Overall, higher-income countries tend to have older populations and higher life expectancies, necessitating more immediate planning around population aging, as well as greater expertise and allocation of resources to formalize and institutionalize plans. This trend suggests that international institutions, including multilateral development banks, can play a key role in supporting low-income countries to address this gap.

Indeed, in an independent evaluation of World Bank Support to Aging Countries, researchers identified funding, capacity-building, and research as key areas in which the World Bank, and other multilateral development banks, such as the Inter-American Development Bank, the Asian Development Bank (ADB), and the African Development Bank can support countries as their populations continue to age. The ADB, for instance, has already begun to consider population aging in its work streams, with specific reference to population aging in its Strategy 2030.

Figure 3

Income Level Directly Correlates with Plan Development

Higher income countries are most likely to develop national plans, while low-income countries
are least likely to develop a national plan.

Mapping Aging Plans, Policies, and Laws: Developing the Database of Action Plans for Aging (DAPA)

This analysis evaluated an initial sample of plans from 13 countries and two subnational jurisdictions and is intended to be part of an ongoing evaluation of plans around the world.1  For the initial assessment, national plans were prioritized and selected based on geographic diversity and level of economic development. They include countries from the six WHO regions and the five United Nations Regional Commissions - the organizations responsible for regional MIPAA reviews. Additionally, they represent countries at varying stages of development, with seven from developed countries, six from developing countries, and two from least developed countries based on classifications provided by the United Nations Conference on Trade and Development. With the exception of Nepal’s Senior Citizens Act (2006), the chosen plans were developed in the last ten years.

Specific information regarding the country context, as well as key points pertaining to each plan’s development, goals, and implementation, are outlined in the Database.

Figure 4

Policies, Plans, and Strategies on Population Aging Included in Analysis

Thirteen national and two subnational plans were identified, with at least one plan from each
global region, and each stage of economic development.

Region Country Plan Name
Africa Malawi National Policy on Older Persons (2016-2021)
Americas Argentina National Plan for Older Persons (2012-2015)
California, United States Master Plan for Aging (2021-2030)2
Chile National Health Plan for Older People and Action Plan(2020-2030)
Uruguay Second National Plan on Aging and Old Age (2016-2019)
Eastern Mediterranean Jordan National Strategy for Senior Citizens (2018-2022)
Lebanon National Strategy for Older Persons (2020-2030)
Europe Bulgaria National Comprehensive Strategy for Active Ageing (2016-2030)
Ireland National Positive Ageing Strategy (2013)
Malta National Strategic Policy for Active Ageing (2014–2020)
Wales, United Kingdom Age Friendly Wales: Our Strategy for an Ageing Society (2021)
Southeast Asia Southeast Asia Senior Citizens Act 2063 (2006)
Western Pacific Cambodia National Ageing Policy (2017–2030)
New Zealand Better Later Life (2019–2034)
Singapore Action Plan for Successful Ageing (2015–2030)

These plans, policies, and strategies were assessed with regard to 19 key themes addressed within MIPAA’s three pillars and across the UN Decade of Healthy Ageing’s action areas. (See Figure 5 and Appendix B for definitions and reasons for inclusion.)

While the approach of the more recent UN Decade of Healthy Ageing highlights four key policy action areas and promotes multisectoral action for aging populations, MIPAA has acted as a foundational resource and norm-building framework for countries seeking to mainstream the needs of older persons across a wide range of policy areas since its publication in 2002. This includes promoting the adoption of national action plans on aging. Every five years, a MIPAA review is conducted by United Nations Regional Commissions. These reviews take stock of country progress toward MIPAA goals as defined in their respective MIPAA Regional Implementation Strategies, including tracking the development of national action plans on aging.  As a result of these reviews, governments continue to draw on MIPAA and utilize its framework when developing and implementing plans, as several UN Regional Commissions ask countries to report progress on national plan development and implementation. Progress toward MIPAA goals is currently under review, and results will be released in 2022.

