**4. Healthy aging (HA) and active aging (AA)**

Author, in this section of the work, finds it appropriate to present brief discussion on two inter-connected concepts: (a) HA, and (b) active aging (AA). The HA was the focal term used in the initiatives on aging undertaken by international developmental agencies, especially, the WHO between the periods: 2015–2030. Notably, HA replaces the WHO's previous focus on AA. The AA was a policy framework developed in the year 2002. The HA, like AA, places increased emphasis on the need for action across multiple sectors. Such initiatives are expected to enable older sections of the population to remain a resource to their (a) families, (b) communities, and (c) economies [1].

The AA, in terms of conceptual framework, is defined as *"the process of taking appropriate measures for the purpose of optimizing opportunities needed for health, participation and security in order to enhance overall quality of life as people age"*. More specifically, it (AA) is a term used to indicate the maintenance (and continuity) of positive well-being. Considered from this point of view, well-being also essentially takes into account two significant aspects, namely: (a) good physical, social and mental health; and (b) continued involvement in one's family, peer group, and community. These developments continue throughout the aging process. Everybody can experience HA. The AA and the HA together help reduce the pressure on (a) health care, and (b) social services. It has been found that aged population (or senior citizens) can make important contributions to:


It has also been found that sections of the older people who stay healthy, active and independent can continue to contribute their skills, knowledge, and experiences for betterment of the society [4]. It is important to remember that process of preparing for an aging population is vital to the achievement of the integrated 2030 Agenda, with aging cutting across the goals on:


*Researching into Commitments for Sustainable Development Goals and Healthy Aging DOI: http://dx.doi.org/10.5772/intechopen.97674*


Therefore, it is imperative to address the exclusion and vulnerability of (and intersectional discrimination against) many older persons in the implementation of the new Agenda to ensure sustainability in health initiatives. At the same time, it is equally important to go extra miles: beyond treating older persons as a vulnerable group. Today, there is increased need for macro level policies that ensure that older people are be treated and recognized as the active agents of societal development. This, in turn, will ensure achieving transformative, inclusive and sustainable development outcomes. The vision, mission and ultimate objective of all these initiatives is to ensure that order adults have HA in the later stages of life, as shown in the **Figure 1**.

It is in this context that the emergence of Decade of Healthy Aging (2021–2030), proposed by the UN, gains increased significance. Plan of action, to be implemented under the Decade, will seek active support and partnership of agencies, such as:


**Figure 1.** *"Enabling Environment among Older Adults at Later Stages of Life".* g. the World Bank; and

h. other relevant national, international and regional organizations.

#### **5. Key considerations for healthy aging**

The author of this review paper has previously outlined the conceptual framework of HA. An attempt has been made in this part of the work to research into key considerations that the policy makers and experts need take into account while framing guidelines for policies aimed at improving HA for all, in general. The author makes a point here that two aspects need special attention: (a) diversity, and (b) inequality. Brief description of these two considerations follows:


The description presented above makes it important to frame policies for older adults that take into account both diversity and inequity aspects. Such an initiative will ensure HA for all. Health has a central place in SDG-3, entitled *"Ensure healthy lives and promote well-being for all at all ages"*. Also, meeting the goal of HA for all will require (a) commitments on the part of national governments (including all other stakeholders), and (b) enabling environment (that will be a facilitator while implementing actual actions at micro or community levels, across various societies and continents of the globe).

#### **6. Discussion**

As outlined above, ensuring healthy lives and promoting well-being at all ages is essential to sustainable development (SD). In this section of the present work, the author presents discussion and analysis of data on HA in the light of specific and general objectives. The discussion follows:

#### **6.1 Inter-linkages between HA and SDGs**

Implementation of action plan for ensuring HA will definitely contribute to the realization of the SDGs. It can be seen from developments taking place across the regions of the globe that the 2030 Agenda for Sustainable Development (2030 ASD, commonly known as: "2030 Agenda") is manifestation of the plan of action (POA) to achieve universal SD in a balanced manner [2]. The POA of this type seeks to realize the human rights for all. In addition, it (the POA) calls for a demographic

*Researching into Commitments for Sustainable Development Goals and Healthy Aging DOI: http://dx.doi.org/10.5772/intechopen.97674*

scenario wherein: (a) no one is left behind; and (b) SDGs are met for: (1) all segments of society, & (2) at all ages, with special focus on most vulnerable ones, including older persons [5].

Preparing the global community for an aging population is, therefore, crucial for achievement of the "integrated 2030 Agenda". *Further*, at this juncture, it is pertinent to note that integrated 2030 ASD of this type requires policy makers to *emphasize* (and also *prioritize*, wherever necessary and possible) addressing concerns of aging population in the context of significant demographic considerations: (a) *poverty eradication,* (b) *good health,* (c) *gender equality,* (d) *economic growth,* (e) *decent work,* (f) *reduced inequalities,* and (g) *sustainable cities.* Interventions in these areas are key to achieving overall sustainable development (SD) [5]*.*

It is in view of scenario outlined above that the policy makers and all concerned stakeholders need to address the issues older citizens are confronted with, especially the aspect of: treating aged population as: *"vulnerable group"*. *Further*more, the integrated 2030 Agenda requires that sections of the population that are aged are accepted & recognized as: *"the active and more meaningful agents of desired changes in the society"* (at micro levels). This, *in turn*, will result in a situation that is conducive to achieve *"transformative, inclusive and sustainable developmental outcomes"* [5].

