LeadingAge Magazine · July-August 2019 • Volume 09 • Number 04

An Age-Friendly World

July 14, 2019 | by David Tobenkin

The Age-Friendly Cities movement embraces approaches that are as varied as the nations and cultures that commit to doing more to respect and include older adults in the life of their communities.

The Age-Friendly Cities movement, encouraging cities and communities to enable people to actively participate in community activities and to treat everyone with respect, regardless of age, has generated a wide range of efforts to realize age-friendliness.

The World Health Organization (WHO)-led global effort offers a general framework, but not surprisingly, different communities are taking different approaches, reflecting cultural differences, different challenges, and different absolute and dedicated resources.

An Ambitious Agenda

The mission of the WHO Global Network for Age-friendly Cities and Communities is to stimulate and enable cities, communities, and other sub-national levels of government around the world to become increasingly age-friendly. There are 8 structural domain components of the WHO effort:

  • Transportation
  • Housing
  • Social participation
  • Respect and social inclusion
  • Civic participation and employment
  • Communication and information
  • Community and health services
  • Outdoor spaces and buildings

It is also structured around 5 key functional abilities essential for older people, including the ability to:

  • Meet their basic needs.
  • Learn, grow, and make decisions.
  • Be mobile.
  • Build and maintain relationships.
  • Contribute.

Members commit to a continuous process of age-friendliness improvement and active participation in the Global Network. Since pilots in 2007 and a formal launch in 2010, the movement has grown to 914 cities and communities in 41 countries covering 230 million people, says Alana Margaret Officer, a WHO senior health advisor responsible for managing the Global Network.

“Membership in the WHO Global Network has increased 4-fold in the last [2.5] years, and more affiliate organizations are supporting the Network in its mission than ever before,” notes a 2018 WHO report that Officer co-authored, The Global Network for Age-friendly Cities and Communities: Looking back over the last decade, looking forward to the next. “These outcomes highlight the recognition around the world of the importance of WHO’s systematic and inclusive approach to becoming more age-friendly, through political commitment, planning, action, and evaluation.”

“Being ‘age-friendly’ touches and positively impacts the lives of people of all ages and across all generations,” says Jane Barratt, secretary general of the International Federation of Ageing, headquartered in Toronto, Canada. “Age-friendliness is transformative—locally to globally—while also impacting the market economy in response to the demographic shift that is happening in most countries of the world. However, age-friendliness is also unique to location, with friendliness in a Mumbai [India] slum looking and feeling different than in New York City. Still, the outcome we are trying to create should be common, even though the environment may be unique.”

Since pilots in 2007 and a formal launch in 2010, the movement has grown to 914 cities and communities in 41 countries covering 230 million people.

In some regions, there is still a stronger focus on meeting basic needs, such as housing and social security and addressing vastly different issues facing men and women, Barratt says.

“The age-friendly program assesses the barriers and opportunities for older people to optimize their health and well-being, whether it is in an African town where income security is critical, or the main transportation is a bicycle,” Barratt says.

What are the current Global Network priorities? A major new initiative launched in 2016 seeks to do more to combat ageism.

“We see in cities and communities existing programs to tackle ageism but not necessarily in any systemic way,” Officer says. “We are trying to address that both at the national level and locally. Ageism is a global problem, though the lack of respect is higher in lower- and middle-income countries, and they often have poorer levels of health, increased dependency, and less support. That affects how older persons are perceived. This often is pronounced in cultures where elders were traditionally venerated but now there are [fewer] children supporting elders due to displacement.”

“We are also trying to address autonomy, but defining this as enabling people to do whatever they value,” Officer adds. “Someone who cannot feed themselves but who can direct others to help them might be categorized as autonomous. There are many supports that can be put in place to increase autonomy.”

Next year, WHO will also launch “A Decade of Action on Healthy Ageing.”

To a great extent, the Global Network has so far been a city-oriented effort, says Gregor Rae, founder of ActiveAge, based in Aberdeen, Scotland, and a consultant to government and corporations with a close interest in the aging demographic.

