Promoting healthy ageing in the Western Pacific: A mini review of good practices and policy responses

Summary

The Western Pacific Region is experiencing rapid population ageing, which has implications for almost all areas of society. Countries will need to prepare for population ageing by investing in health and optimizing living environments. This requires a whole-of-society approach to healthy ageing. Countries in the Western Pacific Region have been making significant progress in healthy ageing. Since the endorsement of the Regional Action Plan on Healthy Ageing, younger societies have also started preparing for population ageing, focusing on social and health systems transformation, community-based integrated care, social and technological innovations and research, monitoring and evaluation. As more countries are interested in healthy ageing and preparing for necessary social and health systems transformation, the case studies in this article can be an inspiration for Member States to transform their approaches to achieving a society where older adults are healthier and can participate fully.

Introduction

Population ageing is a demographic trend observed in many countries in the Western Pacific Region. Based on experiences from different countries, it often brings profound challenges and implications. In 2020, there were more than 245 million people aged 65 years and over living in the Region. This is expected to increase to around 458 million by 2040. Within two decades, the proportion of the region's population over 65 years will almost double from 12% to 23%. Population ageing impacts health systems and many other spheres of society, such as the labour market, education, housing, technology, transportation, and social protection. With the rising burden of non-communicable diseases (NCDs), most countries in the Region might face a financing gap in their health systems, based solely on projected changes in population structure and current financing sources (1). Countries also face challenges to address growing and diverse needs of ageing populations - older adults are a heterogenous group with a variety of preferences, needs and capacities (2).

Countries need to prepare for population ageing. Many countries in the Region, especially low- and middle-income countries, are experiencing rapid population ageing (Figure 1). It is estimated that Viet Nam will take 21 years to transition from an ageing society to an aged society and Brunei Darussalam will take 13 years for this transition. Countries experiencing rapid transition may have less time to form and implement adequate policy responses. Preparing for population ageing takes time and resources, but early investments can deliver high returns from a social and economic perspective. About one-third of economic growth in advanced economies could be attributed to improvements in population health in the past century (3). Every $1 invested in health is estimated to result in an economic return of $2 to $4 across developing countries (4). This will accelerate an inclusive and resilient COVID-19 pandemic recovery and sustainable development. Evidence also shows that promoting the employment of older workers and an age-friendly workplace is likely to have positive economic effects in the coming years, even among those countries with relatively young populations (5).

Figure 1.

Speed of ageing in the Western Pacific Region (except for the Pitcairn Islands): Projected transition time from ageing to aged society. The projections displayed in Figure 1 are based on the United Nations' medium-fertility scenario, while the speed of ageing in Nauru, Palau and Kiribati is estimated by near-term information on population ageing. This article qualifies a country as "ageing society" if the proportion of people aged 65 years or more is between 7% and 14% of the total population. If the proportion surpasses 14%, it is an "aged society"; if over 21%, it is a "super-aged society". Data source: United Nations Department of Economic and Social Affairs Population Division, World Population Prospects 2022.

A complex interplay of multiple factors and conditions that affects health and well-being of ageing populations (6,7) should be addressed using a multisectoral approach. As identified in a systematic review, healthy ageing is affected by various determinants, including socio-demographic, biological, behavioural and psychological and social determinants (8). Social determinants shaping our opportunities to age in good health are largely outside the health sector. The major social factors affecting older persons' well-being are physical activity, diet, self-awareness, outlook/attitude, life-long learning, faith, social support, financial security, community engagement, and independence, as synthesised by a recent literature review (9). Many of the existing practices, aimed to enhance the above-mentioned factors, indicate that multisectoral collaboration and action can be effective in improving health and well-being in later life (7,10).

The World Health Organization (WHO) has developed the Regional Action Plan on Healthy Ageing in the Western Pacific to support countries with achieving a healthy ageing society. It was endorsed in 2020 by the WHO Regional Committee for the Western Pacific. It sets forth a long-term vision of healthy ageing in the Region, namely healthier older adults in the Western Pacific thriving and contributing to society. The Plan outlines five objectives to achieve this vision, including transforming societies as a whole, transforming health systems to address each individual's lifelong health needs, providing community-based integrated care, fostering technological and social innovation, and enhancing research, monitoring and evaluation. Member States have been working on the planning and implementation of customized healthy ageing policies and programs.

Given the emergent good practices and policy responses in the Western Pacific, the present article showcases good policy examples and interventions for healthy ageing and evaluations of progress in specified areas.

