A Society for all ages: challenges and opportunities

United Nations Economic Commission for Europe A SOCIETY FOR ALL AGES: CHALLENGES AND OPPORTUNITIES Proceedings of the UNECE Ministerial Conference on Ageing 6–8 November 2007, León, Spain Prepared in co-operation with the Ministry of Education, Social Policy and Sport, Spain Edited by Astrid Stuckelberger and Andres Vikat UNITED NATIONS New York and Geneva, 2008 ACKNOWLEDGEMENTS This publication includes the documents, keynote papers and summaries of panel discussions at the United Nations Economic Commission for Europe (UNECE) Ministerial Conference on Ageing, which was held from 6 to 8 November 2007 at the Parador de San Marcos in León, Spain. The Conference was co-organized by UNECE and the Ministry of Labour and Social Services of Spain and its Institute for Older Persons and Social Services (IMSERSO). Additional financial support was provided by the United Nations Population Fund (UNFPA). The organizers of the Conference would like to thank the authors of the keynote papers, the Conference participants, and members of the Preparatory Committee and the Expert Group for their contributions and engagement in the discussion, which led to the material contained herein. At the UNECE secretariat, Viviane Brunne, Leonie Fresenius, Dominik Hübler, Airi Lampinen, Gebhard Ottacher, Silke Rusch and Asuza Sato participated at various stages of analysis of the country reports and preparing the corresponding summary report. Javier del Castillo and Luz Cid of IMSERSO and Viviane Brunne and Patricia Eschenlohr of the UNECE secretariat prepared the summaries of panel sessions. Christopher Edgar performed the linguistic editing, Subashini Narasimhan prepared the layout and Yves Clopt designed the cover. The organizers of the Conference would like to thank all these individuals for their dedicated work. NOTE The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The views expressed in authored sections of this publication are those of the authors and do not necessarily reflect the views of the United Nations Economic Commission for Europe or of the Ministry of Labour and Social Affairs of Spain. UNECE Information Unit Phone: +41 (0)22 917 44 44 Palais des Nations Fax: CH-1211 Geneva 10 E-mail: [email protected] Switzerland Website: http://www.unece.org +41 (0)22 917 05 05 UNITED NATIONS PUBLICATION Sales No. E.08.II.E.14 ISBN: 978-92-1-116991-1 Copyright © United Nations, 2007 All rights reserved Printed at United Nations, Geneva (Switzerland) FOREWORD In the United Nations Economic Commission for Europe (UNECE) region, people today live healthier and longer than ever before, which is a great achievement. Accompanied with the trend towards having fewer children, this is leading to the ageing of the population, a stage in the universal process known as the demographic transition. Populations in the UNECE region are entering or have recently entered this stage, which holds significant opportunities but also comes with a number of challenges. The universal nature and broad implications of ageing require that policy responses are discussed internationally, cover a wide spectrum of economic and social issues and involve a broad range of stakeholders. In the context of the United Nations, ageing was first put on the international policy agenda at the World Assembly on Ageing in Vienna in 1982. Subsequently, the United Nations Principles for Older Persons were developed and 1999 was proclaimed International Year of Older Persons. The Second World Assembly on Ageing in Madrid in 2002 set the agenda for discussing the far-reaching implications of population ageing across all spheres of society. The Madrid International Plan of Action on Ageing (MIPAA) was concretized for the UNECE region in the Regional Implementation Strategy (RIS) adopted at the UNECE Ministerial Conference on Ageing in Berlin in the same year. Five years later, ministers and Government representatives came together again in León, Spain, at the UNECE Ministerial Conference entitled “A Society for All Ages: Challenges and Opportunities”, to review the progress made in implementing this Strategy. UNECE co-organized this Conference with the Ministry of Labour and Social Affairs of Spain. The Ministerial Declaration adopted by the Conference renewed the commitment of UNECE member States to the MIPAA and the RIS, and focused on areas that need the most urgent action. Reflecting their vital role in many ageing-related actions, UNECE involved non-governmental organizations (NGOs) in preparations to the Conference early on and acknowledges their contribution to the drafting of the Ministerial Declaration. A forum for civil society and the scientific community was held a day before the Conference, and its final documents are included in this volume. The aim of this volume is to disseminate the Conference proceedings to a wider public and thereby inspire a broader debate. Apart from the Ministerial Declaration, the volume contains the Chairperson’s Summary, a review of the implementation of the MIPAA in the UNECE region, the keynote papers, summary of contributions, the NGO Declaration and the conclusions of the Research Forum. UNECE is grateful to the authors of the keynote papers, to the Conference participants and to the members of the Preparatory Committee for their engagement in discussion and contributions, which have led to the material contained herein. It is expected that this volume will be of interest to a wider audience interested in population matters and will increase awareness about the need for policy responses to demographic change. Marek Belka Executive Secretary United Nations Economic Commission for Europe iii CONTENTS Foreword ........................................................................................................................................................... iii I. León Ministerial Declaration: A Society for All Ages: Challenges and Opportunities ......................... 1 II. Chairperson’s Summary .......................................................................................................................... 5 III. Implementation of the Madrid International Plan of Action on Ageing in the UNECE region: Review of the first five years ................................................................ 9 1. Commitment 1: “To mainstream ageing in all policy fields with the aim of bringing societies and economies into harmony with demographic change to achieve a society for all ages” ........................................................................ 10 2. Commitment 2: “To ensure full integration and participation of older persons in society.” .................................................................................................................. 12 3. Commitment 3: “To promote equitable and sustainable economic growth in response to population ageing” ............................................................................ 15 4. Commitment 4: “To adjust social protection systems in response to demographic changes and their social and economic consequences” ............................................. 16 5. Commitment 5: “To enable labour markets to respond to the economic and social consequences of population ageing” ................................................................... 19 6. Commitment 6: “To promote lifelong learning and adapt the educational system in order to meet the changing economic, social and demographic conditions” ...................... 22 7. Commitment 7: “Striving to ensure quality of life at all ages and maintain independent living including health and well-being” ............................................................ 23 8. Commitment 8: “To mainstream a gender approach in an ageing society” ................................. 26 9. Commitment 9: “To support families that provide care for older persons and to promote intergenerational and intragenerational solidarity among their members” ........................................................................................................................... 27 10. Commitment 10: “To promote the implementation and follow-up of the Regional Implementation Strategy through regional cooperation” ................................................ 29 11. Conclusions ..................................................................................................................................... 30 IV. Keynote Papers ...................................................................................................................................... 33 V. Summary of Contributions .................................................................................................................... 79 VI. Non-Governmental Organizations’ Declaration ................................................................................... 93 VII. Main Conclusions and Recommendations of the Research Forum ..................................................... 95 VIII. Report of the Conference ....................................................................................................................... 97 IX. List of Speakers .................................................................................................................................... 101 v LIST OF TABLES Countries whose reports have been considered in this document ......................................................................... 10 LIST OF FIGURES Figure 1: Commitment 1 – Mainstreaming objectives and policy tools to achieve mainstreaming of ageing issues into general policymaking ................................................ 11 Figure 2: Commitment 2 – Integration and participation of older persons in the three issues areas of functions, infrastructure and intergenerational activity ...................................................................................... 14 Figure 3: Commitment 3 – Sustainable economic growth as a backbone of ageing policies in the four issue areas of monetary, fiscal, social and industrial and education policies .......................................................... 16 Figure 4: Commitment 4 – Adjustments in social protection systems and its constituting elements (the pension system, social protection for women, income security and health provision) ........................................................................... 18 Figure 5: Commitment 5 – Labour market policies on population ageing, including incentive and enforcement policies for employers and employees as well as research ..................................................................................................... 21 Figure 6: Commitment 6 – Ageing-related education strategies with regards to education systems, learning contents, methods and research .......................................... 23 Figure 7: Commitment 7 – Quality of life, health and well-being in ageing societies and its constituting factors, including health-care systems, quality of care and prevention .......................................................................... 26 Figure 8: Commitment 9 – Inter- and intragenerational solidarity in ageing societies in the family, in care and beyond ............................................................................ 29 Figure 9: Prioritization of commitments according to country reports ............................................................ 31 Figure 10: The triangulation process of welfare/care .......................................................................................... 44 Figure 11: Life expectancy at birth and at age 20, 65 and 80 years in 2003 ...................................................... 55 Figure 12: Survival rates up to age 20, 60, 65 and 80 in the period 1995–2005 ................................................ 56 Figure 13: Labour force participation rates in the period 1984–2005 ................................................................ 57 Figure 14: Employment rates in the period 1983–2005 ...................................................................................... 58 Figure 15: Pension duration of people retiring today .......................................................................................... 59 Figure 16: Average effective retirement age in countries of the European Union in 2005 ............................... 62 Figure 17: Lifetime allocation of work and non-work in 2000 ........................................................................... 63 Figure 18: Inactivity and unemployment rates between ages 55 and 64 in 2002 ............................................... 64 Figure 19: Average effective labour market exit age .......................................................................................... 65 Figure 20: Early and late retirement .................................................................................................................... 66 Figure 21: Actuarial fairness in pension systems, 2008 ...................................................................................... 67 vi Figure 22: Preference for living at home in older age when no longer able to perform daily living activities (percentage) .......................................................... 69 Figure 23: Preference for living in an institution in older age when no longer able to perform daily living (percentage) .......................................................................... 70 Figure 24: Views on the responsibility for the care of elderly people (percentage) .......................................... 70 Figure 25: Views on the responsibility of children for the care of elderly people ............................................. 71 vii ABBREVIATIONS BAGSO CEE CIOMS DB ECB ECLAC EFI EU FAO GGS ILO IMSERSO ISSA LTC MIPAA NGO NDC OECD OAD PAYG RIS PHC PPAS UNDESA UNECE UNESCO UNFPA WHO German National Association of Senior Citizens’ Organizations Central and Eastern Europe Council for International Organizations of Medical Sciences Defined-benefit European Central Bank United Nations Economic Commission for Latin America and the Caribbean Experience for Initiatives European Union Food and Agriculture Organization of the United Nations Generation and Gender Survey International Labour Organization Ministry of Labour and Social Services of Spain and its Institute for Older Persons and Social Services International Social Security Association Long-term care Madrid International Plan Action on Ageing Non-governmental organization Notional defined-contribution Organisation for Economic Co-operation and Development Old-age dependency ratio Pay-as-you-go system Regional Implementation Strategy Primary health-care Population Policy Acceptance Study United Nations Department of Economic and Social Affairs United Nations Economic Commission for Europe United Nations Educational, Scientific and Cultural Organization United Nations Population Fund World Health Organization Member States of the United Nations Economic Commission for Europe Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Canada Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Liechtenstein Lithuania Luxembourg Malta Moldova Monaco Montenegro Netherlands Norway Poland Portugal Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden viii Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom of Great Britain and Northern Ireland United States of America Uzbekistan. 1 I León Ministerial Declaration: A Society for All Ages: Challenges and Opportunities1 1. We, the representatives of member States of the United Nations Economic Commission for Europe (UNECE), gathered at the Ministerial Conference on Ageing from 6 to 8 November 2007 in León, Spain, reaffirm our commitment made in the Berlin Ministerial Declaration2 in 2002 to implement the Regional Implementation Strategy3 of the Madrid International Plan of Action on Ageing. 2. We welcome the continuing gains in longevity as an important achievement of our societies and appreciate the changes and adaptations made in response to population ageing. At the same time, we are also aware that in most countries of the UNECE region, the rapid process of ageing and the onset of decline in the workingage population are bringing the period of the socalled demographic bonus to an end. This has important and far-reaching implications across all spheres of society. 3. We are aware of the considerable differences in the pace of the ageing process among countries of the UNECE region. In most countries, rapid ageing of the population calls for immediate action. In some, a relatively young age structure of the population is projected to prevail for many years, which may allow more time for adjustment. 4. UNECE member States have undertaken significant policy actions to fulfil the 10 commitments of the Regional Implementation Strategy, although much more remains to be done. Many countries in the region are seeing an improvement in care for older persons, including both institutionally and provided for at home, based on free choice, an increase in retirement age and an alleviation of poverty in old age as the achievements resulting from their targeted policies. Achievements in implementing the Regional Strategy also include better national and local-level 1 ECE/AC.30/2007/2, annex I. 2 ECE/AC.23/2002/3/Rev.2. 3 ECE/AC.23/2002/2/Rev.6. coordination in different policy areas and closer involvement of citizens in ageing-related policymaking, including involvement through an organized civil society and scientific community. 5. We remain committed to the ultimate goal of a society for all ages that relies on respect for human rights, on protection against age discrimination, on social cohesion, and on equal opportunities for men and women of all ages. In pursuing this goal, we reaffirm the principles of independent living, participation, care, selffulfilment and dignity, as laid out in the United Nations Principles for Older Persons. 6. We are committed to further promote the mainstreaming of ageing across all policy areas at the local, national and international levels. These policies should be based on principles of intergenerational reciprocity, equity and interdependence; they must be comprehensive, properly coordinated, and gender-sensitive, as is the case with the all-inclusive approach of the Regional Implementation Strategy. We commit ourselves to protecting the rights of persons of all ages and to preventing age discrimination and social exclusion. 7. Promotion of a positive image of older persons, including through the education system and media campaigns, can greatly enhance a wider appreciation of the contributions older persons can make to society. We encourage initiatives that raise public awareness about the various and important contributions of older persons to their families and society. 8. Active citizenship, a dynamic civil society and interaction between citizens and government are vital for achieving a society for all ages. These promote social cohesion, help overcome age discrimination, and empower older and younger persons to act for themselves and to work together. We confirm that a favourable environment for active ageing, promotion of lifelong learning, access to modern information and communication technologies, and volunteerism and civic 2 I: León Ministerial Declaration: A Society for All Ages: Challenges and Opportunities engagement are crucial means to promote participation. We recognize the importance of promoting the participation of persons, as they age, in the economic, social, cultural and political life of their societies. The empowerment of older persons and the promotion of their full participation are essential for active ageing, and must be enhanced through appropriate measures. 9. We are committed to continuing our efforts to adjust social protection systems to prevent and reduce poverty and social exclusion and to improve the quality of life at all ages. We strive for timely reforms and policies, with a view to the sustainability of social protection systems. At all stages of reform, adequate standards of pensions, health, personal and family care provisions, and housing must be our goal. We stress the importance of devising policies that enable the pursuit of both economic efficiency and social security and of developing systems of social protection with broader and effective coverage, which should be guided by each country’s needs and circumstances. 10. We are committed to further promoting policies that enable people to reach old age in better health and security and to live independently and with dignity. We emphasize that to extend life free from disability and to improve the quality of life in old age, these policies must address the promotion of health and healthy lifestyles and the rehabilitation and empowerment at all stages of the life course, and must improve the prevention, treatment and care of old age-related diseases, frailty and disability. 11. We call for supporting older persons in need of care. We recognize that a successful strategy for care should strive for a balance between paid work and family life as well as between care provided by different care providers. Coordination between care providers such as the public sector, the private sector, the family and civil society must be improved. Specific policies need to be developed to address the growing number of people with health-related problems. We are committed to developing better, sustainable social services as well as health and long-term care for older persons in need, especially for those who choose to stay at home. 12. We recognize that accessibility, dignity, quality standards and most particularly the protection from elder abuse and neglect present important challenges in care provision. We also recognize and support the contributions caregivers, both men and women, make to society. Men and women of all ages should have equitable and universal access to health care and social services and assistance in accordance with their needs as well as to facilities and services that meet approved standards. These standards must take into account the fundamental principle of treating everyone with dignity. Adequate public resources, strong formal and informal long-term care systems, specialized and sensitized care professionals, and quality assurance mechanisms remain vital prerequisites to providing quality care for all. 13. We are aware that in the context of increasing longevity, life-course transitions among education, work and retirement must be more flexible, leaving room for individual choice with respect to family situation and social security. Such an approach contributes favourably towards releasing the potential of men and women of all ages for the benefit of society, while recognizing their self-fulfilment as individuals, and counteracts age discrimination. 14. We see economic growth as a very important factor in achieving a society for all ages. To promote economic growth in an ageing society, we should make full use of the experience and abilities that older persons have acquired throughout their lives. An older workforce may contribute to greater productivity. Obstacles and disincentives to extend active working life should be removed and work environments adapted to the ageing workforce so that those who wish to can continue to work. These measures would also contribute to tackling poverty among older persons. Health and social protection are important factors for economic growth, and provide the foundation for a longer working life and a higher employment rate. 15. Products and services that take into account the preferences and needs of older persons can improve quality of life and support independent living. We encourage governments and enterprises to pay attention to such products and services and to take advantage of the opportunities they provide for economic growth and social inclusion. Broader access to technological aid and devices should be made available to older people. I: León Ministerial Declaration: A Society for All Ages: Challenges and Opportunities 16. We are aware that lifelong learning and training can contribute to economic growth, as it increases the potential of men and women to contribute in the labour market. At the same time, the learning process itself promotes participation in society and self-realization. We strive to take a lifecourse perspective to learning and to create environments and incentives that promote lifelong learning and training, for the enhancement and retention of jobs for citizens of all ages and all social groups. 17. We are committed to promoting intergenerational solidarity as one of the important pillars of social cohesion and of civil society. We encourage initiatives that raise public awareness of the potential of young people and of older persons and that promote the understanding of ageing and intergenerational solidarity. 18. We are aware that very low birth rates, if they prevail over a long period, can greatly magnify the challenges posed by population ageing in the future. We commit ourselves to familyfriendly policies aiming at the reconciliation of work with family life and with responsibilities for dependent relatives in particular. Such policies can counteract a decrease of the birth rate to very low levels and can augment the employment rate. Those with caring responsibilities, a majority of whom today are women, must be supported in their caring activities, must be protected from marginalization in their professional activities and in social protection systems, and must be offered information, training and respite care. 19. We call for strengthening international cooperation in implementing the Regional Strategy for the Madrid International Plan of Action on Ageing and the León Ministerial Declaration, 3 taking into account the situation and different needs of individual countries. We appreciate the exchange of experience and good practices provided in the framework of the UNECE in collaboration with the European Centre for Social Welfare Policy and Research, affiliated with the United Nations, and the International Institute on Ageing, United Nations-Malta, and note with gratitude the financial support from Austria, Spain and the United Nations Population Fund. We recommend that monitoring and implementation activities be continued and further developed. 20. We are aware that research is vital to the development of effective policies and programmes. Sustainable research infrastructures and crosssectoral cooperation should be further strengthened and developed. 