Implementing Madrid Plan of Action on Ageing: What learnings in the last 15 years? What future directions?
Adjunct Professor, JC Institute of Ageing, Chinese University of Hong Kong, China
Submission: February 08, 2018; Published: February 15, 2018
*Corresponding author: Asghar Zaid, Adjunct Professor, JC Institute of Ageing, Chinese University of Hong Kong, Hong Kong, China, Tel: +44(0)23 8059 3787, Email: Asghar.Zaidi@soton.ac.uk
How to cite this article: Asghar Zaidi. Implementing Madrid Plan of Action on Ageing: What learnings in the last 15 years? What future directions?. OAJ Gerontol & Geriatric Med. 2018; 3(3): 555614. DOI: 10.19080/OAJGGM.2018.03.555614.
Abbreviations: MIPAA: Madrid International Plan of Action on Ageing; DHS: Demographic and Health Surveys; MICS: Multiple Indicator Cluster Survey; AAI: Active Ageing Index; ECE: Economic Commission for Europe
It's no secret that the world's population is aging. As fertility declines and life expectancy increases, the proportion of people in older ages is projected to grow in all regions of the world. Therefore, it is increasingly important to develop metrics that assess the effectiveness of policies and programmes affecting older people. The Madrid International Plan of Action on Ageing (MIPAA), developed in 2002, is central to this measurement agenda. It set out three priorities to guide countries in their policies:
a) Older persons and development (in particular
promoting social protection).
b) Advancing health and well-being into old age.
c) Ensuring enabling and supportive environments.
Fifteen years later, it is timely to assess the effectiveness of the Madrid Plan and indeed reviewing it is a theme of the next UN Commission for Social Development. The MIPAA started with great promise as one of the only international policy frameworks to focus on older people. The latest UN review of MIPAA shows that despite progress in policy formulations, its implementation remains uneven across countries and the three policy priority directions. Major constraints include lack of resources, political will and data.
So, what have we learned from the process? What do we need to do now?
The MIPAA experience so far offers one major lesson: its monitoring lacked a comprehensive global approach. This was partly because of lack of age-disaggregated data in many countries, but mainly for the fact that the MIPAA monitoring toolkit has not been properly developed. In such introspection, another critical question is: how MIPAA stays relevant when the international community is committed instead to its newest and most comprehensive policy framework to date, the 2030 Agenda of sustainable development.
MIPAA Monitoring Lacks a Comprehensive Global Approach
While progress is being made in the implementation of the MIPAA, there is no comprehensive global approach towards its monitoring. Metrics are an area that some feel was underdeveloped in the Plan. This in turn has led to a disproportionate submission of anecdotal, descriptive and self-defined information, with little evaluation of the relationship between outputs and policy impact. In particular, the limited use of indicators in national reporting has hampered comparisons of country-level progress. Such inconsistency and varied reporting is unsurprising in such a voluntary system. A specific example is on reporting progress towards sensitising and reducing elder abuse. Nordic and Western European countries introduced programmes that led to increased reporting and development of policies to prevent violence against older persons.
In contrast, very limited information is available in many Eastern European countries on the extent of violence, abuse and neglect of older persons. Even where data are available, cases are often underreported and prevention policies are lacking. Greater national capacities are needed: not only to design comprehensive policies for the older population but also to provide specific guidelines in assessing their progress. Detailed guidance on data collection, including timescales for reporting, is an area where investment will have significant impacts on the success of the MIPAA. This is even more important now that demographic aging has taken hold within developing as well as developed countries.
Lack of Age-Disaggregated data has been a Major Constraint
Fundamental to the successful implementation of the MIPAA is reliable country-level data collection and research, areas for which there was little guidance in the MIPAA's recommendations. In developing countries, the lack of data disaggregated by age and sex for even basic sociodemographic and health indicators is acute and makes tracking implementation of the MIPAA difficult. For example, in the majority of African countries, much of the available data are for younger age groups. Data that is especially important to older persons. It is not surprising that many African countries were not represented in Help Age International's Global Age Watch Index. Part of the problem lies in the fact that many surveys stop short of collecting data on older persons. USAID's Demographic and Health Surveys (DHS) and UNICEF's Multiple Indicator Cluster Survey (MICS) serve as two of the biggest tools for generating global statistics and they focus mainly on children and women under the age of 49. There could be the option of removing the age-cap in these existing global surveys, as has been done by South Africa.
However, a more desirable option will be that countries invest in collecting data using the specialised survey instruments and methodologies to collect data on older men and women. The new national survey on older persons in Iran, to be conducted during 2018, is a good practice example in this respect where policymaking communities in a resource-constrained country appreciate the value of high-quality evidence base on older people. The formation of the new UN Titchfield City Group on Ageing and Age-disaggregated data provides us a unique opportunity to ensure that countries learn from each other in the collection of age-disaggregated data and monitor progress in the implementation of the MIPAA.
The MIPAA Monitoring took it needs to be Developed
I believe an investment in global assessment tools is also vital to ensure that the MIPAA is implemented seriously. I suggest that a dashboard of indicators aligned with the key priorities of the MIPAA - including an adaptation of the Active Ageing Index (AAI) - should serve as the toolkit for monitor MIPAA implementation in the future. The composite AAI will help point to priority countries by comparing the index value. The dashboard of indicators can then help identify in which areas a country is doing well (or falling short) and what learnings can be drawn from the good global policy practices.
The AAI comprises 22 indicators, organised around four domains:
b) Social Participation;
c) Independent, healthy and secure living and
d) Capacity and enabling environment for active ageing.
The AAI indicators are disaggregated by gender and in large part focus on people aged over 55. The AAI evidence can be summarised in an aggregated country-level score, facilitating global comparisons and the production of a league table. It identifies contexts in which older people fare better, and point to policy interventions that are effective in empowering older people and ensuring their rights. The AAI indicators was used by the UN Economic Commission for Europe (ECE) in the third cycle review of MIPAA, starting in 2015, to reflect the outcomes of ageing policies and to measure the untapped potential of older people. The latest AAI results for European countries show that Sweden, Norway, Switzerland and Iceland are at the top of the ranking, followed closely by Denmark, the Netherlands, Finland, the UK and Ireland.
Future Directions for MIPAA Implementation
I believe that the Sustainable Development Goals of the 2030 Agenda have put ageing back onto the international development agenda. The two pledges made, 'Leaving no one behind' and 'Reaching the furthest behind first', give us a strong momentum to seek inclusion of older people in all policymaking. We are therefore aspiring to live in a world in which no development process is complete without the objective of the promotion of quality of life of vulnerable groups of society, such as the older population, and where the older population's participation make them key contributors to the development process (Figure 1).