Encyclopedia of Gerontology and Population Aging

Living Edition
| Editors: Danan Gu, Matthew E. Dupre

Healthy Aging

  • Christian AspalterEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-69892-2_409-1
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Synonyms

Definition

In recent years, the concept of healthy aging is understood to stand for the absence of limitations, pain, disease, disabilities and frailty, plus the acquisition, the extension and maintenance of functional abilities (WHO 2015a; Full Life Care 2019; see also “Aging Well” in this volume). Hence, today’s healthy aging crises is crises of (A) not doing enough in the realm of staying healthy, that is, extending one’s functional abilities (emotional strength, intellectual ability, musculoskeletal strength, developing and keeping a strong immune system, as well as keeping the ability of getting a full night’s sleep), and (B) not doing enough to ward off “the gradual accumulation of a wide variety of molecular and cellular damage. Over time, this damage leads to a gradual decrease in physiological reserves, an increased risk of many diseases, and a general decline in the capacity of the individual” (WHO 2015a: 25).

Since most disorders of old age (and the vast majority of noncommunicable diseases) are preventable and most of their determinants begin much earlier in life than most of us think, we need to focus, first and foremost, on effective social policy and health policy strategies for the prevention of pain, diseases, disabilities, and the degree of and early onset of frailty, as well as the prevention of decline in individual human capacities and abilities (WHO 2017; McPhee et al. 2016; UN 2015; Kuh et al. 2013). Without healthy aging, a high quality of life, or any decent quality of life, becomes nothing more than a pipe dream, a fictional reality. The very essence of successful aging and active aging – which are key concepts needed to understand aging with a high quality of life – on top, are built upon the foundations of healthy aging. That is to say, healthy aging is always the precondition of active aging and successful aging and hence aging with a high quality of life (see “Active Aging”; “Successful Aging 2.0”; “Quality of Life” in this volume).

Overview

As with concepts like social quality and high quality of life, the concept of healthy aging still needs a great deal of further clarification (Beck et al. 2001; Walker and Mollenkopf 2007; Aspalter 2020a), as well as a greater focus on core issues and core fields related to key problems in healthy aging policy (or the lack thereof). This is due to especially the open-ended nature and lack of theoretical foundations or theoretical framework (Walker 2013: 573) in the world of healthy aging research. “There needs to be a better, shared understanding of how individuals’ health and well-being are shaped by multiple factors and how the risk of ill health can accumulate across life stages and generations. One obstacle is the current focus on single diseases or specific age groups, rather than holistically addressing health throughout life” (Kuruvilla et al. 2017: 1).

Social policy as we know it (today) is highly curative-oriented. Social security systems around the world (Aspalter 2017a) are not primarily, not mainly, not even partially, in terms of system design and the institutional set-up, focused on prevention of poverty, disease, inability, frailty, and so forth. Taking for example the case of cancer, experts today estimate that, for example, about 90–95% of cancer are entirely preventable if one takes care and manages to prevent all preventable factors that cause cancer and/or decrease the body’s immune system to the extent that it causes cancer, from a life-time perspective (Anand et al. 2008; also, e.g., Physicians Committee for Responsible Medicine 2018; Cancer Research UK 2018; Noone 2018). In addition, “… chronic conditions such as diabetes, arthritis, and hypertension … affect older adults and account [for example] for 95% of healthcare cost for U.S. older adults” (Association of State and Territorial Health Officials 2019: 1).

There is an obvious need to fight diabetes (and with it also Alzheimer’s disease, see Health Line 2019; Mayo Clinic 2017; Michel et al. 2016), arthritis (see Arthritis Foundation 2019), cardiovascular diseases, asthma, cancer, as well as frailty from mid-life onwards. Changing life habits and lifestyles at midlife (or before that) has monumental effects on health throughout the life-course, and particularly, in later stages of life, that is, in old age. However, it is never too late to join the fight against unhealthy aging – and in particular frailty, which is mainly the result of sarcopenia (the loss of musculoskeletal strength) and the loss of functioning of the immune system, that is, immunesenescence (e.g., McPhee et al. 2016; Rizzuto et al. 2012).

