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:
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.