FUNCTIONAL

ABILITY

INTRINSIC
CAPACITY

ENVIRONMENTS

DECADE OF
DECADE OF
HEALTHY AGEING
HEALTHY AGEING
BASELINE REPORT
BASELINE REPORT
SUMMARY
Decade of healthy ageing: baseline report. Summary

ISBN 978-92-4-002330-7 (electronic version)

ISBN 978-92-4-002331-4 (print version)

© World Health Organization 2021

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-
ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO).

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes,
provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion
that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you
adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you
create a translation of this work, you should add the following disclaimer along with the suggested citation: “This
translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or
accuracy of this translation. The original English edition shall be the binding and authentic edition”.

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation
rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/).

Suggested citation. Decade of healthy ageing: baseline report. Summary. Geneva: World Health
Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit
requests for commercial use and queries on rights and licensing, see https://www.who.int/about/licensing/en.

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as
tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse
and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any
third-party-owned component in the work rests solely with the user.

General disclaimers. The designations employed and the presentation of the material in this publication do not imply
the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory,
city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines
on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed
or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions
excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by WHO to verify the information contained in this publication.
However, the published material is being distributed without warranty of any kind, either expressed or implied. The
responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for
damages arising from its use.

This summary report was produced by the Ageing and Health Unit, Department of Maternal, Newborn,
Child & Adolescent Health & Ageing. Acknowledgements, annexes, references and photo credits can be found
in the full report in English: https://apps.who.int/iris/handle/10665/338677.
 1

INTRODUCTION
The Baseline Report for the Decade of Healthy Ageing
2021−2030 addresses five issues: THE REPORT STRESSES THAT

1. Healthy Ageing, the Decade’s actions and

At least 142 million older persons
enablers, and a pathway to accelerate impact by
worldwide are unable to meet their basic
2030.
needs.

2. Where are we in 2020? The report provides a first- Optimizing functional ability is a key to
time baseline for healthy ageing worldwide. healthy ageing.

3. What improvements could we expect by 2030? It Governments and other stakeholders must
documents progress and scenarios for improvement. invest in data to monitor healthy ageing
across the life course.
4. How can we accelerate impact on the lives of
older people? It shows how older people and Actions must be accelerated to make a
stakeholders can together optimize functional ability. measurable impact on older persons by
2030; older people must be involved at all
5. The next steps, including opportunities to boost stages.
collaboration and impact by 2023, the next
reporting period. Global evidence and cases highlight what
can be done and what we can learn.
 Healthy ageing is
“the process of developing and
maintaining the functional
ability that enables well-being
in older age”.
3
Decade of healthy ageing: baseline report – summary 4

1 HEALTHY AGEING

Healthy ageing is relevant to everybody and is about

GETTING READY creating the opportunities that enable people to
be and do what they value throughout their lives.
FOR THE DECADE OF e o o t e ec de is to opti i e o de peop e s

HEALTHY AGEING functional ability.

2021-2030 Functional ability e e s to peop e s i ities to

1) meet their basic needs to ensure an adequate
Each older person can drive change standard of living; 2) learn, grow and make
decisions; 3) be mobile; 4) build and maintain
The number of older persons worldwide (2021) is relationships; and 5) contribute to society.
slightly more than 1 billion – about 13.5% of the global Functional ability combines the intrinsic capacity of
population. By 2030, 1 in 6 persons will be 60 years of age the individual, the environment a person lives in and
or older. how people interact with their environment.

Older people are at the centre of a new action plan on

Intrinsic capacity comprises all the physical
ageing and health. The United Nations Decade of Healthy
and mental capacities that a person can draw
ei brings together governments, civil
o i c di pe so s oco oto c p cit
society, international agencies, academia, the media and
(physical movement), sensory capacity (vision and
the private sector to collaborate in improving the lives
hearing), vitality (energy and balance), cognition
of older people, their families and their communities.
and psychological capacity. These capacities are
The vision is a world in which all people can live long and
interrelated and contribute to functional ability.
healthy lives.
For example, hearing helps people to communicate,
The Decade provides opportunities to work together maintain autonomy, and sustain mental health and
to improve functional ability by 2030, with meaningful cognition. Significant declines are closely related to
engagement and empowerment of older people from the care dependence in older age.
beginning. It addresses four areas for action at multiple
levels and in multiple sectors in order to promote health, Environments are where people live and conduct
prevent disease, maintain intrinsic capacity and enable their lives. Environments shape what older
functional ability. The action areas are: people with a given level of intrinsic capacity can
be and do. These include the home, community
• change how we think, feel and act towards age and broader society and relate to products,
and ageing; equipment and technology that facilitate older
peop es c p cities d i ities t e t o
• e s et t co ities oste o de peop e s
built environment; emotional support, assistance
abilities;
and relationships provided by other people and
• deliver person-centred integrated care and animals; attitudes since these influence behaviour
primary health services that respond to older – both negatively and positively; and services,
peop e s eeds d systems and policies that may (or may not)

• provide access to long-term care for older people contribute to enhanced functioning at older ages.

who need it.