21. We recognize that non-governmental organizations (NGOs) play a significant role in representing people and their needs in society and thus can contribute to policymaking. We encourage cooperation with NGOs. 22. We welcome voluntary contributions from UNECE member States and from the international community in support of international cooperation for promoting the implementation of the Regional Strategy, exchanging experiences in its implementation and monitoring. 23. We reaffirm the role of UNECE, in collaboration with other stakeholders, to assist member States in implementing the Regional Strategy of the Madrid International Plan of Action on Ageing and the León Ministerial Declaration. 24. We express our sincere gratitude to the Kingdom of Spain for hosting the 2007 UNECE Ministerial Conference on Ageing and for its hospitality. 5 II Chairperson’s Summary 4 Ms. Amparo Valcarce García, State Secretary of Social Services, Families and Disability, Spain 1. At the 2007 UNECE Conference on Ageing in León, ministers and delegates from 46 countries discussed the challenges and opportunities related to population ageing over three days, with the Ministerial Segment being held on the third day. 2. After the opening of the Conference, the first plenary session featured the presentation of the summary report on the implementation of the UNECE Regional Implementation Strategy (RIS) based on country reports from 31 member States (ECE/AC.30/2007/4). UNECE member States reported significant progress reported in all the 10 commitment areas of the Berlin Strategy. Priorities and actions were concentrated in the area of adjusting social protection systems, including health-care systems and labour markets; here, financial sustainability was very frequently emphasized as an important aim. A great majority of reporting countries had comprehensive national programme documents related to ageing or are drafting them. Member States also emphasized collaboration with civil society and NGOs, and had promoted participatory approaches, although not specifically for the purpose of review and appraisal of the Berlin Strategy and the Madrid Plan. International cooperation in the framework of the UNECE in implementing the RIS had increased. 3. The plenary session was followed by six panel discussions covering all the key policy areas of the León Ministerial Declaration. Panel A: Creating integrated approaches to mainstream ageing 4. Discussions in this panel recognized that mainstreaming could be defined as a strategy and a process leading to a greater social integration of older persons and to the inclusion of ageing into all aspects of social, political, economic and cultural life. 5. To succeed in mainstreaming, simultaneous actions have to be pursued by ____________________________ 4 ECE/AC.30/2007/2, annex II. policymakers and social partners, by Governments and civil society, by organizations and enterprises and by individuals progressing through the life course. International organizations have an important role to play in integrating ageing issues into their programmes and projects and to contribute to monitoring of the implementation of the RIS. Panel B: Participation and social inclusion 6. Active citizenship, a dynamic civil society, and interaction between citizens and government are vital for achieving a society for all ages. In this panel session, the panellists tried to answer the question: “Which kind of enabling environment should Governments create to guarantee independent living and full participation in society?” 7. The key policy areas that lead to such enabling environments are the development of services for long-term care. It was emphasized that focusing on the older persons of today would be too narrow an approach. A life-course view should be adopted instead. Active and healthy ageing starts with the youth of today. 8. Panellists concluded that participatory approaches could only be realized if Governments recognized them as a priority. Panel C: Towards a balanced care strategy 9. Panellists at this session recognized that a successful strategy for care should strive for a balance between paid work and family life as well as between care from different providers. With respect to the achievement of this goal, the panellists discussed how to improve collaboration between government, different care providers, civil society and other stakeholders, as well as collaboration between different governmental departments. 10. Systematic support to non-professional care providers, compulsory social insurance for 6 long-term care and better involvement of modern technology, including information technology, were emphasized in many presentations as suitable avenues for improving systems of care. Another common theme was turning away from institutional care as the primary care mode, and recommending it only where other options could not be applied in practice. Panel D: Living longer – working longer: Challenges for education, the labour market and social protection 11. This session largely focused on the labour market. Panellists emphasized, however, that response to population ageing could not be limited to pension reforms. A move from economic discourse to a more holistic approach was needed. 12. In the context of the labour market, the panellists stressed the importance of combating age discrimination and eradicating forced retirement, as well as of helping to break age-related images or prejudices in the workplace and also in society. Life-course transitions between education, work and retirement must be more flexible, leaving room for individual choice with respect to family situation and social security. 13. As health is an important factor for economic growth and provides the foundation for a longer working life and a higher employment rate, promoting healthy living has major economic importance. 14. Panellists noted that an important objective of the RIS, namely prolonging the working life in the light of longer lives, had not yet been achieved. Panel E: Intergenerational collaboration 15. This panel emphasized the fact that issues related to intergenerational collaboration cut across many policy areas and have many dimensions. Intergenerational solidarity is one of the important pillars of social cohesion and of civil society and must be promoted. Panellists noted that in moving ahead in this, policies focusing on one generation only should be avoided, as they could be detrimental to the others. 16. As specific important policy objectives, participants noted in this context the need for: (a) better access to the labour market for all generations; (b) family-friendly policies to better II. Chairperson’s Summary reconcile work and family life; (c) education; and (d) shaping the attitudes of the media to change the many existing age-related stereotypes. Panel F: Focusing on opportunities: Active ageing 17. Here, panellists discussed active ageing, which is the process of optimizing opportunities for health, participation and security to enhance quality of life as we age. 18. Promotion of active ageing is an important component in all areas of age-related policies. As in some other sessions, the shift towards the lifecourse approach could be noted as a key trend in this area. Continued participation in social, economic, cultural, spiritual and civic affairs was emphasized, not just the ability to remain physically active. Ultimately, the demand for health care in an ageing population depends on the health status of the older citizens and not simply on age. MINISTERIAL SEGMENT 19. The third day of the Conference was devoted to the ministerial panels and the adoption of the Ministerial Declaration. The two ministerial panels gave member States an opportunity to present the progress made in their countries within the framework of the commitments of the RIS. Ministerial Panel 1: A society for all ages: Challenges and opportunities 20. There was a consensus among panellists on the need for comprehensive, horizontal policies in the region, in particular with respect to intergenerational solidarity and approaching the subject from a life-course perspective. The roles of economic growth and poverty were highlighted, emphasizing the importance of adequate social protection for the achievement of social justice and dignity. This discussion involved ideas of universal access and the continuation of care into old age. Furthermore, innovative suggestions from some civil society groups were reflected in some speeches. For policies to be effective, action must be taken now, not in the future. II. Chairperson’s Summary Ministerial Panel 2: Adjusting social protection systems, work and education to population ageing 21. Speakers discussed the role of social security and ageing. Overarching issues were poverty reduction, securing and extending universal social pensions coverage, health access and support for education in older age. The varying nature of the definition of social security was debated. Many pointed out that the rights of older persons must be a critical objective for all policymakers. It was also shown that in several countries, older persons form a disproportionate number of the poor. Finally, the sustainability of such social policy was shown to be important, illustrated by case studies and data sets from some panellists. 22. Panellists also pointed out that while employment and education help to alleviate social problems, they are not sufficient to combat the challenges of ageing. Educating the public about the positive contributions of older persons is important, but older people must also improve the image that they portray of their expectations and capabilities. To achieve this, structural changes must be made through public policy. Concluding plenary session 23. After the adoption of the Ministerial Declaration, the Chairperson of the Conference called for cooperation between the different actors, e.g. government institutions, research institutes and civil society, to implement the principles of the León Declaration, emphasizing that ageing should be considered an asset for society rather than a burden. 24. In his statement, Mr. Bärlund (Director, Environment, Housing and Land Management 7 Division, UNECE) emphasized that it is the actions that member States take in between such conferences that determine the success of such conferences and their adopted programme documents, and that population ageing will continue long into the future, requiring sustainable responses. He also expressed that the UNECE secretariat is prepared to continue assisting member States in fulfilling their commitments. 25. Following suggestions from Finland and Switzerland with respect to the monitoring of the implementation of the León Ministerial Declaration, Spain proposed to create a working group in the UNECE, open to all the member countries. This working group should have the possibility to meet periodically in Geneva, with the purpose of reinforcing and continuing the implementation of the Berlin Strategy and the León Ministerial Declaration. 26. Summarizing its achievements, the Chairperson concluded that the Conference had successfully reviewed the implementation of the Madrid International Plan of Action on Ageing and its UNECE Regional Implementation Strategy five years after the celebration of the Second World Assembly on Ageing in Madrid and the UNECE Ministerial Conference on Ageing in Berlin. This task of revision and completion should not stop here, however, but must remain on the agenda to advance the well-being of the population of the UNECE countries. Arising from demographic development, the consequences of ageing encompass a variety of economic and social issues, affecting the whole society and presenting new challenges and opportunities. The adjustment of societies to population ageing should therefore retain a long-term view. 9 III Implementation of the Madrid International Plan of Action on Ageing in the UNECE region: Review of the first five years In September 2002, five months after the Second World Assembly on Ageing had adopted the Madrid International Plan of Action on Ageing, (MIPAA), the 2002 UNECE Ministerial Conference on Ageing in Berlin adopted its Regional Implementation Strategy (RIS). The Strategy includes a concrete catalogue of measures in the form of 10 commitments. In preparation to the 2007 Ministerial Conference on Ageing, the UNECE secretariat invited member States to report on their activities in the areas of each of these 10 commitments and to highlight priority areas. The current document summarizes the outcomes of the country reports and is structured along the lines of those commitments. The country reports are available at UNECE Population Activities Unit website.5 This summary frequently refers to the country reports that provide the particular information presented. Such reference is made in cases when the reported policy or trend pertained to one or a few countries, and not made in describing general trends pertinent to a large number of countries. For the sake of brevity, the standard United Nations three-letter country code6 is used in these references. THE 10 COMMITMENTS of the Regional Implementation Strategy for the Madrid International Plan of Action on Ageing 2002 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. To mainstream ageing in all policy fields with the aim of bringing societies and economies into harmony with demographic change to achieve a society for all ages To ensure full integration and participation of older persons in society To promote equitable and sustainable economic growth in response to population ageing To adjust social protection systems in response to demographic changes and their social and economic consequences To enable labour markets to respond to the economic and social consequences of population ageing To promote lifelong learning and adapt the educational system in order to meet the changing economic, social and demographic conditions To strive to ensure quality of life at all ages and maintain independent living including health and wellbeing To mainstream a gender approach in an ageing society To support families that provide care for older persons and to promote intergenerational and intragenerational solidarity among their members To promote the implementation and follow-up of the Regional Implementation Strategy through regional cooperation. ___________________________________________ 5 6 http://www.unece.org/pau/age/mica2007/country_reports.htm Available at: http://unstats.un.org/unsd/methods/m49/m49alpha.htm 10 III : Implementation of the MIPAA in the UNECE region : Review of the first five years Table 1 Countries whose reports have been considered in this document 1. Country Abbreviation Country Abbreviation Albania ALB Lithuania LTU Armenia ARM Malta MLT Austria AUT Netherlands NLD Azerbaijan AZE Poland POL Belarus BLR Portugal PRT Belgium BEL Romania ROU Canada CAN Russian Federation RUS Cyprus CYP Serbia SRB Czech Republic CZE Slovenia SVN Denmark DNK Spain ESP Estonia EST Sweden SWE Finland FIN Switzerland CHE France FRA The former Yugoslav Republic of Macedonia MKD Germany DEU Turkey TUR Greece GRC United Kingdom of Great Britain and Northern Ireland GBR Hungary HUN United States of America USA Israel ISR Uzbekistan UZB Latvia LVA Commitment 1: “To mainstream ageing in all policy fields with the aim of bringing societies and economies into harmony with demographic change to achieve a society for all ages” Mainstreaming ageing means integrating ageing issues into all policy fields and including the issue in development plans and policy strategies on the national, regional and local levels. It particularly involves policy on economic, labour, health care, education, housing, social, cultural, family, environment and transport matters. While none of the countries specifically mention commitment 1 as a priority area, a majority of countries follow a holistic approach (DEU, ESP, FIN, HUN, MLT, NLD, SRB) in their ageing policies as set out in national plans, frameworks and strategies on ageing. For the development of these plans and further policies on ageing, the involvement of all relevant stakeholders is of crucial importance. The prevention of age discrimination and all other discrimination and the provision of equal access to services for all are frequently mentioned policy objectives in this context. A number of countries also reported raising public awareness of ageing as a policy priority (CZE, DEU, LVA, NLD, PRT, ROU, RUS). III : Implementation of the MIPAA in the UNECE region : Review of the first five years Several policy tools can be considered to mainstream ageing issues, including laws and regulation activities in ministries and municipalities, formation of councils, boards or commissions, identification of an ombudsperson or an office of age discrimination. Within this policy toolkit, legislation is the most common. Several countries have passed antidiscrimination acts and laws (CYP, DEU, DNK, FIN, GBR, GRC, LTU, NLD, SWE) and may even have adapted their national constitutions or are planning to do so. Most countries have established a national consultative body on ageing issues (e.g. a council, commission or board) that includes relevant stakeholders, such as pensioner representatives, non-governmental organizations (NGOs), the private sector and trade unions (AUT, CZE, DEU, DNK, ESP, FIN, GBR, GRE, NLD, SWE). These bodies are established to ensure the involvement of all affected population groups in policymaking and in the legislative process. One country follows the concept of “champions” – 11 representatives who stand up for older people’s interests and influence policy decisions (GBR). Three countries mentioned dedicated antidiscrimination/equal treatment authorities (DEU, HUN, NLD). One country has introduced an ombudsperson for equal treatment and is preparing to establish a monitoring and advisory office on age discrimination (CYP, AUT). In Cyprus, an advisory board has been set up to implement and improve legislation for older persons, with representation from government, NGOs and local authorities. In several countries, the local level municipalities play a major role in mainstreaming ageing (DEU, DNK, FIN, NLD, PRT). Furthermore, the European Union (EU) Member States also have to implement EU directives in the field of equal treatment and discrimination, including age discrimination (AUT, CZE, DNK, GBR, GRE, HUN, MKD, MLT, NLD, SRB, SWE). Most Governments mention close cooperation with civil society and the NGO sector both in terms of shaping policy and implementation. Figure 1 Commitment 1 – Mainstreaming objectives and policy tools to achieve mainstreaming of ageing issues into general policymaking Mainstreaming Mainstreaming Objectives Objectives   Use Use holistic holistic approach approach to to ageing ageing mainstreaming b mainstreaming across across several several Hanbd ook H a nd policy policy fields, fields, including including ook economic, economic, labor, labor, budgetary, budgetary, health health care, care, educational, educational, housing, housing, social, social, cultural, cultural, family, family, National Plans/ environmental, environmental, transport, transport, National Plans/ Strategies/ security security and and cultural cultural matters matters Strategies/   Include Include all all relevant relevant stakeholders stakeholders in in decision decision making making and and legislative legislative process process Frameworks Frameworks Policy Policy Toolkit Toolkit § Laws/ Constitution/ Regulation Ministries and Municipalities   Prevent Prevent age age discrimination discrimination   Ensure Ensure fairness fairness and and access access to to services services for for all all   Raise Raise public public awareness awareness for for ageing ageing related related issues issues Councils/ Boards/ Commissions Ombudsperson/ Office on Age Discrimination EU Directives 12 2. III : Implementation of the MIPAA in the UNECE region : Review of the first five years Commitment 2: “To ensure full integration and participation of older persons in society.” Commitment 2 demands the full integration of older persons into society. The RIS postulates that a successful country will allow them to participate fully in social, political, economic and cultural activities. This approach rests on the provision of services in three broader areas. First, there should be functional integration of the elderly into the process of political decision-making processes as well as labour market and economic integration. Secondly, governments should commit to providing the infrastructure that enables the elderly to enjoy adequate housing, public transport and cultural participation. Thirdly, governments should facilitate intergenerational integration by encouraging volunteerism and by promoting a positive image of ageing. A final section will deal with the implementation of the participatory approach, a special priority in the implementation of the RIS. Four countries identified integration as a specific priority (AUT, HUN, LVA, SVN). Nonetheless, progress across countries and topic areas is heterogeneous. 2.1 Functional integration In the area of political integration, there is almost universal inclusion of older persons in the legislative and political decision-making processes. One country has a law in place aiming to assure the equality of rights and opportunities for people with handicaps and of old age and which shall support their integration into the social life (FRA). The scope of political participation varies from countries with only informal local arrangements (CZE, ISR, SRB) to countries where pensioners’ organizations are established partners in the policymaking process (AUT, DEU, EST, FIN, FRA, NLD, ROU, SWE). Older persons also tend to be active voters. One country specifically mentioned that it has made provisions for easier participation of disabled persons in the electoral process (FRA). Despite the pensioners’ active voting record, only three countries report that political parties make special provisions for them. Two (SRB, SVN) report the existence of a specific pensioners’ party that is active at the local level, while two (MLT, SVN) report that the major political parties have established specific pensioners sections. Eleven countries report supporting financially the non-governmental infrastructure related to population ageing (AUT, BEL, CYP, DEU, ESP, EST, LTU, LVA, ROU, RUS, SWE). In several countries, organizations of war veterans have a significant role in this infrastructure (AZE, BLR, RUS). One member State (AUT) offers a fixed funding formula with government support pegged to the number of people aged 60 and over, which allows an NGO to maintain funding even when catering for a greatly increased number of pensioners. However, one country reports significant legal obstacles to forming NGOs (TUR) while another (SVN) reports significant obstacles to volunteering by means of a high tax burden on income from voluntary work. In terms of labour market integration, progress is reported in the area of encouraging pensioners to remain integrated in their work context and to use their experience efficiently. One country (FRA) has a national concerted action plan in place in support of the employment of senior citizens, which is seen as a means to their integration into the social and economic life. About one third of the country reports mention incentives to employers and/or employees to extend the working life beyond the mandatory retirement age. Most early retirement provisions are cut back. Six countries (CHE, ESP, FIN, MKD, SWE, USA) report a reduction of the risks of being removed from the place of work that specifically affect older persons. Six countries (CYP, DEU, ESP, EST, PRT, USA) report having made the retirement age more flexible, allowing able and willing employees to continue working beyond mandatory retirement age. Other popular methods of flexible retirement are the practices of subsidized part-time employment and phased retirement (FIN, FRA, NLD, USA). Three countries (CAN, DEU, EST) have programmes to increase the employability of older workers through training, while some offer a wage subsidy for employers offering jobs to lowpaid workers over 54 years old. Another option is a III : Implementation of the MIPAA in the UNECE region : Review of the first five years joint platform of employers and employee associations dealing with the matter (AUT). Economic participation should involve labour market participation as well as recognizing the special product and service needs of elder customers. However, only one country gives its pensioner representatives a seat on the domestic customer council (AUT) and a few provide pensioners with an institutionalized say in service provision (e.g.. FRA). In one country (DEU), the law was amended to assure quality of care-giving in nursing homes and other consumer services. Two countries (BEL, DNK) report that care homes must have standing inhabitant committees that can directly influence the provision of services. 2.2 Infrastructure To ensure that older persons can participate satisfactorily in society, the State needs to provide them with infrastructure allowing participation. This involves delivering the financial and physical means to combat exclusion in the areas of housing, public transportation and cultural activity. There are successful infrastructural initiatives in many countries. However, accessibility of these services, especially in rural areas, is recognized as a problem in six countries (DEU, FIN, HUN, MKD, PRT, SVN). Financial support for housing measures can take various forms, such as a heating subsidy (ROU), a housing benefit (CAN, CYP, NLD, USA), the offer of discounted repair services to older persons (CYP, GBR, MLT), or funding for the remodelling of homes to make them accessible for persons with disabilities (FRA, HUN, MLT). Moreover, some countries (CYP, CZE, DEU, ESP, EST, SVN) are committed to improving the physical availability and accessibility of housing for seniors. One country is doing intensive research into improving home technology adapted to older persons needs (AUT). Furthermore, two countries offer discounted medical products to older persons (EST, ISR). In one country (DEU), a “model housing” project incorporates new designs and concepts to promote self-determined and independent lifestyles for older people. Another area that is crucial to the inclusion of older persons is the provision of affordable and accessible public transport. At least 10 countries (AZE, BLR, CYP, FRA, GBR, ISR, NLD, ROU, 13 RUS, UZB) offer their seniors free or discounted transport, with one even offering a wide range of free national rail tickets that can be paid out in cash when not used (ROU). The introduction of lowfloor buses and improved-access trains is part of development plans in four countries (CZE, ESP, EST, SWE) at different levels of proliferation. Five countries (AUT, CYP, ISR, LTU, NLD) support their elderly in participating in cultural life through subsidized theatre tickets and reduced fees for other cultural activities and courses. In Cyprus, a “social card” is made available to older persons, and reduced tickets to cultural events and grants are made to cultural “creators”. Two countries organize cinematic activities such as a festival for older persons (CZE) and intergenerational cinema circles (BEL). One country (FRA) highlighted that all institutions of teaching and learning have to be made accessible for persons with handicaps. 