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THE JOURNAL OF SOCIAL POLICY STUDIES_
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ИССЛЕДОВАНИЙ СОЦИАЛЬНОЙ
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ARTICLES IN ENGLISH
Alexandre Sidorenko, Asghar Zaidi
INTERNATIONAL POLICY FRAMEWORKS ON AGEING: ASSESSING PROGRESS IN REFERENCE TO THE MADRID INTERNATIONAL PLAN OF ACTION ON AGEING
The central goal of this article is to review progress made in implementing the international policy frameworks on ageing, focusing on the Vienna International Plan of Action on Ageing (VIPAA) and in more detail on the Madrid International Plan of Action on Ageing (MIPAA). The article offers a critical examination of the current approaches to monitoring and assessing the implementation process, outlining promising avenues for the future. In this way, the limitations of the current procedures for following the policy priorities of the MIPAA can be highlighted. What is found is that progress in many countries is hampered by inherent subjectivity in assessing and reporting advancement, lack of continuity and consistency, and difficulties in comparing the national level progress with international development in the same areas. The current year, 2017/2018, is momentous as we reach the end of the third five-year implementation cycle of the MIPAA. Introspection now should not merely focus on assessing the progress made but also on how the implementation of the MIPAA could be strengthened. In the same spirit, the 2030 Agenda of Sustainable Development Goals presents new opportunities; especially its pledges 'Leave no one behind' and 'Reach the furthest behind first', which imply that the older population can serve as agents of development. In moving forward, an essential requirement will have to be the establishment of an internationally acceptable set of indicators, which can be
Alexandre Sidorenko - Senior Advisor, European Centre for Social Welfare Policy and Research, Vienna, Austria. Email: sidorenko.alexandre@gmail.com
Asghar Zaidi - Professor in International Social Policy, University of Southampton, UK. Email: Asghar.Zaidi@soton.ac.uk
© The Journal of Social Policy Studies. Volume 16. № 1
employed for assessing national progress in addressing the challenges and opportunities of ageing and monitoring the international efforts to implement international policy frameworks like the MIPAA. Along the lines of the dashboard of indicators used in the Active Ageing Index 'AAI', there should be a MIPAA monitoring toolkit with different layers of indicators, which are aligned with the three priority directions of the MIPAA.
Keywords: population ageing; older population; global policy frameworks; Madrid International Plan of Action on Ageing; indicators
DOI: 10.17323/727-0634-2018-16-1-141-154 Introduction
The year 2017 marks fifteen years since the adoption of the Madrid International Plan of Action on Ageing (MIPAA) and thirty-five years since the adoption of its predecessor, the Vienna International Plan of Action on Ageing (VIPAA). They are two fundamental international policy frameworks on ageing and older persons for the twentieth and twenty-first centuries. Such international policy frameworks aim at offering universal solutions and proposing unified models for designing national policies in various areas of public concern. The frameworks are verified and elaborated by distilling scientific knowledge and practical experience and translating them into internationally agreed policy approaches, norms and measures. The United Nations (UN) has led efforts in elaborating international policy frameworks for addressing issues of global concern. Typically, such frameworks are adopted at the UN legislative bodies (e.g., General Assembly) by consensus and they may not always bear legal obligations for Member States to report on their implementation.
Population ageing was recognized as a global issue during the second half of the twentieth century. Such recognition eventually led to the convening in 1982 in Vienna, Austria, of the first World Assembly on Ageing. The major outcome of the first World Assembly organized by the UN was the VIPAA - the first international policy framework on ageing (United Nations 1982). The VIPAA outlined sixty-two recommendations for policy actions within seven 'areas of concern for ageing individuals', namely: health and nutrition; protection of elderly consumers; housing and the environment; the family; social welfare; income security and employment; and education. In the Political Declaration adopted along with the MIPAA at the Second World Assembly on Ageing in Madrid, the UN Member States reaffirmed 'the principles and recommendations for action of the (Vienna) International Plan of Action on Ageing' (United Nations 2002).
Despite all good intentions and thoughtful design, the VIPAA had serious shortcomings in its implementation: it had been seen as mostly relevant to demo-graphically, and economically, advanced countries, while developing countries often omitted ageing from their policy agendas and channelling their limited resources towards other pressing priorities. This paradigm was revised in the last
two decades of the twentieth century as several Asian giants, along with many other developing countries, experienced a demographic transition opening up the possibility to progress much faster than the developed countries (United Nations 2013a). The corresponding developmental and humanitarian challenges were recognized and the need for appropriate and timely responses was asserted. Such responses were elaborated in preparing and conducting the Second World Assembly on Ageing and formulated in the MIPAA. The process of drafting the MIPAA included several major players, such as the experts of government offices of the UN Member States, UN system organisations, academia and non-governmental organisations (Sidorenko, Walker 2004). The result was a broad set of actions for governments and other stakeholders, to aim to build 'a society for all ages'.