 5

e t ei is i e ced tip e cto s Almost all determinants of healthy ageing can

t o o t t e i e co se i c di t ose ide tified e i p o ed po icies i ed t di e e t e e s
as priority areas of action in the Decade. Over time, (household, communities, regional, national or
these factors result in trajectories of intrinsic capacity global). Actions that dismantle discrimination and
and functional ability for each person, or for a group level up socioeconomic conditions are likely to uplift
of people (Figure 1). ecto ies e so i e ced the trajectory of healthy ageing for everyone.
by local and global events, as demonstrated by the
COVID-19 pandemic, and can be shaped by other
drivers such as climate change.

Functional
ability
Functional
FIGURE 1 ability
Functional
ability
Intrinsic
Trajectories of healthy ageing capacity
Intrinsic
capacity
optimizing functional ability Intrinsic
capacity
Supportive
environments
Supportive
environments
Supportive
environments

DECLINING
CAPACITY

HIGH AND STABLE

CAPACITY SIGNFICANT LOSS
OF CAPACITY

Functional ability
optimized due
to supportive
environments

Prevent and detect Reverse/slow declines Manage HEALTH SYSTEM

chronic conditions conditions

Support capacity-enhancing Ensure i ni e ate i e LONG-TERM CARE

behaviours

Promote capacity- Remove barriers to compensate ENVIRONMENTS

enhancing behaviours for loss of capacity

Change how we think, feel and act towards age and ageing
Decade of healthy ageing: baseline report – summary 6

ACCELERATE IMPLEMENTATION AND Strong collaboration for transformative change will

OPTIMIZE FUNCTIONAL ABILITY benefit from four “enablers” that are outlined in the
Decade, including:
Our challenge is to see meaningful and measurable
• meaningful engagement with older people,
improvements in the lives of older people,
families, caregivers and others;
their families and their communities by 2030.
Partnerships are needed with older people, decision- • building capacity for integrated action across
makers in governments and those who design and sectors;
implement community programmes. Action needs
• linking stakeholders to share experience and
to be informed by evidence and aligned with older
learn from others; and
people’s expectations.
• strengthening data, research and innovation
to accelerate implementation.

FIGURE 2

The pathway to optimize functional ability

1 2 3
CLARIFY IDENTIFY DESIGN & ASSESS
Clarify what will be Identify the interventions Assess intervention impact
optimized within each – Addressing intrinsic capacity together with older people
domain of functional – Addressing environments
ability
Know the context
Set priorities – Living situations
(What is important?) – Level of care dependance

YES YES YES

Is there demand Is there compelling Is there proof
from older people and/or evidence? it can be done
decision-makers? under ideal conditions?

NO NO NO
Work on better under- Do more research Implement pilots,
standing what older assessing:
Synthesize evidence (relevant
people and their – feasibility
to low-resource settings)
families want – acceptability
Evaluate effectiveness
Nurture leadership Implement multi-site
Outcomes trials, assessing:
– intrinsic capacity
– efficacy
– functional ability
– environments
 7

The report illustrates a six-point pathway that

brings these enablers together to accelerate
KEY MESSAGES:
implementation, scale up effective programmes
Healthy ageing is a dynamic process.
and optimize functional ability (Figure 2).

G overnments and other stakeholders
committed themselves by 2030 to
achieve meaningful and measurable
Sustaining commitment to improvements in the lives of older
high-priority objectives is the people.

key to a transformative process 

Strong collaboration for transformative
change requires the building of systems
that delivers impact. with leaders, scientists and civil society,
including people of all ages.


A transformative pathway illustrates how
this can be done.

4 5 6
EVALUATE REACH ACCELERATE IMPACT
Evaluate what actually Address scalability, Maintain and increase
works & what doesn’t in leaving no one behind effectiveness & efficiency
practice in each setting

4
Do no harm and do not
increase inequality
Communicate the impact
Engage more stakeholders
Mobilize new resources
How can it be done?
Promote technology transfer
Can it be done? Scale up vertically Foster research &
Who is engaged? Scale up horizontally innovation cycle

Who provides it? Leave no one behind Build a culture for impact

How is it delivered? Ensure efficacy &

What is unique to sustainability
this setting? Monitor effectiveness
Which needs, rights & impact
and/or values are
addressed?
How to address barriers
and bottlenecks
Decade of healthy ageing: baseline report – summary 8

2 FUNCTIONAL ABILITY

Some 14% of older people in the analysis were

WHERE ARE WE NOW? shown to be unable to meet their basic needs that
are necessary for a life of meaning and dignity –
GLOBAL STATUS OF i.e. within their environment, they cannot dress

