WHO’s perspective on healthy and
active ageing
Christian Schweizer, Manfred Huber
WHO Regional Office for Europe, Copenhagen
The world ages at different speeds: old-age
 dependency ratios, 1995-2045




Source: Scherbov et al.

                           Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                             London, 15 March 2012
Demystifying the myths of ageing: a prime
goal of our work
 • “Older persons are at
   the recipient end of
   society; they
   increasingly need to be
   cared for”
 • “Burden on public
   budgets” will become
   the main issue
 • Developed countries will
   face the biggest
   challenges
                              Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                London, 15 March 2012
Healthy and active ageing in Europe:
Four strategic areas for action




                          Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                            London, 15 March 2012
Strategic area 1: Healthy ageing over the life
course




                           Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                             London, 15 March 2012
What is active ageing?
• “Active ageing is the process
  of optimizing opportunities for
  health, participation and
  security in order to enhance
  quality of life as people age.”
• Postponement of retirement
  and an ageing workforce
  globally, only part of the story
• “Healthy ageing” and “active
  ageing” reinforce each other


                                     Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                       London, 15 March 2012
Active & healthy ageing: where are the
limits?



                      Fauja Singh, oldest
                      Person ever to run
                         a marathon,
                     Toronto, 16 Oct 2011
                          aged 100




                          Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                            London, 15 March 2012
Human rights, gender, and health
inequalities among older persons
• Human rights concerns, poverty
  of older persons, discrimination
  in quality and access to
  services
• Men and women age differently
• Inequalities in health
  accumulate over the life-course
• An example: elder
  maltreatment often a neglected
  issue
                                     Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                       London, 15 March 2012
Strategic Area 2: Supportive environments
• WHO supports the fast
  growing networks of age-
  friendly initiatives at
  community level
• “Age-friendly cities” illustrate
  that “Health in all Policies” is
  key to healthy ageing at
  community level
• WHO tools and initiatives
  stand ready to support EU
  initiatives on healthy ageing

                                     Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                       London, 15 March 2012
Strategic Area 3: Health systems fit for
ageing populations
• Wider health system & coordination
  between health and social services (most
  diverse pillar of modern welfare systems)
• Issues of adequate workforce and quality
  of care
• Multiple barriers to access and gaps in
  services
• Public support to informal care
• Adapt palliative care to needs
• The role of technology



                                              Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                                London, 15 March 2012
Strategic Area 4: Address gaps in evidence
and research
• Important gaps in the evidence for
  policy about trends in population health
  of ageing societies
• International comparisons of health and
  social services for older persons
• WHO has a role as clearing house on
  evidence for policy in this area (transfer
  of knowledge)
• European Advisory Committee on
  Health Research to play a stronger role
  in the future



                                               Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                                 London, 15 March 2012
Population is ageing... Does this mean there is an
 increased need for institutional care?
           Age-standardised rates of institutionalisation (65+ living in institutions)




Source: Facts & Figures on Healthy Ageing and LTC (forthcoming); Rodrigues & Schmidt (2011).

                                                                           Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                                                             London, 15 March 2012
The importance of physical activity for people
                in later life
Physical inactivity is a leading risk factor for health in
 Europe, associated to nearly 1 million deaths/year

                                                                        Disability adjusted life years lost due to risk
                                                                        factors in EURO, 2004




   Source: Global Health Risks.. Geneva, World Health Organization, 2009
   (http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.html/).


                                                                                  Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                                                                    London, 15 March 2012
Health effects of physical activity in adults
    Life expectancy                                               Coronary heart disease
    Cardiorespiratory fitness                                     High blood pressure
    Muscular fitness                                              Stroke
    Healthy body weight                                           Diabetes type II
    Healthy body composition                                      Metabolic syndrome
    Bone health                                                   Colon cancer
    Sleep quality                                                 Breast cancer
    Health-related quality of life                                Depression
                                                                                          Strong evidence
  Additionally in older adults:                                                           Medium evidence


  Functional health / independence                   Risk of falls
  Cognitive functions      Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines
                                          Advisory Committee Report, 2008. Washington, DC: U.S. Department of
                                          Health         and           Human           Services,        2008.


