EPHA responded to the Consultation on Healthy and Active ageing. Below you will find a text highlighting EPHA`s main issues for the Partnership. The letter is available in PDF as well.
In the framework of this consultation, I would like to highlight some of the past work done on healthy ageing, in particular the 2002 resolution adopted by the European Parliament on “the Future of health care and care for the elderly” guaranteeing accessibility, quality, and financial sustainability.” These are three key pillars to ensure healthy ageing. Availability and accessibility of healthcare should be addressed by the partnership. In addition, I would like to urge the Commission to have a broad definition of “innovation,” one that not only focuses on technological advances or new medicines but also on innovation in the design of health and social care systems. The scope of the partnership should encompass both the late working life as well as life in retirement. Most of all, the partnership and future work should reflect that the older generation is a value to society and enable them to participate in society.
The timeline foreseen to develop and implement the partnership is far too short and there is not enough time to adequately consult with civil society. The links to other EU initiatives, for example, the 2012 European year of active ageing should be clear and strategic. The pilot project is not linked to this year, and could have benefited from the knowledge base that the year will create.
The health dimension of the partnership could be strengthened – the approach taken by the Commission could be broadened. Healthy ageing means leading a healthy lifestyle from cradle to grave. Although it is never too late to start making healthy choices, the root causes of healthy life years occur early in life. Therefore, in addition to encouraging older persons to make healthy choices, the Commission should also put efforts to encourage younger citizens to have healthy habits. Not only is this more cost-efficient, but in general habits are easier to develop at a younger age. At the same time for older persons, efforts need to be made to make healthy choices (including food) more affordable. The World Health Organization suggests the following “Functional health and well-being must be nurtured throughout life and good habits maintained as we grow older. Eating habits, learning to take regular exercise and avoiding smoking and excessive drinking play an important part in determining our health later in life.” 
The Partnership has a strong focus on treatments, products and technology, however there is also a strong need to further work on health promotion and disease prevention. According to the latest World Health Organization figures, 86% of all deaths occurring in the WHO European Region are caused by chronic non-communicable diseases. Four major health determinants: nutrition, tobacco, alcohol and a lack of physical activity - account for most chronic diseases knowing that they also are the most preventable causes of deaths. In this context, the recent WHO Global Recommendations on Physical Activity for Health  emphasised the need for people beyond 65 years old to "be as physically active as possible". In addition, older persons often experience malnutrition, being at home or in institutions. Therefore, EPHA strongly believes that there is an urgent need to act on health determinants, especially when attempting to reach the goal of increasing healthy life years by two years.
Moreover, for the partnership to be effective, it should use a cross-sectoral approach including areas, such as social affairs, employment, education, agriculture and food, housing and infrastructure policies. According to the WHO :”older people need to keep fit and independent for as long as possible, supported by policies that cut across all sectors to influence the determinants of their health. They need adequate income, housing, access to all kinds of health, social and cultural services and strong social networks to enhance their quality of life. They need opportunities to continue contributing in all aspects of society, without age-discriminating restrictions.”  The approach should also be comprehensive, health care has to be tailored to meet the needs of older people, there is additionally the need to have a holistic approach and go beyond treating the disease - ensuring that care includes support and post-treatment assistance. In addition to focusing on specific disease, the partnership should also focus on needs of the older people. The importance of health literacy, patient and consumer education and communication should be stressed in all work areas.
Although ICT has huge potential to improve the quality and delivery of care, the role of carers for older people (including in home care settings) and health care professionals cannot be ignored. The shortage of health workforce should be addressed as part of a wider strategy, which include policies for recruitment, retention and training of healthcare professionals .
The wider social dimension could also be reinforced. eHealth is being pushed for within the Partnership, and the Commission should ensure efforts so that eHealth will not cause inequality to care as the ICT services and products can be purchased and implemented only by a limited wealthy health care providers/users. As the WHO points out, “Not all older people know how best to use their own resources to maintain their full health potential… People with lower income and less education tend to more strongly lack confidence in personal capacity, leading to greater social inequality in health.”  If the use of eHealth, technologies and the inaccessibility of services end up creating inequalities, the Partnership could be counterproductive. Caution needs to be taken to avoid creating inequalities both within and among Member States. At the same time for solidarity and economic cohesion, it would be beneficial if the Partnership were able to tackle health inequalities between Member States and the partnership ensures that the marginalised and “hard to reach” groups would be targeted by the project. This is particularly important within the context of the economic crisis, which has had a significant impact on older people, particularly those who are physically vulnerable, living in poverty and/or dependent on private pensions.  The Commission needs to ensure that the economic crisis does not become a social and health crisis for older people.
The final item that I bring to your attention is financing. For any project or initiative to be effective, adequate financing is essential. Likewise, the Active and Healthy Ageing Partnership should be accompanied by funds for its coordination and implementation. More funds for research, innovation and quality of care are needed and must be spent wisely as there are often very high costs. Financing will be particularly important to ensure the sustainability of this project.
We wish the European Commission continued success with this Partnership and look forward to collaborating with you on this. My hope is that the comments from the Public Health Community will prove useful, as work continues to implement this partnership.
Related EPHA Articles
Council Conclusions on impact of ageing workforce & population on employment policies
2012 European Year for Active Ageing
Council conclusions on Healthy and Dignified Ageing
International Day of Older Persons and Mental Health – October 2007