Of the plans reviewed in this study, nine of 15 (60 percent) explicitly mention MIPAA as being an inspiration for their plan or acknowledge that their plan directly supports the goals and themes laid out in MIPAA, including plans that were developed a decade or more after its release, affirming that MIPAA remains a relevant component of international policy on aging. MIPAA is also the most mentioned international policy document across the 15 plans, followed by the United Nations Principles for Older Persons (1991), which is referenced by six plans.3  Chile’s and New Zealand’s plans were the only ones to directly mention the UN Decade of Healthy Ageing, as the majority of the plans analyzed were developed before the Decade launched. Of the four plans released after the Decade’s launch in 2020, half mentioned the Decade.

As Figure 5 illustrates, the MIPAA and the UN Decade goals broadly relate to promoting social development and protection, ensuring access to quality care, and building enabling environments for older persons.

Figure 5

19 Key Themes in International Frameworks on Aging4

Most plans cited MIPAA and the Decade of Healthy Ageing as inspiration for their targets.

Madrid International Plan of Action on Ageing Pillar 1: Older persons and development Work & labor
Rural development
Education and training
Scoial protection and financial security
Intergenerational solidarity
Emergency response & disaster
Pillar 2: Advancing health and well-being into old age
Training care providers and health professionals
Mental health
Noncommunicable disease prevention
Pillar 3: Ensuring enabling and supportive environments
Support for informal caregivers
Transport & public spaces
Neglect, abuse, and violence
The Decade of Healthy Ageing: Relevant Action Areas
Combating Ageism
Long-term Care
Integrated care
Age-friendly environments

Policy Alignment with MIPAA and the UN Decade Themes Is Significant but Incomplete

When accounting for the MIPAA themes and the UN Decade Action Areas, Argentina, Cambodia, Ireland, Lebanon, and Uruguay have the most comprehensive plans of those evaluated, incorporating 14 of the 19 total themes. These plans are both comparatively broad—covering many types of issues that can impact health, enabling environments, and development outcomes for older persons—and relatively robust, as each policy issue includes at least one actionable objective. Plans from Ireland and Jordan cite other plans, including plans from Singapore, New Zealand, and Wales, as sources of inspiration for plan development. These plans are comparatively less broad in scope but have proven effective in implementation.

Figure 6

Themes Mapped by National and Subnational Plan

Across the 15 plans and supporting documents reviewed in this analysis, two nearly universal themes were identified: (1) preventing neglect, abuse, and violence; and (2) improving or providing integrated health care for older persons. In total, 14 of the 15 plans (93 percent) analyzed included at least one policy recommendation or goal related to elder abuse and neglect and at least one related to integrated care (see Figure 7). Ireland’s national plan was the only one analyzed that did not include any targets relating to integrated care, while only Chile’s plan did not include any targets on elder abuse and neglect. Conversely, plans were least likely to address the themes of HIV/AIDS and emergency response and disaster planning: only two of 15 plans (13 percent) addressed HIV/AIDS, and four of 15 plans (27 percent) included targets relating to emergency response. HIV/AIDS is a major health challenge in certain countries, particularly in the Sub-Saharan Africa region; however, many of the countries where HIV/AIDS is of particular concern do not yet have robust aging plans or frameworks as their populations tend to be younger. Additionally, as the United Nations Decade of Healthy Ageing report (2020) highlights, while older people are disproportionally negatively affected by disasters and emergencies, they are often not considered in emergency planning due to ageist attitudes that lead to older persons and their specific vulnerabilities being overlooked.

Figure 7

Alignment of National Plans with International Frameworks

Plans Ensure Older Persons Benefit from Economic Development

The first MIPAA pillar recommends that governments act to ensure that older persons share equitably in the benefits of a country’s economic development. Thirteen of 15 plans reviewed (87 percent) included targets around improving older persons’ financial security and other social protections, providing education and training, and building intergenerational solidarity. The plans tend to reflect the national context and issues of greatest concern and priority. Bulgaria’s plan, for example, the National Comprehensive Strategy for Active Ageing (2016-2030), has a heavy emphasis on employment - particularly on retraining and retaining older adults in the workforce as the country will soon experience the world’s steepest decline in the working-age population. The profiles in the Database provide contextual information specific to each country that has informed each plan’s development and implementation.