                                                                 Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                                                   London, 15 March 2012
Quantification of effects of physical
inactivity
• 21–25% of breast and colon
                                                   Magnitude of benefits from reaching
  cancer burden                                    minimum recommendations for physical
• 27% of diabetes burden                           activity. Risk reductions:
• 30% of ischaemic heart disease                   •   20-30% for CHD and CVD morbidity and mortality
  burden
                                                   •   Cancer risks:
                                                        – 30% for colon cancer
                                                        – 20% - 40% for breast cancer
                                                        – 20% for lung cancer
                                                        – 30% for endometrial cancer
                                                        – 20% for ovarian cancer
Physical Activity Guidelines Advisory Committee.   •   30% for developing functional limitations
Physical Activity Guidelines Advisory Committee
Report, 2008. Washington, DC: U.S. Department of   •   30% for premature all-cause mortality
Health     and     Human      Services,   2008.



                                                                   Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                                                     London, 15 March 2012
Focus: regular walking saves lives




                                     Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                       London, 15 March 2012

     Source: Hamer and Chida, 2008
Inactivity status in the European Region
•   WHO estimates that in adults :
     – 63% are not reaching the minimum
       recommended level of physical activity
     – 20% of those are rated as “inactive”
     – 38% are sufficiently/highly active


•   Citizens of Mediterranean and central
    European countries tend to exercise
    less


•   In England only 17% of men and 13%          Global Health Risk Report, World Health Organization, 2009

    of women aged 65-74 are physically          Eurobarometer 72.3. Special Eurobarometer 334: Sport and PA
                                                National Centre for Social Research et al (2004) Health Survey for
    active.                                     England 2003



                                                 Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                                           London, 15 March 2012
WHO Global Recommendations on
  Physical Activity for Health
How much physical activity do we need?
WHO Global Recommendations
•   Main aim: providing
    guidance on dose response
    relation between frequency,
    duration, type and total
    amount of PA needed for
    prevention of NCD’s
•   Three age-groups; 5-17
    year olds; 18-64; and 65+
•   Main target audience;
    national and local policy
    makers



                                  Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                    London, 15 March 2012
Global Recommendations
  Intensity of activity                           Domains of activity

                                        recreation             and sports
moderate

                                                         transportation

                           How often?
vigorous                   How long?                              household
                          How much in
                             total?                             work/school
   Type of activity




Aerobic               Strength             Balance                         Flexibility

                                             Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                               London, 15 March 2012
Adults aged 18-64
• At least 150 minutes of Moderate
  intensity PA spread throughout the
  week
  OR
  at least 75 minutes of Vigorous PA
  spread throughout the week
  OR
  an equivalent combination of those
  two
• Bouts of at least 10 minutes.


                                       Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                         London, 15 March 2012
Older adults – >64 years old
• Same recommendations as for adults


Specific recommendations:
• perform PA to enhance balance and
  prevent falls on 3 or more days/ week.
• Muscle-strengthening activities on 2 or
  more days a week.
• be as physically active as their
  abilities and conditions allow.


                                     Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                       London, 15 March 2012
Main points to keep in mind
• The more physical activity, the less disease
• Some physical activity is better than none
• Minimum recommendation of 150 minutes
  (or 5x30) per week of at least moderate
  intensity
• All bouts of physical activity of at least about
  10 minutes duration count
• More physical activity is good for health,
  most of all in inacitve and low-active
  individuals




                                             Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                               London, 15 March 2012
Conclusions and outlook
Strategy and Action Plan on healthy aging
2012-16
Priority interventions:
• Falls prevention
• Environments & social activities for physical
  activity
• Vaccination of older persons and of care staff
• A basic support package for home care
• Improved training of staff in geriatrics and
  gerontology
                              Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                London, 15 March 2012
Strategy and Action Plan on healthy aging
2012-16
Supportive interventions:
• Prevention of social isolation and social
  exclusion
• Quality of care strategies for older people
• Prevention of elder maltreatment




                              Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                London, 15 March 2012
Lets keep the momentum:
2012 , the year of “Ageing & Health”
• World Health Day 2012 on
  Ageing and Health: 7 April
• EU Year of active and healthy
  ageing and intergenerational
  solidarity
• WHO “Strategy and Action Plan
  on Healthy Ageing in Europe”
• 10th Anniversary of Madrid
  International Plan of Action on
  Ageing

