A Paradigm Shift in Understanding Longevity
For decades, conversations around aging were dominated by the idea of 'successful aging,' which often emphasized avoiding disease and maximizing independence. However, this perspective was exclusionary and failed to capture the diverse realities of aging worldwide. In its 2015 World Report on Ageing and Health, the WHO introduced a new, more inclusive definition that has fundamentally reshaped global health policy. This definition moves the focus from a purely disease-centric model to a broader, more holistic one, emphasizing capability and quality of life.
The Core of the WHO's Definition: Functional Ability
The central concept in the WHO's definition of healthy ageing is functional ability. This is the capability that enables people to be and do what they value. It is not merely the absence of disease, but rather the ability to live a fulfilling life by participating in society and maintaining purpose. This capability is the product of two key factors:
- An individual's intrinsic capacity
- The environment in which they live
Functional ability recognizes the great diversity in older age. An 80-year-old with a chronic condition who can still live independently and engage with their community is aging more healthily, by the WHO's measure, than a sedentary 60-year-old with no chronic diseases who is socially isolated.
The Five Domains of Functional Ability
To help articulate what 'doing what they value' means, the WHO has identified five key domains of functional ability. These domains provide a framework for individuals, communities, and governments to assess and improve wellbeing in later life.
- To meet basic needs: This includes the ability to perform daily tasks such as eating, dressing, bathing, and managing household activities. It ensures that an individual's fundamental requirements for living are met.
- To learn, grow and make decisions: Healthy aging involves ongoing cognitive stimulation, continuous learning, and the capacity to make informed choices about one's life. This protects against cognitive decline and promotes autonomy.
- To be mobile: The ability to move around one's home, community, and beyond is crucial for maintaining independence and social connections. This includes everything from walking to driving to using public transport.
- To build and maintain relationships: Humans are social creatures, and strong social bonds are a significant predictor of wellbeing. This domain emphasizes the importance of family, friends, and community connections.
- To contribute to society: Older adults have a wealth of knowledge and experience to offer. This domain acknowledges the value of their contributions, whether through paid work, volunteering, caregiving, or other forms of engagement.
Unpacking Intrinsic Capacity
Intrinsic capacity is the combination of all the mental and physical capacities that an individual can draw upon at any given time. It encompasses a person's biological and physiological health. The main components include:
- Mobility: The strength, balance, and endurance necessary for movement.
- Cognition: Mental abilities such as thinking, remembering, and problem-solving.
- Sensory function: The ability to see, hear, taste, and feel.
- Psychological state: Mental health, mood, and emotional resilience.
- Vitality: The underlying physiological energy and metabolism that supports all other functions.
These components are influenced by factors like genetics, lifestyle choices throughout life, and the presence of any diseases or injuries. While intrinsic capacity may decline with age, the WHO emphasizes that this process is not uniform and can be influenced positively.
The Role of the Environment
Environmental factors play a crucial role in determining functional ability. The WHO's definition looks beyond the individual to recognize that a person's surroundings can either enable or hinder their wellbeing. The environment is broadly understood to include:
- The built environment: The physical spaces people inhabit, from their home design to city infrastructure like public transport, parks, and accessible buildings.
- The social environment: The people and relationships that surround an individual, including social networks, community support, and social values regarding older people.
- Policies and services: The health and social care systems, as well as policies that support older people, such as pension schemes and legislation against ageism.
WHO's Decade of Healthy Ageing (2021-2030)
Building on the 2015 report, the WHO and the UN declared 2021-2030 the Decade of Healthy Ageing. This global collaboration aims to accelerate action across four strategic areas:
- Combatting Ageism: Changing how we think, feel, and act towards age and aging.
- Age-Friendly Environments: Ensuring communities foster the abilities of older people.
- Person-Centred Integrated Care: Aligning healthcare systems to the needs of older people.
- Long-Term Care: Providing access to quality care for those who need it.
This initiative serves as a powerful framework to help countries implement policies and programs that align with the WHO's holistic definition of healthy aging. For more details, see the official WHO Decade of Healthy Ageing page.
Comparison: New vs. Old Approaches to Aging
| Feature | WHO's Healthy Ageing | Older 'Successful Aging' Models |
|---|---|---|
| Core Concept | Functional ability that enables wellbeing. | Avoiding disease and disability. |
| Scope | Holistic, incorporating intrinsic capacity and the environment. | Primarily focuses on individual health and lifestyle. |
| Inclusivity | Inclusive of individuals with chronic conditions or disabilities. | Potentially exclusionary, labeling those with illness as 'unsuccessful.' |
| Role of Environment | Crucial; recognizes that context impacts health and function. | Minimal emphasis; views aging as largely an individual responsibility. |
| Goal | To enable people to be and do what they value, regardless of health status. | To maximize healthy, disease-free lifespan. |
Conclusion: Looking Beyond Chronological Age
The World Health Organization's definition of healthy ageing marks a profound shift from viewing older age as a period of inevitable decline to seeing it as a stage of life with its own unique potential. By focusing on functional ability—the interaction between our intrinsic capacities and our environment—the WHO provides a framework that is both compassionate and empowering. It reminds us that quality of life is not solely dependent on the absence of illness, but on the ability to live a meaningful and purposeful life, supported by our communities and healthcare systems. The success of the Decade of Healthy Ageing will ultimately depend on our collective commitment to this broader vision of wellness.