HEALTHY AGEING themselves, get and take their own medication or

manage their own money, bills or finances. This
Measuring healthy ageing percentage represents some 71 million of the older
persons in the 37 countries with data – and at least
WHO has taken a systematic approach to measuring 142 million of people aged 60 and over worldwide.
healthy ageing. For this global baseline of 2020, items These figures do not include older people living in
commonly used in existing national studies between long-term care facilities or other institutions.
2013 and 2019 of persons aged 60 years and over
e e pped to e c o t e fi e do i s o i t i sic The ability to meet some basic needs was scaled
capacity and functional ability. WHO accessed data from 0 (lowest) to 100 (highest). The highest score
from studies in 55 countries, with 52 released for d s o d e tt i e o de
WHO analysis by June 2020. This showed that 42 persons through a combination of maintaining
countries had some comparable data for either intrinsic capacities, providing enabling environments
functional ability (37 countries) or intrinsic capacity and ensuring targeted support to those who need
(36 countries), with 31 countries having data for it. For each age, on average, this is the case for all
both. United Nations population estimates for 2020 countries until around 75 years although there is a
indicated that these 42 countries had a population lot of variation within each country.
of 678.5 million older people, representing 16% of
the total population in these countries and 65% of Figure 3 shows that on average, based on cross-
all older people worldwide. Results across the 42 sectional data, men and women have similar abilities to
countries included information on 151 718 older meet some basic needs between ages 60 and 80 years.
persons aged 60 years and over, with 68 456 men
(45%) and 83 262 women (55%). te e so e t e di e e ce et ee e d
o e pote ti e ects t t t o de es oe
women are likely to live alone and in poverty compared
Basic needs should be to men. Overall, inequities in gender and education
co t i te to di e e ces it i d et ee co t ies
met for older people at
Basic needs should be met for all older people at any
any age, and approaches age, and approaches should mitigate inequalities in

should mitigate inequali- opportunities. Comparable questions on other basic

needs, such as adequate housing or diet, and all other
ties in opportunities. abilities, are lacking in existing surveys.
 100
9

FIGURE
80 3
Ability to meet some basic needs by age
men and women, 37 countries*
Each dot represents the average score at each age, for men (blue)
and women (red) separately for each country. This represents some
e d o e c oss t e co t ies
60 After 80 years of age, more women are
less able to meet some of their basic
needs than men, with the gap widening
with increasing age.
BASIC NEEDS SCORE

100
40

80

20

60

40 0
60 70 80 90

Female 90th percentile

Female 50th percentile
20
Female 10th percentile
Male 90th percentile
Male 50th percentile
Male 10th percentile

0
60 70 80 90 100 AGE

Female 90th percentile

Female 50th percentile
Female 10th percentile
st i e i iMale 90th percentile
i d ie i ost ic o ti p s ec i e d sto i i d ce
e eece Male 50thepercentile
d s e t t i it i e o t Net e ds o d o t o i o i
o e i p i i Male 10thede
percentile it e d d ited t tes o e ic
 Decade of healthy ageing: baseline report – summary 10

FIGURE 4
Vitality (hand grip strength), score distribution
by 5-year age groups, in 36 countries*
Density plots visualize a distribution of people and their scores.
This represents more than 121 000 older persons in 36 countries, within 7 distributions,
one for each 5-year age group (60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90+ years).

DENSIT Y

The distribution is relatively similar,

but for each increasing 5-year age
.8 group the distribution shifts to the left
(towards a lower score).

.6

This shows older persons

are diverse in their levels
of intrinsic capacity at
every age. In every 5-year
.4
age group there is a
distribution of people with
60-64
higher and lower scores.
65-69
70-74
75-79
80-84
.2
85-89
90+

0
-3 -2 -1 0 1 2 3

STANDARDIZED HAND GRIP STRENGTH SCORE

* Austria, Belgium, Brazil, Bulgaria, Canada, China, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Ghana, Greece,
Hungary, India, Israel, Italy, Latvia, Lithuania, Luxembourg, Malaysia, Malta, Mexico, Netherlands, Poland, Portugal, Romania, Slovakia,
Slovenia, South Africa, Spain, Sweden, and Switzerland.
 11

INTRINSIC CAPACITY ENVIRONMENTS

At every age there is a lot of diversity in older For the baseline analysis, environments and the
peop e s i t i sic c p cit t ep sic d five environment domains were not assessed in a
mental capacities that a person can draw on. comparable manner across a sufficient number of
The report provides a snapshot of two items – nationally representative population-based studies
delayed word recall and hand grip strength – that due to a lack of comparable data. However, to
e ect di e e t do i s o i t i sic c p cit accelerate improvements of functional ability, the
(cognition and vitality). age-friendliness of environments will need to be
tracked and enhanced during the Decade.
Figure 4 documents that, although declines occur
with chronologic age for many older people, declines Combining geographical data and existing studies
are not inevitable: some people at the oldest ages that include older adults is a promising way to
(90+ years) have the same capacity as those at investigate the interaction of environments and
o e es e s intrinsic capacity, and the impact on functional
ability. A feasibility study drawing on data available
This baseline analysis documents that older persons on smartphones illustrates information from a
are not a homogenous group. Differences between number of cities from all regions of the world,
men and women, and between older people in including real-time data on what places or services
general, should be carefully reviewed and assessed can be accessed in nine categories (such as parks,
with regard to whether these differences relate clubs or health providers) and how accessible they
to stature, or are driven by social determinants are to older adults whether by driving, taking public
of healthy ageing. This has implications for global transportation or walking for each.
monitoring of functional ability and intrinsic
capacity. Figure 5 provides an example dashboard with each
category as separate “violin plots” from Tokyo,
Japan. Cities and communities can foster the full
participation of older people and play a crucial role
Some people at the in ensuring that no older person is left behind.

oldest ages (90+ years) Decreasing the digital divide between younger
and older people, particularly those in rural areas,
have the same capacity will enable a wider range of older people who can

as those at younger ages use real-time information to care for themselves

or others, make informed decisions, and pursue
(60−64 years). what they value. Further studies are needed to
evaluate the impact of policies on years of working,
retirement, lifelong learning and flexibility in
employment options for older persons.
 Decade of healthy ageing: baseline report – summary 12

FIGURE 5
Distance and travel times to places and
services within a city
For Tokyo, a dashboard displays information for all nine indicators.