#### **6.2 Demographic transition and need for ensuring HA for all (In the context of new millennium)**

The new millennium is experiencing demographic transition that makes it necessary for all involved stakeholders to maximize initiatives, within the *"framework of available resources", for the purpose of "ensuring HA for all"*. *More specifically*, this aspect gains increased significance when one looks at unpredictable challenges for health care the international community is confronted with: *"the human populations around the globe are rapidly ageing"*. Notably, demographic transition of this type (in terms of significant swelling of aging population) will definitely impact almost all aspects of society [3]. The author of this work outlines below the very specific context in which need for ensuring HA for all can be justified in academic and research terms:

It is decade-old saying that health is: (a) wealth, *in general*, and (b) central to meaningful older age experiences, *in particular*. The author, herewith, makes specific point that although people today (in the new millennium), are living longer, there are not many research evidences which indicate that the extra years (read: *"years spent on old age"*) are spent in good (meaningful) health [4].

One very significant (and also practical) aspect of "old age" (or *"older age"*) is diversity of: (a) *'health'*, and (b) *'functioning'*. This aspect of diversity is (often) a consequence of the cumulative impacts of advantage or disadvantage across people's lives. The policy responses, therefore, need to be designed in manners that overcome (and not reinforce) these inequities. It is for these reasons that the global community together joined hands, in the year 2015, to implement the *"2030 Agenda for Sustainable Development"* (2030 ASD) [3]. The 2030 ASD includes: (a) 17 Sustainable Development Goals (SDGs), and (b) 169 targets. Both these SDGs and 169 targets were adopted on 25 September, 2015 by Heads of State and Governments at a special UN Summit. The 2030 ASD necessarily envisaged the plan of action on "commitment to eradicate poverty and achieve SD by the year 2030 world-wide". Notably, this Agenda (ASD) ultimately aimed at ensuring that no one is left behind. The adoption of the 2030 ASD (also known as: "2030 Agenda") was a landmark achievement, providing for a shared global vision towards SD for all [6].

The document titled "2030 Agenda" urges: (a) that *"no one on the earth will be left behind"*, and (b) that *"every human being will have the opportunity to fulfil their potential in dignity and equality"*. The document titled "Global strategy and action

plan on ageing and health (the Strategy)", published by the WHO, adopted by WHO's Member States in the year 2016, provides a policy level framework. This policy framework calls the international community to make efforts that are aimed at ensuring that "the global response to population ageing is aligned with this ambitious development agenda".

The Strategy (based on research by the WHO and other inter-governmental agencies) is based on new document titled *"WHO conceptualisation of Healthy Ageing outlined in the World report on ageing and health 2015"*. This document focus on the absence of disease. This consideration definitely envisages HA from the perspective of the functional ability that enables older people to be (and to do): *"what they have reason to value"* [4]. The Decade of Healthy Aging (2021–2030) will serve as important tool in ensuring HA for all (including in meeting SDGs for all countries).

#### **6.3 Strategic interventions needed for ensuring HA**

The author of this research paper suggests strategic interventions that are needed for ensuring HA for all on the planet. As outlined under specific objectives, each suggested strategic intervention is supported by evidences [actual initiatives (outcome/s of projects) undertaken in various parts of the globe]. The description given below is divided under two sections: (a) Section-1: Strategic Priority Areas, and (b) Section-2: Priority Interventions. The discussion follows:

#### **7. Section-1: strategic priority areas**

#### **7.1 Strategic priority Area-1**

#### *7.1.1 Statement: healthy aging over the life-course*

The aspect of good health needs to considered by all (including developmental planners) for overall SD. This acquires increased significance for older citizens or older people, as it helps them ensure independence, security, and continued productivity in later years of the life span. But it has been found that the noncommunicable diseases (NCDs) (especially diabetes, cancer, cardiovascular disease) have potentialities to (a) deteriorate (and diminish) quality of life of aged population, (b) increase costs incurred towards health-care, and (c) add to pressure on family members (and others around) responsible for their care [7].

Addressing the NCDs among senior citizens becomes challenging for the health care providers. This concern is considered to be one of the key factors (a) in furthering HA (health gains) at higher ages, and (b) for resigning policies aimed at attaining long-term health and social sustainable goals. It is pertinent to outline here that NCDs account for considerable loss of *"healthy life years"* among aging population [8]. An individual's health, including the level of activity, during older age, therefore, depend on his/her living circumstances and actions (over a whole life span). Priority area in this matter will definitely (a) *"promote health"*, and (b) *"prevent diseases"*. Maintaining mental capacity (and overall) well-being, thus, deserves attention by policy makers and other stakeholders [8].