2.3 Intergenerational activity An important area with respect to improving the integration and participation of older persons in society is the fostering of intergenerational relations and a more positive image of ageing. This is done along the broad lines of media campaigns and support for volunteering organizations. The vast majority of countries have some sort of image campaign in place to promote an image of the older population as active contributors to society. This may involve schooling media workers about undesirable stereotypes (AUT, ESP) and the airing of positive TV programmes (FRA). Many countries also draw attention to the issue by celebrating special days (AUT, CAN, DEU, FIN, GRE, HUN, ISR, LVA, MKD, SVN) or even a whole week (FRA) dedicated to older persons. The latter country (FRA) has a specific organization with the aim of enhancing intergenerational activities through the publication of guidelines and an online best practice database as well as through an intergenerational holiday scheme. A further area of intergenerational exchange is the voluntary sector. Many countries offer financial support to volunteer organizations that play an important role in offering help to older persons. Volunteers can play an important role in caring for older persons without close relatives. 14 III : Implementation of the MIPAA in the UNECE region : Review of the first five years transmission of historic memory of older persons to the youth, for example by going into schools. Three countries (DEU, ISR, USA) make particular use of volunteers for care and support, while many others (AUT, DEU, GBR, SWE, HUN, DNK, NLD) mention supporting volunteer organizations that help older persons. One country (NLD) contemplates the introduction of mandatory community service for high school students. 2.4 Participatory approach One specific feature of the integration and participation programme is the intended use of the participatory approach. The member Governments agreed on involving individuals and pensioners’ organizations in all their evaluation of policy and the development of new proposals, to allow maximum transparency and scope of ideas. A vast majority of countries reports a strong involvement of NGOs in the policy formulation process. Two countries report direct discussion (DEU, ROU) with pensioners, and another (USA) a longstanding tradition of public hearings on policy. In comparison, there are fewer initiatives encouraging older persons to use their knowledge and skills by volunteering themselves (CAN, DEU, FRA, LTU, USA). Only three countries (CAN, DEU, USA) directly encourage this practice, with one other offering intergenerational art courses (LTU) and one encouraging the production of an intergenerational newspaper (EST). Another (FRA) has an organization in place to actively support the Figure 2 Commitment 2 – Integration and participation of older persons in the three issues areas of functions, infrastructure and intergenerational activity CommitmentII: II: Commitment Integration&&Participation Participation Integration Functions Functions 1. Political Participation  Consultation  Political Parties 2. Economic participation  Labour market participation  Specific goods/services Infrastructure Infrastructure Financial and physical Accessibility of:  Housing  Transport  Culture ParticipatoryApproach Approach Participatory practice: ininpractice: Partnerships Partnerships withNGOs NGOs with Intergenerational Intergenerational Activity Activity 1. Media campaigns  Promoting a positive image  Special Days 2. Volunteering  Using their skills  Getting help III : Implementation of the MIPAA in the UNECE region : Review of the first five years 3. Commitment 3: “To promote equitable and sustainable economic growth in response to population ageing” Efforts should be made to raise the economic growth and productivity rates so as to increase available resources for transfer and distribution, and to ensure the financial sustainability of social protection systems in general and pension schemes in particular. Most countries mention that macroeconomic policies must be developed to address the needs of an ageing population. These policies comprise four areas, namely monetary, fiscal, industrial, social and education policies. There has been some agreement that for economies in transition, but not exclusively for them, the eradication of poverty, especially among older persons, is of special concern and several countries have significantly increased or are planning increases in pensions (ALB, BLR, ESP, PRT, ROU, RUS, UZB). Several countries mention inflation-indexation of wages as a way to prevent old-age poverty (EST, FIN, LVA, LTU, PRT). 3.1 Monetary policy Most countries view monetary policy as a key component to sustaining economic growth. Its main task is to provide price stability and low inflation rates through the sensible management of interest rates and money supply. The monetary policy in the Eurozone7 is within the domain of the European Central Bank. (ECB). In all other countries, monetary policy is developed by the respective national banks often following ECB decisions fairly closely. Generally speaking, there is no one single policy that can be prescribed to address certain demographic developments. However, monetary policies should be oriented towards achieving stability in society. 3.2 Fiscal policy Most countries have identified balanced budgets as a main priority for sustainability. Thus, it is important to balance economic growth (AUT, DNK, ESP, FIN, GBR, HUN, LVA, NLD, PRT, ROU, RUS, TUR) with an effort to reduce 7 15 The Eurozone comprises those European Union (EU) Member States which have adopted the euro. government debt and expenditure while increasing tax revenues. One country focuses specifically on efficiency improvements in public services in order to decrease public expenditure (FIN). Countries already in the Eurozone, those who are about to adopt the Euro, and those who aspire to membership in the EU have to put strict budget controls and fiscal discipline in place to meet the Maastricht criteria set up by the EU as prerequisites for joining the third stage of the European Economic and Monetary Union (including an annual deficit cap of 3 per cent of total GDP) (HUN, MLT, TUR). One country makes specific reference to the “Golden Rule”, which states that the Government will only borrow to invest, not to fund current spending. This country also applies the “Sustainable Investment Rule”, which states that public sector net debt, as a proportion of GDP, should be held stable and at prudent levels (GBR). 3.3 Social and industrial policy Several countries refer to their ongoing pension and social security reform efforts. These should help to balance public budgets (AUT, DEU, DNK, FRA, FIN, ESP, PRT, SWE, TUR) while securing old-age income levels e.g. by guaranteeing a minimum pension (CHE, FRA, PRT, SWE). Furthermore, the EU Member States have signed up to the Lisbon Strategy for growth and employment in the EU, aiming at making Europe the most competitive and dynamic knowledge-based economy in the world by 2010 (AUT, DEU, MLT). The Lisbon Strategy includes investments in competitiveness and productivity improvements and the strengthening of labour markets (ROU). Some countries are making specific efforts to increase the number of small and medium enterprises as drivers of growth and employment (AZE, SRB). Several countries observe an increase in the overall employment rate (AUT, CYP, CZE, LVA, NLD) and highlight the employment rate of older people (CYP, DEU, EST, FRA, NLD) as a priority. One country has emphasized their strategy of lower taxation at both the corporate and private levels in order to increase investment and consumption. The same country 16 III : Implementation of the MIPAA in the UNECE region : Review of the first five years has followed the strategy of bringing the ancillary labour costs down, making work for enterprises and employees more worthwhile (DEU). One country specifically mentioned the need to continuously monitor and adapt, if necessary, the optimal ratio between years of payment of contributions and average life expectancy (FRA). One country has reformed its tax and social security schemes to encourage individual initiative and job creation (FIN). Another country facilitates the use of inverse mortgages enabling older people to convert the value of their home into cash to finance other needs (ESP). One country made particular reference to the “silver economy”, taking into account the consumer potential and needs of older persons to enhance economic development. To this end, a website has been developed informing older persons about the safety and userfriendliness of products, goods and services. At the same time, initiatives were reported that integrate older persons into consumer working groups to identify shortcomings in the areas of housing, leisure or media with regards to older persons’ needs (DEU). 3.4 Education and training policy On-the-job-training and continuous updating of skills are needed to further economic prosperity and to increase productivity and employability. Several countries identified investments in education and training, including adult (re-)training as key measures to maintain and propel economic growth (FIN, GBR, LVA, NLD, ROU, SRB). One has begun to improve innovation support, to promote knowledge transfer and new product development to become a “knowledgeintensive economy” (LVA). Improvements in human capital and technology ameliorate the potential for economic growth (cf. commitment 6 on lifelong learning). Figure 3 Commitment 3 – Sustainable economic growth as a backbone of ageing policies in the four issue areas of monetary, fiscal, social and industrial and education policies 4. Commitment 4: “To adjust social protection systems in response to demographic changes and their social and economic consequences” The main issues in providing sustainable social protection systems in the face of demographic ageing are financial sustainability and the continued protection of the weakest groups in society. Measures in this area may involve the strengthening of incentives for citizens to participate in the labour force, the provision of comprehensive health services, sustaining a functioning educational system, and active labour market policies. In order to prevent and/or reduce poverty and to provide adequate security for all, existing social protection systems may have to be adapted to demographic developments and changes in family structures. With regard to pension reforms three pillars have to be differentiated, namely public pension (pillar 1), occupational III : Implementation of the MIPAA in the UNECE region : Review of the first five years pension (pillar 2) and personal savings (pillar 3). Furthermore, the issues of social protection of women, income security and health care must be considered. Adjusting social protection systems was indicated as a priority area by 15 countries (AUT, CAN, CHE, CYP, ESP, FIN, FRA, GBR, HUN, MKD, MLT, ROU, RUS, SVN, TUR). There is much activity in the areas of pension reform, health-care provision and income security. This rise in activities is triggered by the growing number of older persons, which makes changes in the pension, health-care and social security systems inevitable. Thirteen countries reported either starting or completing pension reforms over the last five years. The reforms mentioned in the reports are primarily focused on the adjustment of public payas-you-go (PAYG) systems forming pillar 1 (public pension). In some cases, they also include Pillars 2 (occupational pension) and 3 (personal savings). Reforms of pillar 1 include the adjustment of the official retirement age (AUT, CZE, SRB, ALB, DEU, FIN, MKD, SWE, ARM, LVA, CHE) and required insurance periods (CZE, FRA, SRB, ESP) discouraging early retirement (AUT, FIN, FRA, ALB, ESP, GBR, NLD), changes in the calculation of pensions (AUT), and an increase in insurance contribution rates (CZE). Many countries with a PAYG system in place have made efforts to introduce a stronger link between the contributions an employee makes and the benefits he/she receives (ESP, FIN, LTU, PRT, SWE). One country has introduced a sustainability factor which takes the relationship between those drawing pension benefits and those paying contributions into consideration for the general management of the pension scheme (DEU). Several countries have introduced or are considering the introduction of a flexible retirement age to keep people in the labour market for a longer period (CHE, FIN, GBR, SWE). One country has replaced the combination of age and years worked as requirement for retirement pay with an age-only system (MKD). Another country has reported efforts to improve the management of pensions of people having paid into different pension funds throughout their working careers (FRA). Furthermore, the country has put an emphasis on the simplification of the pension calculation system and on availability information for future pensioners (FRA). 17 of Occupational pension plans (pillar 2) are still playing a minor role. However, Governments encourage increased employer participation (CZE, ROU, GBR, USA, CAN). In most countries, participation in occupational plans is strictly voluntary (AUT, CZE, FIN, FRA, LTU, SWE). Five countries (CYP, DNK, GBR, MKD, NLD) have made them mandatory. One country has introduced a “Pension Regulator” who helps to protect members’ benefits, e.g. in the event that an employer files for bankruptcy, and promotes good administration of work-based pension schemes (GBR). To encourage citizens to plan and save for their retirement, many Governments have introduced personal savings plans (pillar 3) (AUT, CZE, DNK, FIN, FRA, GBR, LVA, MKD, ROU, SRB, SWE). To encourage the use of pillar 3, incentives for life insurance schemes and/or supplementary pensions have been introduced. Incentives may take the form of subsidies or tax relief. As a variation of pillar 3, one country introduced “working time accounts”, which make it possible for employees to save part of their gross salary each year in order to fund a period of unpaid leave in the future, e.g. for care, education, early retirement or sabbaticals (NLD). In addition to the three pillars of pension reform, measures have been introduced with respect to the social protection of women. Childcare times can now be credited as pension contribution periods. One country explicitly mentioned that periods of care provision for relatives (other than their children) may also be counted towards their pension (DEU). In two countries, pension-splitting among partners has been introduced (AUT, DEU). Part-time work regulations and parental leave (GBR), combined with a right to return to the workplace, are another example (AUT, USA). Several countries have introduced laws on equal opportunity (MKD, SRB) or made gender-neutral contributions to social protection schemes mandatory (DEU). One country has started campaigns to raise awareness of the need to reconcile work and family (USA), and one country (ESP) extended the scope of its widowhood pensions to civil partnerships. 18 III : Implementation of the MIPAA in the UNECE region : Review of the first five years Concerning income security for older citizens, several countries provide minimum pensions (ALB, AUT, CAN, DNK, FIN, FRA, GBR, HUN, LTU, LVA, MLT, ROU, SRB, SWE) or make other provisions to provide for basic security in old age (ARM, DEU). In addition, many Governments offer reductions on public transport, telecom services, ticket prices, heating expenses, etc., to their older citizens (AUT, DNK, GBR, HUN, ISR, MLT, ROU), and some support housing expenses for older persons in need (ALB, CAN, DNK, FIN, GBR, ISR). In the field of health care, some countries have also undertaken reforms to cope with increased burdens of their health-care systems which may also be caused by demographic changes. One way to avoid hardships among chronically ill persons or persons with low incomes is to introduce ceilings for health-care insurance payments (DEU). Figure 4 Commitment 4 – Adjustments in social protection systems and its constituting elements (the pension system, social protection for women, income security and health provision) The overall trend in terms of health provision for older persons is to enable them to stay in their homes as long as possible through programmes of activation and “helping them to help themselves”. The means to achieve this objective include a range of monetary (such as tax alleviations) and time benefits as well as targeted services (DNK, FIN, FRA, HUN, ISR). Countries also offer interpretation services to people with hearing disorders (HUN) and provide one-time funding for the remodelling of homes to make them accessible for persons with disabilities (FRA, HUN, MLT). One country (ISR) has developed a range of care facilities that allow older persons to stay in their familiar surroundings for as long as III : Implementation of the MIPAA in the UNECE region : Review of the first five years possible. This is made possible through the involvement and extensive training of volunteer organizations that help organize home help, nursing care, respite care and day-care centres. Hence, it is made possible for older persons to stay with their families even if their relatives work fulltime. Respite-care centres for older persons allow caretakers to go on vacation (ISR, MLT). One country has put in place an early warning system for isolated or fragile persons giving responsibility to the mayor to organize support in crisis situations such as extreme climate conditions (FRA). One country has emphasized the improvement of the networking of gerontological health services (FRA). In the field of housing the emphasis on independent living is supported by the provision of mobile services in a number of countries (AUT, DNK, FIN, GBR, GRC, POL, SWE, USA). New 5. technology is also increasingly being utilized to achieve this goal, e.g. to enable older persons to communicate with their children/grandchildren or medical personnel (CYP, DEU, FIN, GRC). By means of prevention and health improvement of older citizens, the need for services and care can be postponed (FIN, MLT, POL, USA). One country has launched an “Own Your Future” campaign to help consumers plan for long-term care, and provides a special website for information purposes (USA). To support and motivate caregivers, the pension system was adjusted in a way so that caregivers for older persons earn pension credits for the time they spent taking care of their relatives (AUT, GRC). In some countries, the involvement of donors and activities of NGOs plays an important role (ALB, ROU, SRB). Commitment 5: “To enable labour markets to respond to the economic and social consequences of population ageing” Member States have committed to taking measures to enable labour markets to respond to the economic and social consequences of ageing. In this regard, they pledged to seek increases in employment rates, especially the employment rates of older persons. To this end, the member States also agreed to improve the employability of older workers, e.g. through vocational guidance and training, the promotion of lifelong learning and the improvement of working conditions. Finally, member States have committed to taking steps towards increasing the age at which people stop working and towards making retirement more flexible and gradual. The magnitude of the impact of population ageing on national labour markets differs significantly for the UNECE member States. The Member States of the EU are committed to the Lisbon targets8 and are working towards achieving 8 19 The Lisbon targets from 2000 include an increase in overall employment rates to 70 per cent for the working age population as a whole, with over 60 per cent for women and 50 per cent for older workers by 2010. “Older workers” refers to the cohort of workers aged between 55 and 64. them. While countries with high and growing oldage dependency ratio (OAD)9 have long started to develop and deploy a wide range of policies, countries with high general and youth unemployment and lower OAD set their priorities differently. A large number of countries reported that progress had been made towards commitment 5. Nine countries (AUT, CHE, FIN, HUN, LTU, LVA, PRT, ROU, SRB) have explicitly indicated this field as a priority area. Most countries deploy a policy mix comprising incentives and regulatory policies targeted towards either employers or employees in order to increase employment rates and extend the working life of their workers (figure 5). 5.1 Incentive policies: Employers In order to increase the employment rate of older workers, several countries have an option to subsidize their wages or waive parts of the ancillary labour cost such as insurance or taxes 9 Old-age dependency ratio (in per cent) = the population 65 and older divided by the population between ages 15 and 64. 20 III : Implementation of the MIPAA in the UNECE region : Review of the first five years (AUT, DNK, FRA, HUN, MLT, NLD, ROU, SWE). In three countries (AUT, DNK, USA), specific awards for companies committed to the employment and retention of older workers were introduced. One country has mentioned its campaign to sensitize employers to the positive management of older workers and ways of benefiting from their experiences (FRA). In one country, actions towards better risk management of workplace accidents have been attempted that specifically address older persons (FRA). Several countries have identified employment barriers of older workers as one of the reasons for old-age unemployment. In response, they have set up counselling and training programmes, which offer companies advice on how to best design their policies towards older workers (AUT, CYP, DNK, EST, FIN, SWE, USA). One country offers tax breaks to employers who involve their older workers in on-the-job training (NLD). One country has introduced a system whereby companies can be certified with an Equality Label if they protect the equality of both sexes in all age groups (FRA). 5.2 Incentive policies: Employees Most countries identify lack of skills, in particular in information and communication technologies and language skills, as the main barriers to old-age employability. Therefore, most Governments are focused on the provision of vocational training. Adult education programmes are in place in most countries, and some have developed programmes for women and/or older workers (BLR, CAN, CYP, CZE, FRA, HUN, MLT, NLD, RUS, USA). Lack of motivation and self-confidence on the part of older workers is also being addressed through special training (LTU, MLT) and face-to-face career counselling (EST, GBR). Some Governments encourage selfemployment (USA) and entrepreneurial activities of older unemployed. This is done by supporting small and medium enterprises through training and funding (FIN, HUN, LTU, SRB). The EU Member States are cooperating with the European Social Fund, which aims to create employment by funding vocational training. A number of specific initiatives providing employees with more flexibility to combine retirement and work have been introduced. Employees are given the freedom to choose their retirement age and manage their transition using part-time work or job sharing agreements (USA). One country introduced the concept of an on-call pool of retired workers who are re-hired to work on temporary projects following retirement (USA). Flexible retirement ages allow employees to make self-determined decisions about their income to leisure time ratio while not forcing the qualified and motivated workforce into retirement (EST, FIN, GBR, HUN, SWE). Some countries allow pensioners to continue to work after retirement and combine pension income with work income (DNK, EST, FIN, HUN, NLD, ROU, RUS). Sometimes, these arrangements are supplemented by partial income tax exemptions (GBR, NLD, SWE). One country has a programme of persons already retired to be reintegrated into their former workplace as tutors for younger workers (FRA). These policies are intended to ensure a smooth transfer from working life to retirement. One country has made provisions to adjust the services of the national unemployment agency to address the special needs of older persons (FRA). Another (ISR) sponsors employment projects for older workers on low income. The introduction of area-wide childcare and elderly care in combination with flexible part-time arrangements is seen as key for allowing greater participation of women in the labour market (AUT, NLD, SWE). To make part-time or less skilled work more attractive to people near retirement age, one country (NLD) changed the pension calculation so that the pension is calculated based on the salary in the last full-time job. One country (DNK) guarantees employment with the local authorities to long-term unemployed over the age of 55 years. It has also set up a wear-and-tear fund to prevent the premature withdrawal of workers from the labour market due to health reasons (DNK). 5.3 Regulatory policies: Employers Several countries stress the problem of age discrimination in the labour market (AUT, CZE, DNK, EST, GBR, LTU). Some other countries deploy special measures to protect older workers in the labour market that prevent employers from dismissing workers above a certain age, i.e. through job guarantees. Others levy financial penalties on companies that dismiss older workers III : Implementation of the MIPAA in the UNECE region : Review of the first five years (AUT, LTU). One country (DNK) has installed a complaints board. In one country (SWE), the labour legislation demands that employers first dismiss the employees they hired last in the case of layoffs. The gender wage differential between men and women might prevent some women from (re-)entering the labour market. One country (FIN) reports setting up an investigation of the genderwage differential. 