The MIPAA is a comprehensive document: it includes 239 recommendations formulated in order to reach thirty-five objectives within eighteen priority issues, which in turn are consolidated in the three priority directions: (1) older persons and development; (2) advancing health and well-being into old age; and (3) ensuring enabling and supportive environments. The VIPAA had already attempted to balance policy actions in both humanitarian and developmental aspects of ageing. The humanitarian aspects of ageing are defined in the VIPAA as those related 'to the specific needs of the elderly' and the developmental aspects as those related 'to the socio-economic implications of the ageing of the population'. The VIPAA included important elaborations on the significance of developmental aspects of ageing, but the proposals for action in this sphere were limited. Twenty years later, the MIPAA has acquired a well-established developmental focus: its narratives and recommendations have merged the notion of societal (social) development with human development by suggesting measures for individual well-being along with those for inclusion and participation of older persons. The MIPAA asserts that such measures should be applied throughout the entire life course and well into older age. Thus, the MIPAA recognises older people as both agents and beneficiaries of development of their societies and commits governments to mainstreaming ageing in all social and economic development policies.
This paper seeks to address an important question in this regard: thirty-five years following the adoption of VIPAA and fifteen years of implementing the MIPAA, are we in a position to conclude how far the international community has advanced in attaining the goals and achieving the objectives in building a society for all ages? Furthermore, we raise the question whether we have in place the necessary procedures and reliable instruments for review and appraisal exercises.
Modalities for monitoring and assessing progress in international actions on ageing
Both the MIPAA and its predecessor the VIPAA belong to the category of non-legally binding UN documents, which means that national reporting to the UN legislative and consultative bodies on their implementation is voluntary
and often sporadic. The modalities for assessing progress in implementing both global plans are quite similar (see, Table 1): the monitoring of implementation is a periodic bottom-up process, starting at the national, ideally local, level and ascending through the regional (international) level up to the global level. Governments play the central role in monitoring and evaluating progress, as well as in the entire implementation activities. At the regional level, the central players are the five UN regional commissions (United Nations 2017b). The UN regional commissions facilitate the cross-border exchange of ideas and experiences, prepare guidelines for the review and appraisal exercises and organize regional forums for analysing progress in the implementation process.
Table 1
Modalities of review and appraisal (R&A) of VIPAA and MIPAA
Modality VIPAA MIPAA
Periodicity Quadrennial Quinquennial
Principal source of information Responses to questionnaires designed and sent by the UN programme on ageing National reports following guidelines of UN Regional Commissions
Main approach Not defined Bottom-up participatory
Focus 'Areas of concern to ageing individuals' Ageing specific policies as well as efforts aimed at mainstreaming an ageing dimension into national development strategies.
Indicators Not defined Proposed (various sets)
Level of centralization Centralized: UNPoA had been Less centralized: UN regional
playing the central role in commissions assumed primary
organizing and conducting responsibilities for conducting R&A R&A at the regional level.
UNPoA consolidates and analyzes information at the global level. Other divisions of the UN secretariat and organizations of the UN system and international NGOs took the lead in producing reports which contributed to the process of R&A.
The global review and appraisal are assigned to the Commission for Social Development (CSocD) - one of the intergovernmental subsidiary bodies of the UN Economic and Social Council (United Nations 2017a). The work of the CSocD on the subject of ageing is supported and serviced by the secretariat of the UN programme on ageing, UNPoA (United Nations 2017). Within the review and appraisal exercise, UNPoA consolidates and analyses information on
progress in implementing the UN policy frameworks on ageing (since 2002, the MIPAA). The information comes from various sources: governments of the UN Member States - directly and through the UN regional commissions; UN secretariat; UN family organizations; intergovernmental (non-UN) organizations; and international non-governmental organizations and professional associations (Sidorenko, Mikhailova 2014). The UNPoA is responsible for preparing the reports of the UN Secretary-General on the review and appraisal which contain, along with analytical materials, the recommendations providing the basis for debate and resolutions on ageing of the UN legislative (e.g., General Assembly) and consultative bodies (e.g., CSocD).
