By Paul Vincent & Steve Hill
The World Health Organization has revised its Draft Global Strategy and Action Plan on Aging and Health after the consultation with a delegation of experts as well as an extensive online survey. Here we report on the developments of the consultation where some members of our parent organization the International Longevity Alliance (ILA) attended and many of our organization participated in the online survey about aging.
The Consultation meeting was organized at WHO headquarters in Geneva following the survey on October 28-30, which brought together all regional WHO offices, delegates from 75 member states and around 35 non-governmental organizations. The delegations included a wide range of research institutions, regional, national and international organizations, as well as experts from various WHO technical departments and other leaders in the field of aging research.
Based on the findings of this Global consultation meeting and survey, a new revised Draft Global Strategy and Action Plan on Aging and Health, has been proposed for consideration by the WHO Executive Board. A summary of this consultation is available to view at the WHO website here and a PDF of the proposed action plan can be downloaded directly here.
Important Implications for regenerative medicine
There is now clear evidence that the longevity community is having a decisive impact. This includes the work done by the Russian and Kazakhstanian delegations and, of course, the ILA letter writing campaign!
The Russian delegation included Prof. Vladimir Anisimov, President of the Gerontological Society of the Russian Academy of Science, as well as Dr. Daria Khaltourina (Board Member of the International Longevity Alliance) and Viktor Zykov who represented Institute of Preventive Medicine by the Ministry of Health of the Russian Federation. Kazakhstanian delegation was chaired by Dr. Ayash Baisultanova, the President of the Gerontological Association. Direct advocacy by longevity research proponents and scientists yielded some positive results.
Zykov Viktor, Daria Khaltourina and Vladimir Anisimov after the debates, October 30, 2015.
There were interventions in favor of longevity and biomedical research promotion by many delegations including experts from Algeria, Belarus, Brazil, Finland, Germany, India, Nigeria, Norway, Qatar, Sri Lanka, Switzerland, the United Kingdom.
The good news is that, it looks like the WHO agrees that biological aging leads to many of the recognised diseases of aging, whether or not that means aging is a disease itself! So now Let’s take a look at some of the highlights of this consultation below.
1. The WHO Strategy Vision is reworded here:
“25. The strategy’s vision is a world in which everyone can live a long and healthy life” instead of “A world in which everyone experiences Healthy Aging” as per the initial Zero draft.
This is a historical recognition of healthy longevity as a priority goal at the UN level.
2. The destructive and complex nature of the biological aging process is described, perhaps for the first time at the UN level:
“15. The changes that constitute and influence aging are complex. At a biological level, the gradual accumulation of a wide variety of molecular and cellular damage leads to a gradual decrease in physiological reserves, an increased risk of many diseases and a general decline in capacity. But these changes are neither linear nor consistent, and they are only loosely associated with age in years”.
Aging is a multifactorial process that involves the accumulation of cellular waste and loss of systemic signalling environment, leading to declining health and activity. This decline and dysfunction is not directly attributable solely to biological age, meaning they are inconsistent from person to person, more in the manner of a disease.
This demonstrates that despite using the controversial term “healthy ageing” (while some researchers are calling for acknowledging ageing as a disease), the WHO recognises ultimately that biological aging is counter to good health. The Revised Draft Global Strategy and Plan puts greater emphasis on the goal of maintaining people’s health while they grow chronologically older, while keeping functional ability maintenance in case of age-related disabilities as another priority.
It is a promising change in stance, that recognises biological aging as a factor of ill health. This seems to proceed a changing view on how aging should be viewed and the consideration that it is amenable to intervention.
2. The WHO raises at point (89) the intriguing question:
“What biological or cellular advances can be made accessible and relevant to the widest range of people, particularly those with least resources?”
This suggests that the WHO are interested in promoting medical interventions, and that that these should be as affordable as possible, and will be available to all members of society, not just the rich! Great news indeed for everyone, and surely a cause for celebration.
3. The Strategic Objective 5.2 is reworded as the much more positive sounding:
“Strengthen research capacities and incentives for innovation” instead of “Improve research understanding of the gaps between intrinsic capacity and functional ability in specific contexts”
The take home message here, is that they intend to foster research into aging and related treatments. Encouraging research and innovation as a policy on aging based on the consultation is excellent news. This could lead to faster scientific progress, giving a much needed boost for regenerative medicine.
However, right now it is vital for the longevity community to advocate that fundamental and translational biomedical research on ageing becomes a priority, not just other areas like assistive technologies, including ICT sector. While social and assistive innovations are important for the public good, the public opinion surveys show that people tend to value a longer life only if it is healthy. Biomedical research is a major way to prevent disease and encourage healthy longevity.
4. The destructive and complex nature of the biological aging process is described, perhaps for the first time at the UN level:
“15. The changes that constitute and influence aging are complex. At a biological level, the gradual accumulation of a wide variety of molecular and cellular damage leads to a gradual decrease in physiological reserves, an increased risk of many diseases and a general decline in capacity. But these changes are neither linear nor consistent, and they are only loosely associated with age in years”
Aging is a multifactorial process that involves the accumulation of cellular waste and loss of systemic signalling environment, leading to declining health and activity. This decline and dysfunction is not directly attributable solely to biological age, meaning they are inconsistent from person to person, more in the manner of a disease.
5. Interventions to prevent ageing-related diseases are highlighted in another interesting revision here:
“105. Finally, better clinical research is urgently needed on the etiology of, and treatments for, the key health conditions of older age, including musculoskeletal and sensory impairments, cardiovascular disease and risk factors such as hypertension and diabetes, mental disorders, dementia and cognitive declines, cancer, and geriatric syndromes such as frailty. This must include much better consideration of the specific physiological differences of older men and women and the high likelihood that they will be experiencing multi-morbidities. This could also be extended to include possible interventions to modify the underlying physiological and psychological changes associated with ageing”
A better understanding of disease etiology especially those relating to ageing-associated decline could provide valuable insights into the mechanisms of aging and potentially highlight possible ways to intervene. We should however be seeking the common uniting factors many of these diseases share and seek ways to address the underlying causes and the damage that promotes them. Let us hope that this the single disease at a time approach medicine has traditionally pursued gives way to a more preventative approach as suggested here.
Closing remarks
Of course we aren’t quite finished yet, but all the same there is clear movement in established opinions .Now we have established impetus in the right direction, it is hopefully only a matter of time, before our hard work pays off in terms of medical interventions that will be available to people worldwide.
It is becoming increasingly obvious that things cannot remain the same, that aging is a problem to public health, and that it is indeed desirable to do something about it. We are hoping that WHO will actively support research into treatments to treat the decline of aging as a whole, rather than just piecemeal, as has been the case up until now. We must move away from the idea of healthy aging and push hard for support for healthy longevity.
The Consultation appears to have been a success, and whilst the gains here are modest and there is a considerable way to go, it is nonetheless testament to the hard work being done by advocates. It just goes to show that a lot of hard work and perseverance, go a long way but there is more to do before we can truly celebrate.
The International Longevity Alliance would like to thank all the experts and activists who submitted their comments stressing the importance of longevity research, who altogether managed to convince the WHO officials that there is significant support worldwide of the policies to develop biomedical research and innovation to foster healthy longevity.
Additional information
A summary of all the major changes is here.
The WHO has prepared a summary of the comments submitted here, the online comments up to October 31st are included. The Revised Draft Strategy and Plan will be presented to the 138th session of the WHO Executive Board, 25-30 of January 2016, under Provisional Agenda Item 7.4, and it will likely to be adopted at the 69th World Health Assembly on the 23rd-28th of May, 2016.