Sarcopenia is related to (a) a sedentary lifestyle, (b) malnutrition (eating the wrong kinds of food and/or not eating enough or enough the right kinds of food during mid-to-old age), as well as (c) other, biological processes related to aging. Immunesenescence in return is too a large extent the outcome of chronic inflammation (due to eating too much red meat, refined carbohydrates that have a high glycemic index, hydrogenated vegetable oils, fried foods; eating too less vegetables, fruits, herbs and spices; drinking alcohol; smoking and second-hand smoking; prediabetes and diabetes, and leading a sedentary lifestyle, etc.). Frailty is a process that can start as early as in one’s thirties (Cruz-Jentoft and Sayer 2019; Web MD 2019; Wilson et al. 2017; Yaneff 2017; Michel et al. 2016; Martorana et al. 2012; Seene and Kaasik 2012; Li et al. 2011; Time Magazine 2004).

For the most part, the knowledge and the education needed for living better lifestyles and making better daily life choices are not available. Even medical doctors are still learning lot of new insights into the making of cancer, or any other medical condition or disease, as about every 5 years half of all medical knowledge becomes out of date (Pils 2015). Therefore, it is important to start with the basics (as much, and as short, as possible) and works its way to a not-too-large number of policy strategies that can guide policies and policy-making on the ground in every single country, region, city, or community/neighborhood around the world (see “Aging Policy Ideas”). At the same time, it is crucial to apply a lifetime and life-course oriented perspective (American Geriatric Society 2018; Walker 2018a, b; Foster and Walker 2015; WHO 2011, 2002; Ministry of Health, British Columbia 2005; see “Life-Course Approach” in this volume), trying to replace the current general mainstream approach that pursues a mainly curative perspective and curative policies (e.g., Boudiny 2013) with a comprehensive (and theory-based) preventative-cum-curative approach that focuses on different stages of people’s life at the same time (hence, applying a life-cycle perspective in social policy). That is to say, healthy aging policy, in order to be successful at all, must be applied to people of all ages; it must be lifespan-oriented.

Such an approach is indispensable and must lead the way into the future down the road deeper into the twenty-first century. A preventative-cum-curative lifespan-based approach is much more effective in achieving better health outcomes for people of all ages, as well as far greater efficient and with it financially sustainable (Aspalter 2020a; AGS 2018; Giefing-Kröll and Grubeck-Loebenstein 2019; Walker 2018a, b; Kuruvilla et al. 2017; Cesari et al. 2016; McPhee et al. 2016; UN 2015; Foster and Walker 2015; Katz 2013; Kuh et al. 2013; Balbus et al. 2013; Kemp 2012; Ruppe 2011; WHO 2002, 2011; Bovenberg 2008; OECD 2007; Darnton-Hill et al. 2004). One, if not the largest, problem with solving the lack of healthy aging conundrum is the perception that age is the problem, that age is a burden for society, economy, and government altogether. When looking closely, Table 1 clearly demonstrates that age is not the problem, but (a) unhealthy aging, or the lack of healthy aging, combined with (b) not being prepared for the onset and scope of societal aging clearly is (e.g., FLC 2019; Gietel-Basten 2017; Oxley 2009; Knickman and Snell 2002).
Table 1

Relative healthy aging performance by country (and rank)

Rank

Country

Relative healthy aging performance

Rank

Country

Relative healthy aging performance

1

Singapore

100.000

20

Denmark

39.824

2

Cyprus

77.691

21

Korea, S.