In spite of similarities, there are significant differences between modalities of review and appraisal of the two international plans of action on ageing (see, Table 1). One of the major distinctions is the level of centralization of the process. The periodic assessments of the VIPAA were coordinated and also technically conducted by the UNPoA, whose staff distributed periodically updated questionnaires to national governments, organizations of the UN system and other major international stakeholders, and then collected the replies, which were the main source of information on the implementation progress.
In case of the MIPAA, the UN regional commissions play crucial role in organizing and conducting the periodic review and appraisal: they design the review and appraisal guidelines for the national governments, prepare regional summary reports and conduct region-wide review and appraisal conferences, seminars and workshops during the concluding stage of the regional periodic review and appraisal exercises. Thus, 'the review and appraisal process is a regionally driven exercise' (United Nations 2012).
Moreover, during the first two review and appraisals of the MIPAA several UN entities and international NGOs had undertaken special initiatives aimed at supporting the global assessment. In the course of the first review and appraisal exercise, two 'flagship reports' were produced by the UN secretariat: the 'World Economic and Social Survey 2007. Development in an Ageing World' (United Nations 2007) and the 'Regional Dimensions of the Ageing Situation' (United Nations 2008). During the second review and appraisal, several organizations of the UN system and international NGOs led by UNFPA and HelpAge International joined forces in preparing a global report of the situation of older persons and progress in policy actions in implementing MIPAA (United Nations Population Fund, HelpAge International 2012). The third review had a similar structure to the regional reports and then synthesized by the UNPoA to highlight commonalities and differences across regions and countries.
While the major approach to implementing and monitoring the VIPAA was not specified, for the MIPAA it was designated as 'the bottom-up participatory approach' - 'an open-ended, participatory process that seeks to incorporate and link local and national activities to UN regional intergovernmental bodies and global processes of review and appraisal' (United Nations 2004).
Several key components of the approach were suggested, including 'distillation' of local findings into policy-relevant formats and adjustment of policies and programmes in accordance with the conclusions and recommendations of the review and appraisal'. Thus the approach was seen as a cyclical process incorporating a feedback mechanism for adjusting policy as necessary.
Major findings of the review and appraisal exercises
This section briefly outlines major findings of the review and appraisal exercises conducted as part of the implementation of the VIPAA and the MIPAA, spanning the period 1982 through 2017. The materials presented in this section are based on the UN official sources, primarily the reports prepared by the secretariat of the UNPoA. While these reports may not reflect the entire process of implementation, they have served as the primary input for intergovernmental debates on ageing and formulation of resolutions by the UN legislative bodies, such as the General Assembly, and consultative bodies, such as CSocD.
Implementation of VIPAA
Since the adoption of VIPAA in 1982, the progress of its implementation was assessed four times: in 1985, 1989, 1993 and, lastly, in 1997. The findings of all four review and appraisal exercises had revealed insufficient progress in implementing the VIPAA. The first review and appraisal in 1985 identified growing awareness of issues of ageing and increasing commitment on the part of governments in both developed and developing countries to pursue the necessary policy measures. Meanwhile, there was limited progress in developing countries in improving the living conditions of older persons, as well as in expanding the network of services available to them in essential areas of health, housing, the family, income security, employment, social welfare, and education (United Nations 1985). The major constraints to progress were attributed to the global recession of the 1980s, which caused economic reversals with serious social costs, particularly in developing countries.
The second review and appraisal in 1989 revealed obvious progress in a few parts of the world, yet that progress was not recognized as sufficient for changing the global assessment: 'while the world's population continued to age with increasing rapidity and awareness of the phenomenon continued to grow, policies and programmes in response had grown little. Far from anticipating the process of ageing, they have not even kept pace with it' (United Nations 1989). Four years later, in 1993, the third review and appraisal concluded that translating the growing awareness of the consequences of ageing into action-oriented policies and programmes had remained difficult (United Nations 1993). The last review and appraisal of VIPAA, which was conducted in 1997, had determined that the population over 60 had grown dramatically, yet the response had been minimal at best, and that progress in implementing VIPAA remained modest (United Nations 1997).
Several factors underlying the limited progress in implementing the VIPAA were reported by governments (United Nations 2001): the lack of financial resources owing to economic difficulties in developing countries, countries with economies in transition and particularly in countries in armed conflict and those hit by natural disasters; the low priority given to age-related concerns in countries where the proportion of the ageing population was relatively small; the shortage of government staff in most developing countries; the absence of a well-defined body to manage ageing issues and/or the lack of coordination between agencies at different levels in the government hierarchy; and the lack of expertise in policy-making.
