The Gerontologist
cite as: Gerontologist, 2016, Vol. 56, No. S2, S163–S166
Editorial
The World Report on Ageing and Health
John R.  Beard, MBBS, PhD,1 Alana M.  Officer, MSc, MPH,*,1 and Andrew K.  Cassels,
MBBS, MSc2
1
Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland. 2Global Health Programme,
The Graduate Institute of International and Development Studies, Geneva, Switzerland.
*Address correspondence to Alana M. Officer, MSc, MPH, Department of Ageing and Life Course, World Health Organization, 20 Avenue Appia,
1211 Geneva, Switzerland. E-mail: officera@who.int
Today, for the first time in history, most people can expect to
live into their 60s and beyond (United Nations Department
of Economic and Social Affairs [UNDESA], 2007). And those
who reach 60 years of age can expect to live longer than ever
before. When combined with marked falls in fertility rates,
these increases in life expectancy are leading to the rapid age-
ing of populations around the world. These changes are dra-
matic, and they have profound implications for each of us as
individuals, as well as for society more broadly.
Longer lives present many opportunities, and the arti-
cle by Fried (2016) in this supplement makes a strong
case that appropriate social investment can create a “third
demographic dividend” for society. Yet, the extent of the
opportunities that arise from increased longevity will
depend heavily on one key factor: health. If people are
experiencing these extra years of life with good physical
and mental capacity, and if they live in enabling environ-
ments, their ability to do the things they value may have
few limits. If these added years are instead dominated by
declines in capacity and disabling environments, the impli-
cations for older people and for society are much more neg-
ative. Staudinger, Finkelstein, Calvo, and Sivaramakrishnan
(2016) take up this issue and look specifically at the effects
of work on health in later life.
Unfortunately, there is only limited information to sug-
gest that older people today are experiencing these extra
years in better health than previous generations (Chatterji,
Byles, Cutler, Seeman, & Verdes, 2015). Moreover, in many
places, neither the policies nor the infrastructure is in place
to ensure that the opportunities that arise from popula-
tion aging can be realized. Public health action on ageing
is therefore urgently needed. Yet debate on what this might
comprise has been remarkably limited (Lloyd-Sherlock
et al., 2012)
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To progress action in this area, the World Health
Organization (WHO) recently released the first World report
on ageing and health (WHO, 2015). Nearly 200 people con-
tributed directly to the report, including authors of a series
of background articles, many of which have been refined for
academic publication in this supplement. Given the great
diversity of issues that are relevant to ageing and health, it is
not surprising that the scope of these articles is broad.
The report outlines a public health framework for
action on Healthy Ageing that is built around the concept
of functional ability. This is defined by the report as “the
health related attributes that enable people to be and to do
what they have reason to value”. The report emphasizes
that this ability is determined by both the intrinsic capac-
ity of the individual and the influence of the environments
they inhabit. This builds on capabilities-based approaches
used in other fields (Anand, 2005). The report approaches
the changes associated with ageing in the context of the
entire life course, yet focuses on the second half of life. It
describes some of the important underlying physiologic
changes that can occur with age (for example, those out-
lined in the article by Blume-Peytavi et al. (2016) on skin)
but also considers the disorders that become more frequent
in older age and that can impact on functioning. These are
largely chronic conditions, particularly noncommunicable
diseases, hearing loss, and musculoskeletal disorders as dis-
cussed by Davis and colleagues (2016) and Briggs and col-
leagues (2016), respectively.
Many of these can be prevented or delayed by engaging
in healthy behaviors across the life course, and the ben-
efits of these behaviors continue into later life (Hrobonova,
Breeze, & Fletcher, 2011). The article by Bauman, Merom,
Bull, Buchner, and Singh (2016) highlights the importance
of these ongoing influences, making a robust case for
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promoting physical activity among older adults. However,
Bauman and colleagues also show how ageing influences
the relationship of these behaviors to health and the impor-
tance of considering this when developing interventions to
foster capacity and ability. Their article highlights how, for
physical activity, this may lead to a shift in focus that gives
priority to interventions that can help the retention of mus-
cle mass and balance. Subtle shifts in messaging across the
life course may also be required if these interventions are to
succeed (Notthoff & Carstensen, 2014).