5.4 Regulatory policies: Employees Many countries have increased the official retirement age or have started to do so gradually (ALB, ARM, CHE, CZE, DNK, EST, FIN, GBR, 21 LVA, MKD, SRB, SWE). Two countries are planning to index the retirement age to life expectancy (DNK, PRT). Furthermore, most countries have reversed their early retirement policies and hence abolished early retirement incentives. In addition, disincentives for early retirement have been introduced to increase the actual retirement age (AUT, FIN, ALB, CZE, ESP, NLD, EST). One country (GBR) has tied its support allowance payment for unemployed persons to clearly defined and agreed responsibilities, such as job-seeking activities, work-related interviews or trainings. If the responsibilities are not met, benefits are reduced gradually. Figure 5 Commitment 5 – Labour market policies on population ageing, including incentive and enforcement policies for employers and employees as well as research 5.5 Other activities Public awareness campaigns have been launched in several countries to draw attention to the labour market issues related to ageing and to support the aforementioned measures towards increasing retirement age (CAN, DNK, FIN, ISR, ROU, SWE, USA). Several countries (DNK, LTU) have also started to leverage Web-based technology in the form of job search databases for older workers or as a means of raising public 22 III : Implementation of the MIPAA in the UNECE region : Review of the first five years awareness and engaging in dialogue. Furthermore, Governments have set up research projects and 6. Commitment 6: “To promote lifelong learning and adapt the educational system in order to meet the changing economic, social and demographic conditions” The concept of lifelong learning pertains to adults in general and seniors in particular. It involves adjusting the education system to accommodate the needs of older persons, finetuning learning content as well as developing learning methods, e.g. to teach older persons the use of information technology. More research is needed to better understand the educational and training needs of an older target group. Overall, the education system should also aim to achieve better employability of all persons and to increase school retention rates, limiting dropouts and facilitating the reintegration into the labour market of those who left the formal educational system early. Lifelong learning has been identified as an important precondition for longer working life. It also influences the social integration of senior citizens in their societies. Three member States have explicitly named lifelong learning as a priority area (ESP, LTU, PRT) and a few other countries have established systems that offer tailor-made training courses considering the needs and capabilities of older persons. In general, the concept of lifelong learning is not yet fully integrated into most educational systems. However, countries have identified the need to establish institutions for lifelong learning and to further explore and understand the learning needs of their older citizens. 6.1 think tanks to develop labour market policies in response to ageing (DNK, LTU). Education systems The concept of lifelong learning is taking hold throughout the region and the notion of universities of the Third Age is gaining wider acceptance. Whereas in the past it was considered sufficient to guarantee older persons access to adult educational systems, now the standard educational systems are being adapted to meet the learning needs and capabilities of older persons. The education of older persons is mainly State-run, but some countries have put incentives in place to encourage employers to invest in the training of workers nearing the retirement age by offering support and training courses or tax rewards (FRA, ROU, SWE). Some countries state the explicit objective of increasing the participation rate of older age groups in training activities (HUN). While some countries have established national lifelong learning strategies (CYP, EST, HUN, LTU, MKD, PRT), others follow a decentralized approach in which the main responsibility rests with the municipalities (GRC, SWE). One country guarantees a right to lifelong learning through its adult training law (EST); in another, most of lifelong learning activities are offered by NGOs (ARM). One country has mentioned making particular efforts to integrate young people – and female students in particular – in disadvantaged areas into the schooling system to improve their employment prospects and thus enhance their ability to provide for themselves throughout their life course (FRA). 6.2 Learning contents The content of many lifelong learning programmes focuses on computer and Internet literacy (ARM, CZE, GBR, GRE, HUN, LTU, MKD, MLT, NLD). Furthermore, language classes, courses on entrepreneurship, and classes aiming at the empowerment of citizens to influence policies and enhance their intellectual and social skills are being offered (FIN). 6.3 Teaching and learning methods Concerning teaching methods, Third Age education differs significantly from other forms of education, extending from training to counselling. Usually, it does not include exams and focuses on debate and participation. The methods are adjusted to older persons in terms of location, content and duration of courses (LVA). Trainers receive special training on how to train older persons (LTU, LVA). To reach a larger number of students, several countries have developed distance-learning options (ESP, LTU, PRT, SWE). One country has developed a dedicated website, which should III : Implementation of the MIPAA in the UNECE region : Review of the first five years 23 encourage older people to learn more about the Internet (NLD). Another refers to focused TV programmes (MLT). countries have started research projects on how to best organize lifelong learning in their societies, focusing on the needs of older persons. 6.4 To better understand the learning needs of older citizens, several countries have set up research projects to develop policy options. The EU and the European Social Fund in particular support many projects that target the development of curricula for Third Age education. Research The EU is funding the development of curricula for older persons (e.g. through the project LENA – Learning in the Post-Employment Stage of Life) and encourages the exchange of best practice among its Member States. Several Figure 6 Commitment 6 – Ageing-related education strategies with regards to education systems, learning contents, methods and research 7. Commitment 7: “Striving to ensure quality of life at all ages and maintain independent living including health and well-being” Member States have committed to ensuring quality of life at all ages and in particular into old age. Three aspects can be differentiated with respect to this aim. The first is financial sustainability of the health-care system and improvement of access to health care. The second aspect is the availability and scope of care, which provides a precondition for older persons to stay at home. Thirdly, countries have committed to preventive efforts, such as promoting healthy lifestyles throughout the life course, which would improve health and quality of life in old age. 7.1 Health-care systems Increasing dependency ratio can easily bring sustainability of the health-care system under 24 III : Implementation of the MIPAA in the UNECE region : Review of the first five years pressure. While there is agreement on the importance of these issues, actions and requirements in the area of health-care financing vary substantially. Twelve countries have specifically identified health and care as priority areas in the context of the RIS (ALB, ARM, AUT, CAN, CHE, GBR, GRC, ISR, LTU, ROU, SVN, USA). While some Eastern European nations (ALB, LTU, ROU) are expanding their health-care systems, there are severe worries about the sustainability of the more advanced systems in other countries. To this end, systemic reorganizations have been implemented in a number of countries. Four countries report having reformed pension and insurance systems (AUT, CHE, NLD, PRT), others (EST, LVA, PRT, SRB) mention reforms of their service provision systems, and two more (CZE, ROU) have reformed the structure of their hospitals to make them more efficient. Individual countries have also taken further steps to reduce expenditures in and increase contributions to the health sector. One country (CHE) reports having increased the retirement age for women, while another (ESP) has tightened fiscal rules on health spending and established a reserve fund. Other options that were looked into are the extension of private sector elements (USA) and the combination of health and social security systems. All countries are aiming to provide equal access to health care to all their residents either by a universal health-care system with compulsory insurance and free treatment or by means-tested free care for the needy. Four countries (CAN, GRC, LVA, RUS) specifically state that their care systems are universally free, while two others (DNK, SWE) have deductibles small enough not to have a deterrent effect. Several countries are aiming to ensure equal access by means-tested free care for those without sufficient income (AUT, CYP, LVA, ROU, SRB, SVN). However, four countries (CYP, CZE, MKD, TUR) report that in practice there are inequalities in access to health care along regional, gender or cultural lines. A variety of measures to address inequalities have been specified in the member States. One country (ESP) has established special interdisciplinary centres; in another (GBR), an interdepartmental conference has been set up to combat health inequality. One area of particular concern seems to be regional inequality with health-care provision in rural areas lagging behind that in urban centres. Three member States (EST, HUN, ROU) provide financial and training incentives for medical personnel to settle in deprived areas, while other two (GBR, SVN) are tying regional funds to the achievement of care targets. Two other countries (CHE, NLD) are running specific campaigns to improve accessibility to people from different ethnic and cultural backgrounds, by assisting medical personnel from minority groups and by providing information and support to potential patients from non-native backgrounds. Some countries have national priorities on specific diseases, such as on dementia and Alzheimer’s disease (DEU, FRA). One country also has a special focus on research of age-related issues, including through a network of interdisciplinary “Competence Networks” (DEU). 7.2 Care and independent living The trend of allowing older people to stay in familiar environments for as long as possible (as mentioned under commitment 4 on social protection systems) is also important in relation to quality of life and well-being. As mentioned earlier, most countries are adopting an approach that puts independent living above institutionalized care. Among the measures taken to achieve this are activation programmes, the extension of home care and mobile services such as “Meals on Wheels” (ISR) or preventive home visits. New technology is also increasingly utilized to achieve this goal, e.g. to enable older persons to communicate with their children/grandchildren or medical personnel (DEU, FIN, GRC). Accessibility of the living environment, including the public sphere, is highlighted as crucial in maintaining independence of older persons in one country (SWE). Several member States are undertaking projects to develop community centres and to improve the accessibility of public transportation (LTU, SWE). Some other countries are developing good practices for home help and home nursing (FIN) and providing remote assistance for older persons living alone. Once independent living is not an option anymore initiatives such as establishing group (LVA) and nursing homes (MLT) aim to enabling older persons to stay close to home. The introduction of case management and the III : Implementation of the MIPAA in the UNECE region : Review of the first five years integration of social and health services to secure seamless provision of “one care” are growing in popularity (CHE, CZE, SRB, USA). One country has a body in place to direct older persons towards the care and support they need to coordinate the local actors involved in service provision (FRA). Member States are increasingly paying attention to the quality of care both in institutional and home contexts. Many countries have national programmes establishing and monitoring minimum standards for both home and institutional care (CYP, MLT, NLD, PRT) as well as systems to assess the norms of social care (LTU). One country has made annual inspections of nursing homes compulsory and has established a complaint’s body that will follow up on reported misconduct in institutionalized care settings (DEU). Some countries report setting up structures to observe that patients’ rights are met in health-care units (POL, ROU); some countries include patients’ representatives in such bodies. One country has set up a “Learning System” to deal with critical events in care settings (DEU). Moreover, professional training in the areas of nursing and elderly care is extended and improved and one country makes efforts to raise the profile of care professions and to make them more attractive (DEU). One country has introduced the option of persons delivering care to obtain a degree confirming their on-the-job experience. This mechanism has helped to increase the availability of qualified care both in the professional sphere and at home (FRA). The country also offers training for family carers. In parallel, this country has also made additional budgets available to enhance the education and recruitment of additional staff serving in professions to do with older persons (FRA). A few countries also use elaborate campaigns to raise awareness about the abuse of older persons (CAN, MLT) or have research under way to detect the level of violence against older persons (DEU). A number of other member States also offer training and capacitybuilding to professional care personnel, volunteers and care-taking family members (ESP, FIN, GBR, MLT, SRB, SVN). Civil society in one country has demanded an increase in awareness of geriatric issues among general practitioners (DEU). One country has introduced an oral documentation system instead of the written one in order to reduce the amount of time spent on documentation and 25 administration and to generate more time for the actual care-related tasks (DEU). Most countries provide benefits to persons who take care of an old, ill or disabled family member. This support of familial care can encompass necessary services for the client, a compensation for the informal carer as well as leave and support services to the carer. Family hospice leave, respite care, carers’ pensions and especially day-care centres are also frequently mentioned. Day-care centres enable families to care for frail elderly parents at home and to continue with regular work and family responsibilities. In addition, respite care enables family carers to go on holiday, take care of their own personal health, or simply have a rest (AUT, ISR, MLT). Volunteer organizations also play a role for the elderly in need who do not have a family member (ISR). In some countries in transition, NGOs and external donor organizations play an important role in service delivery (ALB, ROU, SRB). 7.3 Prevention and promotion of healthy lifestyles Many member States stress the importance of preventive action. Many countries do preemptive work to promote well-being and a healthy lifestyle. The importance of preventive action in maintaining quality of life, including health and independence, has been stressed during the past years. Prevention is now perceived to be financially and socially viable. Raising consciousness and the promotion of health education and healthy lifestyles are popular means of prevention. A number of member States have programmes focused on reducing the number of home accidents of older persons, preventing falls being a particular focus (AUT, HUN). Alongside various information campaigns on the effects of exercise, nutrition and drug use, this involves sports and fitness offers (CYP, FRA, LVA, NLD). These campaigns can take the form of brochures or TV programmes (AUT, FRA), enterprise competitions (CZE) or transmissions of recommendations via the Internet (LVA). Countries report commemorating special days related to ageing, for example the International Day of Older Persons (MLT, RUS) and the “World Elder Abuse Awareness Day” 26 III : Implementation of the MIPAA in the UNECE region : Review of the first five years (CAN). These are occasions for awareness-raising, health education and the realization of preventive campaigns (MKD). These events include cultural, educational, art and social activities. One country organizes multiple “Health Days”, which are combined with screenings, healthy food and information distribution (HUN). training, theoretical education and consultations to motivate and activate older persons (CAN, LTU). Some countries offer and promote preventive medical examination visits to older persons (DEU, FRA). One country puts a special focus on women’s health, for example through information (DEU). Health and ageing-related training is offered to older persons to promote activity, participation and self-help (ISR, MLT). Two countries have prepared a vocational guidance and counselling programme that includes practical The diagram below describes how the different aspects of the commitment to quality of life, health and well-being are interrelated. Figure 7 Commitment 7 – Quality of life, health and well-being in ageing societies and its constituting factors, including health-care systems, quality of care and prevention 8. Commitment 8: “To mainstream a gender approach in an ageing society” The process of ageing may not affect men and women in the same way. It is therefore imperative that Governments take special precautions to ensure that gender inequalities are avoided in an ageing society. To this end it is important that gender issues are addressed both on a public policy level and regulatory as well as on a more individual basis. 8.1 Gender equality in public policy and regulation While several countries make reference to this topic one country in particular (ESP) has identified gender equality as a priority area in the context of ageing. Nonetheless, inequalities in wages and participation persist. Many countries have passed or extended anti-discriminatory III : Implementation of the MIPAA in the UNECE region : Review of the first five years legislation (DNK, FIN, FRA, GBR, GRC, LTU, NLD, SWE), some having to amend the constitution in this connection. These antidiscrimination laws form the basis for the establishment of equal opportunity councils (BEL, DEU, FRA, GBR, MKD, MLT, ROU, SRB). These councils can operate at various levels ranging from the company or local level to national importance. In one case, they provide a direct way to obtain equal pay (GBR). On average, pensions for female older persons tend to be lower because of shorter periods of contribution payments due to childcare periods, lower general pay levels or part-time arrangements. One measure to compensate for these differences in pension levels is in the form of minimum pensions. Other measures may include compensation for years of discontinued payments of pension contributions due to family responsibilities or the possibility of continuing to contribute to the pension funds during periods at home (FRA). Several countries provide training classes for government officials and employers to highlight issues in this area and to increase sensitivity (ARM, EST, FIN, LVA, MKD, NLD, SRB). Moreover, four countries (FIN, HUN, LTU, SWE) publicly fund self-employment training and encouragement for women, with one providing expertise from experienced “mentors” (SWE). Three countries (FIN, LTU, MLT) have created provisions for each relevant budget item to be gender-checked before passing. The new laws have also led to an adaptation of school curricula in three countries (ARM, EST, MKD) as well as the inception of university courses dealing with ageing and gender in two others (CZE, ESP). 9. 27 The increased awareness of the relevance of the gender aspect is illustrated by the fact that countries increasingly collect gender-sensitive data. While data availability on this issue remains mixed, a majority of countries have data broken down into gender and age groups at their disposal. Two countries (DEU, MLT) run a research and documentation centre open to the public to inform a broader audience about the subject matter, while others have initiated research into the gendered division of household tasks (MKD). 8.2 level Gender equality on the individual Regarding family and work issues, the UNECE countries have mainly invested in making it easier to combine work and child-rearing. Two countries identify this as a specific area of gender inequality that needs to be addressed (MLT, SWE). Six countries (DEU, EST, FIN, GBR, LVA, SWE) have recently expanded childcare provisions through funds or tax breaks for families. Paid parental leave is now commonplace in many countries (DEU, DNK, FIN, GBR, LVA, MLT, NLD, ROU, SWE); some countries offer extra days if child-minding duties are split between the partners (FIN, SWE). More flexible work arrangements are also encouraged (DEU, EST, GBR, MLT), while two countries are re-evaluating the recognition of child-rearing periods for pension payments (AUT, SWE). One country offers an award to the most family-friendly employer (HUN). Some countries also offer financial incentives for family-friendly companies or require them to report on measures taken to achieve equal pay or to make work and family more reconcilable. Another country offers special family equality courses to couples (MLT). Commitment 9: “To support families that provide care for older persons and to promote intergenerational and intragenerational solidarity among their members” This commitment acknowledges that the family remains the prime source of care-giving and support both for children and older persons. Family caregivers make important contributions beyond the publicly available facilities or the services of commercial care providers or NGOs. However, the well-being of the caring persons should also be kept in mind and policies may be developed to facilitate their activities. Achieving high-quality care without unduly draining the resources of the caretaker is crucial for intergenerational solidarity. In addition, intergenerational interaction also takes place beyond the family and may need public support. 28 9.1 III : Implementation of the MIPAA in the UNECE region : Review of the first five years Family policies Many countries recognize the importance of the family in offering care both for children and older persons, although no country has specifically named this area as a priority. In the family policy field the majority of initiatives aim to improve the financial and time situation of working parents with various initiatives allowing more flexible work or financial support. Some of these measures also pertain to those caring for relatives. However, these are usually limited to family members and cannot be extended to friends, thus potentially having a negative impact on older persons without relatives. Another area of action is the development of small auxiliary services and day-care institutions. Various other schemes are used by individual countries. often involving the NGO and voluntary sector. In total, there were relatively few initiatives reported in this section that had not been covered in connection with the other commitments. Concerning the promotion of family policy, one country (FIN) states the explicit aim of allowing everyone to have as many children as they want through the use of free provisions and financial transfers. While others may not be so forthright, the provision and expansion of unconditional child benefits (sometimes called childcare benefits) was mentioned by at least six countries (AUT, DEU, FIN, HUN, SWE, SVN). In two countries (HUN, PRT), the benefits are also available to grandparents if they are the ones rearing the child, while in another it is means-tested (MLT). Three countries offer additional free maternity and child services (FIN, MLT, SWE); two grant special monetary allowances for parents of sick and disabled children (SWE, MLT). In one country, “local alliances” help improve the compatibility of family and working lives, by providing more flexible childcare services such as support services for those who nurse family members (DEU). 9.2 Care arrangements Caring for an old or infirm member of the family puts a particular strain on an individual. Nonetheless, family care remains the most common type of care for older people. The member States are honouring caretakers through financial and time provisions. Family-care benefits usually mean paid time off work and are available in at least seven countries (AUT, BLR, CYP, CZE, FIN, RUS, SWE). In one country, the caretaker can seek “employment” by the municipality, which then covers his or her salary (ROU). Additionally, monetary benefits are available in many countries (AUT, CYP, DEU, DNK, FIN, LTU, MKD, NLD, SWE). One country offers vouchers that can be converted into care services provided by a home care worker or by a service agency (FRA). Normally, these are available to family members only and sometimes there are further restrictions such as payouts to people living alone only (MLT) or means tests (HUN). Only one country reports counting care time as work for retirement purposes (HUN). Another common policy is to make work more flexible, which is done through the option of reduced work time or working part-time in six countries (AUT, DEU, GBR, MLT, ROU, SVN). Elsewhere, the State encourages employers to align work hours with the school day and to advance work at home (SVN). Paid parental leave and extra days off when the leave is split between husband and wife are gaining popularity in at least four countries (EST, GBR, MLT, SWE). Measures mentioned by one country only are the marriage grant (MLT), a special housing allowance (SWE) and close links of parental support schemes with schools (GBR). Other help offered comprises training and services for caretakers (ARM, DEU, FIN, HUN, SWE), respite care allowing caretakers a few days’ break (DNK, LTU, NLD, SWE), and the provision of in-house help (GBR, MLT, SRB, SVN). To offer relief to caretakers, six countries plan the construction of social care centres (ALB, DEU, ISR, LVA, MLT, SRB), usually in the form of daycare centres (CYP, ISR, LVA, MLT, SRB). 