It was also perceived that the VIPAA lacked concrete and refined recommendations and carried no convincing appeal to other stakeholders such as NGOs, the private sector and the media. Limited progress in implementing the VIPAA was one of the impelling motives of convening the Second World Assembly on Ageing. In May 2000 the UN General Assembly decided:
To convene the Second World Assembly on Ageing in 2002, on the occasion of the twentieth anniversary of the first World Assembly on Ageing held at Vienna, to be devoted to the overall review of the outcome of the first World Assembly, as well as to the adoption of a revised plan of action and a long-term strategy on ageing, encompassing its periodic reviews, in the context of a society for all ages (United Nations 2000).
Implementation of the MIPAA
Three cycles of the review and appraisal have taken place since the adoption of the MIPAA. The global results of the two cycles are presented in tables 2 and 31 in a distilled version highlighting major advances and obstacles of the implementation process in more and less developed countries. The information included in the tables is derived from the official reports of the UNPoA submitted to the General Assembly and the CSocD.
In a traditionally cautious manner, the UN report on the first review and appraisal noted 'some success', as well as 'significant gaps in progress' (United Nations 2009). It also identified obstacles, such as lack of political will, inadequacy of human and financial resources, and weaknesses of national capacity on ageing. The second review and appraisal have brought similar results: 'Overall progress in the implementation of the Madrid International Plan of Action on Ageing, 2002, has continued to be uneven, with several shortfalls' (United Nations 2013). The listing of obstacles also looked familiar: insufficient human and financial resources; and limited national capacity on ageing-related issues. The 2013 UN report acknowledged the fact that implementation of the MIPAA has not made ageing a developmental priority in many countries.
1 See, electronic appendix: https://jsps.hse.ru/article/view/7631/8441
Also noticeable was that the bottom-up participatory approach had not become a prominent tool for the review and appraisal exercise.
At the time of writing this article, the third review and appraisal of the MIPAA was ongoing. In 2017, the national findings have been distilled and analysed at meetings of the UN regional commissions. The consolidated reviews are forwarded to the concluding global event at the CSocD session in February 2018 at the UN headquarters in New York. In the meantime, the UNPoA has issued an interim report on the preliminary findings of the current review and appraisal (United Nations 2017c). As follows from the UN report, in the past five years most of the prevalent issues and related policy options have remained unchanged: social protection; health and social care; and human rights. An issue of 'disaster and other emergency situations' has come to prominence in recent years and been added to the listing of prevalent issues of the current UN report in an awkward amalgamation with the issue of 'participation of civil society in policy governance'.
Thirty-five years of international action on ageing: Directed advancement or reactive responses?
The question posed in the title of this section does not have a definite answer. The reasons for this uncertainty are inherent in the features of the prevailing implementation processes of both international plans of action: the benchmarks, the interim results (outputs) and the final points of destination are loosely defined or descriptive at best. The implementation shortcomings are particularly visible in the review and appraisal exercises. In the absence of clearly defined criteria for appraising progress, the findings of the review and appraisal are usually based on anecdotal evidence and self-assessment. Most often it is outputs, not outcomes that are monitored and assessed, thus making the analysis of policy impact obscure. Limited, if any, use of indicators prevents analyzing the dynamics of national actions and comparing implementation progress in different countries. A descriptive presentation of the results makes it difficult to assess progress and plan for future actions.
Generally, the periodic assessments of implementation progress are self-reporting exercises without verification, which may potentially lead to the prevalence of politics over policy in national reporting. It is no wonder that, for the past decades practically the same vague conclusion of 'limited', or 'uneven' progress has drifted from one quadrennial and later quinquennial review and appraisal report to another. Such 'consistency' was noted in the UN report back in 1998: 'the findings of the review and appraisal exercises had consistently shown that, although modest progress had been made, implementation remained a largely incomplete task, particularly in developing countries' (United Nations 1998).
One undeniable role of the review and appraisal exercises is promotional, as they help to mobilize national and international stakeholders to further the
implementation process. At the same time, the power of the review and appraisal exercise to function as a tool for an evidence-informed implementation process is missing. It should be admitted that the deficiencies of the review and appraisal exercise had already been recognized during the years of implementation of the VIPAA. Still then the noted factors included 'the low response rate to the UN questionnaire by Member States, and problems in respect of the interpretation of questions by member states which make it difficult to produce comparable data' (United Nations 1999).
