Global Roadmap for Healthy Longevity (2022) / Chapter Skim
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Pages 1-18
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Despite the value that older people bring to society, however, governments and the news media characterize global aging as a tsunami that will overwhelm governments and consume resources needed for younger people to thrive. One concern is real: as life spans have increased, so too have unhealthy years of life, which can increase reliance on government health and social service programs while also contributing to individual suffering.
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Age is the greatest risk factor for developing chronic conditions, which are responsible for most mortality and disability worldwide, but science is providing insights into how to delay the onset of aging and chronic conditions. Among the most effective interventions for delaying aging and chronic conditions are addressing negative social determinants of health population-wide, for example by ceasing tobacco use, increasing physical activity, and consuming a healthy diet.
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Increased capital, in turn, fuels the systems that support health, social needs, the physical environment, education, and productive engagement through work and formal or informal volunteering, and these systems, collectively, support health and produc
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The roadmap provides a path from fear of global aging to a future that thrives on global aging. While much of the focus is on addressing challenges facing older people, many of the interventions to achieve healthy longevity benefit people of all ages.
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THE LONGEVITY DIVIDEND As life spans increase over time and older adults make up a larger proportion of the population than they have in the past, societies have the opportunity to reap gains if good health is maintained for more of the years of life than has thus far been the case. If longer lives in good health are combined with the structures needed to enable healthier older adults to be productively engaged in life, society and individuals of all ages will benefit.
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, personal savings, and government coffers. Beyond supporting healthy longevity by addressing social and health needs of
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Alternatively, removing structural barriers (e.g., age discrimination and implicit taxes on wages earned after retirement age) that prevent people from working as long as they want and establishing incentives to encourage people to work have historically increased workforce participation.
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SOCIAL INFRASTRUCTURE FOR HEALTHY LONGEVITY The importance of social determinants of health has increasingly been recognized, but across many countries, spending focuses on other priorities, such as health care, and not on unmet social needs. Because of the scope and scale of unmet needs, the commission identified key targets for social infrastructure that impact healthy longevity and challenges posed by aging societies (see Figure S-5)
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Moreover, older people's experience, knowledge, and emotional stability hold the potential to build the social and human capital needed to create and perpetuate healthy longevity. Efforts to foster social connections and build cohesion start in local communities, where informal caregiving for family members, neighbors, and acquaintances is the norm.
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Healthy longevity requires financial security for older people because they have few options for improving their financial security, especially when in poor health. Societies can adopt successful models for providing financial support to older people, some solely government-funded and others involving incentives to encourage private savings.
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PHYSICAL ENVIRONMENT The physical environment is the locus for many of the social determinants of health. The physical environment can enable or impede healthy longevity by affecting social engagement and cohesion, safety, physical activity, and access to essential needs.
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Intentional design of public spaces can strengthen social cohesion, promote urban health and citizen well-being, and support the local economy. Because of their links with healthy longevity, the commission emphasizes the need for green space, walkability, and safety.
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These health conditions and impairments affect the ability to recover from infection and other health threats, as was demonstrated during the COVID-19 pandemic by the disproportionately high mortality rate among older people. Public Health Public health systems that promote population health across the life course will be critical to preventing or delaying chronic conditions.
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Shift health care systems to focus on healthy longevity 6-3. Make available culturally sensitive, person-centered, and equitable long-term care Supporting Structures All Health Systems Integration across public health, health care, long-term care, and social services Public Health Interventions at population and individual level to reduce underlying risk factors for aging and chronic conditions Close collaboration with social service providers, workplaces, and other entities that can promote health Data and analytics systems for surveillance, precision public health, and assessment of the efficacy of interventions Health Care Integrated person-centered care, including care coordination 2022 - 2050 Primary care Comprehensive and shared health records and a goal-based care plan Collaboration with social services to address social determinants of health Primary care systems that provide preventive screening, address risk factors for chronic conditions, and promote positive health behaviors Geriatrics workforce that can adequately care for older people globally Palliative and hospice care Long-Term Care Policy and funding prioritizes care delivery in the setting the person chooses, to the extent possible; respects individual autonomy and maintains dignity; and attends to care quality and the risk of abuse, neglect, and exploitation Care and social supports addressing all needs, including meaning and purpose Supports for families and family caregivers when providing long-term care while making formal care available when needed Technology to support caregivers and people needing care by providing monitoring that allows privacy Goals 7.
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Achieving healthy longevity also will require strengthened public health systems and close collaboration with other organizations responsible for addressing health and social needs, including social service agencies, environmental safety agencies, employers, and labor unions. Programmatic components of public health systems with important roles in healthy longevity include interventions at the population and individual levels designed to reduce underlying risk factors for both aging and chronic conditions, as well as data and analytics systems for surveillance, precision public health, population-wide interventions, and evaluation.
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The commission contends that a number of structures need to be established for health care systems to promote healthy longevity, including • integrated, person-centered care, as described by the World Health Organization (WHO) , delivered by a provider who is responsible for coordinating a person's care across settings and, when possible, by an interdisciplinary team; • mechanisms to promote collaborative relationships with social service providers, which can help address social determinants of health at the individual level; • comprehensive and shared health records that include a care plan based on the person's goals, preferences, and values; • health care systems that leverage data systems to inform individual and population care, monitor quality, and identify effective therapeutics and interventions for patient subpopulations; • primary care systems that focus on prevention and care by carrying out essential screening, addressing risk factors for chronic conditions, implementing evidence-informed interventions to address health behav iors, and maintaining functional capacity; • over time, the potential use of precision medicine to tailor the most effective therapeutics to individuals; and • palliative care and hospice for people with high symptom burden and/or advanced illness, and structures to provide hospice care for those with late-stage illness.
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The commission points to the need for structures to ensure quality long-term care that addresses all human needs, not just personal and health care needs. For example, long-term care policies and funding that prioritize care delivery in the setting of the person's choice show respect for individual autonomy and the importance of maintaining dignity, with attention to care quality and the risk of abuse, neglect, and exploitation.
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The development of effective interventions to change individual behaviors will require targeted epidemiologic, behavioral, and social science research. Academic institutions and biotech companies are already investigating targets for efforts to slow the aging process and prevent or delay chronic conditions, with potential interventions including new pharmaceuticals, intermittent fasting, use of stem cells, and regenerative medicine.
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