Many developing countries, particularly those that are lower-income, have a strong focus on social development and protection, often through filial support laws. These laws require close family members—most often, adult children—to provide financial and material support to aging relatives. Laws that stipulate that family members have a legal duty of care for relatives effectively largely shift the responsibility and funding for care and protection from the state to families. Filial support laws are common in developing countries, particularly in the Asia Pacific and Southeast Asia regions, as policymakers in the 1990s drew upon cultural norms of filial piety and reciprocity to fill gaps in care. Cambodia’s National Ageing Policy 2017–2030, for example, explicitly connects the ideas of filial piety to social development by incorporating “Raising awareness and encouraging adult offspring who are able to provide financial support … in order to fulfill their filial duties” as one of three strategies for that country’s policy social development objective. Cambodia’s National Ageing Policy also identifies intergenerational connection and joint family structures as a hallmark of Khmer society. Some Western countries or jurisdictions also incorporate filial laws into their legal systems of care. As of 2018, 29 U.S. states had filial support laws, although they are rarely enforced. These filial support laws also tie into improving state support for informal caregivers, which is a feature in 11 out of 15 (73 percent) of the analyzed plans, including in Cambodia’s and Singapore’s plans, and is included as a policy issue under MIPAA’s third pillar (called “Ensuring enabling and supportive environments”). Governments have long relied on families to fill gaps in care, and now many are planning or working on providing expanded support to caregivers, as well as acknowledging caregivers as essential stakeholders of healthy aging agendas. Such acknowledgment has driven the inclusion of caregiver support in healthy aging strategies, including Singapore’s Action Plan, which suggests the expansion of training and education for caregivers, respite services, eldercare leave, and improved referral and information services. Several countries have even developed independent strategies, which are not discussed in this report. Examples of independent strategies include New Zealand’s Mahi Aroha – Carers’ Strategy Action Plan 2019-2023, as well as the United States’ 2017–2018 RAISE Act, which directs the development of an independent Family Caregiving Strategy to support informal caregivers.

More Can Be Done to Mainstream Health Targets

Of the three MIPAA pillars, the second pillar, “Advancing health and well-being into old age,” was least prioritized in the sample of 15 plans analyzed in this report. Whereas 12 of the plans reviewed addressed comprehensive assessments for supporting environments, and 11 plans had targets to include older persons in countries’ development processes, only 9 plans addressed more holistic approaches to health. All of the plans have at least one health-related target, but many are not comprehensive across the spectrum of MIPAA’s health-related themes. This trend does not appear to be related to country development status. For example, both the state of California’s and Nepal’s plans address only one aspect of health. However, these gaps may be sufficiently covered in other policy documents beyond the scope of this analysis. Of the plans analyzed, 12 out of 15 plans (80 percent) did include targets to train care providers and health professionals and prevent noncommunicable diseases, respectively. These two themes are the most common MIPAA policy issues to be included in the plans, but such measures are often mere targets that do not offer a policy solution or funding to realize these goals.

Two of the United Nations Decade action areas - improving access to, and quality of (1) long-term care and (2) integrated care - are themes that are relevant to the MIPAA health pillar. Among health-related themes, providing integrated care is the most likely to be included in national plans, with 14 of 15 plans including targets to support the development of better-integrated care. Similarly, 11 of 15 plans target long-term care, particularly through its expansion and improvement. This is important because currently only 5.6 percent of the world’s population lives in countries that mandate full, universal access to long-term care through national legislation. Providing older persons access to long-term care options can reduce the burden of care on families and allow older adults to choose how and where they wish to grow old, which in turn can improve older persons’ well-being.

