Leaving No One Behind In An Ageing World: the collective opportunity.

There are times when you might feel the struggles and obstacles you are enduring are unique to your own circumstances and situation. To be honest it sometimes feels like that in the world of social care in Scotland – that our challenges are unique and peculiar. But they are not. And both this week and in the last month it has become even clearer that there is a shared global set of concerns around social care and ageing but equally important a collective international desire and focus to do something about them. My reason for saying so is because of two reports which have been published in the last month.

The first is from the United Nations Department for Economic and Social Affairs (DESA) which in mid-January published its biennial flagship report that ‘aims to assess the world’s social situation by identifying emerging trends of international concern ‘. The World Social Report 2023 focuses on population ageing and the challenges and opportunities it brings as countries strive to achieve the 2030 Agenda for Sustainable Development.

It is called ‘Leaving No One Behind in an Ageing World,’ and takes its title from the commitment that as the world strives to achieve environmental sustainability that no-one especially the most vulnerable would be left behind. For the purposes of this report, it focuses on older age. It does so by celebrating the reality that we have made huge global strides in advancing health and older age but states quite baldly that there is much still to do to reap the benefit of this ‘demographic dividend.’

The report argues that older persons should be able to continue working for as long as they desire and are able, and it calls for ‘flexible retirement policies with guaranteed universal minimum benefits; eliminating barriers to older people’s participation in the workforce; and supporting learning and skills development throughout the life course.’

But it also advocates for a robust renewal of social care and health supports for our ageing population, stating that:

‘So far, public spending in most countries has not been sufficient to cover the growing demand for long-term care. The average expenditure by countries of the Organisation for Economic Co-operation and Development (OECD) was 1.5 per cent of GDP in 2019, down from 1.7 per cent in 2017. Insufficient funding means caregivers are undervalued, underpaid, and inadequately trained and often work in difficult conditions. A shortage of well-trained caregivers leads to poor quality care. Many countries, even wealthy ones, continue to rely on informal services by paid or unpaid caregivers.’

The report is well worth a read as it articulates a clear link between the economic success of a country and the degree to which it robustly addresses age discrimination and disadvantage. And when it talks about age discrimination it is explicitly referring to the discrimination against older age which is a global shame.

The second report which has highlighted for me our shared global challenge and potential came out a few days ago. It is entitled ‘Long Term Care: A Call for Action on a Global Scale.’ I know this work much better because I had the privilege over the last year of being part of the international group of writers who contributed to its development. That process and the conversations and discussions that were involved showed me first hand just how many shared concerns and solutions we share with one another across the world.

The paper makes many of the same arguments as the UN report but is primarily focussed on the aged care and social care sector and its condition across the world. It is a direct call to the governments of the world to act to address what is effectively an ageing emergency – one just as significant and challenging as our environmental emergency. It is a call to action to ensure that growing old is something which continues to uphold dignity, human worth and value, that celebrates individual autonomy and choice, and which enshrines the human rights of all regardless of age or capacity.  It states quite clearly that positive ageing does not happen by accident but through a clear strategic focus, prioritisation and planning which values ageing at its heart.

It especially states that we are globally, not just in Scotland, faced with very real challenges in terms of the declining numbers of caregivers and insufficient government support for services for older adults at the very same time as there are more and more older people requiring a greater level of support to remain independent, autonomous and valued. It also calls for a radical re-imagining of how we support people in older age, how we value them and how we provide care and support to those who may require it:

“As the aging population grows, there are too many challenges to keep doing things the way we have been doing them in the past decades. Informal family caregivers, who, in every country worldwide play a fundamental role in ensuring older adults’ well-being, are struggling with exhaustion, deteriorating quality of life, and loss of income that feed into negative macroeconomic impacts. We cannot leave this to families alone,” said Jiri Horecky, president European Ageing Network and board chair, the Global Ageing Network. “As the numbers of older adults grow, governments will have no choice but to invest in the supports older adults need, to give them agency and to protect their rights, including the right to long-term care.”

I consider that this international report is of real significance to those of us who care about older age in Scotland. It shows that many of the challenges we are facing in Scotland are global in nature, but it also suggests that the solutions of a better recognised and rewarded workforce, investment in older age care and support, and the innovative use of a human-rights based use of technology are ones we need to build on in Scotland and elsewhere.

If we are to truly ensure that no-one is left behind, we have to raise our heads from the horizon of our local and national concerns to work internationally on shared responses – this is as true of ageing and its potential as much as it is true of the environment and its challenge. Dozens of governments across the globe were presented with the report on Tuesday and I really do hope that they, ours included, will act on its call.

That is why I am delighted that Glasgow will welcome delegates from around the globe in this coming September to debate, talk, share, campaign, create and become active around the issues of ageing and care and support. The Global Ageing Conference will be taking place in the exact spot where COP26 happened – sustainable care and support for our growing ageing human population is as critical to ensuring a sustainable environment as perhaps any other issue. You can find out more details of this event at https://globalageing2023.com/

Both these international reports are appearing at a time when increasingly there is an acceptance of the intimate relationship between ageing and the environment, between celebrating and valuing older age and economic sustainability and success of communities and nations. Sadly, I think Scotland has some way to go to recognise older age as full of potential rather than cost. Scotland’s social care system and its very acute and real challenges can learn much from the insights of other places because there is much more that unites than divides our commonality. But wherever we are in the world the future is one where inescapably older people will increasingly find voice and agency, will demand change and innovation, will demonstrate new ways of being old – I very much hope we have the courage to listen to international voices and learn from global insights because those who are ageing will not allow themselves to be left behind.

Donald Macaskill