Yet, even with effective health promotion strate-
gies, many older people will still experience chronic dis-
ease and most likely more than one of them at the same
time. Integrated person-centered care can ensure these are
effectively managed, particularly if they are detected early
enough. And even for people where these result in signifi-
cant declines in capacity, access to medical and assistive
technologies (see article by Garçon et al. (2016)) and sup-
portive environments can ensure that they can continue to
live lives of dignity and continued personal growth.
These responses would fulfill the right to health and other
related rights and fundamental freedoms of older people
that are enshrined in international law, an issue expanded
on by Baer, Bhushan, Abou Taleb, Vasquez, and Thomas
(2016). Yet, globally, breaching of these rights is almost the
norm, as highlighted by the high prevalence of elder abuse.
The article by Pillemer, Burnes, Riffin, and Lachs (2016)
considers this issue—a problem that has devastating indi-
vidual consequences and societal costs for which we are yet
to identify evidence-based interventions that work.
But few places in the world offer the policies and infra-
structure necessary to ensure older people can experience
a long and healthy life. One challenge for decision mak-
ers is that when it comes to health, every older person is
different. The report highlights how physical and mental
capacity are only poorly associated with chronological age.
Even in low- and middle-income countries, some 80-year-
olds have physical and mental capacities similar to many
20-year-olds, whereas others experience significant declines
in physical and mental capacities at much younger ages.
Furthermore, this diversity of health state in older age
is not random. As the article from Foebel and Pedersen
(2016) states, genetic inheritance plays some role. But most
of the variation is likely to result from personal factors
such as our sex, ethnicity, and occupation, as well as the
physical and social environments in which we live our lives.
Together these influence opportunities and health behavior,
and these impacts start from childhood and continue across
life(Commission on Social Determinants of Health, 2008;
Dannefer, 2003). The article by Sadana, Blas, Budhwani,
Koller, and Paraje (2016) elaborates in detail the causes of
health inequities across contexts and policy and research
options for stimulating change.
Together the articles in this supplement highlight the
complexity in the health and functional states experienced
by older adults. They help raise fundamental questions
such as what do we mean by health in older age, how do
The Gerontologist, 2016, Vol. 56, No. S2
we measure it, and how might we foster it. The reconcep-
tualization of Healthy Ageing provided by the report draws
on many years of gerontological and geriatric research and
debate to start to answer these challenging queries.
In building this public health framework for action,
WHO looked to challenge many pervasive misconceptions.
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In particular, the report seeks
•• to emphasize that action is urgent;
•• to acknowledge the great diversity of health and experi-
ence in older age and the need for policy responses to
reflect this rather than being built on ageist stereotypes
of a “typical” older person;
•• to shift conceptualizations of health in older age from
a focus on the absence of disease in an individual to a
focus on functioning and an acceptance that both the
individual and their environments have a role in deter-
mining this;
•• to frame Healthy Ageing as a process that takes place
across the life course rather than as a state at a par-
ticular point in time, and that both policy makers and
researchers should be interested in how we maintain
optimum trajectories of functional ability and capacity
across life and older age.
•• to understand the cumulative impact of environmental
determinants across life and to shape policy that looks
to address disadvantage rather than reinforcing it.
The policy priorities it proposes are relevant for all older
people, regardless of where they sit on their personal tra-
jectory of Healthy Ageing. They emphasize the need to
build supportive and enabling environments. These can
help people build and maintain capacity (for example, a
walkable environment may foster physical activity). But
they can also provide a range of resources or barriers that
determine whether people with a given level of capacity
can do the things they feel are important. Thus, although
older people may have limited capacity, they may still be
able to get where they want and need to go if they have
access to an assistive device (such as a walking stick, wheel-
chair, or scooter) and live close to affordable and accessible
transport. This will require a coordinated response from
many sectors and multiple levels of government to create
age-friendly environments (housing, employment, trans-
port, and social protection) to facilitate the ability of older
people to age in a place that is best for them and to do what
they value.
The report also recommends a better alignment of
health systems to the older populations they increasingly
serve. This requires a greater integration of services and
shifts from disease-based reactive services to models of
health care that prioritize the functioning of the older per-
son as a whole, take account of the physiological trends
and health conditions that may influence it, and consider
the individual’s circumstances and ambitions.