Case studies on healthy ageing in the Western Pacific

Transforming societies as a whole

Recognising that older adults' health is significantly determined by factors outside the health sector, countries in the Western Pacific have been developing age-friendly environments through cross-sectoral policy and program coordination.

China's national policy on creating an age-friendly society

In 2019, the Chinese government published the National Medium and Long-term Plan for Active Response to Population Ageing, which strengthens its vision, strategy, and institutional capacity of creating age-friendly environments. The objective of this Plan is to create an age-friendly society that promotes respect for older adults, implements the preferential treatment policy for older adults, safeguards the legitimate rights and interests of older adults, and gives full play to the positive role of older adults. It aims to generally establish an age-friendly society by 2035, and generally establish age-friendly cities, villages and communities by 2050.

Korea's age-friendly programs that support the creation of new life models in later life

To support healthy ageing, the Korean government has been working to create an age-friendly environment and has made significant progress in areas like employment and social participation. Seoul 50 Plus Foundation of the Seoul Metropolitan Government has been building a workforce ecosystem for the 50+ aged group. The objective is to support people aged 50 or over to participate in social activities without discrimination and extend their work life so that they can enjoy independent and high-quality life in good physical, social and mental health as they age. Specifically, this Foundation supports this aged group to actively retain their social and economic activities by developing work models fit for people aged 50 and over, providing reemployment and career development opportunities through bridge jobs (i.e. 50+ internships), supporting people aged 50 or over to start a business, and providing social contribution activities. Additionally, Seoul has run an Ageing Policy Monitoring Group to increase opportunities for older adults to get involved in the making of policy decisions.

Philippines' establishment of a national coordinating body that promotes multisectoral collaboration in age-friendly communities

The Philippines, using a future-orientated way of thinking, has worked on creating healthier and safer environments for people of all ages, and on maximizing the contributions and capacities of older persons. In support of the Implementing Rules and Regulations of Republic Act No. 11350, the National Commission of Senior Citizens (NCSC) was established under the Office of the President in 2019 as a national coordinating body on ageing, to ensure the full implementation of laws, policies and government programs to protect older adults' welfare. The Commission closely working with the Department of Health and with support from WHO, has developed an initial draft of the 2023-2028 Philippine Plan of Action for Senior Citizens, through a consultative and participatory process. The plan adopts a whole-of-government approach to create age-friendly environments across relevant sectors. The Commission is now developing a national framework for age-friendly environments and implementing age-friendly programs in five local government units. Moreover, the Commission is promoting healthy and productive ageing through the Wellness, Health, Emergency Response and Benefits Division (WHEREBED), fostering intergenerational transformative dialogues and learning through the Senior Citizens' Action for Development and Nation-Building (SECADNA) project, and advocating that all seniors must have a minimum of an annual regular health, dental, optical, and aural examination (as a building block of a strong primary health care system).

Transforming health systems to address each individual's life-long health needs

Healthy ageing does not mean being disease-free. People may have one or more health conditions, when well controlled, have little influence on their well-being - everyone can experience healthy ageing (7). Healthy ageing requires taking a life-long approach to developing and maintaining functional ability to enable well-being in older age (11). As indicated by a framework for healthy ageing (Figure 2), health systems should address a person's health needs throughout their lifetime, focusing on health promotion and disease prevention rather than the diagnosis and treatment of diseases.

Figure 2.

A public health framework for healthy ageing: opportunities for public health action across the life course. Data source: World Health Organization. (2015). World Report on Ageing and Health.

Countries are encouraged to transform health systems to promote the functional capacity of individuals throughout their lives and create health-enabling environments. Prevention is strongly recommended, as lifestyle and behavioural factors play an important role in preventing disease, disability and death on an individual basis and on a larger scale in communities and populations (7). A person-centered approach inclusive of older adults should be adopted in health systems transformation (12). It applies to encouraging people to lead a healthier lifestyle, developing personalised care plans that address individual needs, and engaging communities in addressing the social and physical environment at an individual level.

