INTRODUCTION

I. OLDER PERSONS AND DEVELOPMENT

A. Mainstreaming ageing into development policy and promoting full
integration and participation of older persons
B. Provision of social protection and security
C. Alleviation of poverty in old age
D. Older persons and emergencies
E. Promoting positive attitudes towards ageing and older persons
F. Employment of older persons
G. Recognizing gender-specific issues in ageing

II. ADVANCING HEALTH AND WELL-BEING INTO OLD AGE

A. Ensuring the quality of life at all ages, including independent living,
health and well-being
B. Providing quality health and long-term care

III. ENSURING ENABLING AND SUPPORTIVE ENVIRONMENTS

A. Older persons and the family
B. Social service and community support
C. Housing and enabling environments
D. Care and support for caregivers
E. Protection of the rights of older persons

IV. IMPLEMENTATION AND FOLLOW-UP

A. National mechanisms on ageing
B. Regional and international cooperation

INTRODUCTION

1. It is estimated that the proportion of persons aged 60 years and older in the world will double between 2000 and 2050, from 10 to 21 per cent (i.e., from 600 million to 2 billion in absolute numbers). In 2025, it is projected that 15 per cent of the world’s population will be aged 60 and over. Among the world’s population aged 60 years and above, 52 per cent lived in Asia and the Pacific in 2002 and this is projected to increase to 59 per cent in 2025. Asia and the Pacific is the most rapidly ageing region of the world. As the region urbanizes, the availability of traditional family support is likely to be reduced.

2. The challenges brought about by the regional trend of population ageing and its implications are enormous, not only for individuals, but also for every aspect of community, national and international life. Many countries within the region are already taking active measures to deal with the challenges of population ageing and to create a “society for all ages”. The Macao Declaration and Plan of Action on Ageing for Asia and the Pacific, endorsed by Governments in the region in 1999, addresses seven areas of concern relating to ageing and older persons. They are: (a) the social position of older persons; (b) older persons and the family; (c) health and nutrition; (d) housing, transport and the built environment; (e) older persons and the market; (f) income security, maintenance and employment; and (g) social services and the community. The Macao Plan of Action provides a regional platform for members in the region to cooperate and share their experiences concerning policies and programmes to meet the challenges of ageing. The Madrid International Plan of Action on Ageing, adopted by the Second World Assembly on Ageing in 2002, in concordance with the Macao Plan, has also set out priority areas and action points that guide efforts towards the goal of ensuring that societies and individuals age with security and dignity while maintaining their full participation and human rights.

3. The results of a regional survey on ageing conducted by ESCAP in June 2002 with the support of the Government of Macao, China, reveal common trends and priorities in national policies and programmes on ageing as well as diversities in policy development and implementation among the countries and areas in the region. While it is generally acknowledged that ageing is a positive outcome of combined social, economic and health advances, the challenge faced by many countries in the region is to develop appropriate policies and take practical measures to transform this positive concept of ageing into reality. Countries that have already developed national policies on ageing will no doubt move on to a more prepared and structured strategy in dealing with population ageing over 30 to 50 years. A national strategy on how to prepare society for the challenges of ageing is essential in ensuring that the goals of active ageing are achieved. The Regional Implementation Strategy aims to provide guidelines on the implementation of commitments on ageing made under the Madrid International Plan of Action on Ageing and the Macao Plan of Action on Ageing for Asia and the Pacific.

I. OLDER PERSONS AND DEVELOPMENT

A. Mainstreaming ageing into development policy and promoting full integration
and participation of older persons

4. While most countries in the region have attached high priority to ageing issues at both the national and international levels, a considerable number of countries have encountered difficulties in mainstreaming ageing into all relevant policy areas. The difficulties include lack of funds, insufficient training for implementation, ineffective interdepartmental cooperation and shortage of staff.

5. Older persons are at a greater risk of being denied the opportunity to participate in society and benefit from economic and social development. Large numbers of older persons in the region live in rural and remote areas without much family and community support and face problems in having access to infrastructure and services. The crucial roles played by older persons in families and communities and their contributions are often insufficiently recognized and their potential and experiences are often underutilized. Creative solutions are required to prevent isolation, neglect and abuse of older persons.