39.583

3

Japan

51.255

22

Netherlands

39.356

4

Spain

49.057

23

Germany

39.058

5

Costa Rica

47.653

24

Portugal

38.987

6

Maldives

45.057

25

UK

38.604

7

Iceland

44.405

26

Cuba

37.399

8

France

44.320

27

Luxembourg

36.449

9

Israel

44.022

28

Australia

36.364

10

Greece

43.809

29

Belgium

35.853

11

New Zealand

43.639

30

Finland

34.619

12

Panama

43.540

31

Sweden

32.463

13

Malta

42.958

32

Croatia

30.762

14

Norway

42.788

33

Qatar

26.025

15

Canada

41.951

34

Chile

25.386

16

Italy

41.951

35

USA

24.025

17

Ireland

40.973

36

Czechia

22.252

18

Austria

40.505

37

Slovenia

18.792

19

Switzerland

39.881

38

Bahrain

0.000

Note: calculated based on WHO 2019; Life Expectancy (LE) rates have been standardized; Healthy Years of Life Lost (HYLL) have been calculated and then standardized and reversed, both have been added and standardized again (so that highest value is 100, and lowest value is 0). The distance between countries performance is exactly relative to the performance in real life, in terms of LE and HYLL (among the group of 38 countries included, which are all countries with a LE of 78 and above). The performance in terms of LE and HYLL is weighted equally

It is very important to understand that increased life expectancy does not necessarily have to lead to higher rates of diseases and disabilities among the population, or higher costs related to health care, long-term care, and social care services in general. Figure 1 and Table 1 show that there are clear positive deviant cases, such as Singapore – with a life expectancy (LE) of 82.9 years, and the number of healthy years of life lost (HYLL) of 6.7 years – and Cyprus – with an LE of 80.7, and HYLL of 7.4 years. Japan, in relative distance, is already far behind and just about leads the pack of other developed countries. The distance in terms of relative performance with regard to healthy life expectancy and healthy years of lives lost is tremendously great between Singapore and Japan, with Cyprus falling more or less exactly in the middle of the two. The performance of Spain is interesting, indeed, placing itself right behind Japan (in terms of both life expectancy and healthy years of life lost). Sweden only finds itself towards the bottom of the 38 countries included (which are all countries worldwide with a life expectancy of 78 years and above) with a life expectancy of 82.4 years, combined with a relatively very high number of healthy years of life lost, that is, 10 years. The United States performed even lower, being ranked 35 out of 38 countries, as the United States have – for a fully developed country – relatively very low life expectancy of 78.5 years, with also 10 healthy years of life lost (Table 1), which is very troubling indeed, to a double extent.
Fig. 1

Healthy years of life lost since birth and life expectancy at birth (183 countries) (Note: Vertical axis shows the number of healthy years of life lost since birth (HYLL), and the horizontal axis life expectancy at birth Source: calculated based on the World Health Survey in 2019)

Singapore is an extremely positively deviating case, and to such an extent that one has to wonder and (the duty to) ask, why Singapore can achieve such high rates of live expectancy at birth combined with such a low number of unhealthy life years among them. Aspalter (2017b, c) has in detail addressed this issue and, hence, shown that the use of a comprehensive provident fund system instead of a health insurance and long-term care insurance system has changed individual incentives and choice-making to such an extent that Singapore is the only advanced country in the world with highest rates of healthy and overall life expectancy, while spending only 4.7% of GDP on its health care system. Singapore’s health care and overall social security system is not “socialized,” but it is for the very most part publicly controlled and/or managed. Up to 25% of total health care costs are subsidized by the government to support social harmony and social quality, and 72% of all hospital admissions are in publicly owned hospitals (Gauld 2012). In a nutshell, we need to learn from Singapore’s social security system, and its intrinsic incentives to live healthy lifestyles and make good life decisions all the way from young age, to mid-age, to older age. Social insurance systems can rather easily be replaced with provident fund systems: by converting cumulative benefit entitlements into cash per person, on an individual savings account, with perhaps an additional starting bonus, or bonuses, given by the government.