Singapore's Healthier SG, a new strategy to transform the way we plan and deliver healthcare

In 2022, Singapore published its multi-year strategy centered on preventive care to improve the health of its population. Healthier SG will be launched in the second half of 2023. The strategy aims to prevent individuals from falling ill and empower individuals to improve their health, enabled by a strong doctor-patient relationship. The strategy helps transform "sick systems" - in which the health sector focuses on treating diseases - into "health systems" with health-enabling environments and systems that empower individuals to improve and manage their health proactively. The key features of Healthier SG are mobilizing the network of family doctors to deliver preventive care for residents, developing health plans that include lifestyle adjustments, regular health screening and appropriate vaccinations; activating community partners to support residents in leading healthier lifestyles; launching a national enrolment program for residents to commit to seeing one family doctor and adopt a health plan; setting up necessary enablers such as IT, manpower development plan and financing policy to make Healthier SG work (13).

Providing community-based integrated care for older adults

Communities can help reorient health and social services towards a more integrated and coordinated model of care to address the diverse needs of older persons. Communities are the meso-contexts of accustomed living environments that can affect older persons' health. Evidence shows that community-based intervention programs can help reduce the risk factors of functional decline and improve the health and well-being of older adults (14). Community-based integrated care is a promising approach to advancing service and support delivery for older adults and their families.

Japan's community-based integrated care system

Community-based integrated care is a system that coordinates the delivery of health-care services, long-term care services as well as social activities, and services to older adults based on their individual needs and preferences (6). Japan has been developing this system since 2006 as a part of the reformed Long-term Care Insurance Law, to support older adults to continue living in areas where they are used to living. To implement this system, Japan has established 24- hour routine home-visit services and needs-based care services, fostered collaboration between medical care and long-term care, improved coordination between a wide range of care providers, and increased integration at different levels (system, organizational, clinical) (15). A variety of stakeholders are involved including older adult users, caregivers, community residents, health and social care providers, non-profit organisations, community associations, municipalities and the state.

Cambodia's national ageing policy and training program on integrated care for older people

The Cambodian government has been operationalising the National Ageing Policy (2017-2030) and enhancing institutional capacity for the care of older people. These efforts include fostering Integrated Care for Older People (ICOPE), which can help identify risk factors for preventing and managing NCD symptoms early, following onset, to maintain the functional ability of older adults for as much as and as long as possible (16). Recognising the importance of a person-centred and community-based approach to care, Cambodia is developing a national training curriculum for primary healthcare services, and a training program for healthcare workers, which are tailored to local context and needs. Such capacity-building efforts are enabling more inclusive, age-friendly care pathways.

Fostering technological and social innovation for healthy ageing

Technological innovations can facilitate healthy ageing in various ways. However, older adults are often left behind in the rapid digital transformation, which has prevented them from opportunities for better health and well-being. As internet access is emerging as a social determinant of health (17), it has become ever more important to close the digital divide. Various types of digital technology could be leveraged to deliver personalised care to address the diverse needs of ageing populations (18). Digital innovations to improve older adults' lives and efforts to close the digital divide should be amplified. New digital solutions to enable a person's increased control over their health, and innovations to maintain and promote the functional capacity of individuals should be accessible and available to older persons of different backgrounds (19).

BruHealth, a mobile health application going beyond COVID-19 control in Brunei Darussalam

BruHealth was developed by the Government of Brunei Darussalam and initially used as a contact tracing app that has expanded into a growing multi-sided e-health platform. The application provides residents updates on COVID-19 transmission and related policy measures, monitors the health conditions of patients through the self-assessment feature and tracks risk exposure of residents using the Bluetooth and GPS tracking features. BruHealth uses algorithms to determine the individual personal health status with the use of questionnaires related to their health status. The key features of this mobile application include personalized health planning, user empowerment, shared decision-making, supporting health behaviour change and integration with the government's health information and management system, namely Bru-HIMS. As we return to normal, the BruHealth App is now in progression towards the digital healthcare engagement journey with the Bruneians. Health score of an individual including disease specific digital therapeutics interventions and care plans will also be available for Bruneians to take ownership of their health. This is an important milestone for Bruneian's Healthcare as the planned digital interventions will address all segments of the population.

China's new national plan on smart eldercare

In 2021, China's Ministry of Industry and Information Technology, the Ministry of Civil Affairs, and the National Health Commission jointly issued the Action Plan for the Development of Smart Health and Eldercare Industry 2021-2025, which is the comprehensive and specialized national policy on smart eldercare and has a clear development direction by 2025. The action plan outlines a series of measures to develop smart eldercare, such as developing new technologies and digital products, expanding smart health services and smart elder care scenarios, increasing capacities of health management and data application, promoting age-friendly technology, improving digital literacy of older adults, optimising industrial environments and enhancing digital public services.