The major reasons for the low participation of countries identified in the monitoring exercises of the VIPAA were both substantive and procedural (United Nations 1998). The substantive reasons were related to the political and demographic transformations since the adoption of the VIPAA; the recognition of those transformations had eventually led to the convening of the Second World Assembly on Ageing and adoption of the MIPAA. Among the procedural reasons, the self-reporting, self-assessing and non-binding nature of the review and appraisal exercise was named. A related obstacle was that the scope of countries participating in the review and appraisal exercises had been changing with each exercise, making progress and comparability difficult to assess.
Several proposals for the 'incremental adjustment' of the review and appraisal process of the VIPAA were made (United Nations 1998). One of the three procedural ideas was establishing a permanent database of public policies on ageing on the Internet, enabling continuous updating and accessing by Member States. That could have allowed for continuing international exchange of information in the years between reviews, even though the national monitoring exercise would have remained self-reporting. This proposal, still valid today, had won the concrete support by the government of the Netherlands, but had not been transferred into the modalities of monitoring the successor of the VIPAA.
Household surveys in selected geographical areas and on chosen subjects were also proposed. However, the high cost of such surveys and difficulty of cross-national comparability of results were acknowledged. Yet another proposal was the elaboration of an ageing-related development index (ADI), similar to the gender-related development index (GDI); the latter was previously introduced to complement the human development index (HDI) of the Human Development Report. During the consultations that followed it was decided that, owing to a lack of sufficient basic data in many countries, the introduction of an ADI would have been premature (United Nations 1999).
None of the above proposals was implemented as this coincided with the preparations for the Second World Assembly on Ageing and the drafting of the new plan of action. The authors believe, however, that ideas formulated almost twenty years ago would benefit from some fundamental rethinking. The overall goal should be seen in making the periodical review and appraisal exercises a source of reliable and timely evidence for policy actions on ageing.
Towards evidence informed implementation of the MIPAA
The issue discussed in this section is how to make the implementation of the MIPAA more evidence-informed through streamlining the processes of monitoring and assessment. To fulfil this task, several options could be employed, as outlined below.
Raising the public visibility and political clout of the UN policy
documents on ageing
This can be achieved by developing and adopting an international legally binding document on ageing, such as a convention. Adoption of such a document would envisage establishing a UN body charged with following the implementation process and a reporting obligation for the countries which ratify it. The UN experience of the last few decades in promoting gender issues and the rights of persons with disabilities suggests this could be a promising direction.
In the area of ageing, the efforts to elaborate a UN legally binding document on the rights of older persons have been undertaken several times since 1948 (Doron, Mewhinney 2007); the current efforts to elaborate a convention on the rights of older persons are under way under the auspices of the UN Open-ended Working Group on Ageing with so far an uncertain outcome (United Nations 2017). Meanwhile, the legally binding regional documents have been adopted in Africa and Latin America and the Caribbean (United Nations 2013).
Designing universal assessment toolkit
In our view, the most promising approach to ensuring objective, reliable and practical information on the processes and outcomes of the implementation of the MIPAA at both the national and international levels is to develop a set of universal assessment toolkit. As noted in the MIPAA, elaborating and using comprehensive and practical tools for evaluation, such as a dashboard of indicators, is necessary to facilitate a timely policy response. The expert group meeting convened by the UN in Malta in 2003 elaborated a set of indicators to assist the review and appraisal process at the national level (United Nations 2004). The suggested indicators were organised by objectives that pertain to priority issues within the three priority directions of the MIPAA. Efforts were also made to link the proposed indicators to those for monitoring the Millennium Development Goals. Two types of indicators were proposed: instrumental (output) and outcome.
The instrumental indicators aim at evaluating the availability and implementation of programmes and policies that have been adopted. The outcome indicators on the other hand attempt to identify changes in the quality of life and socio-economic conditions of older persons. Unfortunately, the proposed global set of indicators has not raised interest levels of governments in this respect and they remained unutilized in the review and appraisal work. One of the reasons for this failure could be that the proposed global indicators were too
closely linked to the objectives of the MIPAA, while individual governments preferred to formulate their own policy priorities and objectives that differed to various extents from the MIPAA's formulations.