1. Key actions

• Take population ageing into account in relevant policy planning;
• Collect and utilize appropriate data to guide policy, in particular age- and gender- disaggregated data from censuses;
• Place emphasis on seeking ways to increase the efficiency of existing systems and open up new sources of revenue;
• Strengthen national capacity for policy-making and implementation through the provision of training opportunities, technical assistance and advisory services on implementation;
• Promote interdepartmental collaboration within countries so that policies in response to population ageing adopt a holistic approach and can be pursued in a coordinated way over a wide range of policy areas;
• Recognize and support the valuable contributions of older persons, especially unpaid activities, such as care for family members, transmission of cultural values, household maintenance and voluntary services in the community, and view those as an integral part of national policies regarding resource mobilization;
• Promote the social, economic, political and cultural participation of older persons through advocacy, educational activities, removing barriers and encouraging representation of older persons and their representative organizations in decision-making processes on issues of concern to them.

B. Provision of social protection and security

6. In many countries in the region, people working in the informal sector, staying in rural areas and engaged in subsistence activities are often not covered by adequate social protection or security. While attempts have been made to introduce more comprehensive long-term provision, currently pension schemes often have very low coverage, are unable to take care of the group of older persons who have retired from work or are currently without work and earnings, or they cater mainly for employees in the public sector. How to meet the present needs of the growing number of retirees, while formulating a long-term viable pension system, has become a pressing concern of both developed and developing countries in the region.

7. The key strategy in this area is to address the issue of how to adapt existing social protection/social security systems to demographic changes and changes in family structures. To be effective, they must be supported by a high level of employment, comprehensive health services and educational systems which enable both the young and older persons to participate in the labour force effectively. Reforms of existing pension systems and the development of alternatives to provide formal retirement protection have grown in urgency in the region. It has been evident from the experience of the advanced countries that no Government can afford to support any universal provision with low tax revenue. There are choices within two polarized fiscal policies: high taxation for more universal provision or a reasonable level of taxation to support only the most needy. The trend is to shift the emphasis more to individual or corporate savings, financial investments and contributory schemes so that the individual can secure a better income for his/her old age.

1. Key actions

• Establish sustainable social protection/social security systems now, taking into account the long lead time necessary to ensure provision for older persons in future decades;
• Establish or develop a regulatory framework for occupational and private pension provision and recognize the growing trend of Governments to encourage private savings and investments during the working years and the introduction of contributory pension schemes;
• Provide adequate social protection/social security coverage for the labour force in general, including the agricultural and informal sectors, and older persons in particular, recognizing the role of government as supporter and regulator, which on the one hand assists employers in adjusting to structural changes and other economic shocks, and on the other hand, guides and monitors;
• Gather periodic information and better utilize existing data on the conditions of living, sources of income and expenditure patterns of older men and women to provide a reliable basis for formulating policies on income security.
  

C. Alleviation of poverty in old age

8. Poverty alleviation is a priority for many countries in the region where the prevalence of poverty is high. Older persons are consistently among the poorest groups in the region. The economic crisis in the late 1990s further indicated the heightened prevalence of poverty and the incidence of extreme poverty in the region, with a resulting increase in unemployment and vulnerability, particularly among older persons.

9. In the absence of more formal employment opportunities and adequate social protection/social security provision, it is important to develop alternative approaches to income security for older persons.

1. Key actions

• Include older persons as a target group in poverty alleviation programmes at all levels, including income generation schemes and savings and credit programmes, with emphasis on high-risk groups such as women;
• Ensure that older persons are provided with adequate social protection and social security, including social assistance;
• Support the capacity of older persons to undertake income generation schemes;
• Ensure the inclusion of older persons and promote their participation in poverty assessment and in the development and implementation of national poverty reduction strategies.

D. Older persons and emergencies

10. Older persons, especially those without families, are particularly vulnerable during natural disasters and other humanitarian emergencies. While less able to find food and shelter during disasters, older persons, however, also provide assistance during emergency situations through assuming primary caregiving roles, their ability to cope and their life skills in rehabilitation and reconstruction of communities after emergencies.

1. Key actions

• Take concrete measures to identify and locate older persons, especially those without families, and provide them with special protection and assistance during and after natural disasters and other emergencies;
• Include older persons’ contributions and vulnerabilities in needs assessment and reporting in emergencies as well as during the reconstruction and rehabilitation of communities after emergencies.