China, Sweden, and Italy have for example shown, to some extent, the way forward, while they still are holding back on the full replacement of social insurance systems with provident fund (or nonfinancial/notional defined-contribution) systems (Holzmann et al. 2012, 2013). Longer lives are a reason to celebrate, a reason to be proud of – for oneself, for one’s loved ones, or for the community and society one lives in (Beard et al. 2017; WHO 2011, 2015a, 2017). Higher average number of years lived are proof to a higher level of social development that a society or country has achieved. “Longer lives are an incredibly valuable resource, both for each of us as individuals and for society more broadly. Oder people participate in, and contribute to, society in many ways, including as mentors, caregivers, artists, consumers, innovators, entrepreneurs and members of the workforce” (WHO 2017: 3).

All government and nongovernment actors, in addition, need to do away with wrong perceptions of what the problem with aging is – it is not the process itself, not the number of people over 65 years of age, not the number of years since birth that one has lived so far (i.e., age is just a number, aging does not occur in a linear or consistent fashion). The real problem is living unhealthy (and not living healthy), making too less healthy life decisions and choices (and making too many negative decisions and choices), as well as not being prepared for later stages in life (financially, socially, psychologically, etc.) and not having access to state-of-the-art health care services and/or sufficient and appropriate long-term care services.

The Importance of Key Objectives in Healthy Aging Policy: Towards a Lifespan-Oriented, Preventative-cum-Curative Approach

One can be very creative in healthy aging policies, for example, by focusing on establishing laughing seminars (like in India and elsewhere), cooking seminars and daily outdoor dancing groups near people’s home (like in China), or using folk music, theatre, and soap operas to educate the general public on health issues, like causes of and remedies against prediabetes, cancer, frailty, etc. (Aspalter 2015, 2017c, 2018). But the core ambitions of healthy aging policy worldwide, and anywhere really, need to stay within a certain range and number of quantifiable and traceable policy objectives. Only in this way, policymakers and leaders at all levels of government can assure themselves and the ones they are ultimately accountable for (i.e., the people, as well as their superiors) that these core ambitions bring home policy objectives of living a long and very healthy life, at high levels of quality of life (Fig. 2) (see “Aging Policy Ideas” in this volume).
Fig. 2

The “Healthy Aging Policy Quadrant”: The core ambitions of healthy aging policies (Source: based on WHO (2011, 2015a, 2017) and Aspalter (2020a). Notes: also refer to the findings of Stephens and Breheny (2018); WHO (2015a, 2017, 2018a), Kuruvilla et al. (2017); Sowa et al. (2016); Sadana et al. (2016); Seene and Kaasik (2012); Sen (1999))

If one asks (or simply listens to) older people what concerns them most, and if one is doing it again and again, one may find out that – for most of them – disease and pain, and with it disability and frailty, are the greatest concerns troubling and impeding their daily lives, for the rest of their lives. To prevent, reverse, lessen, delay, and relief diseases, pain, health limitations, disabilities, and frailty are at the very top of their priority list (Cesari et al. 2016). Only the ones that live a very healthy life, and are mostly trouble free in terms of health conditions, and in good physical, psychological, and mental state, are the ones that are primarily preoccupied with finding one’s passions in life: be it in practicing art, community volunteering, yoga, Pilates, or watching theatre, opera, orchestra performances, joining community clubs (dancing, singing, music, folklore, ice-stock shooting, bowling, etc., clubs), or organizing community festivals, and so forth (Sartariano et al. 2012). These capabilities are very important to all of us, as individuals and as society (See “Aerobic Exercise Training and Healthy Aging”; “Late Life Creativity”; “Leisure Activities and Healthy Aging”; “Yoga Practice and Health Among Older Adults” in this volume). But if different forms of advanced arthritis or frailty – in all of their life-capacity reducing ways – are present, these capabilities do play a secondary role (if at all), in relative terms. Hence, there is priority of policy objectives at hand (Fig. 3). We need to achieve healthy lifestyles and life choices (at least for a much larger share of the population, at least to a much larger degree), in order to avoid levels and early onsets of disabilities, diseases, pain, and frailty, in order to successfully defend, sustain, and develop all important intrinsic human capabilities, as well as all other crucial social, cultural, and economic capabilities.
Fig. 3

