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Part II: Building Healthy Public Policy
- Healthy Public Policy (Chapter 4)
- Policy and Program Innovations for an Aging Society (Chapter 5)
- A Rights-Based Approach to Policies and Practices Involving Older Persons (Personal Reflection 2)
Healthy Public Policy
(Chapter 4 by Peggy Edwards, Jim Hamilton, and Michael Routledge)
Note: Please refer to Figures 4.1 and 4.2 in Chapter 4 to obtain a list of the key national and international reports on healthy aging and public policy. The following are additional resources not provided in these lists or in the chapter references.
Relevant Readings
Benoit, François. (2013) Public Policy Models and Their Usefulness in Public Health: The Stages Model. National Collaborating Centre for Healthy Public Policy. http://www.ncchpp.ca/docs/modeleetapespolpubliques_en.pdf
This briefing note provides a description of the Stages Model and how the five stages of the model can be used to develop a healthy public policy.
Canadian Museum of History (n.d.). The History of Canada’s Public Pensions. Human Resources Development Canada. https://www.historymuseum.ca/cmc/exhibitions/hist/pensions/cpp-a90-wcr_e.html
The history of Canada’s public pensions.
Canadian Nursing Association (n.d.). Health in All Policies Toolkit. https://www.cna-aiic.ca/en/nursing-practice/tools-for-practice/health-in-all-policies-toolkit/toolkit
The CNA toolkit includes definitions and descriptions of key concepts in healthy public policy, expert presentations and research, assessment tools, websites, and references.
Drummond, D., Sinclair, D., Bergen, R. (2020). Ageing Well Report. School of Policy Studies, Queen’s University. https://www.queensu.ca/sps/sites/webpublish.queensu.ca.spswww/files/files/Publications/Ageing%20Well%20Report%20-%20November%202020.pdf
The focus of this report is on living accommodations (see Chapter 7) and the social and health policies that are needed and shown to be effective to help older people age in place and in a community of dignity and respect, where their health and social care needs are met. The authors suggest that promoting healthy aging and addressing what older Canadians want and need requires policy changes and a shift in status quo in four key (interrelated) categories: (1) housing needs to ensure seniors have options that are flexible and adjustable as their other needs change with age; (2) lifestyle needs such as good nutrition, regular rest and recreation, and the maintenance of healthy habits; (3) social needs that reinforce confidence in the continuing support of family, friends, neighbours, and communities; (4) care needs to alleviate physical and mental limitations often brought on by progressive failure of aging bodily systems and/or chronic disease.
Fafard, P. (2008). Evidence and Healthy Public Policy: Insights from Health and Political Sciences. National Collaborating Centre for Healthy Public Policy in collaboration with the Canadian Policy Research Networks. https://www.ncchpp.ca/165/Publications.ccnpps?id_article=160
This report focuses on two linked questions: what constitutes evidence in policymaking, and what models of policymaking are available in political science that can inform our understanding of how evidence is used or not used to develop healthy public policy? The author offers insight into how policy gets made and offers by way of conclusion six propositions to guide those who wish to bring evidence to bear to shape the broad public policies that affect the health of Canadians. The paper contrasts the direct and linear evidence-based model of policymaking found in health sciences literature with three models that are common in political science literature: the Stages Model, the Advocacy Coalition Framework, and the Argumentative Turn Model.
Guterres, António. (2020). Secretary-General’s Policy Brief: The Impact of COVID-19 on older persons. United Nations Department of Economic and Social Affairs: Ageing. https://www.un.org/development/desa/ageing/news/2020/05/covid-19-older-persons/
This policy brief elaborates on the impacts of the pandemic on older persons and the contributions and resilience that older people have shown. It identifies both immediate and longer-term policy and programmatic responses needed across four key priorities for action.