E. Promoting positive attitudes towards ageing and older persons

11. Older persons are entitled to be treated in accordance with the United Nations Principles for Older Persons, namely, independence, participation, care, self-fulfilment and dignity. An all-round approach that emphasizes education, advocacy, legislation and demonstration is required.

12. A major challenge is to undo or alter the often negative stereotypes of older people among the general population. Despite the fact that strategies which promote positive images of ageing have been developed to varying degrees and levels, the stereotyping of older people as dependent, frail, troublesome, unable to contribute and lacking in creativity still prevails, especially when they are portrayed in the mass media.

1. Key actions

• Promote, through such measures as media campaigns and school curricula, recognition of the contribution of older persons to society, which extends beyond their economic activities and benefits families, communities and society as a whole;
• Promote demonstration projects which highlight the abilities of active, healthy, creative and productive older persons and promote volunteer projects or intergenerational learning projects;
• Encourage the media to promote positive images of ageing in newspaper and magazine articles, films and radio and television programmes;
• Encourage older persons to enhance their image consciously by accessing all available means.

F. Employment of older persons

13. Measures to achieve productive ageing through the continued employment of older persons in the workforce have yet to succeed in the region. Increasing aged dependency ratios will put stress on the working-age population to support sustainable income security systems for older persons.

14. In the more developed countries, retirement alternatives have been examined, such as delaying the retirement age and introducing gradual or flexi-age retirement arrangements. People are being encouraged to save more for their old age while Governments are increasingly emphasizing contributory public pension arrangements for workers in the formal sector. There is also evidence of greater interest in Governments providing minimum subsistence benefits through non-contributory pensions for the rural population or means-tested benefits for the poor and needy in the informal sector. There are also suggestions to utilize cross-generational contributions, requiring children to pay for their parents’ daily expenses.

1. Key actions

• Provide incentives and remove disincentives for people to remain in the workforce where appropriate;
• Promote employment and employability through retraining programmes and lifelong education and encourage positive employer attitudes towards the recruitment and retention of older workers;
• Seek effective measures to combat unemployment and create new job openings through implementing active labour-market policies, such as setting up mechanisms for job matching, job-search assistance, training, vocational guidance and counselling, including for older persons who wish to work.

G. Recognizing gender-specific issues in ageing

15. One of the effects of population ageing in the Asian and Pacific region is that women form the majority of people in very old age (75 and above). They are more vulnerable and are more likely to lack income security and skills and to be widowed. Women also are the primary caregivers. Many women work only in the home, experience broken work patterns and lower income levels and in many cases work in the informal sector, resulting in an inability to accumulate sufficient retirement income. It is thus important for policy makers in the region to adopt a gender perspective in their formulation of policies and plans of action.

1. Key actions

• Enhance support for family caregivers, the vast majority of whom are women, to allow them to combine work and family life;
• Promote and support greater male resonsibility in the family, including caring for older persons;
• Increase the participation of women in the labour force through education and training, adopt measures to open up job opportunities for them and reconcile their professional and family responsibilities and avoid discriminatory action in salary scales and pension systems;
• Eliminate all forms of discrimination against women and empower them through the promotion of economic and social independence and their participation in social and political arenas.

II. ADVANCING HEALTH AND WELL-BEING INTO OLD AGE

A. Ensuring the quality of life at all ages, including independent
living, health and well-being

16. Good health is one of the prime factors ensuring a person’s physical, psychological, social and spiritual well-being and quality of life during old age. A life-course and intersectoral approach to health and well-being is the best approach to ensure that both current and future generations of older persons remain healthy and active. Such an approach should address the determinants of health, including behavioural, socio-economic and environmental factors. Policies should aim to reduce the main risk factors associated with major diseases, increase factors that protect health throughout life and provide access to care services.

17. While some countries in the region are striving for adequate provision of basic health-care services for the entire population, others are turning to the provision of primary health-care services as the preferred option to improve, maintain and manage the health of their populations, including that of older men and women. As individuals age, non-communicable or chronic diseases become the leading causes of morbidity, disability and mortality. Non-communicable diseases are most effectively managed, including from a cost perspective, through the primary health-care sector.