Creating Age-Friendly Environments Important to Enhance Older Persons’ Quality of Life

The third MIPAA pillar, which corresponds with the fourth United Nations Decade of Healthy Ageing action area, emphasizes the promotion of enabling and supportive environments. Supporting enabling environments for older persons includes access to quality housing and infrastructure as well as tackling ageism, neglect, and abuse - which can shape how older persons function and their overall well-being, both physically and mentally. Among the national plans analyzed, 14 out of 15 (93 percent) reported targets for protection from neglect, abuse, or violence. Elder abuse is prevalent globally, with one in six people over the age of 60 reporting abusive behavior in a nursing home or community setting - and around 64 percent of nursing home or long-term care staff have reported that they had committed some form of abuse in the past year. Abuse also frequently occurs in home care situations, and 11 of the 15 national plans identified the provision of additional support to informal caregivers, many of whom are family members, as a priority to combat caregiver burnout and lessen the incidence of abuse.

Eradicating ageism is another key target to promote an enabling environment for older persons and was included in 11 of 15 plans (73 percent). According to the WHO’s 2021 Global Report on Ageism, roughly half of the world’s population holds ageist attitudes. Additionally, an ageist environment that does not support the needs of older persons is associated with older generations dying 7.5 years earlier, making the reduction of ageist attitudes an important consideration for country plans. The majority of country plans that included a focus on combatting ageism recommended the creation of positive-images-of-aging campaigns as well as legislation that prohibits discrimination based on age. To combat abuse and ageism, many country plans aim to address and improve the quality of life of older persons holistically, as well as focusing on protection of older persons and improving intergenerational solidarity.

Finally, 13 out of 15 (87 percent) of the plans identified improving housing availability, quality, and affordability, and expanding older persons’ access to transport and public spaces as priorities. New Zealand’s Better Later Life Strategy (2019–2034), for example, identifies the creation of functional, safe, and affordable housing for older people as one of five key priorities, with a particular emphasis on providing an option for older persons to remain independent and age-in-place in their home communities. Malta expanded its National Strategic Policy for Active Ageing (2014–2020), to include a free transportation service called the Silver-T, which assists older people in independently conducting daily activities and errands.

The Future of Mainstreaming Aging: Additional Policy Considerations to Improve Plan Design and Implementation

While the frameworks provided by MIPAA and the UN Decade of Health Aging provide important indicators against which to benchmark plans, this analysis identified four additional policy considerations that impact the future development and current implementation of national plans. For countries that plan to develop a new plan or update existing plans, it is important to also consider: (1) the engagement of older adults in national plan development through consultative or participatory processes, (2) ensuring successful implementation of stated goals and objectives through measurable outcomes, (3) the impact and implications of the COVID-19 pandemic, and those of future infectious disease outbreaks, and (4) the need to enhance equity and reduce disparities among older populations in healthy aging policies. While the first two factors are critical to the development and implementation of plans both new and old, the latter two represent current policy challenges to healthy aging for nearly every country in the world—developed and developing.

Engaging Older Adults in Plan Development

International frameworks on healthy aging, including MIPAA and the UN Decade of Healthy Ageing, acknowledge the meaningful engagement and empowerment of older persons as critical to developing, implementing, and evaluating healthy aging policies. Plans analyzed in this report utilized a variety of participatory processes to draw on the voices of older people during the development phase of these plans. Such processes included public consultations, social media outreach, public surveys, town hall meetings and forums, webinars, and community roundtables. Several jurisdictions - including Argentina, the state of California, Ireland, Malta, and Wales - consulted experts and civil society organizations representing older persons during plan development. In total, at least 11 of 15 plans analyzed utilized a participatory process that included the voices of older people, or organizations that represent them, during the development process.

Of the plans analyzed for this report, the state of California’s Master Plan on Aging, in which included input and involvement by AARP, and the Age-Friendly Wales strategy, stand out in their use of participatory processes in development. The Welsh strategy, in particular, was heavily informed by input from those aged 50 and over through surveys and forums held in each local authority. This extensive consultation process helped ensure that the strategy was specifically designed around the needs and aspirations of older people in Wales. For example, it identifies improving the availability of public toilets as a priority to improving age-friendly communities; this priority was directly informed by the input of older persons, according to the strategy. The solicitation and incorporation of older adult perspectives is a key component of effective and inclusive strategies.