IRPP Task Force on Aging (2015). Designing a National Seniors Strategy for Canada. Institute for Research on Public Policy. https://irpp.org/research-studies/designing-a-national-seniors-strategy-for-canada/
This report draws on a review of the literature, a consultation exercise that included a series of interviews with experts and stakeholders, as well as a round table discussion. According to the task force, only the federal government can compel all the players to adopt a truly integrated and comprehensive approach and ensure that seniors across Canada receive comparable services, regardless of where they live. The task force members also insist that the strategy must go beyond health care and include “age-friendly communities, social and economic policy, and the social determinants of health.” Moreover, the strategy must avoid turning into an intergovernmental tug-of-war that puts the individual at the centre.
Kitchen, H. (2015). No Seniors’ Specials. Financing Municipal Services in Aging Communities. Institute for Research on Public Policy. https://irpp.org/research-studies/no-seniors-specials/
To what extent should local governments be financially responsible for age-friendly initiatives? Should they have access to new taxes or revenues to provide seniors’ services? Is it still appropriate for them to grant lower user fees and discounted property taxes to seniors? The author uses Ontario as a case study to examine these questions, with an analytical framework and some guiding principles. He argues that all local services should be financed the same way, including those for the aged. They should be under municipal authority, except when they affect residents of other municipalities or if they have a redistributive role.
Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B. and Marchildon, G. P. (2018). Canada’s universal health-care system: Achieving its potential. The Lancet 391(10131):1718–1735.
This comprehensive article describes the evolution of the Canadian health care system, current problems (e.g., profound health inequities experienced by Indigenous populations and some vulnerable groups). The authors conclude that the high aspirations of Medicare’s founders require a renewal of the tripartite social contract between governments, health care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity.
Morrison, V., Gagnon, F., Morestin, F. and Keeling, M. (2014). Keywords in Healthy Public Policy. Montréal, Québec: National Collaborating Centre for Healthy Public Policy. http://www.ncchpp.ca/docs/Keywords_EN_Gabarit.pdf
This report examines three concepts and expressions that are common in public health discourse: public policy, the social determinants of health, and population health. The authors take a broad look at these concepts. They do not attempt to pin down a single definition for any of the keywords; indeed, given the polyvalence of these terms, single definitions do not readily present themselves. Where applicable, they point to further reading for additional resources and current definitions.
Petrie, K. and Kickup, J. (2019). Health, care and the 100-year life: How policymakers can ensure health and fairness for all in an era of extreme longevity. London, UK: The Social Market Foundation.
This report addresses a series of questions about the future of the health, care, and medicine systems of the UK in light of increasing longevity raises. Are these systems sustainable? What new challenges might these systems face? Will the 100-year life be beneficial to all members of society? To conclude, the report puts forward five policy recommendations to address the issues raised.
Policy Options. (ongoing). Institute for Research Public Policy. https://policyoptions.irpp.org/?sfid=96459&_sf_s=seniors
This online magazine features many articles and opinions on policy and older persons (seniors) written by academics and leaders in the field.
Toronto Seniors Strategy 2.0. (2018). City of Toronto. https://www.toronto.ca/wp-content/uploads/2019/02/93cd-CoT-seniors-strategy2.pdf
Version 2.0 of the successful Toronto Seniors Strategy upholds the principles that were articulated in Version 1.0 (equity, respect, inclusion, and quality of life). It commits to ensuring all seniors having equitable access to City services and programs and includes 27 new recommendations for achieving an age-friendly city. It also undertakes a series of actions with more immediate benefits for seniors in the areas of heath, housing, transportation, employment and income, and access to information. Note: This is only one example of Age-Friendly Community plans and Older Adult plans at the local level. See, for example, https://www.hamilton.ca/city-initiatives/strategies-actions/age-friendly-hamilton (Hamilton ON); https://ottawa.ca/en/older-adult-plan (Ottawa, ON); https://www.calgary.ca/csps/cns/seniors/seniors-age-friendly-strategy.html (Calgary, AB).
