National aging policies in the context of the United Nations Decade of Healthy Ageing (2021–2030)

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INTRODUCTION

Population ageing is the result of declining birth and death rates, leading to increased life expectancy, one of the major trends of the 21st century. Over the past two decades, the global population has made significant progress in longevity as the overall life expectancy has increased by 6.5 years and healthy life expectancy has increased by 6 years. However, the healthy life expectancy gap between World Health Organization (WHO) regions and between high- and low-income countries is as much as 13 years. The greatest difference is observed between countries with the highest rates (Japan and Singapore, 74 years) and the lowest rates (Lesotho and the Central African Republic, 44–46 years), which amounts to 28–30 years [1].

Despite the rapid growth in the proportion and absolute number of the elderly population worldwide, we have insufficient scientific data on the life activities of this age group, their contribution to society, and the services and resources required to ensure healthy longevity [2, 3]. Population ageing is accompanied by a slow and ineffective government response to emerging challenges and insufficient exploitation of the opportunities provided by the changing demographic situation and the ongoing focus of the WHO on this issue [4, 5].

Implementing policies to promote healthy ageing requires active efforts by governments to understand the diverse needs of elderly populations. Supporting the implementation of the United Nations (UN) Decade of Healthy Ageing 2021–2030 through information, scientific and educational actions allows us to consider the relevant issues of healthy ageing policy in the context of various international and national strategies for the elderly population based on cultural and socio-cultural differences. Each stage has key points and describes the actions to achieve its goals. As part of the UN Decade of Healthy Ageing 2021–2030, WHO manages and implements a set of global actions aimed at improving the quality of life of the elderly population, their families, and the communities where they live. These actions involve policies and systemic strategies in cooperation with national and international partners [6].

Despite the fact that the beginning of the UN Decade of Healthy Ageing 2021–2030 is associated with major global challenges, such as the COVID-19 pandemic, the global economic crisis, and international conflicts, some states have made significant progress in achieving its goals [7]. To successfully continue this work, researchers need to communicate with other stakeholders, who can synergistically influence the implementation of research; it is also required to involve the elderly population in this process [8].

The review describes key actions of the UN Decade of Healthy Ageing 2021–2030 and the analysis of its initial results.

METHODS

We used the method of comprehensive analysis of WHO’s UN Decade of Healthy Ageing 2021–2030 progress reports. The information sources of the paper include official statistics and UN and WHO analytical reports.

EVOLUTION OF ADOPTED APPROACH DOCUMENTS ON POPULATION AGEING

In 2002–2020, key documents were adopted that define the action areas and principles of the ageing policy, including the Madrid International Plan of Action on Ageing (MIPAA) [9] and the WHO Global Strategy and Action Plan on Ageing and Health [10]. Despite the fact that there are various approach documents on the elderly population and their implementation tools, some authors emphasize the insufficient protection of the elderly. The main reason is that the proposed mechanisms are not binding. In this regard, additional action is required to reduce age discrimination and protect rights of this age group [6, 11, 12].

The WHO strategy included implementing evidence, filling gaps, and fostering the partnerships to build a solid foundation for the implementation of the UN Decade of Healthy Ageing 2021–2030 [10]. The WHO’s 2015 World Report on Ageing and Health proposed the first framework for healthy ageing based on supporting the elderly and senile populations, maintaining and strengthening their functional ability using the “ageing in place” approach. It highlights the connection between the physical and cognitive human abilities and interaction with the microcommunity [13].

There are various definitions of healthy ageing, but in the literature it is conceptualized as a process of multisectoral changes aimed at ensuring well-being in old age [8, 14, 15]. The WHO Global Strategy and Action Plan 2016–2020 on Ageing and Health defines Healthy Ageing adopted at the 69th World Health Assembly (on May 24, 2016) defines healthy ageing as “the holistic process of developing and maintaining the functional ability that enables well-being in older age. It combines all elements and components of existence and life valuable for people” [10].

The UN Decade of Healthy Ageing 2021–2030 is a policy document that provides guidance to governments and coordinates the efforts of civil society, international organizations, and other actors, including professionals, academic institutions, the media, businesses, families, etc., to address the challenges of population ageing. The initiative is based on the global trend of increasing life expectancy in all countries; it aims to ensure active and healthy longevity with a high quality of life [15]. Healthy ageing involves multi-level interventions that go beyond disease prevention and health promotion. Healthy ageing strategy includes four key action areas:

• Combating ageism;
• Creating age-friendly environments;
• Delivering person-centered, integrated care;
• Delivering primary health services and the long-term care system [15].