                                    Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                      London, 15 March 2012
Denmark: City of all Generations

                                                    • Competition for most attractive
                                                      city for all generations to live in
                                                    • Award ($$$) by the Danish
                                                      Ministry of Social Affairs and
                                                      Integration to further develop
                                                      local projects
                                                    • Focus on how the built
                                                      environment can promote active
Danish Ministry of Social Affairs and Integration     living
                                                                     Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                                                                       London, 15 March 2012
Good health adds life to years
     ‫الصحة الجيدة تضيف حيا ة ً إلى السنين‬
                健康有益长寿
     Une bonne santé pour mieux vieillir
Хорошее здоровье прибавляет жизни к годам
    La buena salud añade vida a los años
    Gesundheit erfüllt die Jahre mit Leben

             For more information:
            www.euro.who.int/ageing



                            Fit as a fiddle - A Lasting Legacy for Healthy Ageing
                                                              London, 15 March 2012

Christian Schweizer presentation for Age UK

  • 1.
    WHO’s perspective onhealthy and active ageing Christian Schweizer, Manfred Huber WHO Regional Office for Europe, Copenhagen
  • 2.
    The world agesat different speeds: old-age dependency ratios, 1995-2045 Source: Scherbov et al. Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 3.
    Demystifying the mythsof ageing: a prime goal of our work • “Older persons are at the recipient end of society; they increasingly need to be cared for” • “Burden on public budgets” will become the main issue • Developed countries will face the biggest challenges Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 4.
    Healthy and activeageing in Europe: Four strategic areas for action Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 5.
    Strategic area 1:Healthy ageing over the life course Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 6.
    What is activeageing? • “Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.” • Postponement of retirement and an ageing workforce globally, only part of the story • “Healthy ageing” and “active ageing” reinforce each other Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 7.
    Active & healthyageing: where are the limits? Fauja Singh, oldest Person ever to run a marathon, Toronto, 16 Oct 2011 aged 100 Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 8.
    Human rights, gender,and health inequalities among older persons • Human rights concerns, poverty of older persons, discrimination in quality and access to services • Men and women age differently • Inequalities in health accumulate over the life-course • An example: elder maltreatment often a neglected issue Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 9.
    Strategic Area 2:Supportive environments • WHO supports the fast growing networks of age- friendly initiatives at community level • “Age-friendly cities” illustrate that “Health in all Policies” is key to healthy ageing at community level • WHO tools and initiatives stand ready to support EU initiatives on healthy ageing Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 10.
    Strategic Area 3:Health systems fit for ageing populations • Wider health system & coordination between health and social services (most diverse pillar of modern welfare systems) • Issues of adequate workforce and quality of care • Multiple barriers to access and gaps in services • Public support to informal care • Adapt palliative care to needs • The role of technology Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 11.
    Strategic Area 4:Address gaps in evidence and research • Important gaps in the evidence for policy about trends in population health of ageing societies • International comparisons of health and social services for older persons • WHO has a role as clearing house on evidence for policy in this area (transfer of knowledge) • European Advisory Committee on Health Research to play a stronger role in the future Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 12.
    Population is ageing...Does this mean there is an increased need for institutional care? Age-standardised rates of institutionalisation (65+ living in institutions) Source: Facts & Figures on Healthy Ageing and LTC (forthcoming); Rodrigues & Schmidt (2011). Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 13.
    The importance ofphysical activity for people in later life
  • 14.
    Physical inactivity isa leading risk factor for health in Europe, associated to nearly 1 million deaths/year Disability adjusted life years lost due to risk factors in EURO, 2004 Source: Global Health Risks.. Geneva, World Health Organization, 2009 (http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.html/). Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 15.