United Nations Population Fund and HelpAge International (2012). Ageing in the Twenty-First Century: A Celebration and A Challenge. HelpAge International. https://www.helpage.org/resources/ageing-in-the-21st-century-a-celebration-and-a-challenge/
This landmark report makes the case for governments, NGOs, global institutions, and civil society to fully commit to a concerted global effort to realign 21st century society to fit the realities of 21st century demographics. It is based on an assessment of progress since the Second World Assembly on Ageing in 2002 in the three priority areas identified in Madrid: development, health and well-being, and enabling and supportive environments. It reviews progress in policies and actions taken by governments and other stakeholders in response to Madrid’s call for creating a society for all ages. Its unique feature is a focus on the voices of older persons themselves, captured through group discussions with older men and women in 36 countries around the world.
World Health Organization, Regional Office for Europe (2012). Policies and Priority Interventions for Healthy Ageing. https://www.euro.who.int/en/health-topics/Life-stages/healthy-ageing/publications/2012/policies-and-priority-interventions-for-healthy-ageing
This report provides data on Europe’s aging population and identifies four priority policy areas, five priority intervention areas, and examples of supportive interventions for healthy aging.
Relevant Websites and Organizations
Note: See the websites and organizations listed in the General Resources section. Many address healthy public policy and older adults. The following are additional ones particularly related to public policy.
Canadian Public Policy Network (CPPN)
CPPN is a research community of scholars from around Canada interested in public policy.
Institut national de santé publique du Québec (INSPQ)
A centre of expertise and information concerning the impact of public policy on the health and well-being of the population of Quebec, INSPQ supports a portal of information on public policy of interest to policymakers, practitioners, researchers, and students from all horizons and all countries, as well as a monthly newsletter which summarizes the new material and resources available.
Institute for Research on Public Policy (IRPP)
Founded in 1972, the IRPP is an independent, national, bilingual, not-for-profit organization. The IRPP seeks to improve public policy in Canada by generating research, providing insight, and informing debate on current and emerging policy issues facing Canadians and their governments. The IRPP research program Faces of Aging focuses on the following themes: end-of-life care, retirement-income adequacy and pension reform, funding and delivery of health care and social services, social and economic implications of caregiving, policy options to improve palliative care, regulations and quality in private residential care for seniors, improving regimes for advanced medical directives, and reviewing the impact of Tax Free Savings Accounts.
International Federation on Aging (IFA) Policy Portal
https://ifa.ngo/news-and-resources/publications/
The policy portal on the IFA website contains policy resources and publications under the topics of: Age Discrimination Policy, Engaging Older People, International Documents, and Underlying Assumptions & Projection Methodologies, and Health Promotion Through the Life Course: A call to action to leave no one behind. Click here for full event details.
National Collaborating Centre for Healthy Public Policy (NCCHPP)
NCCHPP’s website provides further information on key strategies in healthy public policy including evidence-informed decision-making, health impact assessment and health-in all-policy, as well as free online courses, videos, and publications.
Learning Opportunities: Courses, Webinars, and Online Events
A Framework for Analyzing Public Policies (updated 2017). National Collaborating Centre for Healthy Public Policy. http://www.ncchpp.ca/438/Online_Course.ccnpps
This online training offers a structured approach to analyzing public policies. This approach is based on an analytical framework that reflects a public health perspective, while at the same time integrating other concerns of policy makers. The course includes 24 exercises with detailed answer keys, stories from public health colleagues who have used the analytical framework, and a selection of tools and resources to further advance your knowledge (completion time 6-8 hours).
Health Impact Assessment, step by step (created in 2019). National Collaborating Centre for Healthy Public Policy. http://www.ncchpp.ca/274/online-course.ccnpps?id_article=922
Health impact assessment (HIA) is a structured and innovative process that informs decision-makers about the potential effects of a project, program, or policy on the health and well-being of populations. This online course (approximate completion time: five hours) consists of nine online modules, including: videos featuring experts from the field; different learning activities including quizzes and a case study; and various practical tools for performing HIAs. By the end of the course, participants will be able to: 1) Recognize the fundamentals of the HIA of public policies; 2) Explain the steps of a high-quality HIA; 3) Know the favourable conditions for successful HIA implementation.
National Collaborating Centre for Healthy Public Policy. http://www.ncchpp.ca/en/
Online courses (free, ongoing) intended for practitioners, professionals, students and decision-makers active in the health and social services sector (particularly public health), from non-governmental organizations, or for any person interested in public policies and their impacts on population health.
