**7.4 Strategic priority Area-4**

#### *7.4.1 Statement: strengthening research and the evidence base*

The author opines that *strengthening research and the evidence base* should form part of strategic priority area. Policy makers and collaborative partners should strives to:


Findings of research studies must be disseminated and exchanged among stakeholders and researchers. Most importantly, knowledge transfer should continue to be key in projects for HA, including at the local levels [8].

#### *7.4.2 Evidence in support of statement*

Here, the author presents example of the Longitudinal Study of Aging and Health in the Philippines (LSAHP) in support of priority area-4 (named Strengthening Research and the Evidence Base). It is pertinent to note that the LSAHP is the first study, which is research and evidence-based in nature, that was undertaken in the Philippines in the year 2018. It is multi-actor longitudinal study on aging [12]. Data and information for the study were collected from:

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


Under the LSAHP project, the 2018 baseline data provides comprehensive information on the health, economic status, and overall well-being of a nationally representative sample of older Filipinos aged 60 and older. It is pertinent to note that these data are considered as valuable resource for the crafting of evidencebased policies and programmes for aging population in the Philippines. With regard to objectives, the LSAHP aimed to (1) investigate the health status and well-being, as well as their correlates, of Filipinos aged 60 years and over; and (2) assess and ascertain the determinants of health status and transitions in health status and overall well-being. This initiative (LSAHP), which is part of a comparative study of the Philippines and Viet Nam, is funded by the Economic Research Institute for ASEAN and East Asia (ERIA). The ERIA is an international organization established in Jakarta, Indonesia in the year 2008 by a formal agreement among Leaders of 16 countries in the East Asian region. It aims to conduct research activities and make policy recommendations for further economic integration in the East Asia. The ERIA works very closely with both the ASEAN Secretariat and 16 research institutes to undertake and disseminate policy research under the three pillars. They are: "Deepening Economic Integration". The LSAHP is implemented by the Demographic Research and Development Foundation, Inc. [12].

#### **8. Section-2: priority interventions**

Four Priority areas, as outlined above, form the basis for priority interventions. These interventions are prominent in national or subnational plans related to healthy aging. Worldwide, evidences are growing about effectiveness and contribution of interventions to the sustainability of health and social policies for aging population. The evidence-based policies provide a foundation for the further strengthening of international exchange and knowledge transfer for ensuring HA for all [8]. The author herewith suggests four priority areas in which interventions are needed for the purpose of furthering well-being of elderly population. They are: (a) prevention of falls, (b) promotion of physical activity, (c) public support for informal care giving (with a focus on home care), and (d) geriatric and gerontological capacity building among the health and social care workforce. Description on how these priority interventions enable HA, across the regions of the globe, is presented below:

#### **8.1 Fall prevention**

In terms of health risks among older people, findings of the research studies undertaken across the regions of the globe are suggestive of the fact that the risk of falls increases steadily with aging process. More specifically, older women are more vulnerable than older men. Two contributing factors for this trend, according to medical professionals, is that women (a) tend to have less muscle strength, and (b) are more likely to have osteoporosis. In addition, it is pertinent to note that fallrelated injuries during old age are more likely to be severe. Doctors have reported that once injured, older people are more susceptible to longer-lasting ill health (or hospital) stays, with fatal complications of various types. Again, in terms of

expenses to be incurred towards treatment, *"fall-related injuries"* (mainly *"hip fractures"*) involve considerable amount of costs for two medical aspects, namely, (a) *"hospital admissions"*, and (b) *"rehabilitation interventions"* [8]. In terms of other factors responsible for fall and related injuries, reasons include (a) muscle weakness, (b) balance disturbances, (c) previous history of falls, and (d) multiple medication. Scientific and convincing evidences drawn from research studies indicate that *"most falls are preventable"*.

At this juncture, the author of this paper make a specific point herewith that some of the *"preventive measures"* tend to be *"cost-effective"* (or *"cost-saving"*). Importantly, there are *"good-practice examples"* of how fall prevention strategies can be successfully implemented in different settings, when supported by enabling public policies [8].

In terms of viable and non-medical interventions needed to prevent fall resulting health complications among older people, appropriately designed advocacy initiatives have been found to be effective. This will, however, require multi-sectoral approach. For instance, combination of creating and raising awareness of risk factors, exercise programmes, physical therapy and balance retraining have potential to reduce (a) falls, and (b) number of injuries per fall. It is for this reason that many countries, today, have designed and implemented programmes aimed at home safety assessments. It has also been discovered that scientific modification in home exercises by trained professionals can also reduce incidents of falls and other related injuries. Some developmental projects have, in place, more specialized preventive measures for high-risk groups of older people. Preventive measures advice (for instance, wearing of hip protectors) makes difference in case of fall prevention among older people. In this context, what is of utmost significance is that prevention of falls is prominent in quality management programmes for HA for all in various settings [8].