9.3 Intergenerational initiatives beyond the family and care system Apart from the family and care programmes, a number of other intergenerational initiatives have been created. They are often carried out in cooperation with NGOs (CYP, DEU, ISR, MLT, ROU, SRB, SVN). One country actively encourages public-private partnerships and uses lottery money to support NGOs (FIN), while two others (ESP, MLT) have amended legislation to encourage voluntary organizations and the III : Implementation of the MIPAA in the UNECE region : Review of the first five years involvement of older persons in them. Five countries have established new bodies for the promotion of intergenerational solidarity (GRC, DEU, NLD, PRT, SVN); in one case, a new ministry was even set up (NLD). Elsewhere (SRB), a social innovation fund was established to provide new local projects with money. Further projects 29 include a national programme for social protection (MKD), food kitchens serving the needy around the country (MKD) and joint family learning initiatives. Figure 8 Commitment 9 – Inter- and intragenerational solidarity in ageing societies in the family, in care and beyond 10. Commitment 10: “To promote the implementation and follow-up of the Regional Implementation Strategy through regional cooperation” UNECE member States have the primary responsibility for the implementation and followup of the RIS. In doing so, they are supported through regional cooperation, which takes place on three levels: between member States, between member States and the UNECE secretariat, and between civil society organizations in the member States. 10.1 Cooperation between Member States Overall, regional cooperation has been taking place in various international projects, in the form of sharing good practices and in research. However, the RIS process has been supported by the majority of UNECE member States, by submitting country reports and attending RIS follow-up meetings. Several countries have hosted international expert meetings, conferences and institutions (AUT, DEU, GBR, ESP, MLT, RUS, USA). Others carry out joint projects, e.g. in the framework of the EU, or by financing ageingrelated programmes in other member States (AUT, CZE, LTU, PRT, ROU, RUS, USA). 10.2 Activities coordinated by the UNECE UNECE has been promoting international collaboration in the field of ageing through the exchange of experience and good practices and capacity development. The United Nationsaffiliated European Centre Vienna has been 30 III : Implementation of the MIPAA in the UNECE region : Review of the first five years developing tools for monitoring the RIS based on a Memorandum of Understanding between the UNECE and the Government of Austria. Austria, Spain and the United Nations Population Fund have provided significant financial support to ageing-related activities in the framework of the UNECE. The UNECE secretariat has organized a number of international meetings, the most recent being the Léon Ministerial Conference. Data and analysis for monitoring the RIS are provided through cooperation with the European Centre for Welfare Policy and Research in Vienna. Most member States have attended and played an active role in the meetings organized by the UNECE secretariat and have followed up on international meetings through national implementation workshops or similar activities. In addition, collaboration among EU Member States is guaranteed through regular council meetings of social ministers. One country proposed launching a “year of active ageing” in Europe (HUN). 11. 10.3 Cooperation between member States and civil society The UNECE member States support civil society mainly through funding for organizations, projects or events (AUT, HUN, MKD, ROU). They also enable NGO representatives to attend international conferences and expert meetings (AUT). Furthermore, civil society is closely involved in the policymaking and legislative process in a number of countries (DEU, FRA, HUN, ISR, NLD, ROU). This can take various forms. For example, one country has set up a National Action Plan Office with participation of civil society to facilitate the RIS process (DEU). One country has integrated a statement of civil society to all the commitments into their country report (DEU). At the intersection of the member States, the UNECE secretariat and civil society, several networks of research institutes, public institutions and NGOs have evolved to address population ageing. One member State offers training courses for government and NGO delegates from other member States, and thus facilitates increased collaboration in the region (MLT). Conclusions Significant policy actions have been undertaken by member States to implement the RIS. Progress has been achieved in all the 10 commitments of the RIS, with different commitment areas receiving varying degrees of attention. Implementation has been concentrated on social and economic policy. Out of the 35 reporting Governments, 12 explicitly prioritized the area of social protection systems (commitment 4), 12 the area of quality of life and health care (commitment 7), and 8 the area of labour markets (commitment 5). Within the framework of commitments 4 and 5 (social protection systems and labour markets), most member States prioritized measures aiming at financial sustainability of social protection systems. Progress in the reform of these systems was often reported through the provision of incentives to encourage citizens to participate in the labour force for longer. Many countries have increased the official retirement age or have started initiatives in this direction. To increase the employability of older workers, training, a flexible retirement age, tax reductions and subsidies for companies have been introduced. These measures are usually complemented by an economic policy that aims at fostering sustainable growth through balanced budgets, employee training and initiatives to increase productivity, as well as reforms of the labour market to increase employment rates. Considerable progress was also reported on the commitment 1 (mainstreaming ageing in all policy fields). A large majority of reporting countries either have comprehensive national programme documents related to ageing or are drafting them. Governments are increasingly involve citizens by establishing or strengthening national councils where pensioners’ and older citizens’ organizations are represented and are assisting in preparing and monitoring legislation. Participation of older persons is being promoted by fostering intergenerational collaboration through volunteer programmes and media campaigns conveying a more positive image III : Implementation of the MIPAA in the UNECE region : Review of the first five years of ageing. Improving infrastructure in the housing and transport sectors to provide easy access is another tool to support integration. All in all, member States are increasingly devoting attention to participation: 20 countries reported significant activity in this field, with four identifying it as a specific priority area. Promoting a participatory approach is also seen as an important area where the civil society and NGOs have a special role. Government involvement in this area frequently focuses on financial support to the nongovernmental infrastructure related to population ageing. However, participation and collaboration with civil society and NGOs have yet to be reviewed and appraised systematically. Most countries have passed antidiscriminatory legislation to ensure gender equality (commitment 8). While commitment 7 (quality of life, health and well-being) was identified as a priority area by 12 countries, 20 reported significant activity in this area. Countries have invested in making it easier to reconcile work and child-rearing. Throughout the region, many activities aimed at recognizing the family as the 31 prime point of care for both children and older persons were reported (15 countries). Frequently, policy measures improving life for caretakers, such as paid time off work, monetary benefits and training are applied. Many member States reported on crosssectoral activities that affect society as a whole, e.g. increasing the employability of the workforce through lifelong learning, e.g. Third Age universities and training programmes. However, lifelong learning has not yet come to the fore throughout the whole region. Only four countries have a high level of activity in this area, and only two have declared it a priority area. There has been significant and increasing international cooperation in the framework of the UNECE in implementing the RIS. This cooperation has been carried out in the form of exchange of experience and good practices, capacity-building and the development of monitoring tools. The UNECE secretariat has proven effective in facilitating the RIS and in bringing countries together to exchange on progress made. Figure 9 Prioritization of commitments according to country reports 1 Mainstreaming 2 Participation 3 Economic Growth 4 Social Protection Systems 5 Labour Markets 8 6 Life-Long Learning 2 7 Quality of Life, Health and Well-Being 8 Gender 9 Intergenerational Solidarity 10 Regional Cooperation 4 13 12 1 33 IV. Keynote Papers _________________________________________________________________________________________ Panel A: Creating integrated approaches to mainstream ageing Johan Schölvinck Panel B: Participation and social inclusion Ursula Lehr, Heike Felscher Panel C: Towards a balanced care strategy Joseph Troisi Panel D: Living longer – working longer: Challenges for education, the labour market and social protection Bernd Marin Panel E: Intergenerational collaboration Charlotte Höhn Panel F: Focusing on opportunities: Active ageing Irene Hoskins _________________________________________________________________________________________ Panel A: Creating integrated approaches to mainstream ageing Mainstreaming concerns of older persons into the social development agenda Johan Schölvinck Director Division for Social Policy and Development United Nations Department of Economic and Social Affairs The Madrid International Plan of Action on Ageing, (MIPAA) adopted during the Second World Assembly on Ageing in April 2002 was truly a landmark event. A detailed and wellthought-out document, it provides a practical guide for national and international action for years to come. Population ageing was recognized as a major achievement of society as well as a universal force that has the power to shape the future, much akin to globalization. The Madrid Plan of Action underscores that it is essential to recognize the ability of older persons to contribute to society by taking the lead not only in their own betterment but also in that of society as a whole. Forward thinking is crucial to embrace the potential of the ageing population as a basis for future development. Mainstreaming ageing is an important dimension and essential aspect of the Plan. Mainstreaming is seen as a policy tool and is specifically mentioned in paragraph 15 of the Madrid Plan: “Mainstreaming ageing into global agendas is essential. A concerted effort is required to move towards a wide and equitable approach to policy integration. The task is to link ageing to other frameworks for social and economic development and human rights.” Whereas specific policies vary according to country and region, population ageing is recognized as a process that will have a profound impact on 70 societies in numerous ways. The Regional Implementation Strategy (RIS) for the UNECE region adopted soon after the Second World Assembly serves as a starting point and a framework of commitments to support member States to respond adequately to the challenges and opportunities of population ageing. In the RIS, a specific commitment was made to mainstream ageing concerns into all policy fields with the aim of securing gender-sensitive and evidence-based integrated policies to bring societies and economies into harmony with demographic change. This approach applies equally to such sectors as health care, the labour 34 market, social protection and education, and the economy as a whole. It should be recalled that during the first review and appraisal of the Madrid Plan in the period 2006–2008, all member States were encouraged to focus their attention on two dimensions: (a) ageing-specific policies; and (b) ageing-mainstreaming efforts. The importance of mainstreaming ageing into development agendas will be addressed. In general terms, mainstreaming can be defined as a process of bringing issues to the centrestage that have not received the consideration they deserve, if not the centre of attention. In that sense, mainstreaming is a vital tool for focus and inclusion. It was successfully tested in many countries and has been an effective alternative for advocacy of various issues, such as gender and human rights. In a similar vein, mainstreaming can definitely address issues concerning older persons. By definition, mainstreaming is a multidimensional effort. Successful mainstreaming should lead to greater social integration of a particular group as well as to the inclusion of a particular issue into all aspects of social, political, economic and cultural life. The overall objective of mainstreaming should be the achievement of a more equitable development within a society for the benefit of all social groups. In this light, mainstreaming could be an important tool in achieving a society for all ages as called for by the Madrid Plan. To be effective, policies in response to population ageing should take a holistic approach and be pursued in a coordinated way over a wide range of policy areas. Account must be taken of the multifaceted and intertwined challenges and opportunities arising from population ageing in order to devise a framework from which effective policy responses can emanate. The approach also rests on the premise that a set of well conceived and well-implemented policies in various domains, properly coordinated and consistently applied, would be able successfully to meet the challenges arising from these demographic changes and release the unused potential embedded in some population groups, in particular older persons. Mainstreaming can be an effective approach to consistently highlight and emphasize ageing in policies, programmes, budgets, laws and international treaties. In this light, what are the IV : Keynote papers essential prerequisites of successful mainstreaming? The available experience permits us to draw some conclusions in this regard. First, mainstreaming should be introduced on the basis of well-founded knowledge. Therefore, the comprehensive collection of relevant data is of great importance. Only when sufficient and good quality ageing-related data have been gathered and distilled is it possible for policymakers to develop effective policy approaches. Age-disaggregated data that shed light on the particular living conditions of older persons are obviously of particular interest to policymakers. Lack of such data, however, still remains a major challenge. Second, in many countries, unfortunately, issues concerning ageing and older persons suffer from a chronic lack of attention and resources. This unenviable situation could in part be explained by the lack of insufficient political visibility and attention to ageing in the development agenda. Newly collected evidence should be disseminated to contribute to the overall knowledge of society regarding ageing and older persons. It should also serve as a vehicle for raising awareness. Thus, a concerted advocacy campaign has to be designed after data have been collected and analyzed. Sensitizing the public to the concerns and conditions of older persons would be a logical next step. Ultimately, consistent and multiple advocacy campaigns should lead to a greater appreciation of the concerns of older persons, to overcome negative stereotypes, and to develop or adjust the strategies, policies, programmes and legislation that impact the quality of life, so as to achieve a society for all. Third, when data become available and the advocacy campaign is launched, it is essential to develop tools to assess the mainstreaming process. Developing benchmarks against which potential progress can be measured and introducing appropriate indicators to address the results and progress of mainstreaming are important tools to ensuring continuous accountability. Performance indicators may be used not only to measure progress of individual well-being of older persons (quality of life indicators), but also to highlight the success of overall policy. Some policy action may become inevitable in the case that the outcome is lagging considerably behind the original expectations. In addition, if there is only little IV : Keynote papers progress in a certain area, it is impossible to rely on indicators alone, the root causes must be analysed to understand the situation. The review process and fine-tuning of mainstreaming efforts could be carried out by an office within the governmental structures which lobby for the concerns of older persons. The process of mainstreaming should involve the input of many different policy actors at various levels, whose experience may be diverse. Every existing policy, programme or law should be evaluated using a simple criterion, namely whether it adequately reflects the concerns of older persons. After the review process has been finalized, adjustments to existing laws and policies should be suggested and implemented. In cases when the letter of the law goes clearly against the interests of older persons, changes in the institutional structures should be introduced. Our experience convinces us that certain guidelines on mainstreaming the concerns of older persons into new laws, policies and programmes should be developed before any new legislation is introduced and voted on. An additional mainstreaming office or desk should also be established, preferably within the finance ministry, to ensure that ageing is mainstreamed in the annual budget. It goes without saying that it is vitally important to introduce ageing concerns in annual budget reviews and to ensure that the priorities of older persons are taken into account when decisions on allocation of funds for specific projects and programmes are made. It might be appropriate to emphasize that any attempt to mainstream concerns of older persons along the lines of both development and human rights agendas requires efforts at all levels: from the local and national levels up to the international and intergovernmental level. Multilevel and multisectoral efforts need to be effectively coordinated, especially since they relate to wide-ranging themes – from improving older persons’ access to employment opportunities to combating old-age stereotyping and discrimination. The actors involved – notably Governments, NGOs, international organizations, and donors – should move towards effective mainstreaming together. In their effort to build national capacity on ageing, these actors and institutions should develop and share good practices on efficient specific actions and services to increase knowledge and support research. There is also a need for a 35 more systematic sharing of good practices at the global level, with particular reference to SouthSouth cooperation. Capacity-building should also be facilitated by means of technical cooperation provided by the United Nations system. The elements outlined above are essential for successful mainstreaming. However, a note of caution is needed; while conceptualizing adequate measures for future mainstreaming efforts, some preliminary considerations should be addressed, such as: (a) There are concerns whether mainstreaming might contribute to a partial “disappearance” of some ageing-related issues. When promoting mainstreaming, it is important not to lose sight of the specific needs and expectations of older persons. This leads to an important caveat: mainstreaming must not mean diminishing the funding of specific ageing-related programmes or reduce the attention to the plight of older persons. As a remedy a twin track approach to policy and programmes on ageing is suggested, that is, to address older persons’ specific needs while simultaneously fostering mainstreaming as a cross-cutting issue; (b) Since human rights and gender concerns affect all individuals, mainstreaming seems to be an effective tool to integrate these issues into overall policy planning. Yet it seems more difficult to mainstream issues relating to older persons, as these issues are usually considered to affect only a certain group. To overcome this predicament and to give comparable weight and attention to these issues is a challenge. This situation calls for additional efforts such as advocacy, awareness-raising and public education in order to promote the realization that a sensitive approach to mainstreaming the concerns of older persons will benefit society as a whole. In summary, mainstreaming is a useful and potent means to further the interests and well-being of older persons. It is or can be a convenient tool to promote an equitable age-integrated society for all ages, as is called for in the Madrid Plan. Mainstreaming, however, should not be seen as a panacea to resolve long-standing problems. A realistic approach is essential. Having pointed out the potentials and opportunities that effective mainstreaming can offer, let us not forget the 36 problems and concerns arising from mainstreaming approaches. Mainstreaming could be part of a policy strategy that can be particularly effective if applied prudently but consistently. New policies based on careful planning, sensitive IV : Keynote papers implementation and rigorous evaluation, using well-thought-out indicators, could lead to more satisfying results for older persons and ultimately promote the noble goal of a society for all ages. IV : Keynote papers 37 Panel B: Participation and social inclusion Ursula Lehr Professor, University of Heidelberg, Germany and Heike Felscher German National Association of Senior Citizens’ Organizations (BAGSO) We are living in an ageing world. Never before could so many persons reach an advanced age not only in Europe, but in the whole world. We are witnessing an enormous extension of the lifespan in all our countries, due to the progress of modern medicine, the improvement of the socioeconomic living conditions, as well as the influence of a healthier lifestyle (by preventive behaviors – nutrition, physical and mental activities, etc.). In most of the European countries, a person aged 60 can expect to live between 20 and 23 more years, which means that after retirement a person can count on living between 20 and 25 more years, one fourth of his/her life. Yet today many are not prepared for such a long period of postoccupational and post-parental time. The percentage of people aged 65 years and older, and even more so the percentage of people aged 80 years and older is growing rapidly. A hundred years ago in Germany, the ratio of persons living beyond age 75 to those under age 75 was 1:79 (i.e. 1 person aged 75+ for 79 75-). This ratio changed consistently through the last century: in 1925 the ratio was 1:67; in 1936 it was 1:45, in 1950 1:35, in 1970 1:25, in 1994 1:14.8 and in the year 2000 it is 1:12.8 and in 2040 it will be 1:6.2 (Lehr, 2003). Most older people, even among the group aged 80, are competent and able to manage their daily lives. In the age group of persons between ages 60 and 80, only 3–4 per cent is dependent and needs help, while among those aged 80 and over, this group accounts for 31 per cent, indicating that nearly 70 per cent are able to master their daily lives (BMFSFJ, 2001). These figures show clearly that every effort has to be made to ensure healthy and maintain competent ageing, physical, mental, and social activities as well as promote healthy nutrition, all of which enable older people to enjoy a high quality of life. Consideration should also be given to ensure they are integrated into a society with participation and a high degree of inclusion. The ageing of the world population brings about challenges that can only be met by intergenerational cooperation. The abilities and experience, the expert knowledge and the special skills of older persons are needed in our societies. As the Madrid Plan of Action states: (a) The potential of older persons is a powerful basis for future development. This enables society to rely increasingly on the skills, experience and wisdom of older persons, not only to take the lead in their own betterment but also to participate actively in that of society as a whole (from article 10); (b) We commit ourselves to eliminating all forms of discrimination, including age discrimination. We also recognize that persons, as they age, should enjoy a life of fulfilment, health, security and active participation in the economic, social, cultural and political life of their societies (article 5); (c) The modern world has unprecedented wealth and technological capacity and has presented extraordinary opportunities “to empower men and women to reach old age in better health, and with more fully realized well-being; to seek the full inclusion and participation of older persons in societies; to enable older persons to contribute more effectively to their communities and to the development of their societies” (article 6). Prior to the Madrid Plan of Action, in August 1982, the Vienna International Plan of Action on Ageing, outcome of the first World Assembly on Ageing, mentioned the following: • Policymakers and researchers, as well as the mass media and the general public, may need a radical change of perspective in order to appreciate that the problem of ageing today is not just one of providing protection and care, but of the involvement and participation of the elderly and the ageing. Eventually, the 