VOICES of Canada’s Seniors: A Roadmap to an Age-Inclusive Canada. (2021) CanAge. https://www.canage.ca/work/advocacy/
The Roadmap provides six compass points (V.O.I.C.E.S.) for areas of attention. Under each compass point, it maps critical issues that affect older Canadians, and provides recommendations and practical steps with the aim of improving the lives of Canadians now and in the future. In these free online events, panels of experts in the field of aging discuss each compass point relative to making Canada more age-inclusive. In light of the COVID-19 pandemic, these discussions and courses of action are more vital than ever before.
Policy and Program Innovations for an Aging Society
(Chapter 5 by Sherri Torjman)
Relevant Readings
Carstensen, L., Rosenberger, M., Smith K., and Modrek, S. (2015). Optimizing Health in Aging Societies Public Policy and Aging Report 25 (2). https://academic.oup.com/ppar/article/25/2/38/1501259
Medical advances have ensured that chronic diseases need not afflict future generations in mid-life. The article discusses the fact that optimal population health involves more than physical fitness. Rather, optimal health results from lifelong engagement with families, workplaces, and neighbourhoods. It also involves reduced disparities in access to health care, including health technologies.
Funk, L. (2016). Sociological Perspectives on Aging. London: Oxford University Press.
This book explores how micro-level individual experiences of aging connect to macro-level considerations of how society is organized, including the political, economic, cultural, and historical features of social structure. The text also examines how intersecting inequalities related to class, race, ethnicity, gender, and sexual orientation shape experiences of old age.
Green, D. A., Riddell, W. C., and St-Hilaire, F. (Eds.). (n.d.). Income Inequality: The Canadian Story. Institute for Research on Public Policy. https://irpp.org/research/income-inequality-the-canadian-story/
This volume presents materials from a major study on income inequality in Canada and other selected countries. It presents key trends in income inequality and discusses the relevance of this issue from financial, health and social perspectives. Several chapters consider possible policy remedies to tackle this serious problem.
Kuh, D., Cooper, R., Hardy, R., Richards, M., and Ben-Shlomo, Y. (Eds.). (2014). A life-course approach to healthy ageing. Oxford: Oxford University Press.
Research on healthy aging lacks an agreed conceptual framework and has not adequately taken into account the growing evidence that social and biological factors from early life onwards affect later health. This study conceptualizes healthy aging within a life course framework and summarizes the findings of a review of healthy aging indicators, focusing on objective measures of physical capability.
Novak, M., Campbell, L., and Northcott, H. (2018). Aging and Society: Canadian Perspectives. (8th ed.). Toronto: Nelson.
Canada’s population now has more older people than ever before. While this text explores the resulting demands on health care, retirement income, and housing, it also emphasizes the opportunities associated with successful aging. Improved health and nutrition have extended the years of active middle age. As a result, new models of aging are required to match new patterns of social experience.
Scott, A. (2018). The myth of an “ageing society.” World Economic Forum.
Discussions of the aging effect of population trends in industrialized countries tend to focus on the negatives associated with the “demographic time bomb” narrative. This article argues that the longevity effect is a decidedly more positive phenomenon. If people are leading longer, more productive lives, they can make a greater lifetime economic and social contribution than past generations.
Relevant Websites and Organizations
Note: Please see Organizations and Websites in Overall section at the beginning of the Additional Resources. The following are additional and specific to Policy and Program Innovations for an Aging Society.
Generation Squeeze
https://www.gensqueeze.ca/about_us
The “Squeeze” refers to the fact that younger generations struggle with lower earnings than their parents, higher costs, growing, debt and a deteriorating environment. Emerging from research conducted at UBC’s School of Population Health, Generation Squeeze identifies the systemic roots of the problem and proposes equitable solutions to improve health and well-being for younger generations.
