ALEXANDRE SIDORENKO
For those who have been following the international vocabulary on aging during the past decade or two, its transformation is obvious-from negative and pessimistic to positive and forward-looking. Of course, this does not mean that reaching a secure, healthy, and dignified old age has become a universal blessing and ubiquitous achievement. This is definitely not the case in many countries of sub-Saharan Africa, where life expectancy may not exceed thirty-three years (as in Swaziland), or in the countries of the former Soviet Union, where for millions of middle-age people the progression into old age coincided with the hardship of societal transformation. And throughout the world, too often older persons are left on their own to adjust to changes associated with individual aging-at the workplace, at home, and in a rapidly changing society.
Nonetheless, in the United Nations policy documents on aging, the words aging and problem rarely are placed together. Aging is referred to as an issue, an area, and most emphatically as a challenge and opportunity (United Nations, 2002b). This is not just political correctness, but a reflection of new thinking and emerging new policy responses to individual and population aging in the twenty-first century (Kinsella and Phillips, 2005). The Second World Assembly on Ageing, which took place in Madrid, Spain, in April 2002, elaborated these responses. This chapter outlines the major parameters of the new responses to the challenges and opportunities of aging as formulated in the Madrid International Plan of Action on Ageing and promoted through follow-up actions.
INTERNATIONAL CONSENSUS ON AGING 2002
The majority of decisions made by the United Nations are based on the consensus, or universal agreement, of all its member states. The voting procedure is also envisaged and has been exercised, but in the "social domain" of the UN it is rare. Reaching a consensus could be cumbersome and painful and thus requires a great deal of good political will to negotiate and compromise. One can argue that political compromises may dilute the ideas and obstruct actions. Despite these obstacles, consensus unites the international community on the basis of universally agreed values and goals. In aging, the most recent and most significant international consensus document is the Madrid International Plan of Action on Ageing.
To develop the Madrid Plan of Action, the forum for the political process of consensus-building was the Preparatory Committee for the Second World Assembly on Ageing, which had two regular sessions in 2001. The committee focused on negotiations on the content of the future plan of action on aging. This process was completed during the Second World Assembly in Madrid from April 8 to April 12, 2002, by its Main Committee, which finalized the texts of the Madrid Plan of Action and the Political Declaration.
The entire negotiation process was supported by the work of the Technical Committee: fifteen individual experts and several observers representing various organizations of the UN system and international nongovernmental organizations. The governments of Germany, Spain, and Austria provided financial support to all three meetings of the Preparatory Committee, which were hosted by the governments of Germany (June 2000), the Dominican Republic (Santo Domingo, October 2000), and Austria (Vienna, April 2001).
The most important role of the Technical Committee was its contribution to the formulation of proposals regarding the content of the new plan of action. These proposals helped the UN Secretariat to prepare the draft plan of action for subsequent intergovernmental negotiations at the meetings of the Preparatory Committee and the Second World Assembly.
Two major outcomes of the Madrid Assembly include the Political Declaration and the Madrid International Plan of Action on Ageing. The most important content of the Political Declaration is the commitment of governments to address the challenges and opportunities of aging in the twenty-first century. The United Nations member states that gathered at the Madrid Assembly committed themselves to eliminate all forms of discrimination, including age discrimination; to effectively incorporate aging within social and economic strategies, policies, and action; to protect and assist older persons in situations of armed conflict and foreign occupation; and to provide older persons with universal and equal access to health care and services. Governments also expressed their commitment to act at national and international levels on three priority directions: older persons and development; advancing health and well-being into old age; and ensuring enabling and supportive environments.
Priority Direction I for action strives to integrate global aging within the larger context of development. The overall goal is to ensure that older persons are full participants in the development process and also its beneficiaries.
Priority Direction II emphasizes that the health of the population is vital to development and that for the individual, good health is the most important asset and human right. To reach old age in good health requires the combined efforts of government, civil society, and the individual.