#### **8.2 Promotion of physical activity**

It has been found that physical activity is one of the strongest predictors of HA. Several groups of medical professionals suggest that regular physical activities, in moderate volumes, help older people promote mental, physical and social wellbeing. Also, such activities enable them to prevent: (a) *'illness'*, (b) *'injury'*, and (c) *'disability'*. In support of this research statement, the author of this work makes statement that those sections of people who are physically fit when they enter into old age, tend to stay healthier for longer time. One should also note that physical activities among older people is beneficial not only in preventing diseases, but also in (a) *"lowering the risk of injuries"*, (b) "improving mental health", (c) *"further improving cognitive function"*, and (d) *"enhancing social involvement"* [8].

#### **8.3 Public support for informal care giving (with a focus on home care)**

With aging population, witnessed in several nations and regions of the globe, older people (with functional limitations of various types), from different socialsettings, need support with the activities of daily living. What is alarming in this context is that the growing prevalence of dementia will further increase the demand for this support. Thus, public support for informal care giving (with a focus on home care) is one aspect that requires special attention in initiatives aimed at HA for all [8].

Demographers and researchers (including the office of the WHO) have found that in many of the European countries, most care (in terms of hours) is provided mostly by women informally at home settings. This phenomenon is witnessed even

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

in countries that have well-developed publicly supported elderly care sectors in place. The author of this work advocates that public support for informal care giving is one of the most important public policy measures that needs to be taken in order to ensure future sustainability of health and social care in aging populations [8]. The fact remains is that this type of informal care, with a focus on home care, is a response to multiple disorders. It requires an evolving and tailored combination of six considerations, namely,


Another important dimension of policy for public support for informal care giving that requires intervention from policy makers and all involved stakeholders is that where these services are available, they (a) are often fragmented, and (b) may be prohibitively expensive. *Further*, many of the older people, with chronic health or social care needs, opt for living at home. They prefer to remain independent at home, as long as possible, over the alternative of *"assisted living"* in institutional settings [8]. However, it should be noted that without public support, caring for a relative or friend can result in:


*Furthermore*, lack of support can also have a negative impact on the relationship between care giver and recipient. Also, it can potentially lead to (a) mental and other health problems, (b) the social isolation of both parties, and (or) (c) elder maltreatment. Although most public funding of long-term care is still provided through institutions, in some countries in the European Union region, long-term care provided at home is seen as a preferred and cost-effective alternative to care provided in a nursing home or other facility. In these countries, it has become an important component of publicly funded services [8].

### **8.4 Geriatric and gerontological capacity building among the health and social care workforce**

Gerontological capacity building among the health and social care providers is key in ensuring HA for all. In this context, it is pertinent to note that significant progress in geriatric education has been made in many countries over the years. Geriatrics, today, has become a full-fledged recognized specialty in medical schools: at both undergraduate and postgraduate teaching levels, including as a part of continuous training of health care staff at medical institutions in various parts of the world. However, the progress made in this direction has been uneven. But the growing number of very old population in some nations and regimes has made it urgent to further strengthen national and sub-national capacity for training in geriatrics and gerontology. It has also become necessary to promote a stronger profile for geriatric training, including cross-specialty training. What is more alarming is that the greatest challenges are still gaps in the geriatric knowledge of general practitioners and other health care practitioners, *on the one hand*, and insufficient specialist training and a shortage of specialists in geriatrics itself, *on the other* [8].

#### **9. COVID-19 response to ensure healthy lives and promote well-being for all at all ages**

As outlined in previous sections by the author, ensuring healthy lives and promoting well-being at all ages is essential to SD. There are, therefore, several challenges associated with health that need to be addressed, especially in view of aging population. In addition to this, the globe is confronted with another health crisis: COVID-19. This pandemic is (a) spreading human suffering, (b) destabilizing the global economy, and (c) upending the lives of countless number of people around the globe. It is important to note that before the pandemic (COVID-19) emerged, notable progress was made in improving the health conditions of millions of people. However, the current health emergency poses added global risk. It has shown the critical need for health preparedness at all levels, and in all countries [13].

In addition to the initiatives undertaken by the United Nations Development Programme (UNDP), the WHO has been leading the global effort to tackle COVID-19 crisis, in the form of coordinating global efforts. In terms of COVID-19 response, the WHO (in collaboration with its collaborating partners) has come out with the *"Strategic Preparedness and Response Plan"* (SPRP). The SPRP envisages the public health measures that countries need to respond to COVID-19 health crisis. Again, the Strategy (the SPRP) provides guidelines for the public health response to COVID-19 (at national and sub-national levels). Also, it (SPRP) highlights the coordinated support that is required from the international community to meet the challenge of COVID-19 [13].

The COVID-19 Solidarity Response Fund has been institutionalized. The Fund supports work of the WHO work in order to: (a) track and understand the spread of the virus, (b) ensure patients get the care they need, (c) ensure frontline health workers get essential supplies and information, and (d) accelerate research and development of a vaccine and treatments for all who need them.