International Institute for Applied Systems Analysis: Reassessing Aging from a Population Perspective
https://www.iiasa.ac.at/web/home/research/researchPrograms/WorldPopulation/Reaging/Re-Aging.html
Substantial changes in life expectancy and health status have rendered traditional demographic measures inadequate for the analysis of aging at the population level in the 21st century. A better understanding of age and aging requires new approaches. This project comprehensively reassesses population aging based on innovative alternative definitions of age and aging.
Intergenerational Programs
Canadian Cohousing Network
This website describes the work of the Canadian Cohousing Network, a non-profit organization that enables the creation of cohousing communities. Its work includes raising awareness about this model of accommodation, providing relevant information, and bringing together people interested in living in a cohousing community.
i2i Intergenerational Society of Canada
http://intergenerational.ca/i2i/
This BC-based program was created in 2008 to help build bridges between generations.
The Meadows School Project
http://intergenerational.ca/i2i/meadows-school-project/
This intergenerational model is frequently referenced in Canada.
The LINKages Society of Alberta
This group encourages positive relationships between generations and celebrates age-friendly communities.
Little Brothers
https://www.petitsfreres.ca/en/
This program in Montréal brings together seniors and young people on joint projects that seek to promote mutual respect.
Toronto Intergenerational Partnerships
This program is working towards a society that values and supports the contributions of all individuals throughout their lives.
A Rights-Based Approach to Policies and Practices Involving Older Persons
(Personal Reflection 2 by Margaret Gillis)
Relevant Readings
Ageing, Older Persons and the 2030 Agenda for Sustainable Development. (2017, July 12). United Nations, AARP, and HelpAge International. https://www.undp.org/content/undp/en/home/librarypage/poverty-reduction/ageing--older-persons-and-the-2030-agenda-for-sustainable-develo.html
The 2030 Agenda for Sustainable Development sets out a universal plan of action to achieve sustainable development in a balanced manner and seeks to realize the human rights of all people. Preparing for an ageing population is vital to the achievement of the integrated 2030 Agenda, with aging cutting across the goals on poverty eradication, good health, gender equality, economic growth and decent work, reduced inequalities, and sustainable cities. This brief acknowledges the importance of a life course approach to aging and calls for protecting and promoting the rights of older persons in the implementation of the 2030 Agenda.
Cox, C. and Pardasani, M. (2017). Aging and Human Rights: A Rights-Based Approach to Social Work with Older Adults. Journal of Human Rights and Social Work 2, 98–106.
By focusing on needs rather than rights, the human dignity, security, and autonomy of the individual can be easily ignored. Social workers involved at the micro, mezzo, and macro levels can play key roles in ensuring that private problems are perceived as public issues and that rights are recognized. This paper focuses on policies and practice in the USA impacting older adults and the ways in which social work involvement can be critical to ensuring well-being and social justice for those among the most vulnerable in society.
FAQ – Strengthening Older Peoples’ Rights Worldwide. (2021). Global Alliance for the Rights of Older People (GAROP). https://rightsofolderpeople.org/faq-strengthening-older-persons-rights-worldwide/
This brief document answers all of your questions about human rights and older persons, UN Conventions, and more.
Gilles, M. and Rabheru, K. (2020, June). Protecting Human Rights During and After COVID-19: Challenges to the Human Rights of Older People in Canada. International Longevity Centre Canada. https://www.ilccanada.org/images/Final_Independent_Expert_on_Aging_-_report_on_the_Pandemic_in_Canada__202006_10_FINAL-converted.pdf
It has become clear that human rights legislation in Canada has not protected older people during the pandemic, as illustrated by the rise in elder abuse, the patronizing ageist attitudes towards older people in the media and in our society, and the systemic problems in long-term care. The report confirms the need for a United Nations Convention on the rights of older people in Canada and suggests that Canada should take a leadership role in establishing and ratifying the Convention.