Priority Direction III aims to ensure enabling and supportive environments. It promotes positive perceptions of aging and positive, realistic images of older persons to influence public values relating to social, cultural, and economic exchange between generations. The Madrid Plan of Action also calls for greater access to both the physical environment and services and resources, including care and social protection.
The elaboration of the Madrid Plan of Action was informed by the major United Nations conferences, summits, and special sessions of the General Assembly. The decisions of these international gatherings and their follow-up processes helped to formulate the central themes, or foundations, of the Madrid Plan of Action. These themes include the issues of human rights and fundamental freedoms; empowerment and participation; individual development, self-fulfillment, and well-being throughout life; gender equality; intergenerational interdependence, solidarity, and reciprocity; health care, support, and social protection; partnership among government, civil society, the private sector, and older persons; scientific research, expertise, and technology; and the situation of aging indigenous peoples.
CENTRAL CONCEPT OF THE MADRID PLAN OF ACTION: ORIGIN AND EVOLUTION
The central concept of the Madrid Plan is the concept of a society for all ages. This concept was formulated during the preparations for the 1999 International Year of Older Persons and later became the year's theme. The concept of a society for all ages emerged from the concept of a society for all, laid out in the Copenhagen Declaration and Programme of Action, which was developed at the World Summit for Social Development in 1995 (United Nations, 1995). In the Programme of Action of the World Summit, a society for all was described as an inclusive society, "in which every individual, each with rights and responsibilities, has an active role to play."
The Report of the Secretary General, "Conceptual Framework for the Preparation and Observance of the International Year of Older Persons in 1999" stated that a society for all ages "would ... enable the generations to invest in one another and share in the fruits of that investment, guided by the twin principles of reciprocity and equity" (United Nations, 1999).
Four facets were suggested to explore the society for all ages and, consequently, to develop a strategy to achieve such a society. These are situation of older persons, lifelong individual development, multigenerational relationships, and development and aging of populations.
The situation of older persons, the first facet of the Conceptual Framework, emphasizes a "traditional" approach of policy action on aging. This approach incorporates "policies designed to enhance the lives [of older persons] as individuals and to allow them to enjoy in mind and in body, fully and freely, their advancing years in peace, health and security" (United Nations, 1982, p. 9). The Vienna International Plan of Action on Ageing-adopted by the first World Assembly on Ageing in 1982 in Vienna, Austria-identified the following areas of primary concern to older persons: health and nutrition, protection of elderly consumers, housing and the environment, the family, social welfare, income security and employment, and education. The recommendations of the Vienna Plan of Action are viewed as specific measures for supporting the independence, participation, care, self-fulfillment, and dignity of older persons as outlined in the United Nations Principles for Older Persons (United Nations, 1991).
The second facet of the Conceptual Framework, lifelong individual development, was a relatively new priority within the UN program on aging. It was based on the idea that the interplay of individual behavior and various policies affecting people at different ages will shape the situation of persons in older age. To respond to various needs at different stages of individual development, policy should provide an enabling and supportive environment fostering lifelong education, skills-upgrading, healthy lifestyles, and provision of care when it is required.
Multigenerational relations are the third facet of the Conceptual Framework. The debate during the International Year of Older Persons explored how the relations of interdependence could be maintained in family and society as the proportions of older and younger people change. The implications of aging for family include primarily caregiving, and for society, provision of social services and income security.
The fourth facet, aging and development, focused on harmonization (reconciliation) of population aging with continuing socioeconomic development. This requires multisectoral adjustments, including employment, income security, social welfare, health care, education, and also investment, consumption, and savings patterns. One of the principal directions for such an adjustment is ensuring that older persons have opportunities to participate and contribute and also to receive care when needed.
When first put forth in the late 1990s, the concept of a society for all ages appeared as an innovative approach to aging-and to some as a controversial deviation from earlier commitments to care and support for older people. The controversy was based on a presumption that efforts to achieve a society for all ages could lead to abandoning the policies that address specific and often difficult situations of older persons, shifting already limited resources to other social groups, such as children and youth. In the course of debate during the International Year, the UN Programme on Ageing emphasized that although the concept of a society for all ages took a broad and long-term approach to individual and population aging, improving the situation of older persons would remain a paramount task for future action on aging.
