“I want to live in a city where there is no ageism”
What is an age-friendly city? The WHO has done ample research on this topic, published a guide and started a global network. At the top of the list, says Alana Officer from the WHO's Department of Ageing and Life Course, should be one action: abolishing ageism.
The global guide to age-friendly cities focuses on eight areas: outdoor spaces and buildings; transportation; housing; social participation; respect and social inclusion; civic participation and employment; communication and information; community support and health services. Do different countries have different priorities?
One of the interesting things about the work on age-friendly cities is that despite the diverse contexts, those eight areas really seem to be priorities globally. The only issue that we have found is under emphasised is the need for cities and communities to meet the basic needs of older adults – for financial security, safety etc. The focus of the programmes in different cities may vary. For example in the city of Kolkata in India where there is great income disparity, the main focus is on health, whereas in Oslo for example the focus is on new forms of housing for older adults and innovation in care provision.
Do women and men have different expectations or needs with regard to age-friendly cities? Some of the programmes have “men sheds” …
Yes, the men sheds are a great initiative in Australia, Ireland and other countries. They create an environment where men can come together and learn about issues related to getting older, about nutrition or physical activity, and where there are also other activities, such as woodwork. We did some more specific research in Africa and found that the impacts of older age can be different for men and women.
The 2015 World Report on Ageing and Health states that “although it is often assumed that increasing longevity is being accompanied by an extended period of good health, there is little evidence to suggest that older people today are experiencing better health than their parents did at the same age”. So 70 isn't the new 60 after all?
Interestingly, there is a perception that people now are living longer and staying healthier. The World Report on Ageing and Health looked at the US and Europe predominantly, where we have longitudinal data. In fact, older people today are not necessarily healthier than their parents and grandparents. What the study looked at was whether people were able to function in daily life. Of course there is great diversity, with people from high socio-economic groups having a reasonable income and being generally much healthier. Those in low socio-economic situations are often those with higher rates of disability and less resources to be able to address those needs.
The WHO Guide to Age-friendly Cities
In 2007, the WHO published a global guide to age-friendly cities, the purpose of which it is to engage cities to become more age-friendly so as to tap the potential that older people represent for humanity. It describes the converging trends of rapid growth of the population over 60 years of age and of urbanization, outlines the challenge facing cities, and summarizes the research process that led to identifying the core features of an age-friendly city.
Should cities focus more on health-related topics?
Health is absolutely fundamental to the experience of older age. If we can enhance health across the life course and into older age, the possibilities for older adults are limitless. Another point is ageism, the negative perceptions we have around older adults: that they're a burden, take more than their fair share, and are using up all our resources. Most of these negative attitudes are misconceptions and not substantiated by evidence. If you look at UK research, you can see that older adults in fact make enormous contributions to society, and when you weigh up the costs in health and long-term care with the contributions in terms of purchasing power, taxation and other direct financial contributions like volunteering, they contribute more than they cost.
If ageism is present in the society, it's also an obstacle for age-friendly cities.
Absolutely, combatting ageism needs to really be a precondition to any work on ageing. The WHO is developing a global campaign to combat ageism. Besides sexism and racism, ageism is a very large form of discrimination.
Many of the actions that cities take to be more age-friendly are also positive for people with a disability or for pregnant women or families with young children. It seems that the age-friendly approach is good for people of all ages.
The age-friendly approach really spans all ages. Obviously ramps, accessible low buses, adequate seating in buses and public transport and friendly public servants managing housing and transportation are good for everybody.
In which city would you like to grow old?
Most of the cities have some great aspects to offer. I think there is scope for improvement in all of the cities and communities in our network. But that's the purpose of the network: it's a long journey to become more age-friendly. So I haven't found the city where I would like to grow old in yet – where would you like to grow old?
You've got me there! Maybe in Zurich, but I don't know if I can afford it.
Yes, this is in fact a big issue. We know that women continue to live longer than men, and as a result are more likely to live alone. Coming generations of women will probably spend more time throughout their lives caring, be it for children or parents, and they'll tend to be poorer. Cities, communities and states need to address this issue. That means encouraging people, especially women, to save more when they're younger, but also taking care of older impoverished people. And of course providing appropriate healthcare services. Older people shouldn't be treated as a bucket of diseases, nor should their diseases be treated differently.
Maybe I'd like to grow old in a city without ageism …
Yes, that's what I'd like too! Ageism is an issue we all need to tackle. It really limits the way we think. The challenge with ageism is the negative attitudes around older adults that we're exposed to when we're young. Having been exposed to them all our lives, by the time we're older we believe them ourselves. We say, I'm not going to do that because I'm old. In a substantial US study we've seen that people with a negative attitude towards ageing live on average seven-and-a-half years less than those with a positive attitude. If we could just eliminate ageism, people would also think differently about healthcare services. There wouldn't just be a focus on cost containment, but on how to invest in maintaining a healthy population. It would change how we think about employment, how we invest in our infrastructure. I would definitely want to live in a city that isn't ageist. But I don’t think it exists yet.
Interview: Ruth Hafen / Pictures: WHO
The WHO Global Network of Age-friendly Cities and Communities
The WHO Global Network of Age-friendly Cities and Communities was established in 2010 to connect cities, communities and organisations worldwide with the common vision of making their community a great place to grow old in. As a response to global population ageing, it focuses on action at the local level that fosters the full participation of older people in community life and promotes healthy and active ageing. The network provides a global platform for information exchange, mutual learning and support. However, membership is not an accreditation for age-friendliness. The network currently includes 302 cities and communities in 33 countries, covering around 120 million people worldwide.
Alana Officer is Senior Health Adviser at the World Health Organization’s Department of Ageing and Life Course. Her academic background spans podiatric medicine, applied science (exercise and sports science) and public health. Prior to joining WHO in July 2006, Alana held a number of clinical, technical and managerial positions working on health, disability, rehabilitation and development in West and Central Africa, Europe, South Asia, the Middle East and the Western Pacific. From 2007 to 2014, Alana was the Coordinator for the Disability and Rehabilitation Team. She joined the Department of Ageing and Life course in July 2014 to lead the development of the World Report on Ageing and Health, which was published in October 2015. She currently overseas WHO's work on age-friendly environments including the Global Network on Age-friendly Cities and Communities as well as the Global Campaign to Combat Ageism.