Health Promotion for Older Persons ARE THERE MODERN STRATEGIES FOR HEALTH PROMOTION? Dra. Magaly Ojeda Vida Senior Center Washington DC. USA magaly66@gmail.com

Key Points: The evolution of health promotion has become an increasingly powerful tool in the hands of society. The political framework of active aging is a health promotion strategy. Advances in health promotion strategies should be approved for the promotion of active aging.

Turning Plans into Action Community Participation OPPORTUNITY EQUITY PROMOTION We must look at these concepts and consider the practical application of these concepts. SOCIAL CAPITAL Determinants of health

The Concept of Promotion Health promotion consists of providing communities the means to improve their health and exercise greater control over it. To reach a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and realize aspirations to satisfy their needs and to change or adapt to the environment. The objective is not to create a perceived health, but rather to enrich everyday life. The first International Conference on the Promotion of Health that took place on November 21, 1986 in Ottawa, resulted in Letter for the Health for All in 2000. This letter gives a response to the growing demand for a new concept of health. This letter defined the concept of promotion, which has been complemented in approaches and tools for their implementation and development. This definition emphasizes social and personal resources as well as physical abilities in the concept of health. Ottawa letter for the promotion of health OMS. Ottawa, 1986

Evolution of a Strategy First Conference: Ottawa, Canada, 1986 Main message: New definitions of health Second Conference: Adelaide, Australia 1988 Main message: Public policies for health Third Conference: Sundsvall, Sweden, 1991 Main message: Environments for health Fourth Conference: Jakarta, Indonesia, 1997 Main message: Determinants of health: New challenges Fifth Conference: Mexico City, Mexico, 2000 Main message: Decreasing the equity gap. This slide outlines the various meetings under the World Health Organization that address the conceptualization and development of understanding of health and its determinants.

Evolution of a Strategy Sixth Conference: Bangkok, Thailand, 2005 Main Message: Determinants of health and globalization Seventh Conference: Nairobi, Kenya, 2009 Main message: Promotion of health in the policial development agenda. World Conference on Social Determinants of Health: Río, Brasil, 2011 Main message: Governance in favor of health and development Eighth Conference: Finland, 2013 Main message: Health in politics. The World Conference on Social Determinatns of Health in Brazil marks one of the most important developments in addressing the social determinants of health.

The world has changed The world is aging and will continue to age tremendously in the next 40 years. We have seen that aging is not only a phenomenon in the developed world, but also in the developing world.

An unprescedented speed Increase in the older adult population over 56 years in France and Mexico 8

Barbados is part of this process Barbados, like other Caribbean countries, is beginning to age at alarming rates. See how the population over age 60, marked in yellow, increases greatly.

The challenge of aging and health The aging population is one of the greatest triumphs and also one of the biggest challenges facing humanity. Health is part of this challenge. Making the result of this process positive will depend on the coherent and integrated action in all sectors. The public health sector should assume conceptual advances in health promotion to understand and face this challenge.

Active aging as a health promotion strategy In 1999, the World Health Organization World Assembly on Aging developed a proposal for Active Aging.

Conceptual Framework Active aging is the process of optimizing opportunities for health, participation and secuirty in order to improve the quality of life as people age. To make aging a positive experience, a longer life should be accompanied by continuous opportunities for health, participation and security. The World Health Organization utilizes the term “active aging” to express the process to follow this objective. Active aging applies just as much to the individual as it does to groups and populations. Active Aging allows a person to realize their full potential of physical, social and mental wellbeing throughout their own life, and to participate in society in accordance with their needs, wishes and capacities. World Health Organization, 1999

Active Healthy Functional Active Aging Colin A. Depp, Ph.D., and Dilip V. Jeste, M.D. Definitions and Predictors of Successful Aging: A Comprehensive Review of Larger Quantitative Studies. Am J Geriatr Psychiatry 14:6-20, January 2006

Determinants of Active Aging Economic determinants sex Health and social services ACTIVE AGING Social determinants Behavioral determinants Active aging depends on a diversity of influences or determinants that revolve around individuals, families and countries. We also need to understand the ways in which these determinantes influence the wellbeing of older adults. Personal determinants Physical environment culture

Functional capacity and the life course Functional capacity (such as muscular strength and cardiovascular output) increases in childhood, peaks in early adulthood and eventually declines. The rate of decline is largely determined by factors related to lifestyle, as well as external social, environmental and economic factors. From an individual and societal perspective, it is important to remember that the speed of decline can be infl uenced and may be reversible at any age through individual and public policy measures, such as promoting an age-friendly living environment.

To ensure active aging: Help people to continue living independent and active lives. Strengthen promotion and health prevention. Increase the quality of life. Avoid the breakdown of health and social systems. Balance the care of persons who need assistance between the family and the state. Recognize and support the important role of taking care of others.