1. Key actions

• Promote policies and programmes that support active ageing, which is the process of optimizing opportunities for health, participation and security in order to enhance the quality of life as people age;
• Promote a life-course perspective on health and ageing, through such measures as promoting good nutrition, healthy lifestyles and avoidance of risk factors;
• Ensure a continuum of health-care programmes based on a primary health systems approach, including locally based health-care practices, health education, health promotion, disease prevention and a coordinated referral system to hospital and other health-care services;
• Develop an age-appropriate primary care system integrated with current primary health systems, including financially and physically accessible primary care services, and other elements such as health education, health promotion, disease prevention and a coordinated referral system to hospital and other health-care services;
• Support the training and availability of health workers.

B. Providing quality health and long-term care

18. The combination of demographic ageing and the deficiencies of accommodation and environmental planning make the provision and development of long-term care a serious challenge in many Asian and Pacific countries. However, long-term care systems in many parts of the region are immature and consist of fragmented residential care and some limited official and voluntary home and community care. Most care for dependent older persons is provided by family members with scarce community-based resources. In addition, there is often a lack of quality assurance mechanisms and regulatory provisions in formal long-term care.

1. Key actions

• Pay special attention to the needs of older persons living in rural and remote areas or living alone;
• Improve access to and the quality of long-term care for older persons and develop social support systems to enhance the ability of families to take care of older persons within the family;
• Adopt a comprehensive planning approach taking account of available resources within the community, such as neighbours and volunteers, and direct efforts towards developing interdepartmental as well as intersectoral collaboration. The active involvement of NGOs and the private sector are vital in this regard;
• Provide integrated care services which allow individuals to remain in their communities for as long as possible;
• Promote the mental as well as physical well-being of older persons.

III. ENSURING ENABLING AND SUPPORTIVE ENVIRONMENTS

A. Older persons and the family

19. There is widespread recognition of the importance of family and community support for older persons across the region. Although the ability of families to care for their older members is under pressure as a result of urban and labour migration, unemployment and economic restructuring with resulting internal family pressures, families remain the primary caregivers for the vast majority of older persons. However, the numbers of older persons at high risk of dependency and disability are increasing at the same time as the ability of families to provide care is decreasing.

20. While strengthening traditional support systems and multigenerational solidarity and assisting older persons without family support are accorded high importance, the results of the 2002 survey on ageing conducted by ESCAP showed that providing caregiver support services such as in-home care for home-bound older persons and family elder care training are given lower priority in some countries. However, in order for families and communities to continue to care for older persons, strong support from Governments and other actors may be required.

1. Key actions

• Undertake measures to strengthen family cohesiveness and multigenerational solidarity;
• Develop and/or strengthen a range of community-based services that support older persons with or without families and family caregivers in which caring responsibilities can be shared among individuals, families, communities, NGOs and government.

B. Social service and community support

21. Care for older persons in terms of both home-care services and community support is one of the important emerging concerns of population ageing in the region. Meeting those demands requires more effective coordination and cooperation among agencies and government departments providing such services. Other equally important tasks include the correct assessment of needs and matching of appropriate services for older persons. Additional important factors are the monitoring of standards and the quality of services specially targeted at older persons.

1. Key actions

• Develop schemes for comprehensive needs-based assessment which enables older persons to receive a comprehensive assessment of their needs from an interdisciplinary team;
• Establish standards to ensure quality care in formal care settings, as such measures require Governments to take a more active role in formulating accreditation and quality assurance systems. However, instead of putting emphasis on setting regulations and enforcement, Governments should advocate a shared responsibility for ensuring quality among service providers, user representatives (older persons) and government itself.

C. Housing and enabling environments

22. One of the many challenges facing the countries in the region is to provide appropriate living environments for older persons which enable them to participate fully in the community. To that end, improved housing with barrier-free and age-friendly designs needs to be constructed, thereby enabling families to take care of older persons effectively.

23. Recognizing the rapid development of technology- and knowledge-based economies, which has resulted in the digital divide and a widening gap between countries as well as communities, older persons should have the opportunity and facilities to benefit from the development of technology.

1. Key actions

• Improve housing and living environments to emphasize barrier-free, age-friendly and integrated designs and communities, thereby ensuring older persons a dignified and independent life;
• Promote equitable allocation of public or affordable housing which supports “ageing in place” based on individual preferences;
• Provide training and learning opportunities for older persons in the use of technology within their communities.