The strategies for a society for all ages could embrace aging issues instead of singling them out and thus isolating and marginalizing older persons. This approach was later incorporated into the implementation strategy for the Madrid Plan of Action, which promoted a two-faceted action: advancing the aging-specific programs while simultaneously mainstreaming aging into national and international development strategies (United Nations, 2003).
Subsequently, the UN General Assembly decided that the concept of a society for all ages would serve as the context for the future plan of action on aging, which later became the Madrid Plan of Action. Eventually, the four facets of the Conceptual Framework evolved into the three priority directions of the Madrid Plan.
ACTION ON AGING IN THE TWENTY-FIRST CENTURY: PURPOSE, GOAL, AND CONTENT
The purpose of the Madrid Plan is to respond to the opportunities and challenges of population aging in the twenty-first century and to promote the development of a society for all ages. All three priority directions of the Madrid Plan are designed to guide policy aimed at reaching the specific goal of successful adjustment to an aging world. The success of this adjustment, states the plan, will be measured in terms of social development, improvement in quality of life for older persons, and sustainability of the various systems-formal and informal-that underpin well-being throughout the life course.
The Madrid Plan clearly focuses on developing countries not only because that is where the process of population aging will happen in the twenty-first century, but also-and more important-because these countries will have to respond to the implications of aging from a rather limited economic and social base compared to the developed world. The challenge is to develop policy approaches that keep aging from becoming an additional burden for developing countries and to transform it into an opportunity for development.
Unfortunately, older persons today are largely absent from the international developmental discourse, including in the most prominent document of the United Nations on development, the Millennium Declaration (United Nations, 2000), which fails to address aging among the eight Millennium Development Goals (MDGs)s. Meanwhile, issues related to aging and older persons are being pursued in the context of other global processes, including the International Conference on Financing for Development, held in Monterrey, Mexico, and the World Summit on Sustainable Development, held in Johannesburg, South Africa. For example, the Monterrey Consensus of the International Conference on Financing for Development (United Nations, 2002c) addressed the role of pension schemes as a source of social protection as well as savings and resources for development. The Johannesburg summit outcome-the Johannesburg Plan of Implementation (United Nations, 2002a)-recognized the role of holders of traditional knowledge and practices, who are typically community elders, and called for their effective participation in decision and policy making.
Although these references to aging in Monterrey and Johannesburg were important, one can hardly deny that aging remains at the outskirts of global development efforts and that the developmental potential of older persons remains untapped. Essentially, most policymakers continue to think of aging primarily in humanitarian terms, with concern centered on pensions and caregiving, while ignoring its developmental potential. An inability to recognize and develop the potential of aging will certainly become both unaffordable and inexcusable tomorrow when it becomes a really dominant issue globally-particularly in developing countries.
The major challenge in adjusting to an aging world is to transform aging into a force for progress and development at both societal and individual levels. Such a possibility is real: population aging did not start all at once; in the more developed parts of the world, the phenomenon has been present for more than a century. That period witnessed unprecedented advancement of science, technology, and quality of life, including the increase in individual longevity. Significantly, individual longevity has been growing together with societal development. The reasonable assumption is that societal development and population aging are two parallel processes. The principal task is to ensure that they are compatible and synergistic.
Specific policy action should support the multilevel adjustment to an aging world. Two types of policy approaches are necessary: aging-specific and aging-mainstreaming.
The first policy approach, aging-specific, includes policies and programs designed to address the needs of older persons. Following the Vienna International Plan of Action on Ageing and the UN Principles for Older Persons, policies and programs should be formulated within several areas of primary concern to older persons (discussed previously) and ensure their independence, participation, care, self-fulfillment, and dignity.
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Excerpted from Global Health and Global Aging Copyright © 2007 by Mary Robinson. Excerpted by permission.
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