ILA position with respect to WHO’s Global Strategy and Action Plan on Ageing and Health
The World Health Organization launched public consultations on the Global Strategy and Action Plan on Ageing and Health, which will continue until October 30, 2015, and invited NGOs to take part.
The Longevity community should take part in these consultations, as this document will have a significant influence on the national policies and resources allocated for research on aging and longevity.
The ILA position
Healthy aging (or healthy longevity) is formed during course of a lifetime by the interaction of such factors as genetics, environment, accessible healthcare, and lifestyle and health decisions.
According to the World Health Organization (WHO) Constitution, which is a legally binding treaty, "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition". Obviously, old age is a condition that cannot deprive people of this right.
The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This definition has often been criticized for its spacious wording. However, this definition was chosen intentionally to prevent healthcare systems development slowing down after the attainment of any particular level of public health. It means that the improvement of health as physical, mental and social well-being does not have borders. So the government's’ responsibility to protect the human right to health is not reduced to simply providing access to existing medical technologies or social care, but it extends to the support of biomedical research aimed to explore, prevent and treat all pathological processes that damage health.
It is well-known, that aging is basically a set of pathological processes that damage health, and it is scientifically proven that these processes may be slowed down and even partially reversed by pharmacological and lifestyle measures and medical interventions extending the healthy and productive period of life, postponing age-related diseases and decreasing human suffering.
Therefore, the realization of the human right to health must involve state activities aimed to accelerate fundamental and translational R&D to prevent and treat age-related pathologies.
A number of strategic international documents in the corresponding field (non-communicable diseases, particular age-related diseases) recognize biomedical research as an important part of the action plan to maintain good health in the elderly. It provides a new perspective on how the scientific and technological advances can shape our common future and especially the future of people in older ages.
However, the current draft of GSAP is mostly focused on addressing the growing health problems and needs of the elderly without pursuing a proactive strategy of counteracting processes that underlie aging (such as DNA damage accumulation, change in the profile of DNA methylation, glycation, protein cross-linking and aggregation, cells immortalization, mitochondrial dysfunction, calcification of vessels and tissues, chronic inflammation and others). This approach can lead to excessive expenditures on age-friendly (i.e. disability-friendly) environment, protection against secondary consequences of health deterioration like social isolation and poverty, while the development of the innovative biomedical technologies that can help people enjoy true health and thrive in old age remain unappreciated and do not receive enough organizational and financial support.
We would also like to highlight, that WHO responsibilities towards important health issues like HIV/AIDS include coordinating the corresponding fundamental and translational research. These already prove to be very effective ways to find solutions, helping the governments to choose the most promising research directions and to work jointly on new effective therapies. We believe that the processes that, together, cause age-related functional decline and numerous age-related diseases and deaths, are a health problem that deserve the highest priority and full dedication in addressing immediately.
Taking into account all the above, we propose:
1. One of the first strategic objectives should be to “promote fundamental and translational research to prevent, postpone and treat age-related decline, including frailty and aging diseases”. This priority should be further developed in the following sections:
1.1 Section 4.2 “Guiding principles” should include the principle “fostering scientific advancement to prevent and treat ageing related functional decline and to promote healthy and active longevity”.
1.2 Section 5.3 “Proposed Strategic objectives of the Five Year Strategy (2016-2020)” should include “Supporting biomedical fundamental and translational research aimed to ensure healthy longevity”.
1.3 In Section 5.4. “Strategic Objective 1 proposed actions” should include “promoting, translating and disseminating research to identify the causes of ageing related functional decline, effective approaches for its prevention and control”
1.4 Section 6.1. “Measures of success” should include a set of indicators on fostering scientific advancement to prevent ageing related functional decline and to promote healthy and active longevity, such as having a share of GDP allocated to ageing related biomedical R&D, growing the number of clinical trials to prevent and treat ageing-related disease”, and, the number of new evidence based therapies and diagnostic methods to prevent and compensate for ageing related health decline, the number of new patents in this area, and most importantly, the number of people benefiting from the biomedical technologies, the number of cases of disability and mortality prevented.
1.5. Regarding the section 6.2, a special organizational body should be created by the World Health Organization to coordinate research and development in the area of biological processes that underlie ageing (pathological age-related processes), their prevention and treatment. This organizational body should include research organizations and NGOs supporting biomedical research and advocating healthy longevity.
Of note, the “Healthy Ageing” concept worked well to promote pro-health policies worldwide. However, it does bring complications: a large part of the biomedical research community define ageing as a set of pathological processes and even consider it as a disease or a syndrome so “Healthy Ageing” is then an oxymoron (an expression that contains something and its contrary). Also, in some languages “healthing ageing” is translated as “healthy frailing”. Therefore, we would propose to replace “Healthy Ageing” by “Healthy Longevity” throughout the text.