“More people worldwide are living in cities than outside them for the first time in history,” says Rae. “Cities are where the age-friendly battle is being fought, and many city authorities have focused on the low-hanging fruit, such as allowing longer times for pedestrians to cross intersections, buses that kneel, using bigger street signage—all things that a local city or authority can control. Far fewer are looking at the wider economic, social and business issues, which are more complex and challenging. Yet this ‘longevity economy’ is where the real opportunities lie.”

A common refrain in many locales is the limited and insufficient institutional and corporate engagement in the age-friendly movement, Rae says: “If more is not done, if aging is not woven more deeply into the fabric of the city—in terms of comprehensive and strategic planning—and if it is not more embedded in business, the age-friendly movement could wither on the vine. Yet there are positive signs in some locations, such as the U.K., where The Ageing Society has been positioned as one of 4 Grand Challenges within the U.K. Industrial Strategy. The government’s £350 million commitment [$435 million] to a more strategic and innovative approach to aging is a powerful signal to the rest of the country that aging is a market.”

“More people worldwide are living in cities than outside them for the first time in history. Cities are where the age-friendly battle is being fought, and many city authorities have focused on the low-hanging fruit, such as allowing longer times for pedestrians to cross intersections, buses that kneel, using bigger street signage—all things that a local city or authority can control.”

Below is a look at how age-friendliness is playing out in some of the more dynamic members of the Global Network.

Kanagawa, Japan

The prefecture of Kanagawa, Japan, has featured an age-friendly approach that relies heavily on technology, and has a governor, Yuji Kuroiwa, who has vowed to create “a 100-Year Life Community full of laughter—more literally, a society full of laughing and happy 100-year-olds,” notes Hiroyuki Matsumoto, a group leader in the Policy Bureau of the Kanagawa Prefectural Government.

Kanagawa, an affiliate of the Global Network with 22 prefecture cities that are members, has taken 2 approaches to address its super-aged society: pursuing advanced medical technologies and managing “ME-BYO.”

"ME-BYO originally means pre-disease in Chinese medicine,” says Junko Kodama of the Global Strategy Group. “Kanagawa has given a new meaning and re-defined it as follows: Instead of clearly defining our physical and mental condition as being either healthy or sick, the mental and physical conditions evolve continuously between healthy and sick states, and ME-BYO applies to all conditions between healthy and sick.”

Matsumoto says that Kanagawa is encouraging people to change their behavior so that they can manage their ME-BYO status and become healthier.

Kanagawa is also encouraging the deployment of advanced medical technology within the area. “We are promoting cutting-edge […] technologies that can help older adults to maintain healthy lifestyles and prevent them from becoming sicker,” Matsumoto says. “For example, the use of robots can help [older] people maintain cognitive capacity by giving them someone to talk to, which is important given a shrinking base of caregivers, given the general aging of the population.”

The technology strategy aims to attract more companies to come to Kanagawa for innovation opportunities, make new medical and longevity technologies more accessible to the aged, and enrich the region, enabling more taxes to be raised to support Kanagawa services, says Kodama.

Independent of the age-friendly movement, Japan has long had governmental rules that impose age-friendly principles upon cities and communities, with all municipalities and prefectures in Japan required to establish an older adult health welfare plan every 3 years by national law, Kodama says.

Ireland

Ireland features an age-friendly approach that is among the most robust and systematic of any country. After a 10-year journey of policy refinement, it is the first country to achieve full membership of all participating counties and cities to the WHO Global Network, says Catherine McGuigan, chief officer of Age-Friendly Ireland.

Since 2018, the Age-Friendly Ireland program has migrated into an embedded function of local government as a shared service, hosted by lead local authority Meath County Council on behalf of the sector. Governance at the local level is anchored in strategic alliances chaired (in the main) by the chief executives of the local authorities, underpinned by an older peoples’ council representing older people across each city or county program.

A national advisory board comprises senior officials across 4 government departments, local government, the National Health Service, the National Police Force, and others.

A critical success factor has been the creation of a national network of 31 local Age-Friendly program managers within each local authority, as well as participation and leadership of the local authorities’ chief executives, a powerful position in local government, McGuigan says.