To implement its objectives, the Decade provides a set of guiding principles and is aligned with 11 of 17 UN Sustainable Development Goals (SDGs). SDGs are based on five core values:

• People (thriving society);
• Prosperity (prosperous economy);
• Planet (healthy ecosystems and environments);
• Peace (ethics and justice);
• Partnership (cooperation and collective action) [16].

They apply to all global and national commitments, including the UN Decade of Healthy Ageing 2021–2030. The Preamble highlights “a spirit of strengthened global solidarity, focused in particular on the needs of the poorest and most vulnerable and with the participation of all countries, all stakeholders and all people” [17]. Connections between the above documents are expressed in the following provisions:

• Many systemic inequities limit prosperity and intersecting discrimination, including according to age;
• Without a healthy planet, healthy ageing will be difficult to achieve for people in the second half of their lives and for the generations that follow. Climate change is already widening existing wealth- and age-related divides;
• Partnerships that go beyond the usual coalitions and strengthen global solidarity are essential for attaining the SDGs;
• Actions to foster healthy ageing will contribute to building more inclusive, just, peaceful societies [16, 17].

As part of the integration of the UN concepts of healthy ageing and sustainable development, various governments have recognized that population ageing will affect the achievement of the SDGs. In particular, this is reflected as the increased demand for basic services, the need to adapt the physical environment to the needs of older people, and the increased burden on social security, pensions, and healthcare systems. However, ageing policies and priorities are still poorly integrated into national sustainable development strategies and plans in many countries [6].

The UN Decade of Healthy Ageing 2021–2030 outlines actions for each responsible body, including member states of international organizations, national and international partners, and governance and accountability components of the action plan [18]. The key actions of the UN Decade of Healthy Ageing 2021–2030 include:

• Tools and guidance for a minimum package of long-term care as part of universal health coverage;
• Online resources for caregivers as part of their capacity-building (friends, family, and other informal caregivers);
• Improve the working conditions of care workers;
• Assess the health impact of social protection programs, including pensions;
• Provide technical support for national situation analyzes of long-term care [18].

KEY FEATURES OF NATIONAL AGEING POLICIES

Regional Aspects of Ageing

The number of people aged ≥ 60 years worldwide is expected to increase from 1.1 to 1.4 billion by 2030. According to the WHO’s Decade of Healthy Ageing: Baseline Report, between 2000 and 2019, the expected gap between life expectancy and healthy life expectancy has increased from 7.3 to 8.3 years for men and from 9.7 to 11 years for women [5]. In addition, the gap between life expectancy and healthy life expectancy at age 60 increased from 4.1 to 4.7 years for men and from 5.3 to 6 years for women. According to Decade of Healthy Ageing: Baseline Report, in 2020, 105 Member States (54%) reported having national plans in place aligned with the principles of healthy ageing [5]. According to FPAnalytics research,¹ by November 2023, 141 (73%) UN Member States had at least one targeted national or subnational strategy, plan or law on ageing (see Fig. 1).

 

Fig. 1. Countries with national programs (plans) related to population ageing (highlighted in blue). Image adapted from ¹. © AARP, 2023. All rights reserved.

 

The report analyzes various plans, policies, programs, and strategies implemented by states in response to population ageing. It is noted that eight states have no national laws, policies, or strategies on ageing. However, in addition to national initiatives, several states have developed and implemented regional (provincial) actions. Each WHO region has specific characteristics [19].

Southeast Asia: Southeast Asia, which accounts for over 25% of the global population, is the region with the highest percentage of strategies and laws on ageing. 10 out of 11 countries have some sort of mainstreaming mechanism. By 2050, those 11 countries will account for more than 22% of the world’s population over age 65.

The Americas: 89% of countries in the region have developed national plans highlighting a quick ageing—a total of 31 out of 35 countries. It is expected that one in six people will be over age 60 by 2030. However, the rate of ageing is not consistent across the region. While Canada and the United States are rapidly becoming “super-aged” societies, Latin America and the Caribbean are ageing at slower paces, with only 13 percent of Latin America’s population currently age 60 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 2023, 87% of Europe’s 53 countries have adopted a national plan.