Another attempt to devise a set of 'indicators of achievement' for monitoring the UN ECE's Regional Implementation Strategy of the MIPAA (RIS/MIPAA) was undertaken by a group of European experts (Marin, Zaidi 2007), within the project Mainstreaming Ageing - Indicators to Monitor Implementation, MA: IMI (European Centre for Social Welfare Policy and Research 2018). The work provided a foundation for assisting national governments and their focal points in monitoring RIS/MIPAA. The MA: IMI indicators covered four main topics: income and wealth; labour market participation; social protection and financial sustainability. As far as possible, data for each indicator is collected separately for men and women. Also, wherever possible, a distinction is made between younger old and very old persons. To date, the MA: IMI list of indicators could be seen to be the most sophisticated scientific work in this respect, although the database has not been maintained and indicators set was not developed.
In 2012, to mark the European Year for Active Ageing and Solidarity between Generations, a composite quantitative measure was constructed, called the Active Ageing Index (AAI), for 27 EU countries (Zaidi, Stanton 2015). The AAI has since then served as a new analytical tool for policy makers to enable them to devise evidence-based strategies to address the challenges of population ageing. The AAI toolkit consists of 22 gender-specific outcome indicators, which are subsequently aggregated into an overall and domain-specific composite indices of Employment, Social participation, Independent living and Enabling environment. The inclusion of the domain of an enabling environment is a particular novelty of the AAI as it goes beyond assessing how countries and subgroups fare in terms of actual experiences of active ageing and take stock of the health and human capital of older people that can be tapped to improve their quality of life and to make public welfare systems more sustainable (Zaidi et al. 2017).
The AAI has now been extended to several countries other than the European Union countries. The most notable being the extension of the AAI for China, India, Russia, and USA (Guntupalli, Chakraborty 2018; Varlamova et al. 2017; Xiong, Wisniowski 2018; Zaidi 2014). Furthermore, the AAI is also now calculated at the local and regional levels (Rodriguez-Rodriguez et al. 2017). The lessons learned from this work so far have been that the design of a good set of indicators by academics and the engagement of the European Commission and the UN ECE have played an important role in the adoption of the measurement framework for monitoring purposes. The AAI has now been to be expanded in devising a global framework for the monitoring of the MIPAA (Zaidi et al. 2018).
Another good example of the availability and analysis of data on old age is the Global AgeWatch Index (GAWI), which one of the authors of this article developed in a close collaboration with HelpAge International (Zaidi 2013). The GAWI is the first analytical framework that uses comparative data available to
measure key aspects of the well-being of older people globally (HelpAge International 2013, 2014, 2015). It is inspired by the examples of UNDP's Human Development Index (United Nations Development Programme 2013) as well as the AAI (Zaidi et al. 2013) in its selection, development and use of multi-perspective quantitative indicators. Underpinning the AAI and the GAWI are three key objectives: the need to highlight the importance of comparative data on ageing, the need to present this data in a way that will engage national and international policy-makers, and the need to help point to areas for future policy priorities in different contexts across the world.
Conclusions
The implementation of the MIPAA and its predecessor the VIPAA offers 35 years of international experience in assessing progress on policies and programmes to promote quality of life and well-being of older population. The current year, 2017/2018, is momentous as we are reaching the end of the third 5-year cycle of the MIPAA. The introspection at this stage should help us not just assess progress made but also look back and learn how the implementation of major policy framework of the MIPAA could be strengthened.
Likewise, the 2030 Agenda of Sustainable Development Goals (United Nations 2016) presents new opportunities to include older people in the development process. The pledges offered by the Agenda 'Leaving no one behind' and 'Reaching the furthest behind first' give a strong momentum to seek the inclusion of older people in all policymaking. They imply that no development process is complete without the promotion of quality of life of vulnerable groups of society, such as the older population, and that the older population can serve as agents of development in line with the active and healthy ageing agenda and the MIPAA's policy directions.
Raising awareness of population ageing and mainstreaming ageing into global and national development agendas must remain the paramount task; yet the political mantras should not obscure the policy task to provide concrete and measurable actions. Therefore, we have to ensure that monitoring and assessing progress in reaching a society for all ages, as called for in the MIPAA, are based on reliable, timely and universal evidence. The MIPAA experience so far offers one major lesson: its monitoring lacked a comprehensive global approach. This was partly because of the lack of age-disaggregated data in many countries, but mainly because the MIPAA monitoring toolkit was not properly developed.
Greater national capacities are needed in many countries: not only to design policies for the older population but also to provide guidelines in assessing progress. Guidance on collection of age-disaggregated data, including timescales for reporting, is an area where investment would have significant impacts on the successful implementation of the MIPAA.