Social innovations for healthy ageing offer novel solutions to address complex issues of ageing and represent key drivers for generating positive changes to living environments. Such solutions include identifying new ways of addressing social determinants of health, developing cost-effective interventions to enhance the functional ability of older adults, redesigning spaces for age-friendly environments and fostering social entrepreneurship opportunities.

China's social prescribing program

Social prescribing is a means for healthcare workers to connect people to a range of non-clinical services in the community, to improve health and well-being. It can help to address the underlying causes of health issues, such as anxiety, loneliness, depression and non-communicable diseases (20). Shangrao city in China conducted a social prescribing program in early 2021, as part of the city's strong commitment to improving the mental health care of older adults. The program involves healthcare providers, social and voluntary sector organisations, and link workers (mostly community health workers and volunteers). It is currently being introduced to more communities in various forms that all connect people to a range of non-clinical services in the community. The initiatives are often based on discrete funding sources and small-scale localized programs (21).

Viet Nam's intergenerational self-help clubs

The intergenerational self-help clubs (ISHCs) in Viet Nam are community-based voluntary organizations that promote the well-being of individuals and support community development. ISHCs conduct income-generating, social, cultural and health-promoting activities with older residents and promote international cross-learning and sharing on various topics, with the support of local governments. Each ISHC is composed of 50-70 community members, most of whom are older adults disadvantaged in society. ISHC is an inclusive and cost-effective intervention, given that the clubs are built upon financial, human, technical and other social resources, including older adults. The expansion of the ISHC model was included as a national government target in the 2012-2020 National Plan of Action on Ageing and in the 2016 Prime Minister Decision 1533. By the end of 2019, 2,985 ISHCs have been established covering 60 out of the 63 provinces as more requests to help set up ISHCs continue to be received from throughout Vietnam (22). Viet Nam set up a target of reaching 6,500 clubs nationwide by 2025 and improving integration with health services.

Strengthening research, monitoring, and evaluation

Generating and applying knowledge not only tackles the challenges of ageing societies but also allows us to imagine, create, and sustain new visions for aged societies. Researchers are encouraged to conduct research on building an investment case for policy change, identifying win-win opportunities for aligning health goals with those of other sectors, developing integrated care models for older adults, and evaluating innovative approaches to healthy ageing.

Monitoring the progress on healthy ageing can deepen our understanding of the changes associated with ageing and provide opportunities to evaluate the impact of policy reforms and interventions. Many countries in the Region have weak data systems on the health status and needs of older adults, which can prevent further development of programs, services and policies for older adults. Longitudinal data on older adults is available in countries like Australia, China, Japan, Malaysia, New Zealand, the Philippines, the Republic of Korea, Singapore and Viet Nam. Thus, accelerated efforts are demanded to collect age- , gender- and spatially disaggregated data on older adults in terms of health, socioeconomic status, and the contributions that older adults make to society (6).

Palau's research on ageing for evidence-informed national policy and interventions

There has been a lack of data and evidence generated on older persons in the Pacific Island context, which prevents an accurate picture of older adults' lives and their living environments and often leads to fewer evidence-informed policies and interventions. Palau is conducting research to assess the circumstances, experiences, needs and expectations of older adults, their families and communities, which will help gather knowledge about lived experiences and circumstances of older adults. In addition to the research, Palau conducted consultations with older adults and other stakeholders such as policymakers, non-profit organizations, social and healthcare workers, and community leaders to identify existing resources and actions needed to promote healthy ageing. Such endeavours will support policy development on ageing that suits national and subnational contexts.

Vanuatu's situational analysis of healthy ageing for advocacy and partnership

There is currently limited discussion of the experiences of older adults in Vanuatu and the policy context impacting their daily lives. To address this limitation, Vanuatu is conducting a situational analysis of older adults' health and social circumstances. Informed by the best available evidence, Vanuatu conducted an advocacy initiative and policy consultations that contributed to capacity building for policy development and cross-sectoral collaboration on healthy ageing.

Conclusion

Social and health systems transformation for healthy ageing requires a long-term vision and commitment. Nevertheless, investing early can yield significant returns for individuals and society as a whole. Countries could find inspiration from innovative best practices for healthy ageing from other countries and customize approaches for healthy ageing based on their context. Younger societies can learn from the experience of aged and super-aged societies in transforming social and health systems; aged and super-aged societies can also be inspired by new innovative practices and approaches at work in younger societies. Knowledge exchange will continue to be key in creating a healthy ageing society for the Western Pacific Region.