Monitoring, Evaluation, and Resourcing for Implementation

The implementation of national plans is wholly dependent on the allocation of financial resources by governments toward plan objectives, as well as the application of effective monitoring and evaluation frameworks. While MIPAA briefly identifies the mobilization of resources and the establishment of monitoring and evaluation frameworks as crucial elements of implementation, the GSAP highlights the continued need for improved measuring, monitoring, and reporting systems for healthy aging. Eight plans analyzed in this report recommend the development of indicators to track progress toward the plan’s goals or policy recommendations. At least four of these jurisdictions have published indicators and begun tracking progress related to healthy aging, including the state of California, Ireland, New Zealand, and Wales.

Additionally, Bulgaria and Malta utilize the European Active Ageing Index, a tool developed by the UN Economic Commission for Europe (UNECE) to measure healthy aging. Plans that create specific, actionable targets that are based on data, and then provide sufficient funding to accomplish their objectives, are needed to improve the lives of older persons.

The Active Ageing Index for Europe

The Active Ageing Index (AAI) is a project developed by the United Nations Economic Commission for Europe Population Unit, European Commission Directorate General for Employment, Social Affairs and Inclusion, and the European Centre for Social Welfare Policy and Research in Vienna to measure active and healthy aging. The AAI includes 22 indicators grouped into four domains, which cover employment, participation, independent living, and enabling environments. In its latest 2018 report, the Active Ageing Index compared progress on these indicators across 28 countries in Europe. Since its inception in 2015, the AAI has served as a source of inspiration for countries designing and implementing national aging plans. Several countries, including two outlined in this report, designed plans around the areas of the AAI, and utilize the index as a monitoring and evaluation tool. The creation of a parallel Active Ageing Index is being explored for Asia. 

Active Ageing Index:

Four Areas and 22 Indicators for Measuring Progress

Employment Participation in Society Independent, Healthy, and Secure Living Capacity and Enabling Environment for Active Ageing
Employment rate ages 55–59

Employment rate ages 60–64

Employment rate ages 65–69

Employment rate ages 70–74
Voluntary activities

Care to children and grandchildren

Care to infirm and disabled

Political participation
Physical exercise

Access to health services

Independent living

Financial security (comprised of three indicators)

Physical safety

Lifelong learning
Remaining life expectancy at age 55

Share of healthy life expectancy at age 55

Mental well-being

Use of ICT

Social connectedness

Educational attainment

However, there is a clear divide between developed and developing countries regarding the resourcing and monitoring of plans. One key barrier to monitoring policies, particularly for lower- and middle-income countries, is limited access to data. Approximately 75 percent of the world’s countries have little to no data on older age groups or healthy aging, meaning that many countries have a limited capacity to monitor existing plan goals or develop future evidence-based policies. Beyond monitoring mechanisms, research revealed that only five plans analyzed for this report were provided with a budget for the plan’s implementation: those implemented by Bulgaria, the state of California, Ireland, New Zealand, and Singapore.

Harnessing Lessons Learned from the COVID-19 Pandemic

The COVID-19 pandemic has exposed gaps in national government protections and global health systems for older adults, highlighting a range of complex challenges that must be addressed in future national plans to prepare for an increased risk of future disease outbreaks and their impacts on care and support for older adults and vulnerable people. At the start of the pandemic, it became clear that older adults are at a higher risk for severe infection. However, the impact of COVID-19 on older adults goes far beyond the risk of infection, affecting older people’s daily routines, the care and support they receive, and their ability to stay socially connected. Additionally, the pandemic has caused widespread economic insecurity among older people and even hastened older adults’ departure from the workforce, reducing their ability to support themselves and their families. In particular, gaps in employment, income, care, and social connection are a result of society’s increased dependence on digital technologies during the pandemic to facilitate work, health care, social connection, and widespread digital illiteracy among older adults.