Health facilities Food Health provider

125 125 125
20 20 20

100 100 100

15 15 15
Kilometres

Kilometres

Kilometres
Minutes

Minutes

Minutes
75 75 75
10 10 10
50 50 50

5 5 5
25 25 25

0 0 0 0 0 0
Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk
Transportation Transportation Transportation Transportation Transportation Transportation

Transportation Park Education centre

125 125 125
20 20 20

100 100 100

15 15 15
Kilometres

Kilometres
Kilometres

Minutes

Minutes
Minutes

75 75 75
10 10 10
50 50 50

5 5 5
25 25 25

0 0 0 0 0 0
Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk
Transportation Transportation Transportation Transportation Transportation Transportation

Social club Pharmacy Essential services

125 125 125
20 20 20

100 100 100

15 15 15
Kilometres

Kilometres

Kilometres
Minutes

Minutes

Minutes

75 75 75
10 10 10
50 50 50

5 5 5
25 25 25

0 0 0 0 0 0
Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk Drive Transit Walk
Transportation Transportation Transportation Transportation Transportation Transportation

These violin plots are a combination of a box plot and density

plot, rotated on its side to show the full distribution and shape of
t ed t io i p ot t t sits o t e oo i e t o it o
TOKYO, JAPAN line, indicates that most services for most people are very near.

Park Park

125
20

100
15 For people living in Tokyo, parks are
Kilometres

75
Minutes

within a few kilometres, whether

10
50 driving, taking public transportation
5 or walking.
25

0 0 Some older people may take longer to

Drive Transit Walk Drive Transit Walk walk the same distance.
Transportation Transportation

Some older people may take longer to

walk the same distance.
 13

USING DATA TO DRIVE IMPACT AT COUNTRY LEVEL

Driving impact for healthy ageing is not only about academic partners, to compile reports on the types
data collection. It is also about how leaders and of data sources available to them. Importantly,
decision-makers in multiple sectors are driving the countries provided case studies on how data
the use of these data. Many countries already use from these sources are used to inform policies or
national and subnational data to improve policies and programmes relevant to older adults. The case
p o es o o de pe so s ei t studies – from Chile, China, Finland, Ghana, India,
ministries of health from countries in all WHO regions Qatar, Singapore and Thailand – are highlighted in the
led collaborative processes with other ministries, baseline report.
regional and municipal entities, civil society and

KEY MESSAGES: POLICY IMPLICATIONS

At least 142 million older persons The lack of data on healthy ageing or older age
worldwide currently lack the ability to groups increases the invisibility of older people.
meet their own basic needs. Highly relevant for progress reporting on the
Decade, governments and other stakeholders need
Cases from around the world to invest in data to monitor healthy ageing across
highlight commitment to collecting the life course. This will require:
and analysing data, often with new
technologies and methods engaging • comprehensive information on all abilities,
older people. capturing what older people value to be and to do;

National case studies indicate that

• o e st d di tio o d t o e s i
every country can use existing data
healthy ageing across the life course, and
to inform policies and programmes
monitoring policies and programmes;
for older people and find ways to link
across sectors and use a wide range of
• more disaggregation of data by age (five-year
data sources.
groupings by age and sex to at least age 90 and
ee te s o t e o d s co t ies over) and by place of residence, socioeconomic
have limited or no comparable data status and other markers of inequality;
on healthy ageing or on older age
groups, and this situation contributes • more innovation in collecting, analysing and
to the invisibility and exclusion of older using information;
people.
• more interoperability of data-sharing;

• more involvement of older adults in policy- and

decision-making across sectors.
Decade of healthy ageing: baseline report – summary 14

3 PROGRESS AT NATIONAL LEVEL

WHAT IMPROVEMENTS e ec de s ctio p s 10 progress indicators.

These focus on the number of countries with:
COULD WE EXPECT BY 1) a focal point on ageing and health; 2) national
plans or strategies aligned with healthy ageing; 3)
2030? a national multi-stakeholder forum or committee;
4) legislation and enforcement against age-based
Understanding and measuring success discrimination; 5) access to assistive devices; 6) a
together national programme to support activities; 7) support
to comprehensive assessments of health and social
The Decade advocates for measurable impact on older care needs; 8) a long-term policy or strategy; 9) cross-
peop e s i es o o is to st e t e sectional, nationally representative data; and
country reporting. WHO in collaboration with United 10) longitudinal, nationally representative surveys.
N tio s dep t e ts d speci i ed e cies i ese i dic to s e e fi st epo ted o i d
epo t p o ess i d fi epo t updated in 2020.
aligned to the United Nations 2030 Agenda.
The number of countries that had reported
Many sectors will have to be involved. Indicators of achievement of each progress indicator in 2020 are
progress and impact must: compiled in Figure 6, disaggregated by each of the
si e io s is eco i es t te c e io s
1) i to e di e e ce i t e i es o o de
di e e t e o e e t tes co t i ti to
persons;
the overall number of 194 countries.
2) be able to be improved by governments and other
stakeholders; and Most underlying determinants of healthy ageing
can be shaped by policy and require multisectoral
3) be measured often to track progress.
collaboration.