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 age 35. However, governments in the region are increasingly identifying ageing as a policy priority: 14 of the region’s 20 countries, or 70%, have at least one strategy, policy, or law on ageing.

Africa: The Africa region, which is the second-largest region at 47 countries, has the lowest percentage of national plans, with only 24 countries (51%) possessing a plan on ageing. In sub-Saharan Africa, approximately 70% of people are younger than 30.

Western Pacific: Although 34% of the world’s older people currently live in the Western Pacific region —a population that is expected to double in the next three decades— only 16 of the region’s 27 countries, or 59%, have developed a plan or strategy on ageing.

Ageing in National Policies in the Context of the United Nations Strategies

AARP report¹ stated that countries’ income levels are associated with the development and adoption of national strategies around population ageing. A comparison of the World Bank’s Income Classification for 2023 against countries with national strategies on ageing reveals that countries with higher incomes are more likely to possess a national plan, policy, or strategy on ageing. According to data, the following countries possess a national plan, policy, or strategy on ageing:¹

• 83% of higher-income countries;
• 79% of upper-middle-income countries;
• 70% of lower-middle-income countries;
• 44% of lower-income countries.

Overall, higher-income countries tend to have older populations and higher life expectancies, necessitating more immediate planning around population ageing, as well as greater allocation of resources to formalize and institutionalize plans.¹

These plans, policies, and strategies were assessed with regard to 18 key themes addressed within MIPAA’s three pillars and across the UN Decade of Healthy Ageing’s action areas¹ (see Table 1).

 

Table. 1. Overlapping Key Themes of the United Nations Policy Papers on Population Ageing (2002–2021)

Pillar	Key areas
Madrid International Plan of Action on Ageing (2002)
Pillar 1: Older Persons and Development	Work and labor; Rural development; Education and training; Social protection and financial security; Intergenerational solidarity; Emergency response and disaster.
Pillar 2: Advancing Health and Well-being into Old Age	Training care providers and health professionals; Mental health; Disability; Noncommunicable disease prevention and nutrition; HIV/AIDS.
Pillar 3: Ensuring Enabling and Supportive Environments	Housing; Support for informal caregivers; Transport and public spaces; Neglect, abuse, and violence.
United Nations Decade of Healthy Ageing (2021)
—	Combating ageism; Long-term care; Primary health services and integrated care

 

While the approach of the UN Decade of Healthy Ageing highlights four key policy action areas and promotes multisectoral action for ageing 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 [9]. Every five years, an 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. 62% of strategies explicitly mention MIPAA as being an inspiration for their national principles as it directly supports the goals and themes laid out in MIPAA. MIPAA is also the most mentioned international policy document across 50 plans, followed by the United Nations Principles for Older Persons (1991). The policies adopted by Barbados, Chile, Eritrea, New Zealand, Panama, and Turkey were the only ones that directly mentioned the UN Decade of Healthy Ageing 2021–2030. For 12 plans developed after it was effected, 1/4 of the countries referenced it.¹

Across 50 national plans and supporting documents on ageing reviewed in the baseline report, only a few MIPAA themes or UN Decade Action Areas were present in every single plan. The most prevalent were [5]:

• Addressing non-communicable diseases;
• Training care providers and health professionals;
• Social protection and financial security;
• Education and training.

The first MIPAA pillar recommends that governments act to ensure that older persons share equitably in the benefits of a country’s economic development. Seventy-six percent of plans included targets around providing education and training and 64% included targets to build intergenerational solidarity. Plans tend to reflect the national context and issues of greatest concern and priority. For example, Bulgaria’s plan, 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 working-age population.¹