    Health effects ofphysical activity in adults  Life expectancy  Coronary heart disease  Cardiorespiratory fitness  High blood pressure  Muscular fitness  Stroke  Healthy body weight  Diabetes type II  Healthy body composition  Metabolic syndrome  Bone health  Colon cancer  Sleep quality  Breast cancer  Health-related quality of life  Depression  Strong evidence Additionally in older adults:  Medium evidence  Functional health / independence  Risk of falls  Cognitive functions Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services, 2008. Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 16.
    Quantification of effectsof physical inactivity • 21–25% of breast and colon Magnitude of benefits from reaching cancer burden minimum recommendations for physical • 27% of diabetes burden activity. Risk reductions: • 30% of ischaemic heart disease • 20-30% for CHD and CVD morbidity and mortality burden • Cancer risks: – 30% for colon cancer – 20% - 40% for breast cancer – 20% for lung cancer – 30% for endometrial cancer – 20% for ovarian cancer Physical Activity Guidelines Advisory Committee. • 30% for developing functional limitations Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of • 30% for premature all-cause mortality Health and Human Services, 2008. Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 17.
    Focus: regular walkingsaves lives Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012 Source: Hamer and Chida, 2008
  • 18.
    Inactivity status inthe European Region • WHO estimates that in adults : – 63% are not reaching the minimum recommended level of physical activity – 20% of those are rated as “inactive” – 38% are sufficiently/highly active • Citizens of Mediterranean and central European countries tend to exercise less • In England only 17% of men and 13% Global Health Risk Report, World Health Organization, 2009 of women aged 65-74 are physically Eurobarometer 72.3. Special Eurobarometer 334: Sport and PA National Centre for Social Research et al (2004) Health Survey for active. England 2003 Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 19.
    WHO Global Recommendationson Physical Activity for Health
  • 20.
    How much physicalactivity do we need? WHO Global Recommendations • Main aim: providing guidance on dose response relation between frequency, duration, type and total amount of PA needed for prevention of NCD’s • Three age-groups; 5-17 year olds; 18-64; and 65+ • Main target audience; national and local policy makers Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 21.
    Global Recommendations Intensity of activity Domains of activity recreation and sports moderate transportation How often? vigorous How long? household How much in total? work/school Type of activity Aerobic Strength Balance Flexibility Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 22.
    Adults aged 18-64 •At least 150 minutes of Moderate intensity PA spread throughout the week OR at least 75 minutes of Vigorous PA spread throughout the week OR an equivalent combination of those two • Bouts of at least 10 minutes. Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 23.
    Older adults –>64 years old • Same recommendations as for adults Specific recommendations: • perform PA to enhance balance and prevent falls on 3 or more days/ week. • Muscle-strengthening activities on 2 or more days a week. • be as physically active as their abilities and conditions allow. Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 24.
    Main points tokeep in mind • The more physical activity, the less disease • Some physical activity is better than none • Minimum recommendation of 150 minutes (or 5x30) per week of at least moderate intensity • All bouts of physical activity of at least about 10 minutes duration count • More physical activity is good for health, most of all in inacitve and low-active individuals Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 25.
  • 26.
    Strategy and ActionPlan on healthy aging 2012-16 Priority interventions: • Falls prevention • Environments & social activities for physical activity • Vaccination of older persons and of care staff • A basic support package for home care • Improved training of staff in geriatrics and gerontology Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 27.
    Strategy and ActionPlan on healthy aging 2012-16 Supportive interventions: • Prevention of social isolation and social exclusion • Quality of care strategies for older people • Prevention of elder maltreatment Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 28.
    Lets keep themomentum: 2012 , the year of “Ageing & Health” • World Health Day 2012 on Ageing and Health: 7 April • EU Year of active and healthy ageing and intergenerational solidarity • WHO “Strategy and Action Plan on Healthy Ageing in Europe” • 10th Anniversary of Madrid International Plan of Action on Ageing Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 29.
    Denmark: City ofall Generations • Competition for most attractive city for all generations to live in • Award ($$$) by the Danish Ministry of Social Affairs and Integration to further develop local projects • Focus on how the built environment can promote active Danish Ministry of Social Affairs and Integration living Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012
  • 30.
    Good health addslife to years ‫الصحة الجيدة تضيف حيا ة ً إلى السنين‬ 健康有益长寿 Une bonne santé pour mieux vieillir Хорошее здоровье прибавляет жизни к годам La buena salud añade vida a los años Gesundheit erfüllt die Jahre mit Leben For more information: www.euro.who.int/ageing Fit as a fiddle - A Lasting Legacy for Healthy Ageing London, 15 March 2012