#### *7.1.2 Evidence in support of statement*

With regard to priority area titled "Healthy Ageing over the Life-Course", several initiatives have been undertaken across the regions of the globe. The European Research Area in Aging (ERA-AGE), for instance, launched and implemented joint *Researching into Commitments for Sustainable Development Goals and Healthy Aging DOI: http://dx.doi.org/10.5772/intechopen.97674*

research programme in aging by publishing a call for multidisciplinary research applications on the "Active and Healthy Ageing Across the Life Course" in Europe. Aspects to be considered under the "Active and Healthy Aging Across the Life Course" are outlined in the **Figure 2**.

The call, in response to Active and Healthy Aging Across the Life Course approach is dedicated (a) to the achievement of enhanced and healthy aging and, (b) in particular, to address the major priority established by the Active and Healthy Aging Innovation Partnership (AHAIP). This project aimed at increasing healthy life expectancy by 2 years in the European Union (EU) by the year 2020. This is Europe's first response for aging research. It also envisages second round of ERA-AGE's post-doctoral fellowship programme, known as Future Leaders of Aging Research in Europe (FLARE) [9].

#### **7.2 Strategic priority Area-2**

#### *7.2.1 Statement: health and long-term care systems fit for aging population*

Attainment of long-term health care system that is appropriate for aging populations is another area of concern. This should form part of strategic priority area. In this context, the question needing answer is: what can be done in order to ensure that different levels of health (and social) care: (a) are better coordinated, and (b) provide services that are appropriate for sections of the aging population confronted with multiple chronic conditions and functional limitations? [8].

The above consideration becomes more important in view of increasing governmental spending on providing quality health care for older people (especially in the long-term) everywhere (and more in the context of countries in the European region. There are research evidences that suggest that several of the older people, today, look forward to enhanced access to high-quality healthcare services. Health care expectation of this type also includes informal health care that is provided by: (a) *"family members"*, (b) *"network of friends"*, and (c) *"civil society members"* at large [8]. The author (of this work) makes special mention here that contribution of these sections of the population makes difference, as they are health care providers who

#### **Figure 2.**

*"Active and Ageing Across the Life Course" in Europe model. [Source: Sheffield University (year of publication not mentioned). "Futurage: A Road Map for European Ageing Research". Sheffield, United Kingdom: Department of Sociological Studies, Sheffield University (Acessed on April 10, 2021 from: https://www.age-pla tform.eu/sites/default/files/Research-briefing\_futurage.pdf)].*

truly understand the health concerns due to their close connections (and prolonged interactions) with aged people in course of social living.

#### *7.2.2 Evidence in support of statement*

In support of programme undertaken in response to 2nd priority area named "Health and Long-Term Care Systems Fit for Ageing Population", the author presents here the example of Approach to Geospatial Modeling (AGM) initiative which was undertaken in Australia. As a part of this project (AGM), an effort was made to select and ascertain health and aging demand (in terms of *"community needs"*) and supply (in terms of *"social infrastructure available"*) indicators. Further, these indicators have been mapped on the basis of publicly available data projected for the years 2025 and 2040. Furthermore, the programme implementers used trend data and current state data in order to determine assumptions about projected future: (a) *'demand'*, and (b) *'supply'*. It is interesting to note that the resulting maps enable to illustrate both the level of current and projected demand and supply. Most importantly, this exercise enabled find out the gaps that prevail in provisions of social infrastructure by local government area (LGA). The AGM initiative considered three focus areas, namely:


It is pertinent to note that these three focus areas were selected (and scoped) based on these three parameters: (a) scale and burden of disease, (b) level of publicly available information, and (c) potential need for reform. It was found that within each area of focus, there are a range of measures that can be used as indicators of demand (or need). It is important to note that this approach provides summary of key infrastructure for health and aging in Australia. This list, however, is not a comprehensive. This is because of the fact that in Australia, many state (and local community) initiatives exist that are beyond the scope of this project to map in their entirety. In terms of outcomes of the initiatives of the AGM, it has been observed, in broad terms, that there are also key programmes and services that the project managers might be aware of. But the fact remains is that they (programmes and services) have not been able to map the required indicators due to the lack of sufficient publicly available data (that needs to be made available by the LGA). Most importantly, in terms of lessons learnt, it has been noted that continuation of the current health and aging models (like LGA) would require significant investment. This aspect is significant in order to meet the projected demand for infrastructure in years 2025 and 2040 in view of the fact that most obvious gaps remain in "aged care social infrastructure" [10].

#### **7.3 Strategic priority Area-3**

#### *7.3.1 Statement: supportive environments*

This aspect (of environments that are conducive and supportive) is important priority area. The author makes points that initiatives aimed at building (and creating) *supportive environments* is promising development. This type of promising development is reflection of network of cities and communities that: (a) interact

with each other in meaningful way, and (b) cooperate among themselves. This working mechanism creates age-friendly (and supportive) environments [8].