The AARP Report¹ provides the summary and analysis of national strategies to support ageing populations and their priorities. Many countries have a strong focus on social development and protection of the elderly population, often through filial support laws. These laws require close family members—most often adult children—to provide financial and material support to ageing relatives [11, 20]. In many countries, laws stipulating that family members have a legal duty to care for relatives effectively shift to a larger extent the responsibility and funding for care from the state to families, particularly in the Asia Pacific and Southeast Asia regions, as policymakers drew upon cultural norms of filial piety and reciprocity to fill gaps in care. For example, Cambodia’s National Ageing Policy identifies intergenerational connection and joint family structures as a hallmark of Khmer society.¹ Many European governments have long relied on families to fill gaps in care, and now they are working on providing expanded support to informal caregivers [21] and acknowledging caregivers as essential stakeholders of healthy ageing agendas. In many regions, informal caregivers still bear the brunt of long-term care, yet only 16% of low-income countries provide them with training, support, and enhanced social protection [8]. The acknowledgment of caregivers has driven the inclusion of caregiver support in healthy ageing strategies. This seeks to shore up and support traditional familial mutual support systems by providing educational and training opportunities to informal caregivers and respite services. New Zealand and the United States have community-based care programs, and more holistically improving household income and well-being to build the economic capacity of the family.¹

Of the three MIPAA pillars, the second one, “Advancing health and well-being into old age,” was least prioritized in most national plans. 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. Targets relating to noncommunicable diseases and the health care workforce were the most common MIPAA policy issues to be included in the national plans. Moreover, 82% of the countries have plans with targets to prevent noncommunicable diseases, which are the leading causes of death and disability worldwide, and 78% of the countries have plans with targets to train care providers and health professionals. Two of the United Nations Decade action areas—improving access to and quality of long-term care and integrated care—are themes that are relevant to the MIPAA and included in 60% of the plans. This emphasis is important because it 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. This approach is consistent with previously adopted documents and noted by some authors [22–24].

The third MIPAA pillar emphasizes the promotion of enabling and supportive environments, corresponding with a key UN Decade of Healthy Ageing action area promoting “Age-friendly environments” and aligning closely with the WHO’s Age Friendly Cities and Communities program [25]. Supporting enabling environments for older persons includes ensuring 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 [26]. 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. Abuse can all too often occur in home care situations and 66% of the plans identify the provision of additional support to caregivers, many of whom are family members, to combat caregiver burnout and lessen the incidence of abuse.¹

Eradicating ageism is another key target included in 56% policies. Roughly, half of the world’s population holds ageist attitudes [26]. Plans that included a focus on combating ageism generally recommended the creation of positive-images-of-ageing campaigns as well as legislation that prohibits discrimination based on age. To combat abuse and ageism, many national strategies aim to address and improve the quality of life of older persons holistically, as well as focusing on the protection of older persons and improving intergenerational solidarity. 72% plans identified improving housing availability, quality, and affordability, and expanding older persons’ access to transport and public spaces as priorities. For example, New Zealand’s, Slovenia’s, and Malta’s strategies are focused on providing an option for older persons to remain independent and age in place in their home communities, including a free transportation service, which assists older people in independently conducting daily activities and errands.¹

Thus, the analysis shows that national planning to mainstream ageing is a key pathway to facilitate healthy ageing. It is also crucial for societies to prepare for and cope with demographic changes. According to WHO, by 2020, 141 UN Member States had developed national or subnational policies or programs on ageing, marking significant progress compared to 105 countries three years before. However, 54 member states lack any sort of broad strategy related to ageing. Resource limitations and data gaps, especially sex- and age-disaggregated data, present significant barriers to developing plans on ageing and informed management decision-making [5, 19].

FIRST PHASE OF THE UNITED NATIONS DECADE OF HEALTHY AGEING 2021–2030: PROGRESS

Despite the challenges of the COVID-19 pandemic, significant progress had been made in first phase of the implementation of the UN Decade of Healthy Ageing 2021–2030 to promote its key action areas [8, 27]:

• New long-term and integrative care strategies to promote access to the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care throughout life;
• Systematic approach to involve older people in attaining the objectives of the UN Decade of Healthy Ageing 2021–2030;
• New mechanisms, including online platforms and databases, to collect and monitor data on healthy ageing;
• New multistakeholder partnerships.

Key actions in the action areas of the UN Decade of Healthy Ageing 2021–2030 are shown in Table 2 [8, 27].