The order of importance in healthy aging policies (introducing a Maslow-style hierarchy) (Note: Based on the Healthy Aging Policy Quadrant (see above), for the general idea of the Maslow-Pyramid, also Maslow (1943, 1987); “other abilities” stands for outdoor/out-of-house activities and participation in nature and society (Aspalter 2020a; Cesari et al. 2016; WHO 2015a, 2017, 2018; Seene and Kaasik 2012))

There is a high discrepancy with regard to the levels of healthy life expectancy in between developed and in between developing countries, in the world, with a few very positive deviant cases, and among which Singapore stands out like the north star. While (1) economic factors, (2) the application of universal access to health care systems, and (3) the increase in health care providers (particularly doctors, nurses, and a closely-knit and evenly distributed network of hospitals, clinics, and general practitioners) that by and large, but not consistently (not at all), comes along with economic growth are major overall factors determining outcomes of healthy aging, the greatest differences of healthy life expectancy and good health between different people in higher age are fundamentally based on individual behavior (e.g., MHBC 2005; WHO 2017). For the very most countries and societies, the largest health discrepancies are between different people of the same population, as the main culprits for ill-health, especially in old age, are still smoking tobacco or being exposed to second-hand smoke, drinking (too much) alcohol, eating too much food, eating the wrong kinds of food (and not eating the right kinds of food), and, last but not least, exercising (or being physically active) far too less than one should.

While there is a cumulative impact of socioeconomic determinants throughout one’s life-course (WHO 2017), there is also an even greater progressive (see below) cumulative causation between individual lifetime behavior on the one side, and ill-health and the lack of an individual’s capacities throughout the life-course and particularly in higher age on the other. Figure 4 demonstrates the universal truth is that our body remembers everything, all the good things we do (and we don’t do), and all the bad things we do (and we don’t do), like a bank account. It is for this reason, we must come to understand that health is a cumulative affair of our own making, while the economic development and the often accompanying extension of health care services and access to it form a secondary (yet still very important), additional layer of health protection and security.
Fig. 4

The “Healthy Aging Balance Sheet” (that determines the existence, length and quality of healthy aging) (Note: ∗which in the following reinforce, speed up and strengthen each other, leading in return to a negative domino effect of health problems, that is, co-diseases and co-morbidities (or multimorbidities); for the importance of individual behavior in healthy aging policy, as well as chronic inflammation, refer to some, for example, Pan-American Health Organization 2019; Government of Ireland 2017; WHO 2017, Beard et al. 2016; Sadana et al. 2016; Cesari et al. 2016; Sowa et al. 2016; Michel et al. 2016; UN 2015; Martorana et al. 2012; TM 2004; Crystal et al. 1990; also see “Life-Span Development” in this volume)

In response to the rise of modern risk society, Beck (1986, 1999) proposed the most important solution to most problems and risks modern societies of Second Modernity (i.e., postindustrial society, prior to the arrival of artificial intelligence in day-to-day life) and Third Modernity (i.e., postindustrial society, since the arrival of artificial intelligence in day-to-day life) (Aspalter 2020b): that is, basically, to increase the quantity and quality of useful education and knowledge. Kelly and Barker (2016), in addressing the very same solution to modern public policy and health policy in particular, arrived at a rather dim conclusion and outlook, that is, that for the very most part alcohol, dietary and physical inactivity-related disease prevention in the past were not very successful, or failed to change behavior to a significant extent. This is so, because simple health and disease-related education or knowledge is not enough. There are other key factors that need to be taken into consideration (e.g., GOI 2017). Only by doing so, one can expect to be much more effective and efficient in implementing preventative health policies, and healthy aging policies here in particular. The following equation may demonstrate the quite a bit more complex problem constellation at hand:where HAnew stands for today’s (or this year’s) balance of health credit or health debt, and HAold stands for yesterday’s (or last year’s) balance of health credit or health debt, while the other variables also refer to yesterday (or last year).