The baseline assessment includes two types of

National commitment to Healthy Ageing improved
i dic to s e do sed i t e ec de s ctio p
slightly between 2018 and 2020 on all 10 indicators
namely: indicators of progress at national level and
(with the biggest increase in national policies and the
i dic to s o o tco e d i p ct o peop e s i es
smallest in legislation and enforcement against age-
including healthy life expectancy and healthy ageing.
sed disc i i tio o i dic to s o
New indicators could be considered prior to triennial
countries have not reported on progress.
reporting periods.

A projection based on current progress suggests that

four indicators would be reached by all countries
only after 2030, and only one by 2023. Consequently,
action must be accelerated.
 15

FIGURE 6

Number of countries responding “yes” to each indicator*

region and percentage of 194 Member States, 2020

NUMBER OF
COUNTRIES Africa (AFR) 47 countries
Americas (AMR) 35 countries
Eastern Mediterranean (EMR) 21 countries
Europe (EUR) 53 countries
South-East Asia (SEAR) 11 countries
140
este cific 27 countries

63%
120
14
54%
53%
100 10 49%
9 5
46%
6 5
10
7 7
80 34 6
37
37 31% 32%
30% 29%
60 46 4
11 40 5
6 3 5
4 24%
9 6 7
7 3
40 24 29 3
32 21 20 6
4
25 25
5 26
21 4 4 19 5
20
16 15 17 1
21 15
17 19 10
12 13
6 8 6 5 3
0
1 2 3 4 5 6 7 8 9 10
Focal point National Stakeholder Age-based Assistive Age-friendly Comprehensive Long-term Cross- Longitudinal
plan forum discrimination devices cities assessment care sectional studies
studies

*Further details on percentages by indicator and region available in the full report.
Decade of healthy ageing: baseline report – summary 16

FIGURE 7

Gap increases between life expectancy and healthy

life expectancy at age 60, 2000-2019

EXPECTANCY (YEARS) AT AGE 60

Women LE
Men LE
At age 60, the gap for Women HALE

men was 4.1 years and Men HALE

for women 5.3 years.

22

20
By 2019, this increased
to 4.7 for men and
18 6.0 years for women.

16

14

12
2000 2005 2010 2015 2019

OUTCOME AND IMPACT ON Whether this gap is increasing or decreasing, the

PEOPLE’S LIVES i po t ce o opti i i ctio i it e i s

relevant for all older people. Enabling environments
e t i e e pect c is another outcome can enhance the abilities of all older adults and can
indicator endorsed in the Decade – and is the overall mitigate the declines in intrinsic capacity that many –
i dic to o e s i t e i p ct o s ip e though not all – older people are likely to experience.
i io t ets especi te e s
reflects the extent to which years of life are spent
in good health. Efforts to accelerate improvements WHAT CHANGES COULD WE
i co p e e t e o ts to s ppo t e t EXPECT BY 2030?
ageing. However, globally between 2000 and 2019,
i e e pect c s i c e sed ste t Scenarios for the Decade engage stakeholders to
both at birth and at age 60 (shown in Figure 7). This define a shared vision and a desired future. Building
reflects an increase in the number of years in ill- scenarios can clarify what we are willing to work
health. towards.
 17

Three scenarios – deterioration, stagnation or improve-

POLICY IMPLICATIONS
ment – are considered from 2021 to 2030, anchored
to t e e fi di t t i io o de peop e e
unable to meet some of their basic needs. Working together in every country and in every
community to build and maintain intrinsic capacity,
prevent and manage existing diseases, respect
Of the three scenarios, improvement is the one that o de peop e s p e e e ces d o s d i c e se
stakeholders have committed to in the Decade. the reach of enabling environments that leave no
o de pe so e i d i co t i te to opti i i
functional ability.

SCENARIO: IMPROVEMENT • Improvement on 10 out of 10 indicators documents

an increasing worldwide commitment to healthy
i ific t i p o e e t e ecti t e i it o ageing but the level of reporting and pace of
older people to meet their basic needs relative to progress needs to be accelerated.
the baseline, a rebound after the pandemic, and
improved access to services. • e e t tes co it e ts i et c ed i
order to make older people visible.
• Person-centred integrated care and long-term
care for older people developed and provided
• New indicators could be considered prior to
as part of Universal Health Coverage (UHC)
triennial reporting periods.
• Attitudes towards older people change
positively • “What if” scenarios provide inputs to Member
t tes d ot e st e o de s de i e tio s
• Faster recovery and inclusive response,
and offer a stimulus to transform how we work
iti ti t ep de ic s dis ptio s
together.
• Accelerated improvements in the meaningful
and inclusive engagement of older people • Because benchmarking requires strengthened
country data and information systems, WHO with
• Governments, civil society and the private other partners will provide standards and tools to
secto o to et e to opti i e ctio support countries to measure healthy ageing.
ability

