by Dr Martin Cunningham, Treasurer and Chair of the Audit and Risk Committee at BHC
While attending the WHO Healthy Cities 2025 Conference I had the opportunity to attend a workshop with the theme: Local Action for Healthy Ageing: Co-developing the WHO European Strategy on Ageing. This was facilitated by Dr Yongjie Yon (Leads the Ageing and Health program for WHO Europe as a Technical Officer for Health Through the Life-Course Unit). He was supported by Dr Geoff Green (Professor of Urban Policy, Sheffield Hallam University).
The workshop introduced the strategy’s four proposed pillars: Strengthening Prevention; Transforming Care; Enabling Age-friendly Environments and Tackling Ageism. It introduced the preliminary findings from a regional Member State survey on implementation priorities. Yongjie presented the priorities that were universally agreed and then priorities over which there was some debate relating to their level of significance. During the workshop, using the mobile phone app “Mentimeter” delegates were asked to rank various priorities and then discuss the results of the ranking order. This proved an interesting opportunity to discuss the proposed priority areas.
The quality of the presentation was excellent – there was an incredible amount of collected data and research that was presented in the introduction of the strategy. I came away feeling I wanted to know more (which is never a bad thing to feel at a conference!) and I plan to research this further.
The main messages, I believe, relates to the title of the strategy: “Ageing is Living” i.e. getting older is part of the life course which needs preparation by individuals and society. The statistics show that we have been very successful in extending the average lifespan of our population but much less successful at extending the “healthy lifespan” (that is the average length of time individuals live healthily without long-term conditions. These are often referred to in WHO parlance as NCDs ~ non-communicable diseases such as Diabetes, Ischaemic Heart Disease, Chronic Respiratory Disease, Stroke, Cancer and Dementia). The statistics also show that the effects of NCDs on mortality and morbidity display a significant level of inequality between the healthy lifespan enjoyed by those in the least deprived areas compared by those in the most deprived. (Calculated by WHO and others as Disability-adjusted life years [DALYs] where one Daly represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost due to premature mortality and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population)
There is an increasing challenge from the demographic transformation related to ageing which is affecting populations worldwide (with the exception of Sub-Saharan Africa) but specifically in Europe which shows that the average population is getting older with lots more people living into their eighth, nineth and even tenth decades whilst at the same time less younger age groups in the population related to the reducing birth rates within these countries. More people living longer will, therefore, mean more people suffering from NCDs putting increasing demands on the health and social care sectors. This requires a new paradigm when considering ageing. It requires a much more focused approach on prevention and early intervention of NCDs in earlier adulthood to ensure more people reach their seventh and eighth decades in better health. This includes addressing the health inequities across the socio-economic groups. This is important not only for the most deprived groups but also for the wider population as this will generate better health universally and to avoid overwhelming the health and social welfare services down the line. There also needs to be appropriate planning of services that can accommodate the health and social care needs of a population that is getting older and, hopefully, living healthier meaningful lives well into what we currently consider old age (Seventy may become the new fifty!). Health and social services need to be fit for purpose for the older population. This needs to include addressing any workforce and support service deficiencies (possibly with the aid of technology and AI) and tackling any overt or covert ageism.
Along with climate change and the inevitability of future pandemics the demographic transformation associated with the ageing population needs preparation and planning at pan-national, national, regional and local government levels along with a greater level of preparedness amongst the citizens in the countries which essentially means that cities such as Belfast need to mitigate and adapt for these changes. This is where WHO Healthy Cities can play a leadership role. In many respects climate change and the age-related demographic transformation have many similarities: they are both challenges that are here now and not some future threat; they require national, regional and local actions; they both have disproportionally worse effects on the most deprived communities; resources deployed now (financial and other resources) will pay dividends in the long run (the longer the delay the greater the ultimate cost!) and both challenges require the involvement of individuals and communities to ameliorate their adverse effects (and this involvement will have positive health and social effects for both those individuals and their communities).