Hence, this equation above sharply points out the effect of progressive cumulative causation of increased health knowledge and health education over time, that is, over one’s life course (GOI 2017; McPhee et al. 2016; Mirowsky and Ross 2005). Both X and Y stand for education and knowledge (X stands for new education and knowledge over time, Y stands for new major education and knowledge events, for example, diagnosis of one’s own or one’s family member’s disease) – while G stands for one’s age, which translates to one’s life experience and with it the willingness to learn and accept health knowledge and health education. R stands for reluctance, which is referring to the problem of human inertia (e.g., Oliver 2019; Webpsychologist 2014). AC is the variable for access to health care services and health-related social services, such as long-term care services (WHO 2017, 2015a). SE on the other hand factors in the impact of a supportive environment, or the lack thereof.

A supportive environment includes: (1) the natural environment (hiking and walking paths, lakes to swim in and free access to it, including toilets, shower facilities, changing clothes facilities, etc.) (Aspalter 2020a); (2) the physically built environment (buildings, ramps, elevators, park benches, railings, etc., availability of nearby shops, doctors’ practices, parks, as well as the availability of retirement homes that provide dignity and a homely atmosphere nearby one’s original home, etc.) (Aspalter 2020a; WHO 2018a, b; Mooney et al. 2017; Kuruvilla et al. 2017; Golant 1984, 2011, 2015; Rowles and Bernard 2013); and (3) a friendly and supporting social environment (e.g., Aspalter 2020a; Age in Place 2019; Singer 2019; McPhee et al. 2016).

Healthy Aging and Policy Making

The greatest theory, however popular it may turn out to be, is worth nothing if policymakers and administrators on the ground cannot translate these policy concepts and strategic recommendations into concrete, realistic and feasible, policy proposals and programs, or have great difficulties doing so. There is no need to reinvent the wheel of how to do social policy, health policy, or healthy aging policy, but there is dire need to add new wheels and newly designed wheels to the wagon (of healthy aging policy) that currently has great difficulty catching up with new developments on the ground and solving problems of the past. “There is … little evidence to suggest that older people today are experiencing their later years in better health than their parents. While rates of severe disability have declined in high-income countries over the past 30 years, there has been no significant change in mild to moderate disability over the same period” (WHO 2019: 1).

As of today, experts from around the world point to the fact that up to 95% of modern mass diseases (i.e., noncommunicable diseases) are being caused by lifestyle choices and personal habits and/or the lack thereof (e.g., CRUK 2018; PCRM 2018; Noone 2018; Galaviz et al. 2018; Marsa 2018; National Cancer Institute 2017; Beat Cancer 2017; Better Breast Health for Life 2015; Asif 2014; Anand et al. 2008). Here are a number of key healthy aging strategies and policies that can be derived from the above analysis:
  1. 1.

    From Ulrich Beck’s theory of risk society, which continues on now in the early period of Third Modernity (starting in the year 2016, Aspalter 2020b), we learn that the core activity of any healthy aging strategy must be to provide each individual, regardless of their age – as early as possible, and on a continuous – repeating basis with as much updated health knowledge and health education as possible (e.g., GOI 2017; Cesari et al. 2016; Mirowsky and Ross 2005).

     
  2. 2.

    The government (at all levels of government) needs to employ the method of conducting and orchestrating a continuous barrage of advertisements in the public interest (APIs) covering all forms of media (including social media, online advertising, and advertisements in computer games) to educate all of the population, starting from early ages, on the merits of making the right food and exercise choices, including the why and the how of doing things in the right way, and how to check and assess one’s own health risks and conditions (e.g., GOI 2017; Cesari et al. 2016; Mirowsky and Ross 2005). These APIs can be legislated to become mandatory, that is, free-of-charge for the government (or paid for by government, if the government wishes to do so, as in the case of Hong Kong, ISD 2019).