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Attachment
Table 2
Major findings of the first review and appraisal of implementation of MIPAA (2007): advances and obstacles / challenges
I. Social Protection
Developing Countries Developed Countries
Advances Obstacles/Challenges Advances Obstacles/Challenges
Introduction of Universal social Reforms and Financial liabilities.
'social' (non- protection adjustments of
contributory) programmes are rare. pension and
pensions. Prevalence of informal economy prevents establishing, funding and maintaining traditional contributory pension health-care programmes aimed at achieving financial stability and ensuring that programmes continue to deliver to
future generations: e.g., raising pensionable age; life
programmes.
Declines in informal expectance indexing
systems of social of benefits, etc.
protection owing to
migration and
changes in family
structures.
II. Labour Market and Older Workers
Developing Countries Developed Countries
Advances Obstacles/Challenges Advances Obstacles/Challenges
Better access to credit for older workers to start own business. Poverty. Unemployment. Emigration of younger workers. Forestalling early retirement. Elimination of mandatory retirement ages. Extension of the number of working years through flexible employment arrangements, and increased spending on older-worker training programmes. Ageing of labour force. Prevalence of early retirement. Mounting old-age dependency ratios. Impending skills gaps and potential labour-force shortages.
III. Health and Social Care
Developing Countries
Developed Countries
Advances
Obstacles/Challenges
Advances
Obstacles/Challenges
Steps to regulate long-term care institutions. Introduction of informal care programmes. Provision of free medical care to older persons. Introduction of geriatrics into academic programmes and universities.
Declining family support. Support for family carers and training for social workers are rare.
Reliable data on the overall burden of disease on older persons are scarce.
Age inequalities in terms of access to and outcomes of health care, including primary health care.
Health concerns of older persons are often ignored.
Shortage of qualified professionals - both medical doctors and
Introduction of mandatory long-term care insurance system; enhanced sustainability of the system.
Provision of community care.
Provision of services for informal carers, including older carers.
Projected significant increase in the number of very old persons. Increasing demand for long-term care.
Declining availability of family carers.
Financing of programmes for older persons not covered by private, long-term care insurance.
Age inequalities in terms of access and outcomes of health
Shortage of qualified professionals- both medical doctors
and nurses.
Lack of coordination of health and social care services.
IV. Empowerment of older persons: protecting rights, facilitating participation and promoting positive and balanced images of ageing
Developing Countries Developed Countries
Advances Obstacles/Challenges Advances Obstacles/Challenges
Promulgation of special rules and regulations to protect human rights of older persons. Adoption of legislation protecting the rights of older persons in institutions. Insufficient understanding of the effects of human rights violations, marginalization and abuse on the situation of older persons. Absence of internationally agreed human rights instruments in the area of ageing. Adoption and enforcement of laws protecting the rights of older persons, including those of older workers. Development of advocacy and training and education programmes. Absence of internationally agreed human rights instruments in the area of ageing
Greater involvement of older persons in decision-making: mobilization of older persons' groups to monitor the implementation of government policies and programmes on ageing; partnering of non-governmental organizations with governments to meet the objectives of MIPAA; creating the coordinating bodies on ageing issues, which include older persons. Multifaceted participation of older persons has not been universally achieved.
Growing public awareness about the ageing of societies. Media stories tend to focus on alarmist reports about the potentially negative impact of changing age structures and the growing number of older persons.
V. Research on ageing and policy action
Developing Countries & Developed Countries
Advances Obstacles/Challenges
Growing body of policy-related research. Lack of age-disaggregated data. Little research is available outside of academic circles. Insufficient progress in evidence-based approaches to policy development, implementation and evaluation. Research and policy are often disconnected and communications between policy makers, practitioners and researchers are poor.
Sources: United Nations 2006, 2008.
Table 3
Major findings of the second review and appraisal of implementation of MIPAA (2012): advances and obstacles/challenges
I. Income security
Developing Countries Developed Countries
Advances Obstacles/Challenges Advances Obstacles/Challenges
Establishment of new social protection programmes. Social protection in Africa has become an effective tool for combating poverty. Creation of non-contributory pension Programmes (e.g., social pensions). Introduction of needs-based financial assistance allowances. Provision of access to housing, food security and medical care. Upgrading social security schemes, safety nets and pension funds. Financial sustainability of cash transfer programmes. Limited coverage of pension schemes. Lack of comprehensive pension coverage. Poverty. Pension reforms: increasing the required contributory periods, limiting early retirement, increasing the retirement age and equalizing the retirement age between men and women. Provision of social assistance payments when pension levels acquired through contribution-based systems fell below minimum subsistence levels. Sustainability of social protection systems.