 

Table. 2. First Phase of the United Nations Decade of Healthy Ageing 2021–2030: Progress

Action area	Summary of actions (2021–2023)
Changing how we think, feel, and act toward age and ageing	More countries have national legislation to prevent discrimination related to age, and effective strategies to combat ageism; 60% of countries have mechanisms to promote and protect the rights of older people and specific legal, administrative and other effective means to protect older people who have been subject to discrimination.
Ensuring that communities foster the abilities of older people	The percentage of countries with national programs to support the activities of the WHO Global Network for Age-Friendly Cities and Communities has increased.
Delivering person-centered, integrated care and primary health services responsive to older people	More countries had national policies to support comprehensive assessments with older people in 2022 than in 2020. This approach has generated wide interest among Member States, and many have undertaken pilot projects to initiate training of health and care workers; Challenges in providing integrated care, including human resource constraints.
Providing access to long-term care for older people who need it	National and regional initiatives have been conducted to strengthen long-term care for older people, including national policy development; Recognition of the human resource challenges in relation to long-term care, including the reliance on family care, usually provided by women, many of whom are older; Need for timely vaccination of older people and development of a multi-level system of long-term care with an emphasis on family and community care (microcommunity).

 

Implementing the next phase of the Decade will require coordinated efforts to support healthy ageing in low- and middle-income countries, where 80% of the world’s older population will live by 2050 [19]. Priority will be given to low-income countries, which often lack national policies, strategies, and plans targeting the elderly population. The next phase of the Decade will be focused on the engagement of older persons, who are key to attaining the objectives of the UN Decade of Healthy Ageing 2021–2030. However, resources required to promote healthy ageing are limited, necessitating a consistent action plan and significant investment [8].

CONCLUSION

Population ageing is a major global socio-demographic issue. It requires stronger national strategies to provide adequate resources to improve the quality of life of the elderly population. The UN and WHO analytical reports emphasize the diversity of planning approaches and priorities included in national and regional programs based on demographic trends in individual countries, the legal framework, and socio-cultural norms. Most national policies are developed in accordance with the pillars of the Madrid International Plan of Action on Ageing (MIPAA) (2002); however, they significantly overlap with the main goals and objectives of the UN Decade of Healthy Ageing 2021–2030. Despite significant progress in developing national policies (plans, strategies, programs), disparate approaches are observed in UN Member States. National policies in this area vary significantly and there is still no unified global agenda. The next report, scheduled for 2026, will involve collecting data to monitor progress in each action area of the UN Decade of Healthy Ageing 2021–2030, consulting with countries on statistics of healthy ageing, and assessing it in the context of the SDGs.

ADDITIONAL INFORMATION

Author contributions: E.Yu. Golubeva: conceptualization, writing—review & editing, supervision; A.G. Soloviev: conceptualization, writing—original draft; N. Mishra: literature review, writing—original draft, writing—review & editing. All authors approved the version of the manuscript to be published and agree to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethics approval: Not applicable.

Funding sources: No funding.

Disclosure of interests: The authors have no relationships, activities, or interests for the last three years related to for-profit or not-for-profit third parties whose interests may be affected by the content of the article.

Statement of originality: No previously published material (text, images, or data) was used in this study or article.

Data availability statement: The editorial policy regarding data sharing does not apply to this work.

Generative AI: No generative artificial intelligence technologies were used to prepare this article.

Provenance and peer review: This paper was submitted unsolicited and reviewed following the standard procedure. The peer review process involved two external reviewers, a member of the editorial board, and the in-house scientific editor.

 

¹ FP Analytics, AARP. Planning for aging societies. an analysis of governmental plans for healthy aging from around the world [Internet]. Washington: The Slate Groupe. 2023–. URL: https://www.aarpinternational.org/resources/healthy-aging/national-plans. Accessed on March 13, 2024.

About the authors

Elena Y. Golubeva

Northern (Arctic) Federal University named after M.V. Lomonosov

Author for correspondence.
Email: e.golubeva@narfu.ru
ORCID iD: 0000-0002-4791-258X
SPIN-code: 7637-5730

Dr. Sci. (Biology), Professor

Russian Federation, Arkhangelsk

Andrey G. Soloviev

Northern State Medical University

Email: ASoloviev1@yandex.ru
ORCID iD: 0000-0002-0350-1359
SPIN-code: 2952-0619

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Arkhangelsk

Nidhi Mishra

Gandhi Institute of Technology and Management

Email: nmishra@gitam.edu
ORCID iD: 0000-0002-8830-4839

Ph.D, Associate Professor

India, Visakhapatnam

References

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