Due to these profound impacts, national aging plans developed after 2020 increasingly address COVID-19 and the digital divide. Four of the plans examined in this report - those from the state of California, Chile, Jordan, and Wales - address the impacts of COVID-19 on older adults. In addition, New Zealand’s latest four-year Action Plan for the implementation of the Better Later Life Strategy addresses the impacts of COVID-19 on social isolation, digital inclusion, working older adults, and housing. Bulgaria and Singapore are reportedly releasing updated action plans on healthy aging that account for troubling trends produced by COVID-19 and pandemic response measures. Malta also plans to release a new Strategic Policy for Active Ageing, which will incorporate targets related to COVID-19. Countries could identify and aim to cover key gaps that were exposed by COVID-19 including addressing digital inclusion, as they develop their national plans.

Enhancing Equity and Reducing Disparities

Older women, racial, ethnic, and religious minorities, displaced peoples, persons with disabilities, LGBTQ persons, indigenous peoples, and people in specific settings such as fragile states face significant inequities, particularly relating to health and financial security that demand attention in national plans. Ireland’s Positive Ageing Strategy stands out for its attention to Irish Travellers, a nomadic ethno-cultural group that has traditionally faced political and social discrimination and exclusion. As of 2018, the Positive Ageing Strategy includes 14 indicators on healthy aging for Irish Travellers, covering their social and cultural participation, housing, access to health care, and health behaviors. Ireland’s example of collecting and publishing data relevant to an older historically marginalized group reveals the importance of data in making older, marginalized populations more “visible” in policy frameworks, as well as older people in general, which can reduce the impacts of ageism and improve older populations’ resilience. Equity, equality, and non-discrimination are key human rights principles and must apply equally to all people and marginalized groups in a country. Another gap is that MIPAA specifically addresses HIV/AIDS, and yet it is under-addressed in national plans. While this challenge has been diminished in developed country contexts in recent years, it remains a health concern across the developing world.

Looking Ahead

National planning to mainstream aging is a key pathway to protect older populations and facilitate healthy aging. It is also crucial for societies to prepare for and cope with demographic changes. To date, only 128 United Nations Member States have developed some form of policy to mainstream older persons and aging across relevant policy areas, meaning that as many as 65 member states lack any sort of broad strategy or law related to aging at the national or subnational level. For many of these countries, resourcing limitations and data gaps present significant barriers to developing and implementing a plan on aging.

The ‘Return on Investment’ for Prioritizing Aging and Older Persons:

While data availability on older persons and its collection has been identified as a key “enabler” for the UN Decade of Healthy Ageing and prompted significant international work on the issue (see the Titchfield Group on Aging-related Statistics and Age-Disaggregated Data), more research is needed on the economic impact of funding national aging agendas and potential returns on investments in older persons. Although the full economic benefits of mainstreaming aging are still unclear, an independent report commissioned by Public Health Wales explores the potential return on government investments in older adults. The report ‘Living Well for Longer’ estimated that every £1 investment in facilitating active aging can generate between £0.79 and £112.42 in social value within Wales. Other analyses have concluded that investing in the retention of older adults in the workforce can provide significant returns. According to the OECD Promoting an Age-Inclusive Workforce report, building multigenerational workforces could raise GDP per capita by 19 percent by 2050. Preparing health care systems and workforces for an aged population will be critical, particularly in developing countries where fewer plans exist and 71 percent of population aging will occur by 2050. In addition to economic gains from investing in older persons, prioritizing older persons also can lessen ageism, increase intergenerational support, and improve social cohesion across a country’s population, according to a 2017 report by HelpAge International. This shift of perspective can help all generations view older persons as worthy of respect and dignity, and as people who can contribute to society rather than those who are ‘a burden’ on the system. The potential dividends of investing in older persons extend across the economy, health, and social spheres, yet support for healthy aging agendas in multilateral financial institutions remain in preliminary stages.

Developing a national plan is a key opportunity for countries, especially those facing a major demographic shift, to plan for aging populations and improve the health and well-being of older persons. To achieve these goals, policymakers should first consider the themes laid out in international frameworks on aging, including MIPAA and the UN Decade of Healthy Ageing, which are explored in this report’s policy map. Future plans should also consider lessons from the COVID-19 pandemic and address equity concerns for marginalized groups.