Notably, the WHO, together with partners, also provides guidance and advice for elderly people to look after their mental health during the COVID-19 pandemic. Aged people (including older adults) are at increased risk of being infected with the COVID-19 [13].

#### **10. Summing up**

The discussion presented above highlights need for ensuring HA in line with SDGs. Several deliberations have taken place at national and international platforms on this subject area. Also, the conceptual framework of Decade of Healthy Aging (2021–2030) has come into existence. All these developments have resulted in desired commitments and strategies, including plan of action: both at policy (macro) and ground (micro) levels. However, there many crucial gaps in

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

*'knowledge'* and *'capacity'*. This fact emphasizes need for "capacity-building" in areas where programme implementers have (a) either *'failed'*, and/or (b) *"achieved little success"*. Several initiatives are underway throughout the world for *'bridging'* and '*narrowing'* the gap. In this very context, the author of this work specifically points out that several of the initiatives DO NOT have in-built scientific mechanism to measure or evaluate the outcomes in exact terms. For instance, one can come across instances wherein an organization has: the objective of reaching out to 100 college student population with messages on *"what society at large should do to care for those older people living in isolation"*. The author states that:


In view of very specific statements made above by the author, there is need to propose "time-bound" Programme of action (PoA) in the area of HA. Such PoAs should necessarily envisage following two key aspects: (a) availability of resources, including resource support from collaborating agencies (working at local, national, international, and inter-governmental levels); and (b) locally prevailing socioeconomic and demographic profile.

In order to ensure that above outlined aspects form the integral part of the initiatives aimed at ensuring HA for all, the author suggests, in this paper, that those responsible for implementation at the actual ground/community levels programmes propose "time-bound projects" (TBPs). Such TBPs, in the context of mega cities (which are demographically characterized with, among other factors, huge population base), should envisage two significant considerations: (a) *resource support that will be actually available at the time of programme implementation*, and (b) *likely hindrances that may come up*. In the absence of ascertaining answer to these questions on needed resource support and likely obstacles, initiatives aimed at HA for all may not yield desired outcomes [14].

Author of this paper has outlined above concrete actions that are required if the Decade [UN Decade of Healthy Aging (2021-2030)] is to be a success (in terms of HA for all). However, the priority areas should be left open to series of dialogs and consultations among: (a) expert, and (b) stakeholders [15]. *Most importantly*, (a) POAs needs to commence immediately, and (b) actual project implementation is possible ONLY through collaboration with many key partners. The author outlines that: Policy coherence and equitable impact will only be achieved if there is coordination and integration between the stakeholders and actions. Actual implementation of the POAs require resourcing (that may sound like: *"investments"*).

At this juncture, it is important to outline that the emergence of UN Decade of Healthy Aging (2021–2030) is a significant development. This initiative (2021– 2030), sought to be undertaken, in global collaboration, is aligned with the last ten years of the SDGs that brings together all partners (including governments, civil society, international agencies, etc.) to improve the lives of older people, their

families, and the communities they live in. Health for all is need of the hour, as populations around the world are aging at a faster pace (than in the past). This demographic transition will have an impact on almost all aspects of society in relation to aging process [16]. To sum up, there is need for life-course approach to aging. This calls for protecting and promoting the rights of older adults in the implementation of the 2030 Agenda [17].

The author briefly presents here the strengths and limitations of this study. In terms of strengths, this paper has extensively researched into strategic interventions that need to be taken by the providers of health care, policy makers and other stakeholders involved in order to ensure HA all, in the context of SDGs that are set to be met by the year 2030. Most importantly, this research work has also looked into selected relevant initiatives that have been undertaken, at both macro and micro levels, in various countries. The initiatives have been quoted in support of each strategic intervention that the author has suggested in this work (in view of general and specific objectives). Based on findings and data analysis, significant lessons have been leant (that are briefly outlined above). With regards to limitations, the author has outlined very few and selected actual initiatives undertaken in various parts of the globe in support of each suggested strategic intervention. Many more projects on HA for all have been implemented, over the years, by developmental agencies (including national governments, and inter-governmental agencies), across the regions of the globe. However, the author could not incorporate all of them, mainly because of space limitation that was suggested. Selection of initiatives that form part of this study (chapter) was made by the author, using research wisdom, including envisaging consultations with demographers in the network of the author. However, this does not, in any way, undermine the significance of this research work. Quoted initiatives are ample demonstration of need for interventions needed in the area of HA for all, including for meeting SDGs in timely manner.

None of us should forget that investments in a future that enables people to live longer and healthier lives are key. Also, it is significant for policy makers to ensure that they have the opportunity to contribute to the society, so that THEY ARE NOT BE LEFT BEHIND). These two aspects are key to creating societies that respect elderly population [18].

### **Acknowledgements**

The author gratefully acknowledges the support of his wife, Anjila Santosh Mishra, in authoring this research paper. Although she does not possess required subject knowledge & expertise, she has life experiences (which is outcome of nonformal learning). I say that she provided cherished comments on my work on commitments for SDGs & HA for all, & that her contributions are treasured.

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