38 IV : Keynote papers transition to a positive, active and developmentally oriented view of ageing may well result from action by elderly people themselves, through the sheer force of their growing numbers and influence” (article 32) • Governments should facilitate the participation of older persons in the economic life of the society (recommendation 37, Vienna International Plan of Action on Ageing) These recommendations were made 25 years ago and what has happened between the Vienna Plan and the Madrid Plan is questionable. In the Madrid Plan (article 12), one finds the following recommendations: • Older persons should have the opportunity to work for as long as they wish and are able to, in satisfying and productive work, continuing to have access to education and training programmes. The empowerment of older persons and the promotion of their full participation are essential elements for active ageing. The León Ministerial significantly mentions the following: Declaration • Active citizenship, a dynamic civil society and interaction between citizens and government are vital in order to achieve a society for all ages, as this promotes social cohesion, helps overcome age discrimination, and empowers older and younger persons (to act for themselves and) to work together. • We confirm that lifelong learning and active ageing, access to modern information and communication technologies, volunteerism and civic engagement are crucial means to promote participation. (article 9) The increasingly important role of elderly people should be acknowledged not merely as potential voters for the next elections. Their experience, authority and social responsibility are needed in politics. Although the number of active older persons has slightly increased in recent years, the effective participation of older people in social and political life is not yet fully realized. Much remains to be done. Older people need and want greater opportunity for involvement in the political arena: they want to be part of social development. The majority of senior citizens should be in a position to take a responsible and independent part in social, cultural and political life and be able to make a valuable contribution to society. Senior citizens do not merely want to join in the elaboration and discussions on specific decisions or be the centre of interest for elections; they also want to take their share of responsibility. Participation is far more than just voting in the elections: it is an ongoing process that must be developed through suitable formal structures (advisory bodies, consultation processes, etc.). We want to live in a world where governments and parliaments of all states as well as leaders of all political parties increase their efforts to satisfy the needs of older people, to listen to them and to facilitate their cooperation in resolving matters of concern to them. This also means that senior citizens themselves are encouraged to stronger political involvement, as all decisions affect their future: such decisions are made in political committees. Let us underline that senior citizens policies should not be restricted to the specific area of senior citizens. The rich experience of life and accumulated knowledge, after having reached a particular age, is too precious to be ignored and remains a matter of public interest for all generations. Therefore, any opportunity for the active cooperation of older people in all social fields should be seized. Political participation in old age How powerful is the older generation in our society? This is not an easy question to answer. Some conclusions can be drawn through looking at the representation of different age groups in various sectors of public life. In Germany, for example, older parliamentarians tend to be under-represented in parliaments at the State and federal levels in Germany. In a lead article in the newspaper Die Zeit, Baltes (2002) underlined a “dramatic underrepresentation of the older generation” in the Federal Parliament and in the Berlin State Parliament: • In the Federal Parliament only 1.6 per cent of 666 members were older than 65 at the time elections took place. 0.4 per cent was over 70 years old. That is just one person. In the new legislation period (since 2005), 613 members of IV : Keynote papers the parliament, 4 persons (2 men, 2 women), were 70 years and older (0.6%) and 3.9 per cent were 65 and above (a slight increase from 1.6% to 3.9%). In the 16 States’ Parliaments, the percentage of the over-60-year-old varies between approximately 3 per cent in Thüringen and 22 per cent in Niedersachsen. These figures show that in terms of political participation in the Federal Parliament, as well as in many States, people over 65 and those under 25 are strikingly under-represented. In Germany, we now have nearly 1,200 representative bodies of senior citizens in cities and communities, which for the most part are representing very effectively the concerns of elderly people. We need more elderly members in the Parliament, not only for addressing a policy for the aged, but to harness the experience, special skills and wisdom of the elderly in all the political areas, from foreign policy, economy and finance to cultural, educational and research policy as well as in the policy for developing countries. Social participation of the aged in voluntary work Ten years ago, data showed that in the age group 65 and over, only 3.3 per cent were in the labour market, while 12.4 per cent were engaged in official voluntary work, 13.2 per cent were caring for an aged person and 19.5 per cent were caring for children (mostly grandchildren) (Kohli and Künemund, 1997). The latest data shows that in the 55–64 age-group, 40 per cent are involved in voluntary work, and an additional 30 per cent are ready to engage in voluntary work if they find the right occupation. In the next age group, age 65–74, the proportions are, respectively, 32 per cent already involved and more than 20 per cent ready to do so; in the next age group, 75 and above, 19 per cent are active volunteers and 10 per cent are willing to volunteer (BMFSFJ, 2006). Longitudinal studies reveal clearly that social participation develops over the life course: a positive correlation can be found between activities and social participation during youth, young and middle adulthood and late-life participation; the type of volunteer work in young adulthood (e.g. in 39 sport clubs) is different from the activity in old age (e.g. helping an old and a sick neighbour). How to empower older persons? What can be done to improve participation of the elderly? These questions address the challenges we are facing. As the older generation will have an increasingly important role to play, the potential of the older population must be used by society. Recent programmes for senior-trainers seem to be very successful and are important steps in this direction. Programmes such as Experience for Initiatives (EFI) are promising: “Around 1000 elderly people have taken part in these courses to be senior trainers in order to learn something new and to use their experience in many local projects for the benefit of all age and population groups” (Ursula von der Leyen, Minister for Family Affairs, Senior Citizens, Women and Youth, Germany). Participation in everyday life Individual ageing is a lifelong process that requires maintaining a healthy and active life from childhood to old age in different ways: physical activity, mental activity and social activity. While we have to enable the elderly to live a healthy and competent life in old age, healthy ageing starts in early childhood and adolescence. In order to optimize a lifelong healthy development, we must begin at an early age with a health-oriented lifestyle (healthy nutrition, physical activity, social activity, development of interests and hobbies) and include the development of successful coping strategies. Participation in old age starts in young adulthood (Staudinger, 2002). Physical activity. Today’s generations of older persons are more active in sports and physical activities than former generations of senior citizens. Today, 28 per cent of the male members and 11.4 per cent of the female members of sport clubs are 60 years and over; many more engage in sports activities without being a member of a club. Mental activity. Mental activity is not only a prerequisite to health but to social participation. In adult education classes in Germany 21.7 per cent of the students are 50-65 years of age, 11.4 per cent are 65 and over. More and more elderly are taking courses at universities successfully and gain from 40 an intergenerational environment as there often is a close relationship between the younger and the older students. Social, educational and leisure activity. We have to ensure lifelong learning and teach the elderly of today (not only those of tomorrow) how to use computers, e-mail and the Internet. Special programmes exist in Germany and the number of Internet users is increasing steadily: during the last three years we have had an increase of 33 per cent in online users aged 60 years and over. Today, 24 per cent of older women and 47 per cent of older men use the Internet. Just looking at the statistics of travel agencies, the elderly are very well represented. The 60-and-over generation travels much more than the younger ones. Senior citizens have more time and usually travel for longer periods of time than the younger generation, which has forced the tourism sector to adapt to the special wishes and needs of the elderly. We have to enable society to cope with demographic change not only at the individual level but at the societal level as well. It is necessary to change the attitude toward older persons, to consider ageing as an opportunity and to use these opportunities. In this perspective, empowerment in old age is a challenge in sectors such as mass media and television too. We need many more popular movies, success stories such as the German TV movie Der grosse Bellheim, in which the experienced seventy-year-old protagonist is more successful at solving problems than the younger ones. Environment and housing. We also have to change the environment. The cities and countries in the world are increasingly and inevitably called upon to adapt the environment to an ageing society: for example through better traffic systems so the older persons can enjoy greater mobility. Many of our cities are not age-friendly nor are they comfortable for our elderly. Town planning and traffic system have to take into account the high percentage of older persons. Are there enough possibilities for physical activity and are there enough public gardens (with seating accommodations) or places where older persons can go for sports, gymnastics, indoor-swimming pools, etc.? Transport design, such as that of buses, leaves much to be desired and requires adjustment to the needs of an older person: for example, high and narrow steps in a double-decker bus are handicaps (and toilets should always be available). IV : Keynote papers Our architects and designers need to adjust to an ageing world. This is as important for the private living environment as it is for public buildings and hotels. So many details could be improved and optimized, e.g. railings on both sides of stairs. There are many ways to facilitate daily living: Why are the seats and chairs often too low and without armrests (necessary for standing up)? Why are bathtubs not automatically equipped with a grip? Why are toilet seats not at an optimal height? Why are some hotels equipped with bedside lamps with such weak lights that reading is impossible? How does one find the way to the bathroom at night? Why is the sound on the TV set so low that seniors are unable to hear well? If the reason is to avoid disturbing other guests, why are hotels not providing earphones? etc. Industry and manufacturers have to take into account the ageing society and change some of their products. Many older people retain the ability to drive a car well into very old age (even those who find walking difficult), but often car designs are not adapted to older persons’ needs, and it is difficult for them to get in and out of a car. Furthermore, many electronic devices are found in cars that are confusing for older people and thus will never be used or needed. In the future, gasstations will need to offer more services and help to older drivers. The same is true in the supermarket: not only will more help be needed, but also packaging for single households. A policy for senior citizens The German Federal Government’s National Plan of Action on Ageing, “Challenges and opportunities of an ageing society”, includes both national plans and projects of Federal States and not-for-profit organizations. These are related to the 10 commitments of the RIS of the Madrid Plan (BMFSFJ, 2007). By providing different framework conditions, the German Government enables older people to live the third phase of life at all stages in an active and independent way with dignity and contentment. Much can be done: promoting voluntary work and active citizenship, providing social protection systems in case of sickness or need of nursing care and setting up standardized training programmes for geriatric nurses at national level are just a few examples. IV : Keynote papers • 41 Policy priorities of the German Federal Government regarding senior citizens • To adapt social protection systems in a sustainable way in response to the ageing population • To promote a positive image of ageing and old age in public • • To increase the rate of employment of older employees To enhance independent living and active participation of older persons in all social processes, including voluntary work and active citizenship • To support senior citizens’ organizations • To maintain and develop educational opportunities for older persons • To ensure high-quality care and assistance in old age • To promote solidarity and responsibility between generations • To pass legislation regarding protection and assistance in old age • To analyse the consequences of the demographic change, in particular with regard to a better use of the potential of older persons • To promote the idea of older persons as consumers • To take into account the special needs of older migrants • To support European and international cooperation • To promote the economic factor of ageing • To take into account the special needs of older persons with disabilities • To develop differentiated policies for older persons according to the different needs and experience of men and women To respect the gender mainstreaming approach in all projects Source: BMFSFJ, 2007, S.10. See also http://www.monitoringris.org/documents/norm_reg/unece_ris_german.pdf The Federal Government’s reports on ageing The fifth report on ageing – “Potentials of ageing” The Federal Government’s reports on ageing, issued for each term of office, provide information on the life situation of older persons in Germany. At the same time, these expert opinions from academics contain concrete proposals on how to make better use of the enormous potential of older people in the economy, working life and society. The reports are prepared by special committees whose members are experts from different fields chosen according to the topic of the report. The fifth report on ageing, published in 2005, focuses on the topics of strength and practical knowledge of the older generation. It proves clearly that older persons have a considerable wealth of knowledge and experience as well as higher levels of education and qualifications than younger generations, and that they also generally have a good level of income. It also shows that many senior citizens in Germany not only want to support their family and 42 their direct private environment, but also that they are prepared to get involved in voluntary work for society. In a series of lectures on the topics of the “Gainful employment of older persons” and the “Economic potential of older persons” as well as workshops on “Products and services”, the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth disseminated the Fifth report on ageing and stressed the role of multipliers in politics, business and associations. The sixth report on ageing – Images of ageing in society” It is only possible to meet the demographic challenges and develop the necessary solutions by taking a new view of ageing. The Federal Government’s forthcoming sixth report on ageing, on the topic of “Images of ageing in society”, will develop modern, realistic scenarios of ageing and make recommendations on how these proposals can be firmly anchored in society. Today, a policy for the elderly must go beyond mere policies for pension schemes or health-care policies to include non financial aspects as well. To cope with the challenges of a greying world, the issues outlined below should be stressed. The first issue is maintaining and increasing the competence of the elderly so as to prevent dependency and secure healthy ageing with a good quality of life. A policy for the aged is a policy for healthy ageing, combined with a state of psychophysical well-being. We know that ageing is influenced by biological heredity as well as by individual behaviour and a wide range of social, environmental, cultural and political factors. Healthy ageing is the result of a lifelong process that requires the optimum development of the individual. We know that a variety of factors in early childhood, adolescence, during early and middle adulthood and the present life situation of the aged all determine the process of ageing and well-being in old age. Policies should promote intergenerational understanding, which requires the participation of all generations through integrating senior citizens in political decision-making. IV : Keynote papers Concluding remarks Demographic change, the ageing Europe and the ageing world present a challenge to all of us. A policy for the aged, however, should not be determined only by the question, “What can we do for the aged?”, it also should ask: “What can the aged do for the society?” For this, we need to revise the negative image of the aged that is prevalent in some countries. Most of the elderly are competent and wish to make commitments for society, groups, communities, churches, clubs, etc. Such readiness for voluntary public engagement should be accepted and a framework should be provided to utilize the potential and services elderly people are willing to offer. Integration and participation of the elderly are a prerequisite for the quality of life of the elderly and for their health and productivity, but it is also important and helpful for the society in general. In 1985, Robert Butler noted that “The participation of older people enriches societies, economically, culturally and spiritually.” Health and productivity are closely connected: the loss of one may entail the loss of the other and so lead to dependency, decline of mental, psychological and physical abilities and incompetence. Conversely, productivity, participation, responsibility and the feeling of being can have a favourable effect on health. Butler added: “Much discussion of health … is really a discussion of medicine. The medical model is a very restricted one”. Therefore, we must “recognize that health and productivity are interacting conditions. The unproductive human is at higher risk of illness and economic dependency and the sick person is limited in productivity and is, therefore, at higher risk of dependency” (Butler, 1985: 12). Old age and longevity should not be seen as a problem, but as a chance and a challenge – a challenge for everyone: for the ageing individual, for his or her family and for our society. We should not address only the problems and deficits of ageing and old age: ageing from birth to dying and death is development. We should address and initiate research on the new potentials of the aged, their competence and new potentials for society. IV : Keynote papers 43 References Baltes P.B. (2002). Unsere Gesellschaft kommt in die Jahre, frönt aber dem Jugendkult und verpasst eine Chance. Die Zeit 14/2002. BMFSFJ – Bundesministerium für Familie, Senioren, Frauen und Jugend (2007). Nationaler Aktionsplan zur Umsetzung des Zweiten UN-Weltaltenplans, Madrid 2002 und der UNECE-Regionalen Implementierungsstrategie, Berlin, 2002. BMFSFJ – Bundesministerium für Familie, Senioren, Frauen und Jugend (2006). Potentiale des Alters. Fünfter Altenbericht – Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland. Berlin. BMFSFJ – Bundesministerium für Familie, Senioren, Frauen und Jugend (2001). Alter und Gesellschaft. Dritter Altenbericht – Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland. Berlin. Butler R.N. (1985). Health, productivity and ageing: an overview. In Butler, R.N. and Gleason, H.P. (Eds) Productive ageing p.114 ff); New York: Springer. Kohli M. & Künemund H. (1997). Nachberufliche Tätigkeitsfelder. Stuttgart: Kohlhammer. Lehr U. (2003). Psychologie des Alterns (10.Ed.) Wiesbaden-Heidelberg: Quelle and Meyer (1.Ed.1972). Staudinger U. (2002). Produktivität und gesellschaftliche Partizipation im Alter, (64-86) in: Schlag, B. & Megel, K. (Ed) Mobilität und gesellschaftliche Partizipation im Alter. Stuttgart: Kohlhammer. United Nations Programme on Ageing (1982). Vienna International Plan of Action on Ageing, Recommendations for Action, Goals and Policy Recommendations. 44 IV : Keynote papers Panel C: Towards a balanced care strategy Current state of policy-relevant knowledge Joseph Troisi Director International Institute on Ageing, United Nations - Malta Introduction Europe is the most aged continent. One out of every five Europeans is already above the age of 60. This percentage is expected to increase further within the next 47 years. It is estimated that by 2050 every fourth person within Europe will be older than 60. The fastest growing group of the older population are those aged 80 and over (UNECE, 2005a; Commission of the European Communities, 2006). In all European countries, increasing old age is combined with more frequent and longer phases of being in need of care. The significant increase in life expectancy implies not only a heightened demand for existing services but also the need for new services and alternative approaches for care (Nijkamp et al., 1991). The non-achievement of such standards would result in dire consequences including unnecessary suffering and prolonged dependence among the older persons involved (Commission of the European Communities, 2005). Theorists studying the welfare system of care and its administration within the UNECE region identify three types of welfare/care for the Europeans’ socio-economic and health needs: “market welfare”, “State welfare” and the “welfare society” (Giarchi, 1996). Various writers locate the principal sectors of care within a three-way system: the State, the market and the family are the three corners of what can be called the “Triangulation process of care” (figure 10). The Regional Implementation Strategy recognizes four main key players/stakeholders in the provision of care of older persons: the family, the State, civil society and the older persons themselves. Figure 10 The triangulation process of welfare/care The State The Market The Actor / Society: Civil and religious Based on P. Abrahamson (1989:35) IV : Keynote papers In meeting the challenges of population ageing, especially in the sphere of caring for older persons in Europe, we must be aware of the following salient features: (a) The heterogeneity of our continent, consisting of societies at vastly different levels of economic and social development with a number of countries less equipped to face the challenges of population ageing; (b) The older persons as a non homogenous group, “but rather have different social and cultural needs” (United Nations, 2003:65); (c) The needs of the older migrant and ethnic minorities for a number of countries will have to be taken into account such as the diverse health and social needs of a growing number of older black Africans and various white ethnic minorities. Many return to their motherland, but greater numbers are settling down in their homeland (Giarchi, 1996); (d) The comprehensive approach to care should not only include the health/disease approach, but take into consideration the totality of the individual, “…the economic, social, cultural, environmental and behavioural factors are reliable predictors on how well both individuals age” (United Nations, 2003:54). Moreover, care should be seen as a continuum over the life course engaging all actors, “promoting health and well-being over the entire life course requires an intersectoral approach” (United Nations, 2003:66). It is not only family and social structures and relations which are changing, but also attitudes, aspirations and expectations, particularly with respect to providing and receiving assistance, help and care (Hantrais, 2005; Philipov, 2005). Two sets of different, yet not mutually exclusive, needs and preferences should be recognized: on the one hand, the needs of the dependent older persons themselves, on the other, the needs of those who provide care. Until recently, in various countries, ageing was perceived as an issue to be resolved by the family. Many Governments depended on the traditional role of the family for the welfare of their elderly population. Very often, the family unit was taken as a convenient means of shouldering the 45 sole burden in the family care and financial support of older relatives in need. Over the past decades, the family has undergone a significant structural and functional transformation in many regions of the world. Its traditional role of being the provider of daily care and support of its older members is being subjected to severe economic, social and psychological strains (Troisi, 1999). These demographic, economic and social pressures on the traditional family’s structure, functions and kin relationships on the one hand, and the dramatic population ageing on the other, are inevitably leading to an increased awareness that the needs of the older population can no longer be met by the family alone. Support of specialized programmes and services from the formal sector are needed to complement family care and at the same time reduce the burden on the family. Policymakers should recognize the fact that unless family traditions of mutual aid and support are strengthened, a vast service infrastructure will be required to replace the informal caregiving system. There is ample evidence that the modern social pressures which are undermining the traditional forms of care and support are leaving increasingly large numbers of older persons with hardly any supportive care at all. Recommended course of action Governments should be careful not to repeat the past experience of a number of countries which considered institutionalization as the best principal societal response to their dependent older citizens. Such a strategy resulted in marginalizing older persons from the community at large and usually entailed a surrender of personal independence. Older persons were being relegated to being mere passive observers and deprived of the opportunity to participate in and to contribute to the very development process of their countries (Evers and Svetlik, 1993). The RIS of the Madrid Plan for Europe and North America emphasizes the fact that “where institutionalization is unavoidable, it is imperative that the dignity and individuality of the older person be protected”. Moreover, “Geriatric and gerontological assessment is an effective instrument to determine whether institutionalization is required” (United Nations, 2003:57). 