Getting ready for a Decade of Healthy Ageing - unece
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27-28 September 2018, Bilbao
2nd International seminar on the Active Ageing Index
Getting ready for
a Decade of Healthy Ageing
Dr Ritu Sadana, Senior Health Advisor
Dr Jotheeswaran Amuthavalli Thiyagarajan, Epidemiologist
Department of Ageing and Life Course, WHO
sadanar@who.int @RituSadana
amuthavallithiya@who.int @AT_Jothees
DREAM
VISION
Healthy Ageing as the process Health equity implies that of developing and maintaining ideally everyone should have the functional ability that a fair opportunity to attain enables wellbeing in older their full health potential and age. Functional ability is “all that no one should be the health-related attributes disadvantaged from achieving that enable people to be and this potential. It's about to do what they have reason social justice and social to value.” inclusion.
1. Healthy ageing, leave no one behind 2. Decade 2021-2030 3. Baseline report, 2020
1. Healthy ageing, leave no one behind 2. Decade 2021-2030 3. Baseline report, 2020 "A continuous phenomenon, an inclusive concept, not equivalent to disease-free, not simply age dependent"
Healthy Ageing trajectories - continuous World Report on Ageing and Health 2015
Healthy ageing – unpack it
Intrinsic Capacity Functional Ability Environment
Cognitive Learning and applying Products and
Psychological knowledge technology
Sensory
Communication Natural and built
Neuromusculoskeletal
Voice and speech Mobility environment
Cardiovascular Self-care Support and
Haematological Domestic life relationships
Respiratory Interpersonal Attitudes
Immunological interactions and Services, systems and
Digestive relationships policies
Metabolic
Major life areas
Endocrine
Genitourinary Community, social
Reproductive and civic life
Skin, hair and nails
8
Healthy Ageing trajectories - unmask inequities Distribution – differences accumulate including unfair, avoidable or preventable differences Intrinsic Capacity
CAN WE MEASURE IT
Intrinsic capacity, cross sectional,
by age, 6 countries, WHO SAGE
Source: World Report on
Ageing and Health
Data Source: SAGE wave 1,
cross sectional
data, 6 countries, 2007-
2010Intrinsic capacity, India and Russia,
men and women, age 50 plus, by household wealth
Poorer Richer
Data Source: SAGE wave 1, cross sectional data, 2 countries Sadana et al. forthcomingHand grip strength, India and Russia, men and
women 50 years plus, by household wealth quintiles
India Russia
45 Right Hand - men
Mean grip strength, kg
Right hand - women
40
Left hand - men
35 Left hand - women
30
25
20
15
10
1 2 3 4 5 1 2 3 4 5
Wealth quintiles Wealth quintiles
Data Source: SAGE wave 1, cross sectional data, 2 countries Sadana et al. forthcomingDistribution of intrinsic capacity score
(WHO world population standard, 50+, both sexes)
.05
.05
.05
Pull up
.04
.04
.04
China Russia India Shift
.03
.03
.03
Density
Density
Density
.02
.02
.02
Narrow
.01
.01
.01
0
0
0 20 40 60 80 100 0 0 20 40 60 80 100
0 20 40 60 80 100
composite composite composite
.05
.05
.05
.04
.04
.04
South Ghana
Africa Mexico
.03
.03
.03
Density
Density
Density
.02
.02
.02
.01
.01
.01
0
0
0
0 20 40 60 80 100 0 20 40 60 80 100 0 20 40 60 80 100
composite composite composite
Source database: SAGE, WHO, wave 1, cross sectional data Sadana et al. forthcomingWHAT DOES THIS MEAN
Intrinsic capacity score distribution for ages 50+, Russia
.04 Private sector
workers, women 57.6
Private sector
Informal sector workers, men 62.4
workers, men, 54.8
.03
distribution
Informal sector
workers, women,
Density
48.1
.02
90+, lowest
wealth quintile,
least educated, 50-54yrs, highest wealth
35.8 quintile, most educated
66.2
Frequency
0 .01
0 10 20 30 40 50 60 70 80 90 100
Intrinsic capacity score Sadana et al. forthcomingIntrinsic capacity score distribution for ages 50+, India
.04 Informal sector
Private sector workers, men, 48.2
workers, women
45.4 Private sector
Informal sector workers, men 54.1
.03
workers, women,
distribution
42.5
Density
.02
90+, lowest
wealth quintile, 50-54yrs, highest wealth
least educated, quintile, most educated
.01
Frequency
26.0 62.2
0
0 10 20 30 40 50 60 70 80 90 100
Intrinsic capacity score
Sadana et al. forthcomingCurvilinear trajectories of IC and cohort effects in later lives of older people in Britain Amuthavalli Thiyagarajan et al. forthcoming
Effect of cohort on cognitive capacity by
childhood socioeconomic position
Solid line = high socio economic position
Dash line = low socio economic position Amuthavalli Thiyagarajan et al. forthcoming"I am convinced that the commitments outlined by the Strategy will help countries … improve health equity across the life course and other development goals." - Foreword, Global Strategy and Action Plan on Ageing and Health
1. Healthy ageing leave no one behind 2. Decade 2021-2030 3. Baseline report, 2020 "By 2020, establish evidence and partnerships necessary to support a Decade of Healthy Ageing from 2021 to 2030"
New WHO
Baseline
report on
Healthy
Ageing
2002 2015 2016 2017 2018 2019 2020 2030
Decade of
Healthy Ageing
2021-2030What impacts do we expect by 2030? What would success look like globally and nationally in 2030? What good practices and new evidence can guide actions that will increase overall impact and reduce inequities? To support healthy ageing, are there specific global public goods we should ensure?
Clarify concepts, determinants and pathways,
and outcomes of interest - "blocks"
Health and
Link measures to each well being
Report on each "block" separately, to
facilitate interpretation on what can be done, Systems, built
and progress
environment, other
Report on outcomes, to be accountable interventions
Strengths,
Avoid combining
determinants and outcomes
exposures,
(UHC Index) vulnerabilities
Biologic and
Social
stratification
Root or
structural
determinants1. Healthy ageing leave no one behind 2. Decade 2020-2030 3. Baseline report, 2020 "global status report on healthy ageing for submission to the 73rd WHA (May 2020), reflecting agreed upon standards and metrics and new evidence on what can be done in each strategic theme, to inform and provide baseline data for a Decade of Healthy Ageing 2020-2030”
1. Where we are – 2020
Global baseline – levels and distribution - Intrinsic capacity, functional ability,
enabling environments and other important indicators such as care
dependence
- new analysis of existing nationally representative data
- new data from nationally representative surveys
2. Where we want to go – by 2030
Goal alignment, targets and Indicators – projections towards potential targets
Scenarios to support national planning & investments (informed by projection
work)
3. How are we going to get there
What can be done (reflecting systematic reviews & norms in key areas) relevant
to different contextsGlobal Strategy midterm country progress May 2018 Cross-sectional Only 54 Longitudinal Only 35 10 indicators full results: www.who.int/ageing/commit-action/measuring-progress/en/
Thank you WHO Geneva For further information: sadanar@who.int amuthavallithiya@who.int
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