WHO consultation on the Global Strategy and Action Plan on Ageing and Health
Currently there takes place the World Health Organization’s consultation on the Global Strategy and Action Plan on Ageing and Health (until October 30). This is an opportunity to emphasize the importance of biological and biomedical research of aging for the development of effective health care for older persons.
Here is the participation page: http://www.who.int/ageing/consultation/en/
It is possible to download the full questionnaire as a Word file and send to HealthyAgeing@who.int Or there is a choice to relate to several or one strategic objective out of the five, for example “Strategic Objective 5: Improving measuring, monitoring and understanding” [of healthy aging]
http://www.who.int/ageing/consultation-strategic-objective5/en/
There may be several quite encouraging elements in the existing draft of the Action Plan, that can be interpreted for the advantage of longevity research. It is just necessary to infuse and emphasize a more biomedical/biological interpretation, as the text allows for different kinds of interpretation.
The Action plan draft is available here: “WHO DRAFT 0: GLOBAL STRATEGY AND ACTION PLAN ON AGEING AND HEALTH”. And it does include what may be interpreted as a strategic objective for biomedical aging research!
http://www.who.int/ageing/global-strategy/GSAP-ageing-health-draft.pdf?ua=1
http://www.who.int/ageing/global-strategy/en/
For example, the Strategic Objective 5: “Improving measuring, monitoring and understanding”, includes Action 1 – “Agreeing on metrics, measures and analytical approaches for Healthy Ageing”. It proposes:
– “developing and reaching consensus on metrics, measurement strategies, instruments, tests and biomarkers for key concepts related to healthy ageing including functional ability, intrinsic capacity, subjective well-being, health characteristics, personal and environmental characteristics, genetic inheritance, multimorbidity and the need for care”
– “reaching consensus on approaches for the assessment and interpretation of trajectories of these metrics and measures over the life course. It will be important to demonstrate how the information generated serves as inputs to policy, monitoring, evaluation, clinical or public health decisions, and their link to the need for health and long-term care and broader environmental change”
AND
– “developing and applying improved approaches for the testing of clinical interventions and population based approaches that take account of the different physiology of older people and multimorbidity” [!]
The Action Plan also includes actions for:
- “developing evidence informed national Healthy Ageing strategies or plans that are part of overall national plans through a process that involves all stakeholders” (“Strategic Objective 1: Fostering healthy ageing in every country” Action 1)
AND
- “including core geriatric and gerontological competencies in all health curriculums” (Strategic Objective 2: Aligning health systems to the needs of the older populations. Action 3).
All these objectives and actions can be interpreted to support biomedical research of aging *if* emphasizing the correct biological/biomedical aspects. For example “national healthy aging strategies” must be understood to include biomedical research. And “gerontological competencies” should also be understood as including biogerontology. Otherwise the biological and biomedical interpretation of these objectives can be overwhelmed by conventional social, psychological, assistive technological or lifestyle approaches. The latter approaches are important, but need not exclude the biomedical therapeutic approaches. Still, the basis for a biomedical interpretation exists in these documents, but needs to be emphasized and made more explicit.
For example, to the question of the consultation:
“For Strategic Objective 5, do you think another first-level priority action should be added to this list?”
It may be suggested to add a fourth action: “4) Elucidating basic mechanisms and processes of aging, their relation to disease, and mechanisms of their amelioration for the development of therapies to achieve healthy longevity.”
And to the question for Objective 5 “Do you think another measure of progress could be useful?” it may be suggested to add the measure: “Consensus occurs on metrics, measurement strategies, instruments, tests and biomarkers for the formal, biological and clinical, definition of aging and for the effectiveness of interventions and therapies against aging-related ill health”.
These kinds of biological/biomedical interpretations need to be emphasized both now at the stage of consultation and at the later stages of implementation!