     
  3. 3.

    Another arm of a major health knowledge and education offensive of each government is the use of formal education (by adding health classes) and continuing life education (by, e.g., seminars, etc.) to teach knowledge and skills about food and cooking, diseases, co-morbidities, aging in general, and how to avoid aging stereotypes and aging discrimination, etc. (e.g., GOI 2017; Kuruvilla et al. 2017; Cesari et al. 2016; Sadana et al. 2016; UN 2015; Mirowsky and Ross 2005; Also see “Senior Learning” in this volume).

     
  4. 4.

    In order to increase acceptance of information (knowledge on health and diseases, etc.) provided, a key weapon needs to be early diagnosis of all major kinds of noncommunicable mass diseases (or modern mass diseases), including formerly neglected and pushed aside issues and problems like the rising tsunami of early diabetes (i.e., prediabetes, which is really the first stage of diabetes, Balbus et al. 2013). In China, for example, 35% of the population suffer already from prediabetes, pushing up the total number of people suffering from this first stage of diabetes (i.e., prediabetes), and beyond, to about half of the total population of China (Science Direct 2017). In emphasizing very early diagnosis on a mass scale, a much greater number of people respond to (welcome, accept and digest) health education, which concerns them now personally (or their loved ones, or friends, relatives, neighbors, work colleagues around them) to a much greater extent, and much faster.

     
  5. 5.

    A key strategy for healthy aging needs to be providing universal access to health care security systems for all of the population all around the world, for example, on the basis of smart universalism – combined with health care and long-term care provident funds, top-up schemes, and general supply-side investments in health care and long-term care services by the government (Aspalter 2017a, b; Midgley and Aspalter 2017; UN 2015).

     
  6. 6.

    In addition, it is fundamentally crucial – and indispensable – to alter the system logic regarding incentive systems of health care security systems: by switching from health insurance and long-term care insurance systems to Singaporean-style provident fund systems that also include system features, like certain voluntary additional insurance elements, as well as top-up schemes that redistribute resources; apart from subsidizing overall health care provision by additional major direct government subsidies, as in the case of Singapore (e.g., Teo 2017; Aspalter 2017b; UN 2015; Gauld 2012; Lagarde et al. 2010; Low and Aspalter 2003; Low and Aw 1997).

     
  7. 7.

    Apart from increasing health education and knowledge (and the acceptance thereof) and providing universal health security coverage with positive, health-encouraging individual financial incentives (Aspalter 2017b, c), supply-side investments in health care providers (and systems), governments also need to focus on providing a positive natural and physical environment and free universal access to it in order to truly support the development of people’s abilities (Aspalter 2020a, WHO 2015a, 2017, 2018a, b; Mooney et al. 2017; Golant 1984, 2011, 2015; Rowles and Bernard 2013). This approach in normative social policy is called environmental social policy (Aspalter 2014, 2015; Midgley and Aspalter 2017). Free-of-charge national parks, hiking paths, access to lakes and beaches for swimming, camping areas (including all-year-around camping facilities), zoos, public sports spaces, public playgrounds for physical exercise (for all people, but older people in particular) with blanket coverage, etc., are still, for the very most part, neglected or nonexistent in national and international healthy aging policy. It is not enough to have older-people-friendly buildings and sidewalks (Aspalter 2020a; Zheng 2018).

     
  8. 8.