“We think that this is a replicable model and one that we were able to fast-track using a municipally led, existing governance structure,” McGuigan says. “We believe what we have done and built has been the best way—it could not have worked better. It has proven to be a more sustainable model to use the existing local government structure than to create a separate structure.”

McGuigan says Age-Friendly Ireland has carried out more than 8,000 age-friendly initiatives, many of which are being scaled up and replicated across the country, including:

  • The Age-Friendly Town program that enables older people to do walkability audits and influence the installation of age-friendly seating, lighting, pedestrian crossings, community gardens, parking, and signage.
  • Adoption of an Age-Friendly Business Recognition program.
  • Implementation of an intergenerational program across health, social care, and other areas that stretch across the 8 domains of the WHO Global Framework.

“We think that this is a replicable model and one that we were able to fast-track using a municipally led, existing governance structure. […] It has proven to be a more sustainable model to use the existing local government structure than to create a separate structure.”

Melville, Australia

The age-friendly approach of the City of Melville, Australia, a suburb of Perth, has particularly emphasized the importance of retail locations as a hub for potential age-friendly initiatives. In the city (one of the WHO age-friendly pilot cities of 2007), the AMP Garden City shopping mall is a linchpin for community social interaction. The shopping center features age-friendly events, such as weekly mall walks, among seniors to provide social interaction and exercise in a safe environment.

In addition, a monthly “Memory Café” is a gathering in a coffee shop at the Garden City Shopping Centre, where those with dementia are invited to participate in an environment in which their cognitive condition-related challenges are not stigmatized, says Christine Young, Melville’s director of community development. This was the first of its type in Western Australia, has been operating now for 2 years, and has supported more than 1,000 people in that time, Young says.

Involving business in age-friendly efforts has been a part of the city’s success, Young says.

“Local businesses who provide services and products to older people are an important group who were identified as missing in much of the work to develop an age-friendly city,” Young says. “Early on, when we were doing engagement work, we heard of many issues with retail environments, such as the lack of chairs in changing rooms in stores, and issues with how people were treated if they had gray hair or were frail.”

The city responded by establishing the Melville Age-Friendly Business Network (MAFAB). Due to collaboration and intensive work with the shopping center’s management and retailers, and the implementation of MAFAB, Garden City is now incorporating both age-friendly and dementia-friendly principles into the design and construction of a major redevelopment set to increase the floor space by 100% over the next 2-3 years, Young notes.

Newcastle, United Kingdom

The City of Newcastle, long an on-the-skids former U.K. manufacturing center, has in recent decades revitalized itself with new industries, some directed at serving its increasing aging population.

Newcastle’s population over age 65 is growing, with people aged 75-84 expected to increase by 60% over the next 20 years and those aged 85-and-up expected to grow by nearly 100%, says Colin Williams, principal advisor to Newcastle’s chief executive.

Williams says the city’s age-friendly approach has included 2 priorities: the economy and health care. “If a city’s economy is failing, it is unlikely to respond to the challenges and opportunities of an aging population,” Williams says. “Also, many older people in the developed world are living in reasonably good health and are at least comfortably off. The opportunity and challenge is, what are the products and services they want and how do they differ from earlier generations.”

Williams adds, “Unlike most other cities, 7 or 8 years ago, we started to engage with businesses of all sizes to think about how we could work with them. And a year ago, we were awarded a large sum to set up a National Innovation Centre for Aging at Newcastle University that is intended to work with businesses to translate aging research into products and business opportunities. After London, we have the most business startups focused on aging products and services of any city in the U.K. A recent example is MyFolks, a ‘compassionate concierge’ database of supporters that enables families to provide holistic care to their loved ones.”

There is tremendous synergy between the health and economic spheres, Williams says. “If I have a driverless car, it may allow me to be more mobile, have more social contacts, engage in more activities, and feel better, all of which contributes to my well-being,” he says. “In Newcastle, we are a long way toward dissolving boundaries between health, economics, and caregiving.”

David Tobenkin is a journalist based in the Washington, DC, area.