There are also some encouraging elements in the recently issued “World Report on Aging and Health” (October 1, 2015)
http://www.who.int/ageing/events/world-report-2015-launch/en/
http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
For example the report includes a section entitled “Reframing medical research” (pp. 113-114). It has such pro-biomedical-research statements as:
“Much medical research is focused on disease. This prevents a better understanding of the subtle changes in intrinsic function that occur both before and after the onset of disease and the factors that influence these changes…. Specifically, more research is needed that looks at how commonly prescribed medications affect people with multimorbidity, which is a departure from the typical default assumption that the optimal treatment of someone with more than one health issue is to add together different interventions. And outcomes need to be considered not only in terms of disease markers but also in terms of intrinsic capacity.”
Furthermore, the report states: “This will require the reallocation of budgets, which are currently relatively small in ageing-related research” and quotes Fontana et al. article in Nature (2014) “Medical research: Treat ageing” in support of that statement! (http://www.nature.com/news/medical-research-treat-ageing-1.15585)
Still, the biological and therapeutic interpretation of medical research of aging will need to be emphasized, or there is again the risk it will be pushed to the corner or even suppressed by non-biological and non-therapeutic approaches.
For example that “intrinsic function” or “intrinsic capacity” that the report wishes to improve is very vaguely defined as “the composite of all the physical and mental capacities that an individual can draw on”. This can be given to all kinds of functionalist, mentalist or even downright non-rigorous and unscientific interpretations. But it can also be given more scientific content based on biomarkers of aging and formal clinical definitions of aging. This scientific content may need to be stronger emphasized in the consultation and in the later stages of the action plan’s implementation.
There is also the simultaneously present, but apparently little related to the aging action plan – “International Classification of Functioning, Disability and Health (ICF)” which seems to hardly even mention aging or the “intrinsic function” in aging.
http://www.who.int/classifications/icf/en/
The ICF hypothesizes that “it is possible to see if people with similar levels of difficulty are receiving similar levels of support services irrespective of age such as when there are separate systems for aged or younger individuals with disabilities” (ICF Manual, p. 78). But the evaluation of aging-related disability is lacking.
The addition of a scientifically grounded biomedical classification of aging-related disability and function may greatly increase the utility of the ICF (currently feedback is requested by WHO on “A Practical Manual for using the International Classification of Functioning, Disability and Health (ICF)”
http://www.who.int/classifications/drafticfpracticalmanual2.pdf?ua=1
This addition to the ICF may be parallel to an addition of some clinically applicable, practical definition or classification of aging or senility within The International Classification of Diseases (ICD). The addition of aging to the ICF as an impairment of biological function may be actually easier than outright defining aging as a disease.
(See on senility as a part of ICD http://www.icd10data.com/ICD10CM/Codes/R00-R99/R50-R69/R54-/R54 Consider also that senility is currently considered a “garbage code” in the ICD http://www.sciencedirect.com/science/article/pii/S0140673612617280 )
Most importantly, all these texts and their interpretations may remain on paper, unless they are backed up by some actual local involvement, both at the grass roots and professional level, at the stage of implementation. It is very unclear to me personally how this implementation could work at the level of countries and institutions. But apparently it is at that “lower” level where the real action will need to happen. And the WHO seems to acknowledge this. As the global strategy and action plan (GSAP) draft states (p. 22):
“Contributions aligned to the GSAP from countries, non-state actors including older adults, civil society organizations, multilateral agencies, development partners and those who develop, manufacture and distribute aids, equipment or pharmaceuticals to improve intrinsic capacity or functional ability, can transform the action plan from a document to a movement.”
So, in a sense, the implementation and interpretation of whatever is written in those documents will largely depend on “us”, on the individual and organizational involvements. If the longevity advocates are vocal, active and influential, the WHO authorities will need to “come to us” for the implementation of their plans..
PS. There is little doubt that, if active enough, the longevity advocates can emphasize the importance of biomedical research of aging. For example, watch this video on centenarians that was just released by the UN Department of Economic and Social Affairs – Division for Social Policy and Development ! The authors refer to this video as a “call to action” – there is a growing realization that achieving healthy longevity is possible. But it will still be the job of longevity advocates to emphasize that in order to actually make it possible and accessible to people we need the scientific “know-how”!
https://www.youtube.com/watch?v=eBP8ycObpbU&feature=youtu.be
Ilia Stambler, PhD. Outreach Coordinator. International Society on Aging and Disease (ISOAD)
ilia.stambler@gmail.com