• Better distribution of global investments • Over the 10-year period, the tracking of

and progress. indicators through regular accumulation of data

in every country will reveal what works and what
does not, helping to shape efforts with updates
and progress reports in 2023, 2026, 2029 and a
Current levels of progress and outcome final report in 2030.
indicators, and the improvements we
have committed to by 2030, converge
on the importance of accelerating
actions and impact.
Decade of healthy ageing: baseline report – summary 18

4 Research on healthy ageing should not focus only on

health issues. New knowledge is also needed to link
the social, biological, economic and environmental
HOW COULD WE determinants of healthy ageing throughout the
life course. For that, new studies are needed with
IMPROVE BY 2030? research across countries, building on existing
networks – for instance, of household surveys –
Learning and working together to and multiple disciplines engaging older people.
accelerate impact

pti i i ctio i it o o de peop e BUILDING UP EVIDENCE TOGETHER

2030 requires that all actions taken are underpinned
by evidence and developed with older people. ep t to opti i e ctio i it (Figure 2)
Existing “evidence synthesis reviews” indicate what introduced in Section 1 addresses research, knowledge
could be drawn on for further appraisal and expert t s tio d sc e p oc si o o de peop e s
review to provide guidance on what can be done. needs and priorities. This requires leadership and
However, very few of s e isti ide i es and knowledge from a range of stakeholders in government,
evidence packages address ways to enhance older the private sector and academia, including civil society
peop e s i t i sic c p cit so epte e (such as the International Federation of Ageing and
ep e te tio d o de peop e o i fi
Figure 8 shows that only three guidelines with gaps and provide new insights to accelerate action.
a total of 14 recommendations focused on older
people, most notably the WHO Integrated Care The WHO Consortium on Metrics and Evidence
for Older People (ICOPE) package of guidance that for Healthy Ageing and the Cochrane Campbell
addresses person-centred integrated care for older Global Ageing Partnership provide examples of new
people and the domains of intrinsic capacity. and existing evidence reviews on what can be done,
addressing the main causes of disease burden in
older adults, the five domains of functional ability
de c o t e ec de s o p io it ctio e s
Gaps are also highlighted.

Optimizing functional ability of all

older people by 2030 requires that all
actions taken are underpinned by evidence
and developed with older people.
20
19
15

10FIGURE 8
Cumulative number of WHO guidelines addressing any
domain
20 of intrinsic capacity by life stage, 2009-2019
5

15
0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
10

Only three guidelines with a

total of 14 recommendations
5 focused on older people.

0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Preconception Prenatal Postnatal Infancy Childhood

Adolescence Adulthood Older age Life course Not specified

LEARNING FROM PRACTICES

Preconception Prenatal Postnatal Infancy Childhood
IN COUNTRIES
Adolescence Adulthood Older age Life course Not specified

The need to speed up actions in countries and

communities to engage older people and deliver
i te e tio s is ce t to t e ec de s c to e
e s e i p ct o peop e s i es s
we build the evidence base, we can learn from
programmes and activities around the world.
Decade of healthy ageing: baseline report – summary 20

Applying the transformative pathway (Figure 2) to Five narratives are composed to address each
opti i e ctio i it i t od ced i ectio functional ability, acknowledging that the five
evidence and programmes drawing on 350 cases are domains are interrelated.
sed to i st te e c o t e p t s co po e ts
namely: Clarify, Identify, Design & Assess, Evaluate, Ability to meet basic needs
Reach, and Accelerate Impact.
Ability to be mobile

Selected through review, agreed-on criteria and Ability to build and maintain relationships
efi e e t t e e ide ce dp o es i i t Ability to learn, grow and make decisions
actions across stakeholders and jurisdictions, found in
Ability to contribute to society.
the main report. Many actions are led by governments,
by civil society, some by the health or social care
sectors, and many by other sectors or by multiple Many activities enable older people to use their skills
sectors that have shared goals and objectives. These and talents. Some cases are pilots or programmes that
i c de icip ities s c s t ose e o i to remain to be evaluated yet provide insights on practices
WHO Age-friendly Communities and Cities. that are underway worldwide to speed up actions that
i p o e o de peop e s ctio i it

ABILIT Y
TO MEET
BASIC NEEDS

ABILITY
TO BE
MOBILE
 21

o t specific i o tio p o ides i si ts o adults have (spanning intimate partners to caring for
example, that households with older persons are at grandchildren). Apart from challenging ageism (negative
greater risk of catastrophic health spending compared attitudes, stereotyping, prejudice and discrimination
with those without, calling for universal health on the basis of age), several areas of action relate
co e et t ed ces fi ci ds ip t es to lifelong learning, retirement, pensions, work and
Innovative approaches to tackling loneliness and social e po e t Ne pp ic tio s o e p o isi
iso tio eco i et e tip e e tio s ips o de platforms that can bring together older people and
pote ti e po e s e i o de d ts to fi d e
opportunities for employment and social engagement.