46 One cannot, however, deny the fact that, in certain countries, providing alternatives to institutional care will take time. Given the scarce financial resources, the emergence of some private homes can hardly replace the large institutions (Dooghe, 1993). One must also bear in mind the fact that private nursing homes, growing in a number of countries, usually cater for the more affluent, while the traditional institutions catered for the lower classes and poorer older persons (Kavar-Vidmar et al., 1980). Ageing in place and the care of older persons in the community has become the accepted perspective of present social policy in many countries. Various studies show quite clearly that older persons prefer to continue living in their own environment. Thus, by providing care and support where the family and the individual are unable to manage alone, social services help maintain older persons in the community and enable families to cope, which prevents, or at least delays, the need for institutional care. Considering older persons only as receivers of care is a misconception of ageing, many of them are also caregivers. “It is necessary to recognize and support the contribution of older persons in family care” (United Nations, 2003:56). Empowerment. Older persons, especially when they are dependent on care, should be involved “in the design, implementation, delivery and evaluation of policies and programmes” (United Nations, 2003:53) aimed at improving their health and well-being and should be able to make choices. “Older persons should, where possible have the right to choose between different options of long-term care” (United Nations, 2003:57). They “need to be made aware of the range of social and health services available in their country” (United Nations, 2003:65). Education and training. It is emphasized that “while more knowledge, information and health education is important at any age, this is even more so at older age” (United Nations, 2003:62; Troisi, 2006). “The ageing of populations in the region requires that formal and informal care providers possess adequate professional as well as personal qualifications and skills [...]. Education and ongoing training programmes for professionals in the field of health-care and social services at all IV : Keynote papers levels should be offered and enhanced” (United Nations, 2003:72) (Troisi, 2005). To meet the specific needs of patients suffering from mental diseases, it is essential that “multidisciplinary geriatric and gerontological assessment (physical, psychological, social), counselling, care treatment and rehabilitation, accompanied by specific training schemes for care providers” (United Nations, 2003:59). Education and training are not to be restricted to the formal and informal care providers but also to the older persons themselves: “The quality of life and independence of older persons through self-care, health promotion, prevention of disease and disability require new orientation and skills among older persons themselves” (United Nations, 2003:72). All those concerned are to facilitate the adoption of healthy lifestyles and “this should be achieved through a range of policies, including appropriate information campaigns and education starting at an early age that enable people to make healthy choices” (United Nations, 2003:74). Adequate and acceptable care policies need to be embedded in the common value system of a given society. They must be based on the fundamental human rights. The Berlin Ministerial Declaration emphasized that the “promotion and protection of human rights and fundamental freedoms are essential for the active participation of older persons in all aspects of life and for the creation of a society for all ages” (United Nations, 2003:8). Main challenges for policymakers A group of experts meeting to address the policy challenges of care provision in 2005 in Malta10 identified the following priority issues requiring urgent policy action in care provision: (a) Preventing dependency in old-age and helping older persons to maintain their autonomy and independent living; (b) Providing a continuum of care across, health, social, economic and psychological services; 10 Workshop on “Care provision in ageing societies: What are the policy challenges and how to address them” (Malta, 19–21 May 2005). IV : Keynote papers (c) Implementing an appropriate organization for and financing of long-term care provision, based on comprehensive need assessment; (d) Guaranteeing the quality of care services; (e) Supporting the economic, social and psychological recognition and protection of informal carers, including the role of older persons as caregivers; (f) Ensuring a balance of paid employment and family responsibilities; (g) Meeting the needs of carers and of older persons who are suffering from mental disabilities, as well as those suffering from dementia. (h) Ensuring environmental and physical factors as reliable predictors to maintain independent living and dignity (UNECE, 2005b) Conclusion The demographic changes which the European countries are facing pose not only profound economic, political, cultural, psychological and social consequences and implications, but also unique policy challenges to our societies. Every part of society, including government, civil society and the private sector, have a responsibility to seize these opportunities and fully respond to these challenges. 47 The provision of care should constitute a commitment of society towards its citizens. It lies in the general interest of every society and represents a common good for which the State is particularly responsible. The maintenance of intergenerational family solidarity is a must: on the one hand, the family needs to be supported, protected and strengthened, to enable it to continue responding to the needs of its older members, while on the other hand, the continued involvement of older persons within their family should be more than encouraged. Governments, while trying to support and strengthen the family’s traditional role, must at the same time provide public delivery systems for those older persons who cannot rely on themselves or on their families. A major issue Governments must tackle is precisely to find a proper balance between the formal and the informal support services for older persons within their populations. A new equilibrium has to be found to reconcile individual and social needs and responsibilities, in particular with respect to intergenerational solidarity, aid and care. For this purpose, all stakeholders need to agree on various issues including effective care assessment, possible forms of care, efficient structures and divisions of tasks, quality standards, methods of financing, training, protection of users and providers, and monitoring and evaluation (UNECE, 2005b). References Abrahamson P. (1989). Postmodern Welfares: Market, State and Civil Society, towards Year 2000. Roskilde: Institute of Economics. Commission of the European Communities (2006). The demographic future of Europe – from challenge to opportunity. Commission of the European Communities (2005). Green Paper confronting demographic change: a new solidarity between the generations. Dooghe G and Van den Boer L. (1993). Sheltered Accommodation for Elderly People in an International Perspective, Amsterdam: Swets and Zeitlinger. Evers A. and Svetlik J. (Eds), (1993). Balancing Pluralism: New Welfare Mixes in Care of the Elderly, Vienna: European Centre for Social Welfare Policy and Research. Giarchi G. G. (1996). Caring for Older Europeans, Great Britain: Hartnolls Ltd. Bodnum. Hantrais L. (2005). Living as a Family in Europe, European Population Conference Demographic Challenges for Social Cohesion, Strasbourg. Kavar-Vidmar A., Mesec B., Milosevic V. and Tamaskovic M. (1980). Open Care for the Elderly – Yugoslavia. In Amann, A. (Ed.) Open Care for the Elderly in Seven European Countries (pp.155-177). Oxford: Pergamon Press. Nijkamp P., Pacolet J., Spinnewyn H., Vollering A., Wilderom C. and Winters S. (Eds.) (1991). Services for the Elderly in Europe: A Cross-national Comparative Study, Louvain: Catholic University of Louvain. 48 IV : Keynote papers Philipov D. (2005). Portrait of the family in Europe, European Population Conference, Demographic Challenges for Social Cohesion, Strasbourg. Troisi J. (2006) “Meeting the Challenges of Population Ageing: Education and Training of Older Persons, Beijing Forum 2006 Population and Regional Development, Collection of Papers, Vol. 1: pp.164-170. Troisi J. (2005). Need for Training in Health Care. In S.D.Gokhale and Radha Raj (Eds.), Frontiers of Research in Longevity Medicine, India: International Longevity Centre, Pune. Troisi J. (1999). The role of the family as care giver to the frail elderly. In selected papers from the 2nd Bessie and Louis Stein International Geriatrics Conference, Israel: Tel Aviv. UNECE (2005a). The New Demographic Regime. Population Challenges and Policy Responses, Geneva: United Nations. UNECE (2005b). Care Provision in Ageing Societies: What are the Policy Challenges and How to Address Them, Geneva: United Nations. UNECE (2003). Ageing Populations. Opportunities and Challenges for Europe and North America, Geneva: United Nations United Nations (2003). Political Declaration and Madrid International Plan of Action on Ageing, New York: United Nations. IV : Keynote papers 49 Panel D: Living longer – working longer: Challenges for education, the labour market and social protection Bernd Marin Executive Director European Centre for Social Welfare Policy and Research “Working shorter” outcomes versus “working longer” objectives Since the end of the last century, extending working life has become a major, consensual, almost unanimous political goal. Working at least up to retirement age and shifting it according to longevity gains was accepted a key response (figures 11 and 12). This has been recognized in principle, but not yet been practically implemented through appropriate policies (figures 13 and 14). While goal formulation has been advanced, policy formation has been delayed and confused. As a result, “working shorter” outcomes have been countering “working longer” objectives. There is a widespread though not universal failure of “extending working life” in proportion to increased longevity in almost all countries of the UNECE region (figure 15). No other policy goal has been adopted as unanimously and has, at the same time, been missed so conspicuously over decades than a turnaround in early retirement trends. While most countries have by now started some initial and small turnaround with respect to both increasing labour force participation rates of older workers and actual retirement age, all are still far below the activity levels of the 1980s or before, for persons aged 50 or over (figure 16). Within the European Union, for instance, “older workers’ employment” is the only dimension of the so-called Lisbon, Stockholm and Barcelona employment targets where much less overall progress has been made – despite the fact that the gap to the goals continues to be biggest and the room for catching-up and improvement the largest. It is actually the only dimension where regress could be observed during the last decade in that already low rate of labour force participation of persons aged 55–64 and the actual retirement age had gone further down in several countries – and significantly and sufficiently up in very few countries only. The same applies to the OECD countries: some are still regressing; most are improving a bit, but far from sufficiently. In some countries, policy initiatives have been undertaken to encourage later retirement: for instance, the official retirement age has been raised; opportunities for early retirement through disability have been made more restrictive, the pension system has been actuarially adjusted, and accrual rates for delaying retirement have been improved. Although many such changes have already been legislated, their effect on retirement age will occur much later. Recent data suggest that these policies may be working, albeit slowly. Nonetheless, for a sizeable majority of European workers, withdrawal from the labour force is still happening early, up to six years earlier than the legal retirement age. Labour slack and “age exclusion” If an ongoing reduction of active life or “age exclusion” is considered neither acceptable nor desirable, neither feasible nor sustainable, immediate action should be taken in order to reverse the trend in the mid term. But why have policymakers failed so far to turn around trends towards ever later labour market entry, ever earlier workforce exit, and an ever tighter compression of working life during working age around the early middle adult or “prime age” years (25–54) – contradicting conspicuously both ageing and longevity? Mainstreaming ageing in rapidly ageing societies is deeply ambivalent: well-intended programmes to raise the retirement age are followed, but their outcomes are not up to the challenge. However we measure active, working lifetimes, their absolute and relative size has been reduced significantly over the decades throughout the UNECE region – with very few, minor exceptions, which may or may not turnout to be 50 temporary, but certainly will prove to be largely insufficient in coping with the overall challenges ahead (figure 17). Even good practices (e.g. in Finland, the Netherlands) have not generated a full and sustained turnaround. While the historical lowestlow of middle-aged labour force participation may be behind us (turnaround between 1993 in the United Kingdom and 2001 in Germany and Italy), a full swing back to activity rates on the 1960s level, indispensable as an answer to longevity and population ageing, is still not in sight. Whether there is some slight convergence between the avant-garde countries of working longer with living longer (e.g. Iceland, Switzerland, Sweden, Denmark and Norway) and the originally lagging countries (e.g. Hungary, Italy and Spain) towards a middle ground is still uncertain. Generally, there are many impediments to economic growth, employment creation and sustainable social welfare. Among the most important in many European countries are the predominance of non-working status during working lifetimes, the relative importance of such non-working, inactive or dependent over active and working population groups as well as the predominance of household production over market production and of unpaid work over paid work. Massive labour slack (inactivity or nonemployment, unemployment and long-term unemployment, long-term sickness and invalidity) is among the main barriers to European economic growth, competitiveness, prosperity and rising living standards. They are also main barriers to health, mental health and well-being, happiness and life satisfaction, which by far are not matching with the increasing wealth and life expectancy. After 2012, when the EU-27 population of working age will be shrinking, and even more so after 2017, when rising employment will not offset this overall trend and the ageing effect will become dominant throughout, economic growth will be driven by productivity growth, innovation, research and development alone. These latter factors will hardly be able to fully compensate for the decline in the working age population. After 2018, only a highly improbable and radical extension of working life responding to extended healthy life expectancy, and steep IV : Keynote papers productivity increases would prevent economic growth and social prosperity from declining as well. Otherwise, the contracting labour supply would depress growth and the rising share of older population will make public expenditures fiscally unsustainable, undermining pension security. Every 1 per cent decrease in economic growth would correspond to an approximate 20 per cent decrease in pension entitlements or an additional five to six years’ extension in the work requirement, and would thus reinforce a vicious cycle of economic and social decay. The scale of non-employment in the region Today, inactivity or non-employment – not unemployment – is the single most significant component of labour slack: non-employment is five times as high as unemployment. While one-infive adult men of working age are now outside the labour force, and unemployed males make up less than a third of the male non-employed in Europe today, the proportion of women out of the workforce is six times greater than the number who is unemployed. Above the age of 50, the ratio of non-employed to unemployed increases to 8:1 for both genders and rises even more sharply with age, as the risk of disability and other forms of early exit increase while the risk of unemployment decreases. As a result, non-employment in the 55–64 age group is on average 30 times higher than unemployment. It is 10 times higher for men, and up to 90 times higher for women. Unemployment, in contrast, is only erroneously considered to be a major problem among so-called older workers, because it is – with very few exceptions, such as Germany – normally disproportionately low in this age group. In countries such as Austria, Belgium Hungary, Italy and Slovakia, for example between 81 per cent and 89 per cent of the women in this age group are non-employed as opposed to an unemployment rate of 0.3–1.5 per cent (figure 18). In Europe today, the single most important group of inactive people of working age are the middle-aged or mature workers aged 55–64, with social exclusion, dropout, or exit rates affecting up to 89 per cent of the female population. In many countries, three out of four (Spanish) or four out of five (Austrian, Belgian, Bulgarian, Hungarian, IV : Keynote papers Italian, Turkish) middle-aged women who have more than three decades of additional life expectancy are still excluded from the world of work. Thus, large-scale social exclusion makes for an entire “lost generation” in mid-life. However, this also presents the opportunity to tap the enormous potential of this silent labour reserve. Aggravating the problem, but also improving the potential for a solution as well, the 50–65 age group is rapidly growing in absolute and relative size, with baby-boom generations making this the largest age group in the labour market for decades. Whereas Nordic and other early baby boomers are already approaching a pension-eligible age or will be within a few years, in countries like Germany persons aged 67 will be the most populous age group around 2030. The only relevant question is whether or not current reforms will encourage people to continue working up to that age more regularly. Early retirement still a preference and rule, retirement at legal age as an exception Contrary to widespread belief, there is no universal “iron law” of a five-year gap between legal and actual retirement age in Europe: such a gap does not exist in Denmark, Iceland, Portugal or Switzerland; rather, it varies between 0.8 years for males in the United Kingdom to 6.4 years for Austrian men. Austria, Luxembourg and Belgium have far larger than the five-year gaps, while Germany, Hungary, Norway, Spain, Sweden and the United Kingdom have gaps that are much shorter (figure 19). If there is an iron rule regarding early retirement it is this: choosing between a legal and an early retirement age, people normally exit at the earliest retirement age or age of first eligibility, for whatever pension benefits (“first exit opportunity habit”), regardless of (up to five years) different legal retirement ages between men and women and regardless of highly divergent (up to the double) inactivity rates between men and women aged 55– 64. Spain is a perfect illustration of the iron law: the earliest possible jubilación anticipada is 61 years of age, and the average effective retirement age is 61.3 for women and 61.6 years for men (this, however, has been raised recently). 51 Almost everywhere in Europe, “exceptional” early retirement has become the rule while “normal” legal retirement age has become the exception, frequently a rather rare one: up to 91 per cent of working populations retire before the official retirement age of 65 in a country like Austria, 72.1 per cent below the provisional legal retirement age (being temporarily lower – 60 – for women during a 40-year transition period up to the year 2033) (figure 20). One major explanation, accounting for most of the variance, is that with very few exceptions, and contrary to all political rhetoric and good intentions, working after the prime age (+50) simply does not pay in Europe (figure 21). Continuing to work beyond the earliest possible exit point, and especially beyond the legal retirement age, is implicitly “taxed” heavily in many European countries while early retirement continues to be heavily subsidized. Without such subsidy, there are fewer incentives and a lower propensity to exit early from the labour market (e.g. in Switzerland and Sweden). Still, in many European countries, declared preferences by citizens and residents in Eurobarometer surveys and other public opinion polls show a strong inclination toward early retirement, and preferences revealed by actual behaviour display an even stronger preference for leisure as against extending working life – as long as it does not cost too much to do so. Any policy which does not take into account this massive, though not all-encompassing, preference for the earliest possible exit is doomed to fail. Likewise, any policy that does not account for the contradictory preference of significant minorities to extend the working life opposing the majority views will also fail. A viable solution may be to allow different interest groups different open choices which are all actuarially neutral and fair. Examining public opinion offers a coherent image of public perception – and misperception – regarding challenges, policies and preferences. These perceptions include: • A vague sense of problems and doubts about the future viability of mandatory systems. • Little confidence in government policies. • Largely unchanged attitudes regarding current retirement practices and little popular support for increasing the retirement age. 52 • Widespread belief in the “lump-of-labour” fallacy that elderly workers “should give up work to make way for more younger and unemployed people”. In some countries (e.g. in Denmark, Finland, Ireland, the Netherlands and the United Kingdom), the public awareness and sensitivity has been raised by governmental campaigns. • A growing opposition to forced retirement at a fixed age (with great differences between northwestern and south-eastern Europe). • Support for contributory conceptions of social justice, including the view that later retirement should lead to a higher pension and that pensioners should be allowed to earn freely on top of their pension. Policies for working longer Apart from financial disincentives to work longer, and hidden or revealed preferences to exit early, there are other determinants of early retirement, inter alia: the reluctance of employers to hire or retain older workers; negative attitudes toward older workers and age discrimination; steep age-wage profiles in which labour costs outpace productivity increases over the working life; strict job protection that perversely functions as an employment barrier; insufficient training to compensate for deskilling and inadequate placements services, both weakening employability; and, above all, a poor, unsafe and unhealthy work environment and demoralizing working conditions. These factors seem to play an even greater role than low economic rewards in the decision to retire early. General policy conclusions from the analysis are quite clear in their overall direction: (a) “lifetime-indexing”; (b) making work pay through actuarial neutrality or even increasing pension rights with age; (c) increasing opportunities and choices for flexible retirement practices; (d) repealing early retirement options and pathways; (e) combating age discrimination; and (f) changing employer attitudes and practices by eliminating employment barriers and improving employability through training, re-qualification, and better working conditions. Empirical evidence from the SHARE database suggests that it is more important to focus on improving the work environment than on employment, more on employment than on IV : Keynote papers unemployment, and more on retirement rules and work satisfaction than on health. Evidence also supports the conclusion that health matters much less than expected for determining the length of the working life, whereas working longer may actually improve health and mental health in particular. While the overall policy direction is obvious and generally agreed upon, a long series of difficulties emerge regarding hard choices to be made and with respect to technicalities of policy design and its implementation. Let us point to a few such uncertainties and complexities involved. How, for instance, should eligibility ages of earnings-related pensions and guaranteed minimum pensions be differentiated fairly and effectively (e.g. between the ages of 61 and 65 in Sweden)? How can work-retirement decisions be made more flexible and “pension corridors” widened without simultaneously encouraging even earlier exit? How can collective bargaining agreements be prevented from fixing an age lower