Governing for Health as the World Grows Older: Healthy Lifespans in Aging Societies

So much of global health governance focuses intensely on a brief moment in the human lifespan—from a safe birth to infant and child survival. Yet, with all the attention to this early window of life (infancy to age five), the opposite end of the life spectrum is comparatively neglected. The Millennium Development Goals (MDGs) do not mention a healthy lifespan or a healthy old age. This inadequate attention to the older years of the life appears to be a glaring omission given the universal challenges posed by aging societies. Aging is a demographic fact in almost all countries, but it is occurring more rapidly in low- and middle-income countries. Today, almost two in three people aged 60 or over live in developing countries. By 2050, nearly four in five of those aged over 60 will live in the developing world. Across the globe, declining fertility rates, lower infant mortality, and greater longevity drive population aging: people live longer because of improved nutrition, sanitation, health care, education and economic wellbeing. In many respects, therefore, global aging is a triumph of social and economic development. But sitting alongside the stunning success of longer lives (and the future prospect of still longer lives), are the personal, social, and economic consequences of a global demographic transition to a decidedly older population. A fundamental dynamic for global health in the coming decades is to find innovative governance tools to shape the way the international community can enhance the well-being of older people living in aging societies—from civil society, philanthropy, industry, and governments to international agencies and global public-private partnerships. Reflecting on the journey from the new millennium to today, there has been undeniable—although decidedly inadequate—progress. The 2002 Madrid International Plan of Action on Aging (“Madrid Plan”) framed aging policies as integral aspects of economic development and human rights—a form of mainstreaming we support. Yet, more than a decade later, the United Nations processes have failed to yield concrete changes in law and governance. The goal of healthy aging is unmistakable, and benefits everyone equally in society. Society should afford all human beings the opportunity to live dignified and long lives where they are healthy and active for as long as possible, allowing them to continue to enrich their own lives and that of those around them. The challenge of global aging is significant and universal. Almost 700 million people are now over the age of 60, and by 2050, 2 billion people—over 20 percent of the world’s population—will be 60 or older. Recognizing the need to combat this population shift, Anna Garsia and Professor Gostin look at the impact this changing dynamic will have on global health and the structures currently in place. In this Article, Garsia and Gostin analyze the current state of affairs for older persons around the world, looking at both international and domestic efforts and ultimately calling for a course of action that enhances the application of existing human rights law while campaigning for a robust new international treaty on the treatment of elder individuals