We sat down with Dr. Jane Barratt, Secretary General, International Federation of Ageing to discuss the adoption of a life-course approach to health system challenges; the positive impact of adult vaccination across generations; and concrete policy recommendations to prevent the onset of dementia.

The Decade of Healthy Ageing(2020-2030) has begun. Why should we adopt an ageing and life-course approach to health systems challenges? How is the adoption of a life course approach to health in synergy with the SDGs?

The vision for the Decade of Healthy Ageing is a world in which everyone can live a longer and healthier life.  Ageing starts at birth and across the life course individuals may have a range of social and economic resources and opportunities influencing their power to make choices about their lifestyle as well as the care services.

Ageism is bad for your health – older people who experience prejudice, discrimination and stereotyping live on average 7 years less.  To harvest the full social and economic potential that longer lives provide, a broad multisectoral, multidisciplinary action is required at all levels to foster healthy ageing, that includes finance, planning, employment and social protection.  Ensuring that the aged are healthy and are in good health is even more crucial as we are faced with new epidemics, such as Covid-19.

Although the Decade has 4 action areas to improve the lives of older people, their families and their communities: (1) changing how we think, feel and act towards age and ageing; (2) developing communities that foster the abilities of older people; (3) delivering primary health services responsive to older people; and (4) providing older people who need it with access to long-term care.

These are strongly interconnected and aligned with the SDGs.  For example health systems that are responsive to older adults’ needs are essential to ensure long-term care; person centred integrated health and social care are key for developing communities in ways that foster the abilities of older people.  Multisectoral action is important to promote health and address the environmental and social determinants of healthy ageing. Combating ageism needs to take place across all policies, settings and practices and geographies.

Immunisation has been used as a cost-effective healthy ageing strategy at a global level. What is the impact of adult vaccination across generations?

Immunisation is a key public health actions; it saves lives, protects health, and contributes to healthy and productive populations.  We need to move beyond the notion that vaccination is a one-off for children and encourage governments and societies to embrace vaccination throughout life.  This strategy can not only prevent individual infections but lead to a healthier ageing population.  A current example is the vulnerability of older groups to Covid-19, which points to the importance of a healthy life course approach to immunization as a preventive measure – to boost immunity and significantly reduce susceptibility to life threatening ailments.

A life-course approach to immunisation further protects against co-morbidity effects with other diseases and reduces the burden of non-communicable diseases.  This creates a “win-win” effect as vaccines, by reducing infections, limits the need for antibiotics and thereby protect future generations from the spread of antimicrobial resistance (AMR). Finally, immunisation programmes have a unique ability to reach hard-to-reach populations and can be used as a foundation for primary health systems strengthening along the life-course and thereby also to advance UHC and general population health.

The G20 Health Ministers Declaration called for health investments that focus on ways to extend healthy life expectancy and quality of life. What concrete policy recommendations can the International Federation on Ageing give for countries to do so in an era of already constrained national budgets?

Policy change is integral to overcoming the many issues associated with ageing by fighting the stigma of old age, creating friendly environments, and fostering healthy ageing.  At IFA we recognize the importance of including non-state actors, including the private sector, academic community, and civil society to develop robust policy frameworks.  There is no single policy solution to this complex and multi-faceted issue, however, governments must prioritise investment in age-related research on vaccination to develop targeted and specific policy frameworks.

The recent G20 Health Ministers Declaration highlighted dementia as a common challenge which has significant impacts of health and quality of life for sufferers, their families and care givers, as well as wider society and the entire economy. What concrete policy recommendations can International Federation of Ageing give for countries to address risk factors and social determinants of dementia and Alzheimer’s while research is underway to find a cure?

Globally, nearly 50 million people live with dementia, with almost 10 million new cases per year and the WHO estimates the economic costs as equivalent to 1.1% of global Gross Domestic Product.

Collaboration and partnership are essential for governments to uphold the commitments made in the G20 Health Ministers Declaration to adopt an integrated approach to dementia to improve the quality of care and lives of people with dementia and their communities.  Programs that focus on risk reduction, early detection, diagnosis, and treatment of dementia will be essential to make progress on reducing the global burden of dementia.  The private sector are key players in leading the quest for novel treatments for dementia, therefore governments must also play their role and create ecosystems where access to these programs is available and easily accessible.

What are some of the innovations that can help us rethink our approach to healthcare to tackle the healthcare system constraints on caregiver and health workforce shortages?

Long-term care should be underpinned by a person-centred rights-based approach.  In the main health systems are designed to respond to acute conditions and manage a person’s health portfolio in fragmented ways with a lack of coordination.  Appropriate long-term care services reduce care dependency later in life, curtail the inappropriate use of acute healthcare services, reduce financial hardship and provide a balance between family caregivers and formal systems of care.  To enable this transformation, training for healthcare workers needs to be dynamic, valued and compensated adequately.  Innovative approaches, including technological solutions and quality of life technologies and artificial intelligence (AI), such as a smartphone for screening for diabetic retinopathy, the leading cause of preventable blindness are enablers for accelerating better care for older persons.

Author

• Jane Barratt