The analysis of this report demonstrates the importance of alignment with international frameworks as well as the use of participatory, consultative, and inclusive processes when developing plans. Effective plans are also contextually sensitive and tailored to local realities. Critically, they estimate and allocate financial resources to support implementation and harness data to monitor progress toward stated goals and objectives.

For additional information on these national plans, see the Database of Action Plans for Aging (DAPA), and for additional case studies and resources on Healthy Aging, explore the AARP-FP Analytics Toolkit.

Appendix Glossary of key Themes

This glossary provides a description of the 19 key themes used to assess plans, policies, and strategies on aging. These themes were derived from the Madrid International Plan of Action on Ageing as well as the UN Decade of Healthy Ageing. The glossary identifies the source of each key theme, including the specific MIPAA pillar or UN Decade action area the theme falls under.

Source: MIPAA (Pillar 1: Older persons and development)
  • Education and Training
    Continuing education and training can support older adults in finding and keeping productive, meaningful, and lucrative work. Additionally, educational opportunities, including education around ICT, can help older adults maintain autonomy as well as find social connection and personal meaning, which in turn can promote well-being and wellness.

  • Emergency Response and Disaster
    Natural and human-made disasters, public health emergencies, conflicts and violence, and humanitarian crises impact a growing number of older persons worldwide. Emergencies are increasing in frequency, gravity, and impact due to climate change, industrialization, urbanization, and globalization. Despite these trends, the needs of older persons are often neglected or not considered in disaster risk-reduction strategies and emergency responses, even though older persons are highly vulnerable during emergency situations and often less resilient to shocks and stressors that threaten their lives and livelihoods.

  • Intergenerational Solidarity
    Intergenerational solidarity refers to actions that enable social cohesion, support informal systems of care, and reduce ageism, as people experience the benefits of engaging with other generations, both younger and older than themselves.

  • Rural Development
    Rural and remote areas across the globe experience more pronounced population aging than urban areas. Due to lower population density and geographically dispersed populations, rural areas face financial and logistical challenges related to accessing comprehensive health care, social services, and other forms of support that are necessary to successfully age in place. The development of comprehensive rural service infrastructure is integral to supporting aging populations in many countries.

  • Social Protection and Financial Security
    Instances of discrimination in the workforce as well as the increased likelihood of disability as people age leaves many older adults at risk of financial insecurity. Strengthening social protection, including access to non-contributory and contributory pensions, is critical to preventing poverty among older adults.

  • Work and Labor
    Cultural norms and discrimination against older workers, particularly older women, decrease labor force participation rates among older adults. Many older persons need or want to continue working and could be productively integrated into a country’s workforce through explicit protections against discrimination, accommodations, or other forms of educational and training support.

Source: MIPAA (Pillar 2: Advancing Health and Well-being into Old Age)
  • Disability
    Incidence of disability increases with age, and older women are particularly vulnerable to disability in old age. This theme is not referring to disability legislation or targets that include persons with disability in general of all ages, but instead to targets that aims to reduce the incidence of disabilities among older adults.

    A growing number of older adults are living with HIV/AIDS due in part to the increased availability of treatment for the disease. However, over a million people, including older persons, are newly infected with HIV each year. Older persons, particularly in some developing or least-developed contexts, can be at risk of HIV infections as they may not be targeted in public health campaigns and may not know how to protect themselves from infection. Sub-Saharan Africa, followed by South and Southeast Asia, are some of the hardest hit regions of the world, with adult HIV prevalence reaching over 10 percent in at least nine countries.

  • Mental Health
    Over 20 percent of adults aged 60 and over suffer from a mental or neurological disorder, according to the World Health Organization. Mental health challenges can lead to reduced well-being and quality of life for older persons, and mental health care is often inaccessible due to cost or availability.