D. Care and support for caregivers

24. Within the region, relatively low priority is attached to supporting caregivers through training, information, psychological, economic, social and legislative mechanisms. This may lead to a lack of services for caregivers, in many cases, elderly women and female spouses. The HIV/AIDS pandemic in several countries in the region has also added to the responsibility of caregivers. Governments must pay greater attention to providing direct care and support to caregivers.

1. Key actions

• Promote and provide direct support to family caregivers in the form of material aid, tax reduction, subsidized housing or training on home care and develop an integrative model combining both formal and informal care in enhanced community care to help to relieve the care burden of family members;
• Promote and encourage community-based programmes which assist and act as relief mechanisms for family members and caregivers;
• Promote support systems for elderly caregivers of people living with HIV/AIDS in general, AIDS orphans and older persons living with HIV/AIDS.

E. Protection of the rights of older persons

25. It is recognized that neglect, abuse and violence against older persons take many forms - physical, sexual, psychological, emotional and financial.

26. The right of older persons as an important consumer group with common needs, interests and preferences to receive proper goods and services must be recognized.

1. Key actions

• Take active measures to ensure that older persons have access to information regarding their rights;
• Take into account the views of older persons on the design of products and the delivery of goods and services;
• Place emphasis on the suitability of services and the right of choice of older persons, whose specific needs and preferences should be recognized;
• Facilitate and regulate the development of the market by providing appropriate safeguards to prevent exploitation of older persons;
• Take active measures to combat discrimination, abuse and violence against older persons.

IV. IMPLEMENTATION AND FOLLOW-UP

A. National mechanisms on ageing

27. It must be emphasized that Governments and other national actors should play a key role in the implementation of commitments on ageing. Many countries in the region have developed national policies, plans of action or legislation on ageing. For those which have adopted a national plan of action on ageing in response to the recommendations of the Macao Plan of Action on Ageing for Asia and the Pacific and the Madrid International Plan of Action on Ageing, the challenge is to implement their plans and find ways to overcome difficulties in resources, knowledge, expertise and other areas. For those countries that have not yet developed a national plan on ageing, immediate action should be taken.

1. Key actions

• Put into place comprehensive and systematic frameworks at the national level for gathering data and information and undertaking research to identify the circumstances and needs of older persons, as well as options and priorities for policy action on ageing;
• Encourage the use of the Research Agenda on Ageing for the Twenty-first Century endorsed by the Valencia Forum at Valencia, Spain, in April 2002 and presented to the Second World Assembly on Ageing as a guide to the formulation of national research frameworks;
• Enhance the participation of NGOs, older persons’ associations and other sectors of civil society in the implementation of the regional and international plans of action on ageing, through their participation in the review of national policies and programmes and national implementation; private sector representation or participation in major projects and programmes should also be encouraged;
• Establish indicators to measure the impact of strategies to assist Governments and other national actors in the implementation process;
• Develop, in those countries that do not yet have a national policy or plan of action on ageing, measures that would allow a systematic review of the implementation of their commitments on ageing.

B. Regional and international cooperation

28. Countries in the region vary greatly in their economic, social and political situations. Despite the economic, social and cultural diversity in the region, population ageing is a common challenge that every country will have to face. Regional and international cooperation will facilitate the exchange of information and experience among Governments and their development partners in the implementation of programmes for older persons and in coping with population ageing.

1. Key actions

• Promote regional and international cooperation to support national implementation processes;
• Facilitate more interdisciplinary and intersectoral collaboration among relevant organizations in the region;
• Promote intercountry exchanges of information and experience on ageing through participation in subregional, regional and interregional activities, including South-South cooperation;
• Promote the inclusion of ageing-related issues in policies, programmes and meetings of all relevant regional bodies;
• Encourage United Nations bodies and agencies and other international organizations to appoint and/or strengthen focal points on ageing, conduct training activities and support advocacy aimed at the mainstreaming of ageing issues in development policies and programmes;
• Strengthen the role of ESCAP as the United Nations regional focal point on ageing and promote its role in providing technical assistance and advisory services and in coordinating regional activities on ageing;
• Support regular review by ESCAP, as specified in the Macao Plan of Action on Ageing for Asia and the Pacific, of national policies on ageing and the implementation of international and regional commitments on ageing through regional surveys and review meetings;
• Support ESCAP in its role of facilitating the development of a regional network on ageing.