    Recent initiatives around the world to provide greater integrated health and social care (like, e.g., in Japan or Sweden) are promising steps in the right direction. Especially, the case of Japan is worth mentioning here with a new kind of “one-stop-shop” approach where doctors nearby people’s homes are taking on the jobs of multiple health care and other care providers (generalists, specialists, end-of-life care provider, etc.), while also linking up their services with other professionals (e.g., other specialists, specialized social workers) – hence providing long-term, close-up, and all-around services that transcend the traditional limited role of health care providers, now also including nutrition counseling, etc. Best practices and positive experiences and developments with regard to programs and practices on the ground need to be shared around the world, and in time scaled up and spread across the world (Yokokura 2018; GOI 2017; Andersson Bäck and Calltorp 2015). This is especially important with regard to age-in-place (at home or in people’s communities) policies and programs, which, for example, is a core element and distinguished positive feature of the current Austrian long-term care system (Leichsenring 2017) (see “Aging in Place”; “Aging in Place and Quality of Life”).

     
  9. 9.

    International and national government actors need to foster current international cooperation in healthy aging policies and increase the scope and intensity thereof, especially under the umbrella of the World Health Organization, and other United Nations organizations, with global initiatives like WHO Regions for Health Network (WHO 2015b, 2018b), and the Global Network for Age-Friendly Cities and Communities (WHO 2017; also see “Age-Friendly Cities and Communities: New Directions for Research and Policy” in this volume).

     
  10. 10.

    International and national government actors need to continuously improve and extend measurement and monitoring of healthy aging outcomes and the related detriments thereto, especially with the increased use of international data bases, international rankings, as well as international research initiatives regarding healthy aging and unhealthy lifestyles (lack of exercise, wrong food intake, lack of right food intake, smoking, drinking more than low-to-moderate levels of alcohol, etc.) around the world (see “Active Aging and Active Aging Index” in this volume).

     
  11. 11.

    International, national, local government actors, NGOs, professionals, and academics need to establish and strengthen positive perceptions about aging and fight negative ones, especially ageism and negative stereotypes of aging, that is, older people and the aging process itself (Schenk 2019; Marantz Henig 2019; Officer and de la Fuente-Núñez 2018; Beard et al. 2017; Docking and Stock 2016) (see “Ageism Around the World” in this volume).

     

Summary

Looking at the normative theoretical framework based on both absence of pain, diseases, disabilities, and frailty, as well as the encouragement, development, and nurturing of people’s capabilities, that is, functional abilities that enable older people to be, and to do, what they choose and have reason to value (WHO 2017; Beard et al. 2017), we need to change how policymakers and common individuals throughout the world “think, feel and act on age and aging” (Beard et al. 2017: 730). Age is not the problem and never was – however, lack of health care resources and access to it, as well as the accumulation of negative life choices and actions and, very importantly also, the absence of positive life choices and actions throughout one’s life-course are.

The perception of old age being an inescapable culprit and being a culprit at all needs to be changed. Hence, individual ageism in terms of people’s own thinking, perceptions, and actions (and the lack thereof), together with public ageism, age discrimination, and often century-long and culturally cemented negative stereotypes of aging and older people in society and its institutions (like public and social media, laws, administrative rules and regulations, etc.), constitute the root cause to the root problems of unhealthy aging (e.g., Officer and de la Fuente-Núñez 2018; Beard et al. 2017). An additional source of the presence and/or the absence of healthy aging can be found in the availability and (free-of-charge) accessibility of a positive exercise-encouraging, healthy and happy (i.e., happiness creating and fostering) natural and physical environment.

Health education and health knowledge are the perhaps most important ingredients that will enable healthier, and hopefully a great deal healthier or very healthy, later stages in life. Important is that these forms of health education and knowledge building need to be devised to integrate the state-of-the-art of health sciences, while focusing first and foremost on constant health screening and as much as possible early-stage diagnosis of all major diseases (including especially prediabetes) from earlier stages of life onwards.

Cross-References

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.United International CollegeBeijing Normal University-Hong Kong Baptist UniversityZhuhaiChina

Section editors and affiliations

  • Danan Gu
    • 1
  • Leilani Feliciano
    • 2
  1. 1.Population Division, Department of Economic and Social AffairsUnited NationsNew YorkUSA
  2. 2.University of Colorado at Colorado SpringsColorado SpringsUSA