II. Labour market
Developing Countries Developed Countries
Advances Obstacles/Challenges Advances Obstacles/Challenges
Measures to eradicate ageism in employment through job training and the dissemination of databases and information on jobs for older persons. Age discrimination. Limited mobility, particularly of older women. Extending active working lives. Establishment of legal frameworks to ensure equal treatment and non-discrimination based on age or disability. Ageing of labour force.
Promotion of access Public opinion: given Adjustment of
to entrepreneurial youth priority over pension legislation to
loans for older older persons as the facilitate working
persons. main target for labour beyond retirement
Expanding work market initiatives. age.
opportunities and Subsidies for
providing career employers when
counselling and recruiting older
re-employment unemployed workers.
programmes. Adjustments to the workplace and allowing for more flexible work arrangements. Support for entrepreneurial opportunities for older persons.
III. Health and well-being
Developing Countries
Developed Countries
Advances
Obstacles/Challenges
Advances
Obstacles/Challenges
Introduction of action plans and programmes for healthy and active ageing.
Drug-access programmes. Improved provision of drugs and prostheses.
Regulation of long-term care facilities.
Introduction of university programmes and in-service training in gerontology and geriatrics.
Programmes of affordable and age-friendly housing.
Human and material resource gaps in public health
systems.
Shortage of specialized medical professionals, compounded by emigration of health-care workers.
Discrimination.
Limited access - both physical and financial - to health care, particularly for older women.
Malnutrition.
High incidence of both infectious and non-infectious diseases.
Integrated strategies or plans on health care for older persons.
Efforts to reduce inequalities in access to health care.
Provision of a range of services free of charge, or at reduced prices, for older persons in need.
Continuum of care, ranging from support for independent living, home-based care and geriatric and palliative care, as well as institutional
Limited access to affordable services.
Inadequate health promotion and disease prevention.
Unsatisfactory service quality.
Low capacity of care staff.
Insufficient coordination of services and integration of health and social care services.
Free or discounted transportation.
Extending healthcare programme to
rural areas.
Support for
community-based
care.
Weakening traditional support systems.
Expanded services for those suffering from Alzheimer's disease and other forms of senile dementia.
Improved legal frameworks to meet the increased role of the non-profit and private sectors.
Support for
community-based
care.
IV. Human rights
Developing Countries
Developed Countries
Advances
Obstacles/Challenges
Advances
Obstacles/Challenges
National and regional (Africa; Latin America and the Caribbean) legislation on the rights of older persons.
Prevention campaigns.
New institutions (e.g., a Prosecutor for older persons in the Dominican Republic) and special programmes for preventing
discrimination, abuse and mistreatment of older persons.
Socio-legal services for victims of abuse.
Participation of older persons in decision-making processes on matters that affect their lives, through their representation at various levels of local government.
Lack of awareness of the human rights of older persons, age discrimination and marginalization. Violations, abuse, neglect and lack of legal protection for older people.
Low participation of older persons in public life and legislative activities. Older persons' participation has often been confined to the level of community and voluntary activities and services.
Strengthened legal frameworks: adoption of anti-discrimination legislation or relevant articles in constitutions prohibiting age-based discrimination.
Creation of additional institutions for oversight, such as an ombudsperson.
Increased awareness, improved monitoring and support to victims.
Continuing challenge of abuse and violence against older persons.
V. Policy frameworks
Developing Countries
Developed Countries
Advances
Obstacles/Challenges
Advances
Obstacles/Challenges
Increase in the number of countries developing policies specifically addressing older persons.
Establishment of national coordinating mechanisms to ensure multisectoral responses to population ageing.
Growing evidence informed policy implementation and evaluation.
Collaboration among stakeholders in developing and implementing policies; partnerships between governments and civil society.
Establishment of consultative forums (councils,
committees) with the involvement of older persons and their organizations for advising governments on policy actions.
Involvement of older persons in designing and promoting national policies/ legislations.
Establishment of specialized departments and services for older persons in respective ministries.
Limited systematic mainstreaming of policies on ageing into national development strategies and policies.
Minimal implementation.
Budgetary constraints. Shortage of data.
Development of new ageing-related strategic frameworks.
Establishment of national-level multi-stakeholder bodies
providing advisory services to the government that have included older persons or their representatives.
Inclusion the views of both civil society organizations representing older persons and of individual older persons themselves in national review and appraisal processes.
On-going financial and economic crisis - austerity measures taken by national and local governments.
Sources: United Nations 2012, 2013.