ABILITY
TO BUILD &
MAINTAIN ABILIT Y
RELATIONSHIPS TO LEARN,
GROW &
MAKE
DECISIONS

ABILIT Y TO
CONTRIBUTE
Decade of healthy ageing: baseline report – summary 22

LEARNING FROM DISEASE-BASED

PERSPECTIVES KEY MESSAGES:

Cases from around the world highlight

fi ti e p oposes e i o dise se
what can be done and what we can learn
programmes – particularly approaches addressing
from each other.
noncommunicable diseases (NCDs) among older people
given that chronic and NCD conditions make up the 10 Evidence and cases highlight approaches
major causes of dis i it d sted i e e s s in to research, knowledge translation,
older people globally. The COVID-19 pandemic at the programme development and scale-up
start of this decade reveals the importance of underlying that engage older people, enable them to
conditions (mostly NCDs) which increase the risk of use their skills and talents and focus on
severe disease and death which are concentrated or furthering their abilities and well-being.
elevated among older people in many countries.
Healthy ageing in the presence of
e t ei e i es opti i i ctio i it dise se i c di N s e ects oc s
among those with disease; it also requires person- o opti i i ctio i it t it
ce t ed i te ted c e t t oc ses o peop e s also means ensuring coordinated care
c p cities d dise se e e tt t e ects that manages disease with a focus on
personal goals. Governments at all levels are promoting i di id s pe so o s
healthy ageing by reducing exposure to risk factors for
NCDs, including primary and secondary prevention Research on healthy ageing should focus
of environmental, metabolic and behavioural risks, not only on health issues.
integrating NCD treatment and management into
i e s e t co e e e efit p c es d Understanding what can be done and
alleviating individual and societal burdens. what we can learn across the life course
will contribute to improving healthy ageing
National programmes, such as in India, Mexico and trajectories that are inclusive of all ages.
t e eo i i t e p o isio o sic
screening, diagnosis and treatment services through
an integrated, multilevel approach that is inclusive of
older people. Integrated packages can promote healthy
ageing – e.g. the management of cerebrovascular health,
opportunity for healthy diet and physical activity, the
avoidance of harmful substances, and addressing
violence against older persons.

What needs to be done, and in which order, will

depend on the person and situation. All activities
must nevertheless be conducted in ways that engage
older people and overcome inequity and age-based
discrimination.
 23

POLICY IMPLICATIONS
• Some promising interventions will require further • New knowledge is needed to link the social,
evaluation and review, while in other areas new biological, economic and environmental
knowledge is needed. Building up recommendations determinants of healthy ageing throughout the life
that address all components of healthy ageing that course.
are relevant to older people will contribute to policy
dialogues during the Decade. • Evidence syntheses that capture what works to
enhance all domains of functional ability, intrinsic
• Multiple activities involving older people are capacity and environments, are also needed.
underway in many countries, underlining the
eed o s c e e e t to e eco i ed d • During the course of the Decade, WHO, with
evaluated. partners including older people, expects to have a
suite of evaluated interventions and programmes
• The emerging trend to transform disease-based that further demonstrate impact with details on
approaches into person-centred programmes what works and why.
inclusive of older people should be encouraged
and evaluated – with multiple sectors and partners, • Cases from around the world show that older people
including civil society. ed i i c e d t ei co t i tio s e efit
their families, communities and society as well as
their own well-being.
Decade of healthy ageing: baseline report – summary 24

5
2023 IS THE NEXT MILESTONE
FOR THE DECADE

A NEW DECADE OF pti i i ctio i it d cce e ti

e s e i p ct o o de peop es i es e
ACTION the main thrusts of the Decade. These also link
to s ip e i io o s: 1) one billion more
Healthy Ageing is about creating the opportunities people benefitting from universal health coverage;
that enable people to be and do what they 2) one billion more people better protected from
value throughout their lives. The report is a health emergencies; and 3) one billion more people
baseline, setting the stage for the Decade and enjoying better health and well-being.
advocating the need to accelerate actions to reach
all older people. Sustained commitment and For the first goal, accelerating impact means scaling
p t e s ips o c e e eeded to e i e t e up interventions that reach all older persons who
improvements we want to see by 2030. would benefit from universal health coverage.
For the second goal, accelerating impact must
The pathway described in the report brings the address how to respond to natural, manmade and
ec de s e e s to et e to cce e te other environmental emergencies. This includes
implementation in each area of action and to leveraging learning from the COVID-19 pandemic.
opti i e ctio i it cce e tio o i p ct And for the third goal, evidence from the report
requires policy coherence throughout WHO and shows the importance of coordinating multisectoral
alignment across the United Nations shaped by the action in cities and communities, and addressing
vision of a world in which all people can live long them from the perspective of older people.
and healthy lives. This includes coordination based
on shared values and goals, and collaboration to Before the next progress report in 2023, practical
support governments and stakeholders in countries tools are needed to design and track delivery
to implement the UN Decade for Healthy Ageing of services that address intrinsic capacity and
it ctio s t t e c o de peop e functional ability.