And this integration of services must extend to the sup-
port and care needed by those older people with signifi-
cant loss of capacity. Crucially, the report is very clear that
The Gerontologist, 2016, Vol. 56, No. S2
“In the 21st Century, no country can afford not to have
an integrated system of long term care.” Population and
social trends mean it is no longer feasible, sustainable, or
equitable for governments to leave this to families alone.
This does not mean that this role should instead fall solely
to governments, but if families are to provide adequate care
and not be unreasonably burdened, at a minimum they need
information that can allow them to fill this role, and have
access to support such as respite care. Governments also
need to put in place mechanisms to ensure the quality of
the care that might be contracted by private care givers or
in institutions. Positive responses from WHO’s “Member
States” to the Report suggest that this new emphasis on the
need to build systems of long-term care, even in the poorest
countries, may result in much greater global attention to
this neglected issue.
Finally, the report emphasizes the extensive knowledge
gaps that form a major barrier to evidence-based policy
development. There is little global consensus on even
widely used terms in the field, and although longitudinal
research and population surveys are increasingly common,
the instruments they use are often not comparable and may
not provide the information needed by decision makers.
Most of the treatments offered to older people are derived
from clinical research that excludes them and that fails to
take account of the influence of the comorbidities most of
them will have.
These recommendations will not be surprising to geron-
tologists and geriatricians. However, to date, policy related
to older age in many countries has often prioritized cost
containment over the investment needed to enable the
human and social resource that is inherent in older popula-
tions. Moreover, policy can appear disjointed, reflecting a
political polarization that portrays older people as either
vulnerable and needing support, or robust and needing to
contribute. Although each characterization may have legiti-
macy, they are simply the ends of a continuum of diversity,
and broader policy responses are needed to encompass this
heterogeneity in a coherent way.
We hope that the World Report and the articles in this
special issue help progress work to achieve this. Certainly,
the framework for action outlined in the report is designed
to speak to all people at all stages in life and to look to how
society can help them experience more positive Healthy
Ageing trajectories. Moreover, rather than tell them what
they should do, it looks to build their abilities to navigate
the challenges and seize the opportunities of later life. As
the report says, enabling these abilities is likely to be a
sound investment in a future where older people have the
freedom to live lives that previous generations might never
have imagined.
The World report on ageing and health can be found
at http://apps.who.int/iris/bitstream/10665/186463/1/978
9240694811_eng.pdf?ua=1. To navigate the report—which
features content from the articles in this supplement—
Chapters 1 and 2 cover all the main ideas. The analysis of
S165
context and rationale for action in Chapter 1 is followed
by the development and explanation of a Public Health
Framework for Action in Chapter 2. Chapter 3 provides a
comprehensive, stand-alone update of current knowledge
on health in older age. It includes a review of demographic
and epidemiological change; the characteristics of health
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in older age, including underlying changes as well as the
health conditions of older people; changes in intrinsic
capacity and functional ability; behaviors that influence
Healthy Ageing; and key environmental risks. Chapters 4,
5, and 6 can be read together. They take the Public Health
Framework for Action (Chapter 2) as their starting point
and examine in detail the implications for health care
systems, long-term care, and age-friendly environments,
respectively. Chapter  7—Next steps—sets out a menu
of options for action applicable to countries at all levels
of development. It is organized in four sections: aligning
health systems to the needs of the older populations they
now serve; developing long-term care systems; creating
age-friendly environments; and measuring monitoring and
understanding.
References
Anand, P. (2005). Capabilities and health. Journal of Medical Ethics,
31, 299–303. doi:10.1136/jme.2004.008706
Baer, B., Bhushan, A., Taleb, H. A., Vasquez, J., & Thomas, R.
(2016). The right to health of older people. The Gerontologist,
56, S206–S217. doi:10.1093/geront/gnw039
Bauman, A., Merom, D., Bull, F. C., Buchner, D. M., & Singh, M.