  • Noncommunicable Disease Prevention and Nutrition
    Noncommunicable disease prevention refers to the holistic health of people as they age, through activities such as encouraging healthy diets and exercise routines, ceasing smoking, and supporting mental health. Food security, including access to nutritious foods, is also integral to overall health, and it can be challenging in certain contexts, particularly in developing or least developed countries.

  • Training Care Providers and Health Professionals
    Globally, there is a lack of qualified care professionals—especially geriatricians—to serve the growing population of older persons. This results in many older people going without adequate access to, and quality of, specialized care, which is a gap that many countries aim to fill in their national plans.

Source: MIPAA (Pillar 3: Ensuring enabling and supportive environments)
  • Housing
    Many countries struggle to provide sufficient access to affordable and decent housing for older persons. Access to housing that is maintained and appropriately modified for the needs of older persons is especially crucial to maintaining individual health, mobility, and societal participation among older adults. Choice in housing is also an important consideration, in that providing older persons a choice in where and how they live can result in positive health and well-being outcomes as well as greater autonomy.

  • Neglect, Abuse, and Violence
    Neglect, abuse and violence against older adults includes physical, psychological, or financial abuse. Elder abuse can have serious consequences for older adults including injury, premature mortality, depression, and cognitive decline. A 2017 review of 52 studies across 28 countries found that 1 in 6 people aged 60 years and older experienced some form of abuse in community settings. Given the individual and societal impacts of elder abuse, policies and plans may consider action to protect them from abuse in all forms.

  • Support for Informal Caregivers
    Informal caregivers, who are often family members, receive little or no governmental support or recognition. Providing support for informal caregivers may entail paying a wage to caregivers, training caregivers in simple medical procedures, or setting up accessible respite care.

  • Transport and Public Spaces
    Transportation systems and public spaces may assume a level of physical fitness that older persons cannot maintain (such as having stairs to access public buildings), which can inhibit older persons from being fully integrated into society. Accessing transportation services, in particular, may be a challenge for older adults living in rural areas, where they may be physically and socially isolated.

United Nations Decade of Healthy Ageing (Decade Action Areas)
  • Age-Friendly Environments
    Implementing age-friendly environments entails actions that would support older persons’ autonomy, capacity, and health, and promote removal of physical or social barriers that prevent older persons from freely integrating in society. This theme, while integral to the UN Decade’s goals, is overarching covering several key themes addressed by MIPAA, including employment, housing, transport, and public space. As a result, this theme shares a section with “ensuring enabling and supportive environments” or the purposes of this analysis.
  • Combating Ageism
    Ageism refers to the stereotypes, prejudice, and discrimination directed towards people on the basis of age. According to the WHO’s 2021 Global Report on Ageism, roughly half of the world’s population holds ageist attitudes. For older people, ageism can result in social and economic exclusion and worse health and well-being outcomes. Policies or actions to combat ageism include campaigns that aim to reframe aging as a positive process or older generations as playing an essential societal function, such as caring for children.

  • Integrated Care
    Older people require non-discriminatory access to quality essential health services, including prevention; promotion; curative, rehabilitative, palliative, and end-of-life care; essential medicines and vaccines; dental care; and assistive technologies. Integrated care addresses all factors affecting health holistically and avoids siloes of care and information between doctors and specialists, as well as other forms of social and health support into a person-centered care system.

  • Long-Term Care
    Declining physical and mental capacity as people age can limit older people’s ability to care for themselves and participate in society. Long-term care, including rehabilitative care as well as home and community-based care, enables older adults to live with dignity, choose how to spend their older years, and access on-site health care, especially for those with complex medical conditions. In many countries, long-term care is challenging to fund or provide sufficient with quality and accessibility, due to shortages in the global caregiving workforce.

Additional Themes Considered but Not Included
MIPAA (Pillar 2: Advancing Health and Well-Being into Old Age)
  • Nutrition and Food Security
    This theme was integrated into the noncommunicable disease prevention theme. Additionally, few policies or plans included specific targets around supporting nutrition and food security for older persons.


References from Synthesis Report and Database of Action Plans on Aging