Pillars of Active Aging Three pillars define Active Aging: Participation, Health and Security.

Active aging should grow as a strategy We believe that in the last decade, we have made significant progress in both health-related issues and promotion as well as major advances in strategies for active and healthy aging of our population, and we believe it appropriate to increase active aging as a strategy, taking advantage of these opportunities.

Inserting aging in health promotion strategies It is important that we understand that we are capable of inserting aging in the health promotion strategies, and we should work towards this in the coming years. What do we have for 2014?

Public Policy United Nations Declaration on the Rights of Older Persons (1999) International Plan of Action on Aging (2002), Chile International Agreement (2003), the Brazil Declaration (2007) and the San Jose Letter (2012) The Regional Strategy and Plan of Action on Aging and Health 2009-2018 (2009) World Health Day (2012) Advancement toward the Convention on the Rights of Older Persons

Other Tools Other tools from international organizations: Older People in Emergencies: Considerations for Action and Policy Development (WHO) A Global Response to Elder Abuse and Neglect (WHO) Towards an International Consensus on Policy for Long-Term Care of the Aging (WHO)

Promoting the creation of age-friendly environments

Promoting the creation of favorable environments The strategy for promoting the creation of favorable environments is composed of a group of thematic areas, based on local experiences. These areas include: Transportation Housing Social participation Respect and social inclusion Civic participation and employment Communication and information Outdoor spaces and buildings

Strengthening Community Action Essential components to healthy aging: Physical activity Mental activity Social activity Social Commitment: Productive and significant roles in society Only in the community and with the community can we achieve this

The reorganization of health services. (The problem) Health systems were not constructed for the management of chronic disease. Chronic diseases last for many years and are long-term problems.. The most significant diseases are affected by our personal context and behavior, which the system cannot entirely support. Older persons oftentimes have multiple complex needs, complicated by the influence of health determinants. We must reorient our objectives to understand the necessities of older persons.

The reorientation of health services (How to solve the problem) Design health services that satisfy the needs of persons with chronic diseases. Planned and integrated care. Patients who are conscious of the management of their disease. Continuous attention to the promotion of health and quality of life. Access to medicine and appropriate technologies. 26

Other Tools We also have tools that may help you in this objective: The implications for training of embracing a life course approach to health WHO Global Report on Falls Prevention in Older Age Age-Friendly Primary Health Care Centres Toolkit

Developing personal skills (The problem?) Health behavior is the cause of many premature deaths. People need to be educated on health material and have support from other people, programs, institutions and specific tools in overcoming their difficulties. It is difficult for people to start changing their habits and even harder to keep these long-term changes. It is not enough to simply tell someone to stop their bad habits. Patients must make their own decisions regarding their behavior and habits.

Developing personal skills (How do we resolve the issue?) Education on the basic principles of health behavior. This education should be given by those who can relate and should include practical advice, suggestions and ideas. Understand that different patients have difference needs. Each case is unique. People go through different stages of change: some are willing to change now, while others may not be ready yet. Interventions should be based on individual needs and their social and cultural environment.

Developing personal skills (With what?) We have evidence-based programs (Taking Control of Your Health, etc.) that should: Offer motivation and confidence en the management of a person’s condition. Establish goals, plans of action and support from their partners. Achieve behavior changes that are significant in reaching healthier results – specific, measurable and realistic. Resolution of problems, review and feedback. Y por suerte hemos acumulado experiencias y contamos con que Tenemos programas basados en Evidencias (Tomando Control de su salud, etc) que deben: Ofrecer motivación y confianza en el manejo de la condición de una persona. Establecer metas, planes de acción y apoyo de sus pares. Lograr comportamiento para cambiar planes que sean significativos para el paciente - específico, mesurable y realista. Resolución de problemas, revisión y retroalimentación.

World Health Day 2012

Participation VS Compromise Provide education and training opportunities throughout the WHOLE life cycle. Recognize and allow the GUARANTEE of the active participation of people in economic development activities, formal and informal work and volunteer activities as they age, according to their needs, preferences and individual capacities. Encourage people to participate fully in family and community as they age. 32

Convention on the Rights of Older Persons Security Ensure the protection, security and dignity of older persons while addressing the social security rights and needs of people who are aging. Reduce inequalities in the security rights and needs of older women. Convention on the Rights of Older Persons

Intersectoral action Measures in various sectors other than health and social, such as education, employment and labor, the economy, social security, housing, transport, justice and rurarl and urban development. These measures support the goals of improving health through intersectoral action. This approach emphasizes the importance of the many different public health partners and strengthens teh role of the health sector as a catalyst for action.