Gilles, M. and Rabheru, K. (2021, April 13). Thematic Report on Ageism and Age Discrimination by the United Nations Independent Expert on the Enjoyment of Human Rights of Older Persons. International Longevity Centre Canada. https://www.ilccanada.org/images/FINAL_Report_to_the_Un_Independing_Expert_on_Ageism__April_13th.pdf
This report responds to the request from the United Nations Independent Expert on the Enjoyment of Human Rights of Older Persons to highlight the negative impact that ageism has on the human rights of older Canadians. The report provides evidence of systemic ageism and discrimination and calls for a legally binding document that addressed the gap in United Nations Human Rights Legislation in regard to older persons.
Gilles, M. and Rabheru, K. (2021, April 14). Thematic Report on the Human Rights of Older Women by the United Nations Independent Expert on the Enjoyment of Human Rights of Older Persons. Longevity Centre Canada. https://www.ilccanada.org/images/FINAL_Theatic_Report_to_the_UN_Independent_Expert_on_Older_Women_.pdf
This report chronicles how the specific impacts of ageism and age discrimination are multiplied by sexism. Canadian women face particular barriers to human rights that need immediate remedy. A United Nations Convention on the Rights of Older Persons can address ageism and gender discrimination, transforming the lives of older women by addressing issues such as the underfunding and neglect of long-term care, and increases in age- and gender-based violence.
It’s about rights: Practical Toolkit (2020). HelpAge International. https://www.helpage.org/silo/files/its-about-rights.pdf
This toolkit is designed to help older people and their advocates: 1) Identify new opportunities to talk about older people’s rights in the context of COVID-19, and 2) Build your case so you can communicate effectively about a UN convention on the rights of older people
Strengthening Older People’s Rights: Towards a UN Convention. (n.d.). HelpAge International. https://rightsofolderpeople.org/wp-content/uploads/2013/12/Strengthening-Rights-English-Low-Res.pdf
This publication was produced to strengthen understanding and awareness of the need for a Convention on the Rights of Older Persons. It aims to provide the arguments and tools for engaging stakeholders across the globe in debate about older people’s rights and the role of a convention.
Relevant Websites and Organizations
Note: Please also see the organizations and websites in the General Resources section. The following are additional and specific to Personal Reflection 2.
Global Alliance for the Rights of Older People (GAROP)
https://rightsofolderpeople.org/
Established in 2011, GAROP was born out of the need to strengthen the rights and voices of older people globally. Today, GAROP is a network of over 380 members in around 80 countries worldwide, united in their work to strengthen and promote the rights of older persons and the adoption of a Convention on the Rights of Older persons. The website contains multiple resources including publications, advocacy statements and timelines, webinars, and other material.
The Open-ended Working Group on Ageing (OEWG on Ageing)
http://social.un.org/ageing-working-group/index.shtml
The OEWG on Ageing is a UN working group that meets in New York. Since the establishment of this working group, a resolution by the UN General Assembly in 2010, eleven sessions have been held. The OEWG has a wide mandate to examine the existing international framework in relation to the human rights of older people, and to identify possible gaps and how best to address them, including through considering the possibility of new human rights instruments.
United Nations, Office of the High Commissioner: Human rights of older persons
https://www.ohchr.org/EN/Issues/OlderPersons/Pages/OlderPersonsIndex.aspx
This website provides the rationale for a focus on the human rights of older persons and the various ways that the UN addresses this with links to key offices, events, and reports.
Relevant Videos
International Federation on Ageing. (2021, February 3). IFA/GAROP 2021 Webinar Series: Time for a UN Convention on the Rights of Older People! YouTube. (5 minutes). https://www.youtube.com/watch?v=HGjqxobJXjA
This is the first in a series of two webinars in preparation for the 11th Session of the UN Open-ended Working Group on Ageing. Experts explore what difference a UN convention will make for older people and for governments, particularly in the context of COVID-19, and the importance of national advocacy and civil society mobilization.
International Federation on Ageing. (2021, April 9) In Conversation with Ms. Margaret Gillis, President of the International Longevity Centre Canada. Facebook. (56 minutes). https://www.facebook.com/watch/live/?v=163064729014403&ref=watch_permalink
Margaret Gillis discusses how to strengthen the protection of the human rights of older peoples after the 11th Session of the United Nations Open-ended Working Group on Ageing.