About the authors:
Louise Plouffe, PhD, is director of research, ILC Canada. A gerontologist and public policy analyst, Louise coordinated the World Health Organization (WHO)’s research on age-friendly cities and wrote the WHO age-friendly cities guide. She chairs the steering committee of Age Friendly Ottawa as a volunteer.
Margaret Gillis is president, ILC Canada. An award-winning executive and the founding president of ILC Canada, Margaret played a key role in establishing the age-friendly community program in Canada and internationally; this program is now in over 900 Canadian communities.
International Longevity Centre (ILC Canada) is an independent think-tank providing policy research and advice on matters of an aging society and the wellbeing of older persons, in affiliation with the Faculty of Health Sciences, University of Ottawa"
The old adage “An ounce of prevention is worth a pound of cure” is true in all areas of life but especially when it comes to health, particularly as we advance in years. A lifetime of healthy behaviours, material security, positive relationships and meaningful activity leads to a vital and engaged older adulthood – and lowers the need for acute or long-term health care services. The Canadian Institute for Health Information reported unequivocally that the use of health care services is related to the presence of chronic disease, not age per se,[i] thereby debunking the myth that an aging population necessarily drives up health care use and costs. The key is to keep people healthier throughout their lives by acting on the factors outside of the health care system that determine health. Another advantage of staying healthy is that people who have good basic health respond better to medical intervention than those in poorer health. A recent article in the Journal of the American Medical Association[ii] shows that people with the lowest incomes have a longer life expectancy in rich, progressive cities designed to promote physical activity and discourage smoking.
Canada is recognized worldwide as a leader in health promotion policy. This recognition started when the Ottawa Charter for Health Promotion[iii] was signed in the 1980s and the population health framework[iv] was developed in the 1990s, which focused attention on the social determinants of health. Health promotion is an important public health strategy at all levels of government. However, we have learned from many years of experience working in federal health policy that health promotion programs have overwhelmingly targeted children and youth and have paid insufficient attention to mature adults and seniors, despite evidence showing the effectiveness of health promotion interventions for older persons.[v]
The introduction of the age-friendly cities initiative in 2007 has been a positive development in health promotion for seniors in Canada and around the world. Developed by the World Health Organization (WHO) in 2006[vi] in collaboration with partners in 33 cities in 22 countries, including Canada, the goal of the project was to identify the essential characteristics of cities that promote active aging (defined by WHO as “the process of maximizing opportunities for health, participation and security over the life course in order to enhance quality of life as people age”[vii]) and to stimulate community development to make cities more age friendly. The WHO age-friendly cities guide[viii] discusses the enabling urban features and the barriers experienced by older adults in eight areas: outdoor spaces and buildings, transportation, housing, social participation, employment and civic participation, respect and social inclusion, communication and information, and community support and health services. This guide has given rise to initiatives around the world, such that the WHO Global Network of Age-Friendly Cities and Communities now includes 209 municipalities in 26 countries, in addition to 10 affiliated state or national programs.[ix] In Canada, over 900 communities in all 10 provinces are taking action to become more age friendly in all or many of the eight areas.
An age-friendly community promotes health, participation and security for seniors and for persons of all ages. For example, low-floor buses provide easier access for both seniors and people transporting a child in a stroller. A mixed-services neighbourhood encourages people of all ages to do errands on foot. The ambiguity of the term age friendly was part of the reason this term was chosen for the initiative, although the core target group of the initiative is seniors and they are actively involved in the initiative’s efforts.[x] The WHO guide gives a good picture of what an age-friendly community is like: it
- recognizes the wide range of capacities and resources of older people;
- anticipates and responds flexibly to aging-related needs and preferences;
- respects the decisions and lifestyle choices of older adults;
- protects those who are most vulnerable; and
- promotes the inclusion of older adults in, and their contributions to, all aspects of community life.
So what are Canadian communities doing to become more age friendly? Specific activities vary from community to community, but many are similar. More attention is being paid to maintaining sidewalks in good repair, adding benches in public areas, modifying crosswalks at intersections for slower pedestrians and making city buses more accessible and affordable for older riders. City parks are starting to feature exercise displays and equipment for adults. Streets are being redesigned to promote safe walking and cycling and to slow down traffic. Accessibility and safety equipment are becoming more common in new social housing, and community housing options are being explored, such as small cooperative arrangements. Community outreach and social programs are being targeted to isolated seniors, and more social activities are being designed to bring younger and older generations together. Communities are providing more information to seniors in accessible formats and venues. Health-related actions include “better balance, better strength” falls prevention classes and health literacy programs. The list goes on. Innovative activities are being shared among communities in Canada and promoted internationally by the WHO Global Network of Age-friendly Cities and Communities.
The WHO World Report on Ageing and Health[xi] sets out a global policy framework to transform health systems to deliver appropriate, high-quality and sustainable care for aging populations. Developing age-friendly communities is one of the five components of the WHO strategy. As a world leader in age-friendly community planning, Canada is well placed to make this a pillar of a national health plan for older Canadians. The health care system supports, protects and restores health at all ages, but health is created in our homes and communities.
[i] Canadian Institute for Health Information. Health care in Canada 2011. A focus on seniors and aging. Ottawa: The Institute; 2011.
[ii] Chetty R, Stepner M, Abraham S, Lin S, Scuderi B, Turner N, et al. The association between income and life expectancy in the United States, 2001-2014.JAMA 2016;315(16):1750–66. doi:10.1001/jama.2016.4226.
[iii] World Health Organization. The Ottawa Charter for health promotion. Adopted on 21 November 1986. Available: www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html
[iv] Evans RG, Stoddart GL. Producing health, consuming health care. Soc Sci Med 1990;31(12) 1347–63.
[v] Haber D. Health promotion and aging. 7th ed. New York: Springer Publishing Co.; 2016.
[vi] Plouffe L, Kalache A. Towards global age-friendly cities: determining urban features that promote active aging. J Urban Health 2010;87(5):733–9. doi:10.1007/s11524-010-9466-0.
[vii] World Health Organization. Active ageing: a policy framework. Geneva: The Organization; 2002.
[viii] World Health Organization. Global age-friendly cities: a guide. Geneva: The Organization; 2007.
[ix] Plouffe L, Kalache A. A critical review of the WHO age-friendly cities methodology and its implementation. In: Moulaert T, Garon S, editors. Age-friendly cities and communities in international comparison. New York: Springer Publishing Co.; 2015. p. 19–36.
[x] Kalache A. Active ageing and age-friendly cities – a personal account. In Moulaert T, Garon S, editors. Age-friendly cities and communities in international comparison. New York: Springer Publishing Co.; 2015. p. 65–77.
[xi] World Health Organization. World report on ageing and health. Geneva: The Organization; 2015.