The Gateway team recently worked with the World Health Organization (WHO) on their Baseline Report for the Decade of Healthy Ageing 2021-2030. Following on the WHO’s 2015 World Report on Ageing and Health, the Baseline Report defines “healthy ageing” as the “ongoing process of developing and maintaining the functional ability that enables wellbeing in older age.” WHO further conceptualizes this process by distinguishing between three components: intrinsic capacity, functional ability, and environments.

The component of intrinsic capacity encapsulates the physical and mental capacities of the individual, including locomotor, sensory, cognitive, and psychological capacity. Environments are where people live and conduct their lives and include the built environment, people and their relationships, societal attitudes and values, and health and social policies. Functional ability is the product of the interaction between an individual’s intrinsic capacity and their environments. Specifically, the WHO highlighted five domains of functional ability: 
 

1. ability to meeting one's basic needs
2. ability to learn, grow and make decisions
3. mobility
4. ability to build and maintain relationships
5. ability to contribute

The UN Decade of Health Ageing is a 10-year global collaboration designed to improve the lives of older people, their families, and the communities in which they live. The Baseline Report is designed to assess the global status of healthy ageing and to provide recommendations to optimize functional ability and accelerate measurable impact on older people’s lives. While the WHO set out to gather information on all three components of healthy aging, they were only able to assess two domains of intrinsic capacity, cognition and vitality, and one domain of functional ability, the ability to meet one’s basic needs (Michel et al., 2021).

To capture the ability to meet one’s basic needs the WHO constructed a score using 3 Activities of Daily Living (ADL) questions:
 

• Ability to get dressed
• Ability to take medication
• Ability to manage money

WHO chose these three survey measures because they found them most frequently asked in national surveys, including many of the HRS family of surveys. Using this score, WHO compared individuals aged 60 and over in 37 countries, representing 49% of all older people worldwide in 2020. They found that 14% of older people, representing 71 million people aged 60 and over, are unable to meet some of their basic needs. 

The Gateway team further highlighted the gender inequality in meeting basic needs (Section 2.10 of the report), by summarizing the work of our publication (Lee et al., 2020). For this analysis the onset of  disability, defined as having difficulties with bathing, dressing, feeding, toileting, and/or getting in or out of bed, was compared between men and women in 23 countries. The authors found the societal-level indicators of gender inequality, such as inequalities in political power and access to social and economic resources, explained some of the observed individual-level gender difference in disability incidence.

This analysis as well as the majority of the studies highlighted in the baseline report utilized data from the HRS Family. As of 2019, the HRS and its sister studies have conducted nearly 1.1 million interviews across 45 countries. The Gateway team illustrated the growth and expansion of the HRS family of surveys, by plotting the number of interviews conducted by year, highlighting the countries covered (Figure 3.2 of the WHO report). 

You can read more about the global expansion of the HRS Family of Surveys in our earlier blog post here. 

After establishing a current baseline for a few domains of healthy aging for as many countries as possible, the WHO calls for greater collection of comparable data in more countries and across more domains of healthy aging. WHO plans to compile progress reports in 2023, 2026 and 2029.
 

References

• Lee, J., Meijer, E., Phillips, D., & Hu, P. (2021). Disability incidence rates for men and women in 23 countries: evidence on health effects of gender inequality. The Journals of Gerontology: Series A, 76(2), 328-338.
• Michel, J. P., Leonardi, M., Martin, M., & Prina, M. (2021). WHO's report for the decade of healthy ageing 2021–30 sets the stage for globally comparable data on healthy ageing. The Lancet Healthy Longevity, 2(3), e121-e122.
• World Health Organization. (2015). World Report on Ageing and Health. World Health Organization.
• World Health Organization. (2020). Decade of Healthy Ageing: Baseline Report.