Sustained commitment and

partnerships for change are needed to
realize the improvements we want
to see by 2030.
 25

FIGURE 9

Development assistance for health and disease burden

in 2017, by age groups

40%
PERCENTAGE development assis t ance for health disease burden

35%
There is an opportunity to improve
30% the flow of international development
assistance for health and investments
25% at every stage of the life course, also
including older people.
20%

15%

10%

5%

0%
s

s
yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr

yr
<5

14

19

24

29

34

39

44

49

54

59

64

69

74

79

84

89

+
90
to

to

to

to
to
to

to

to

to
to

to

to
to

to

to

to
to
5

10

15

70
55
25

35

45

65
20

75

85
30

50

60

80
40

One such tool – the UHC Compendium which lists of the life course. Further insights on investment
so e e t i te e tio s i st d di ed opportunities at every stage of the life course
format – was launched in December 2020. The can identify which actions encourage positive
Compendium enables users to map interventions trajectories of development and healthy ageing (e.g.
and their associated actions according to the local building intrinsic capacity early in life, including
context and across different delivery platforms. reserves, and approaches to delaying declines and
slowing the rate of eventual declines). Country-
The flow of development assistance for health specific information on the disease burden and
(DAH) could be better matched to morbidity and healthy ageing across age groups will help to
mortality across age groups (Figure 9). Increasing identify what can be done – including reducing
funding to health system strengthening or sector- financial hardship.
wide support would benefit people at every stage
Decade of healthy ageing: baseline report – summary 26

The relevance of the Decade’s four

action areas to COVID-19
The pandemic at the start of this decade sharply underscores the importance of concerted,
sustained focus, investment and action to foster healthy ageing. It also highlights the relevance
o t e ec de s o ctio e s to ide tc e do e

Changing how we think, feel and act Delivering person-centred, integrated

towards age and ageing care and primary health services
responsive to older people
The Decade provides an opportunity to
engage the media, update information and Scaling up person-centred, non-discriminatory,
foster solidarity among generations, drawing accessible and integrated care for older people
attention to negative stereotyping, prejudice and will require investment in and transformation
discrimination because of age, and to violence of health systems. This requires involving older
against older people, including during isolation people in clinical trials, developing new technologies
and restricted movement. “No person, young or and practical application of telehealth/medicine,
older, is expendable.” and working with non-health sectors to create
opportunities for people to build and maintain
capacities and abilities.

Developing communities in ways that Providing older people who need it with
foster the abilities of older people access to long-term care

Existing infrastructure in cities and communities To increase the availability of long-term care, the
must be leveraged to identify those at risk, Decade can draw lessons from the pandemic –
disseminate information, meet basic needs, i c di o to p io iti e t e testi d
ensure social support and health and social vaccination of older people in such settings – and
care. Collaboration is needed with local e d to co c ete ctio s to e i e s st i e
service providers, businesses, civil society and equitable long-term care services, including at home
co it o i tio s to p ess e d it and in communities.
action to interrupt transmission of COVID-19
and mitigate its secondary impacts.

Other opportunities to align commitments to those

in the Decade should be relentlessly pursued.
 27

NEXT STEPS The next steps will increase cooperation across

stakeholders and partners in order to facilitate
This baseline shows that at least 142 million older coordination and implementation at the country
persons are unable to meet their basic needs. As the level. It will also increase the visibility of older people
number of older people worldwide increases during within the indicators and targets of the Sustainable
the Decade, the report urges us to work together Development Goals and other international policy
to ensure their needs are met and to foster the instruments and support countries to monitor Healthy
elements that contribute to their well-being. Ageing. These will contribute to the 2023 progress
report for the Decade, that is expected to coincide
Tracking progress throughout the Decade will take with the conclusion of WHO’s Thirteenth General
stock of the vision and the action areas, and will Programme of Work and will be aligned to the Fourth
continue to extend other WHO and UN global policy Global Review of the Madrid International Plan of
instruments to include older people and support Action on Ageing.
national policy development. Progress reports on the
implementation of the UN Decade of Healthy Ageing We must work together to ensure that all basic
2021-2030 will be compiled by WHO in collaboration needs of older people are met, and to foster all
with the United Nations Department of Social and abilities that contribute to older people’s well-being.
Economic Affairs, the United Nations Population This is what healthy ageing is about and what we
Fund, other UN offices, departments and specialized are collectively committed to accelerate during the
agencies, and relevant stakeholders – including Decade in order to achieve inclusive societies where
international and regional organizations, civil society, older people are drivers of change – a world where
the private sector, academia and the media. all people are accepted at every age and all are able
to be and do what they value throughout their lives.

We have committed, within the

Decade, to work together, with older
people leading the way, to transform
societies to achieve the same freedom
for all people.

The World Health Organization acknowledges

financial support from the Velux Stiftung to prepare
the Decade of Healthy Ageing: Baseline Report
including this summary.
DECADE OF
HEALTHY AGEING
2021-2030
BASELINE REPORT SUMMARY

At least 142 million older persons Optimizing functional ability is a key to
worldwide are unable to meet their basic healthy ageing.
needs. Inequities of gender and education
contribute to differences within and A wealth of evidence and cases from
between countries. around the world highlight what can be
done, and what we can learn from each
Governments and other stakeholders other. This includes what we can evaluate
need to invest in data to monitor healthy better and how we can reach and engage
ageing across the life course. Only 25% more older people.
of Member States have limited,
comparable data.

Actions must be accelerated

to make a measurable impact
on older persons by 2030.
Older people must be engaged
at all stages.

For more information,

please contact:

Department of Maternal, Newborn,

Child & Adolescent Health & Ageing

World Health Organization

Avenue Appia 20
CH-1211 Geneva 27
Switzerland

Fax: +41 22 791 4853

E-mail: healthyageing@who.int
https://www.who.int/teams/
maternal-newborn-child-adoles-
cent-health-and-ageing