A. F. (2016). Updating the evidence for physical activity: sum-
mative reviews of the epidemiological evidence, prevalence, and
interventions to promote “active aging”. The Gerontologist, 56,
S268–S280. doi:10.1093/geront/gnw031
Blume-Peytavi, U., Kottner, J., Sterry, W., Hodin, M. W., Griffiths,
T. W., Watson, R. E.  B., … Griffiths, C. E.  M. (2016). Age-
associated skin conditions and diseases: current perspectives and
future options. The Gerontologist, 56, S230–S242. doi:10.1093/
geront/gnw003
Briggs, A. M., Cross, M. J., Hoy, D. G., Sànchez-Riera, L., Blyth, F.
M., Woolf, A. D., & March, L. (2016). Musculoskeletal health
conditions represent a global threat to healthy aging: a report for
the 2015 World Health Organization World Report on Ageing
and Health. The Gerontologist. 56, S243–S255. doi:10.1093/
geront/gnw002
Chatterji, S., Byles, J., Cutler, D., Seeman, T., & Verdes, E. (2015).
Health, functioning, and disability in older adults—Present sta-
tus and future implications. The Lancet, 385, 563–575.
Commission on Social Determinants of Health. (2008). Closing
the gap in a generation: Health equity through action on social
determinants of health. Final Report of the Commission on
Social Determinants of Health. Geneva, Switzerland: World
Health Organization.
Dannefer, D. (2003). Cumulative advantage/disadvantage and the
life course: Cross-fertilizing age and social science theory. The
Journals of Gerontology, Series B: Psychological Sciences and
Social Sciences, 58, S327–S337. doi:10.1093/geronb/58.6.S327
S166
Davis, A., McMahon, C. M., Pichora-Fuller, K. M., Russ, S., Lin, F.,
Olusanya, B. O., … Tremblay, K. L. (2016). Aging and hearing
health: the life-course approach. The Gerontologist, 56, S256–
S267. doi:10.1093/geront/gnw033
Foebel, A. D., & Pedersen, N. L. (2016). Genetic influences on func-
tional capacities in aging. The Gerontologist, 56, S218–S229.
doi:10.1093/geront/gnw006
Fried, L. P. (2016). Investing in health to create a third demographic
dividend. The Gerontologist, 56, S166–S177. doi:10.1093/
geront/gnw035
Garçon, L., Khasnabis, C., Walker, L., Nakatani, Y., Lapitan, J., Borg,
J., … Berumen, A. V. (2016). Medical and assistive health technol-
ogy: meeting the needs of aging populations. The Gerontologist,
56, S293–S302. doi:10.1093/geront/gnw005
Hrobonova, E., Breeze, E., & Fletcher, A. E. (2011). Higher levels
and intensity of physical activity are associated with reduced
mortality among community dwelling older people. Journal of
Aging Research, 2011, 651931. doi:10.4061/2011/651931
Lloyd-Sherlock, P., McKee, M., Ebrahim, S., Gorman, M.,
Greengross, S., Prince, M., … Vellas, B. (2012). Population
The Gerontologist, 2016, Vol. 56, No. S2
ageing and health. The Lancet, 379, 1295–1296. doi:10.1016/
s0140-6736(12)60519-4
Notthoff, N., & Carstensen, L. L. (2014). Positive messaging pro-
motes walking in older adults. Psychology and Aging, 29, 329–
341. doi:10.1037/a0036748
Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder
Downloaded from https://academic.oup.com/gerontologist/article-abstract/56/Suppl_2/S163/2605374 by University of New South Wales user on 07 March 2019
abuse: global situation, risk factors, and prevention strategies.
The Gerontologist, 56, S194–S205. doi:10.1093/geront/gnw004
Sadana, R., Blas, E., Budhwani, S., Koller, T., & Paraje, G. (2016).
Healthy ageing: raising awareness of inequalities, determi-
nants, and what could be done to improve health equity. The
Gerontologist, 56, S178–S193. doi:10.1093/geront/gnw034
Staudinger, U. M., Finkelstein, R., Calvo, E., & Sivaramakrishnan, K.
(2016). A global view on the effects of work on health in later life.
The Gerontologist, 56, S281–S292. doi:10.1093/geront/gnw032
World Health Organization. (2015). World report on ageing and
health. Geneva, Switzerland: World Health Organization.
United Nations Department of Economic and Social Affairs. (2007).
World Economic and Social Survey 2007: Development in an
ageing world. New York: UNDESA.