than legal retirement age as the age to which employment protection is provided as the mandatory retirement age for whole occupations such as pilots, military personnel, opera singers etc.? How can the outflow rate for the large number of persons on disability benefits be increased from currently less than 1 per cent? Who should be supported in order to create the most effective work incentives, and how can it be guaranteed that simple age-targeting will not miss its goals? How can legislation on age discrimination be made more effective? Finally, though there are some quite robust recommendations (“to do’s” and “not to do’s”) available, policymakers still regularly fail to implement these evidence-based proposals that would promote good practices or avoid entrapments. The principles of work first, making work pay and of raising overall (in particular postprime age) employment rates are rarely followed as high-priority guiding principles. The wide range of good practices available for adoption to improve workers’ lifelong education, occupational training, work safety, health promotion, professional rehabilitation, job rotation/upgrading/enrichment, late-career measures, mobility support, age-specific adjustments of the work environment, personal time off, and lifetime banking account systems, partial pension and phased, flexible retirement IV : Keynote papers schemes, etc., are not systematically evaluated and widely shared. Experiments and systematic, rigorous evaluations are rare. For instance, social security contributions could be age-risk-rated over the life cycle, making the compound non-employment and unemployment risk by age the yardstick for differentiating social security contributions according to age-specific out-of-work risks. Tax credits or subsidies for recruiting and retaining post-prime-age workers may be experimented more and then rigorously evaluated. But worse than missed opportunities, corroborated knowledge is widely unknown or ignored in practical policy implementation. For example, the suggestions that pension rules should follow notional definedcontribution (NDC) schemes, or that definedbenefit (DB) systems should be actuarially neutral in order to avoid setting perverse incentives for early retirement, are often not followed. Automatic adjustment or “lifetime indexing” of early, normal, and reference retirement age to rising survival rates, prospective age, and residual life expectancies, though indispensable in the long term, is almost never implemented. Many countries allow for a minimum “guaranteed” pension not only at a regular retirement age, but at the earliest possible eligibility age, instead of permitting only the collection of earnings-related or supplementary pensions and savings at early retirement age. Age discrimination and forced retirement have not yet been effectively banned, and in fact continue even in intergovernmental organizations that preach the opposite, such as OECD or the United Nations, which force employees to retire at ages (60 or 62) that are far below the legal retirement age of most of their member States. Many Governments in the UNECE region still dismiss large-scale early exit as either irrelevant or as an inevitable phenomenon instead of acting analogously to the “broken window” theory and effectively blocking all early-exit pathways. Consequently, if a critical share of middle-aged populations retire early – and this is visible and socially accepted for whatever reason – even more people will do so for their own reasons, regardless of whatever weakened opposition to this trend may emerge. Governments should never allow for special pension schemes to appease special interest groups, regardless of how strong the pressure is or how noble the causes underlying 53 their claims are. Rather, pension rules should always be universal and fully transparent and avoid corporatist and sectional privileges for special occupational groups. Apart from being costly themselves, such privileges tend to demoralize a great majority of the working population and to reinforce and legitimize widespread resistance to any change or reform. In short, pension justice must not only be done, it must also be seen to be done. A lack of fairness and transparency is actually among the major obstacles to pension reform, e.g. while differing retirement age by gender has been outlawed by the European Court of Justice as fundamentally unjust, several countries within the EU and dozens within the UNECE region have kept this illegal and costly pension rule and will phase it out over periods of up to 40 years – if at all. Some lessons not yet learned A series of basic policy failures such as the following explain the lack of success in extending active working life. Pension policies are regularly abused for labour market purposes (or other supposedly “good” purposes), for instance when allowing for early retirement because of industrial restructuring. When it comes to early exit from the world of work, basic social safety nets, old-age security (which by definition can only apply beyond the working age) is regularly confused with unemployment, accident, sickness, or invalidity insurance and disability benefits, etc. Great autonomy or even veto power is given to social partners regarding retirement practices and the implementation of pension schemes. Instead of being explicitly generous in a focused way to the poor, the sick, persons with disabilities, or other disadvantaged groups in a generalized generosity benefiting the greatest number, namely early retirees, forces authorities not to show solidarity to all others in need. A price is being paid for failing to fully integrate foreign residents and citizens who may differ significantly in their labour market participation and retirement behaviour. The same applies to low self-employment rates, as the selfemployed, small shopkeepers, and workers in the liberal professions tend to work several years, and in some cases up to more than a decade longer than waged workers and employees. Assisting the transition to self-employment for middle-aged 54 employees could be a major step towards effectively extending active working life. Another succession of failures emerged in connection with widespread “invalidity pensions”. Despite outflow rates close to zero, disability “pensions” are still frequently awarded as lifelong instead of temporary benefits, even at early ages. Today, significant parts of the working-age population – almost one in two men in countries such as Austria and Hungary and up to a majority of persons in some occupations and professions – retire as “invalids” (at an average “retirement” age of 42 in the Netherlands). If about one in eight adults “retire” for reasons of ill health or disability in the richest, healthiest and longest-living societies that humankind has known so far, the very concept of “disability pension” may have to be reconsidered and replaced. Work injury and longterm sickness insurance will have to be clearly disentangled, institutionally differentiated and psychologically distinguished from unemployment insurance on the one hand and from old-age security on the other. Receiving disability benefits should have nothing to do with working or not working, nothing to do with labour market IV : Keynote papers problems, and absolutely nothing to do with oldage entitlements. Awarding old-age benefits should be strictly restricted to uncompromising – and demographically adjusted – age thresholds, and/or to actuarial adjustments, such that the overall lifetime pension entitlement will not be increased by adverse retirement behaviour such as early exit. Generally, governments and enterprises as major actors seem not yet capable of sustainable action, i.e. to be widely out of tune with both what is required in terms of fiscal stability and social adequacy and sustainability. According to a 2006 Oxford Institute of Ageing global survey, e.g. 72 to 80 per cent of a majority of world’s citizens want to scrap mandatory retirement and freely choose their preferred age of leaving work with actuarial adjustments, while in reality flexible retirement age corridors and protection against forced retirement are still rare exceptions within the prevalent age discrimination patterns that are more or less silently accepted. Public opinion polls and surveys document important mismatches between the policies offered and the programmes demanded, between real social conditions and normative expectations. Reference (for empirical evidence throughout) Marin, B. and Zaidi A. (Eds.) (2007). Mainstreaming Ageing: Indicators to Monitor Sustainable Policies. Aldershot: Ashgate. IV : Keynote papers 55 Figure 11. Life expectancy at birth and at age 20, 65 and 80 years in 2003 Belarus France Italy Russian Federation Sweden Switzerland 56 IV : Keynote papers Figure 12. Survival rates up to age 20, 60, 65 and 80 in the period 1995–2005 Russian Federation, women Russian Federation, men Sweden, women Sweden, men United Kingdom, women United Kingdom, men IV : Keynote papers 57 Figure 13. Labour force participation rates in the period 1984–2005 Belgium Czech Republic Denmark Russian Federation 58 IV : Keynote papers Figure 14. Employment rates in the period 1983–2005 Finland Poland Switzerland United Kingdom IV : Keynote papers 59 Figure 15. Pension duration of people retiring today Austria Austria Estonia Estonia France France 60 IV : Keynote papers Figure 15 (continued) Germany Germany Italy Italy Portugal Portugal IV : Keynote papers 61 Figure 15 (continued) Spain Spain Sweden Sweden United Kingdom United Kingdom 62 IV : Keynote papers Figure 16. Average effective retirement age in countries of the European Union in 2005 IV : Keynote papers 63 Figure 17. Lifetime allocation of work and non-work in 2000 Belgium Czech Republic Denmark Finland Switzerland United Kingdom 64 IV : Keynote papers Figure 18. Inactivity and unemployment rates between ages 55 and 64 in 2002 Women Men IV : Keynote papers 65 Figure 19. Average effective labour market exit age Belgium Denmark Estonia Finland Switzerland United Kingdom 66 IV : Keynote papers Figure 20. Early and regular retirement Austria Belgium Denmark Estonia Finland United Kingdom IV : Keynote papers 67 Figure 21. Actuarial fairness in pension systems, 2008 (Relative income in retirement persons retiring at age 65 = 100%) Notes: NDC: national defined-contribution scheme. DB: defined-benefit system. age at retirement 68 IV : Keynote papers Panel E: Intergenerational collaboration A demographer’s introduction Charlotte Höhn Director and Professor Federal Institute for Population Research, Germany Preliminary remarks Studies on intergenerational collaboration are scarce since one has to deal with a group of family members which can greatly vary: it may be small (the “beanpole family” may consist just of a great-grandmother, a grandmother, a mother and a child), numerous (1–2 great-grandparents, 4 grandparents, the parent couple and several children, and there may be aunts and uncles) or constituting a complex network of divorces and remarriages in the older generations (“patchworkfamily”). Since members are of different ages, a reference person is needed to determine who belongs to which generation without mixing up mothers and children. Data can be obtained from two sources: official statistics and surveys. Official family and household statistics would lead us to believe that the three or four-generation family is rather a rare exception and on the decline. But taking a closer look at the situation, this conclusion is not correct and nor are the results from the co-residence principle on which most official household statistics rely. This co-residence principle stipulates that only those family members living in the same household, characterized as an economic unit, are statistically considered a family. Since the elderly used to live in their own households for decades, they continue to declare themselves to be living in their own household even if they are increasingly dependent on their children. Therefore, if three generations live in the same house, but the older generation as well as the middle generation and their children have their own apartments, they are not co-residing in the same household and we can then omit this three generation family. Indeed, while statistics show that only very few households comprise a three- or fourgeneration family with one common kitchen (as a proxy definition of a multigenerational household), numerous surveys show that most generations do not live very far apart. Internationally comparable data sets such as the Generation and Gender Survey (GGS) have been gathering such important information. Many surveys in Europe demonstrate that not only is there residential closeness, but that the interactions between generations are regular. As long as grandparents belong to the “young old” age group (i.e. younger than 80), they contribute through their financial and emotional support to their children and grandchildren. Young grandparents regularly or occasionally take care of their grandchildren, thus facilitating the reconciliation between the paid work and the family life of their daughters or daughters-in-law. However, if grandparents are already well in their seventies, caring for children can be perceived as too demanding. As the age of the mother at the birth of the first child increases all over Europe, the age difference between parents and grandparents increases too, which may hinder “older” grandparents from being available as carers of their grandchildren. While very relevant, these interactions between grandparents and their adult children and grandchildren will not be further discussed here. The introduction below will provide survey results on intergenerational support in the case of the older generation needing help in the activities of daily living, which refer in particular to paragraphs 92 and 93 of the Madrid Plan of Action. The relevant questions which will be addressed in this contribution are: • How do older people want to live if they need some help? • Do older people want to live at home or in an institution? • Who should be the care providers? IV : Keynote papers 69 allowed for a vast age range including persons who may or may not need help in daily activities.12 Before answering these questions, it may be useful to underline a few important findings from population studies: • The risk of long-term exponentially after age 80. care Preferred living arrangements when needing help in activities of daily living increases • The increasing “care risk” might shift to the age of 85 or higher, and is a typical development accompanying longevity. During the interview, people were asked the following question: “Suppose that you have aged and that you are no longer able to manage (perform) the activities of daily living on your own at home. What living arrangements do you prefer? How would you prefer living?” Figure 22 shows that the majority of people want to live at home, ranging from 64 per cent in Slovenia to 87.9 per cent in Poland. • Many ailments are age-related: joints and muscles loose energy and thus mobility is reduced, sight and hearing diminish and the incidence of dementia increases. • The increasing life expectancy implies that more people will live to a very old age, which increases the proportion of the elderly in relation to the total population. • Surveys in Germany have revealed that the spouse is the main person providing care (husband or wife), followed by the daughter or daughter-in-law, and then, less frequently, the sons and other relatives. Friends or neighbours are rarely mentioned except as providing occasional help. Solutions, such as children moving in, are not the preferred choice of living arrangement. Preference is given to help from children and the family, especially in the Central and Eastern Figure 22. Preference for living at home in older age when no longer able to perform daily living activities (percentage) PL RO 8,4 60,2 9,5 53,0 DE EE AT 14,0 30,1 10,9 21,3 17,0 21,8 12,6 10,0 4,8 27,6 87 ,9 8 5 ,1 8 0 ,7 29,3 41,4 18,8 5,3 5,2 74,1 73 ,4 The following 69 ,9 LT 8,5 35,5 16,3 9,6 empirical findings are from the 64,1 CZ 12,9 23,3 17,8 10,1 Population Policy Acceptance SL 9,8 34,2 14,1 5,9 64 ,0 Study (PPAS) part of the 0 10 20 30 40 50 60 70 80 90 DIALOG project funded by the European Commission At home, but with one of children or other relatives moving in with me At home, but with regular professional help and help from children or other relatives [Grant No HPSE-CT-2002At home, but with regular help from children/family 11. 00153] The data of PPAS At home, but with professional help was collected between 2001 and 2003 through interviews of women and men aged 18–75 in 14 European countries and a Source: DIALOG IPPAS 2001–2003 (for explanations, see Avramov and Cliquet 2008) specific module on ageing was conducted in Austria (AT), European countries such as Poland and Romania, Czech Republic (CZ), Estonia (EE), Germany or to the combined support from children and/or (DE), Lithuania (LT), Poland (PL), Romania (RO) and Slovenia (SL) with some questions also taken 12 Results of the overall results from the DIALOG in Finland (FI) and the Netherlands. The study 11 For further information, please consult: www.bibdemographie.de/ppa/IndexDialogStart.htm. project may be found in: Höhn et al., methodological information, in particular on the International Population Policy Acceptance Study Database (IPPAS), in Avramov and Cliquet, and detailed studies of the ageing module in vol. 2, part IV in Höhn et al. 70 IV : Keynote papers higher. Increasing childlessness, reluctance to marry or increasing divorce are all factors jeopardizing the chances of staying at home at an advanced age. Data show that single persons are already today over-represented in homes for the elderly. family and regular professional help, such as in Estonia. Request for family help with the support of ambulant care are the most preferred form of care provision, even in countries such as Germany and Austria with a high demand for professional care only. The first questions posed to respondents concerned the place they wished to live in old age, while the second question asked was who should take responsibility for the care of the elderly in general. Figure 23. Preference for living in an institution in older age when no longer able to perform daily living (percentage) SL 18,9 AT Responsibility for the care of older persons 11,0 DE 10,8 CZ 6,6 RO The question of the interview was the following: “There is a wide variety of views about the care of the elderly in our society. Would you please indicate your own opinion on the following statements”. Figure 24 answers the question on overall perceptions of whether old people should generally live in institutions or only if nobody in the family can take care of them. 4,0 PL 3,2 EE 2,9 LT 2,8 0 2 4 6 8 10 12 14 16 18 20 22 In a home for the elderly Source: DIALOG IPPAS 2001–2003 (for explanations, see Avramov and Cliquet 2008) Living in an institution was another possible choice for a living arrangement. Figure 23 illustrates that only a minority of respondents wants to live in an institution when they are no longer able to cope with daily living at home. Slovenia has the highest percentage with 18.9 per cent having a preference for the institutional solution, compared to much lower proportions in other countries: from 11 per cent in Austria and Germany to 2.8 per cent in Lithuania. However, if the person responding has neither a spouse nor a child, the preferred living arrangement at home cannot be maintained without support and thus the risk of institutionalization is Figure 24. Views on the responsibility for the care of elderly people (percentage) 80 70 79,1 77,2 70,3 66,5 67,9 62,4 60 57 51,9 47,9 50 40 , 38,3 30 17,7 20 14,6 12,9 8,5 10 8,4 8 6,1 5,3 0 SL FI DE CZ LT EE AT PL RO Old people should live in an old people‘shome Old people should live in old people's homes only when there is nobody of the family who can take care of them Source: DIALOG IPPAS 2001–2003 (for explanations, see Avramov and Cliquet 2008) IV : Keynote papers 71 “Children should take care of the elderly”, from a maximum of 90.1 per cent in Poland to 57.5 per cent in Estonia and a clear distinction for Finnish respondents (31.6%) where a minority support this view. The Figure 25. opposite statement that “it is not Views on the responsibility of children for the care of the task of children to look after elderly people their aged parents” is supported by a minority of respondents with the lowest figure, 5.8 per cent, in Lithuania, around 15 per cent in Germany and Slovenia (this item was not measured in Austria), and 23.9 per cent in Finland. Respondents in Slovenia agreed to a surprisingly high degree (66.5%) that “old people should live in an old people’s home”, which From the results of this survey, a few conclusions may be drawn. The three and more generation family remains stable and supportive both in reality and in their choices for living arrangement and care preferences. If there are fewer members of younger generations left in a family (due to childlessness), then Source: DIALOG IPPAS 2001–2003 (for explanations, see Avramov and professional and eventually Cliquet 2008) institutional care becomes a choice and a necessity, although parallels Slovenians’ relatively frequent preference such arrangements are more expensive. The results for living in an old people’s home (although only indicate clearly that on one hand staying at home is 20%). It should be mentioned that the standard of the preferred living arrangement, and on the other institutions in Slovenia is quite high. that for those needing help with the activities of daily living, family involvement is the best For all the other countries, the solution of solution. older people entering an institution is quite low. While for some countries this solution should only Demographic trends do not go in the be considered when there is nobody of the family direction of the preferred living arrangements at who can take care of them (LT, SL AT, PL, CZ, advanced age. It goes without saying that there is a RO, EE), for others there is little agreement even need to strengthen the intergenerational solidarity on that conditionality for Germany and especially and collaboration, as stipulated by the Madrid Plan for Finland (38.3%). The highest agreement for of Action, remains prominent on the political both options is held by Slovenians (77.2% and agenda. For the majority of Europeans, home66.5%). The discrepancy is greater between the based care is the preferred choice in living two options among Lithuanians (79.1% and 8.5%), arrangement in old age, which requires family which shows that the old people’s home is the last members to help and provide informal care. To resort only if care is needed. achieve these preferences, great efforts are needed to support families through appropriate policies and Figure 25 displays results on the estimation measures. of the role of children as care providers. A clear majority of respondents agree that indeed 72 IV : Keynote papers References Avramov D. and Cliquet R. (2008). From population policy acceptance surveys to the international population policy acceptance study database. In Höhn C., Avramov, D. and Kotowska, I. (Eds.): People, Population Change and Policies, Vol. 1, 19–46. Höhn C., Avramov D. and Kotowska I. (Eds.) (2008). People, Population Change and Policies, 2 volumes, Springer IV : Keynote papers 73 Panel F: Focusing on opportunities: Active ageing Irene Hoskins President International Federation on Ageing Introduction: defining active ageing Defining active ageing requires a closer look at how it is defined in various international or European organizations (OECD, the EU and WHO) as well as those in the United States. In the United States, active ageing is a term most commonly associated with policies and programmes to ensure that people, as they age, remain physically active and in good health. Various public policy initiatives, including a “National Blueprint on Active Aging”, strongly underline the long-term health benefits of remaining physically active into advanced age (Robert Wood Johnson Foundation, 2001). OECD defines active ageing in economic terms, as referring to “the capacity of people as they grow older, to lead productive lives in society and in the economy. This means that people can make flexible choices in the way they spend time over life – learning, working, and partaking in leisure activities and giving care”. (OECD, 2000). The EU approach is summarily presented in the European Commission document, “Towards a Europe for All Ages” (1999): Active ageing is a coherent strategy to make ageing well possible in ageing societies; it is about adjusting our life practices to the fact that we live longer and are more resourceful and in better health than ever before, and about seizing the opportunities offered by these improvements. In practice it means adopting healthy lifestyles, working longer, retiring later and being active after retirement. Promoting active ageing is about promoting opportunities for better lives, not about reducing rights and adequate income provision as part of an agenda (Commission of the European Communities, 1999). Finally, the WHO definition of active ageing brings a broader approach by emphasizing the entire life course in all its aspects and policy goals: • Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age (WHO, 2002a). By shifting the emphasis to the entire life course and the social determinants of health as well as by focusing on the optimal quality of life at older ages, the WHO definition stresses the importance of continued participation in social, economic, cultural, spiritual and civic affairs and not just the ability to remain physically active or to participate in the labour force. Both the WHO and the EU definitions take a rights-based approach. The WHO life-course perspective brings the following additional elements: (a) older people are not a homogenous group and individual diversity tends to increase with age; and (b) health promotion and prevention policies play an important role and their implementation at an early stage of the life course can contribute to preventing disability and costly curative interventions later in life (Ervik, 2006). According to the WHO definition, active ageing policies focus on three principal goals: health, participation and security. This contribution explores how the objectives of active ageing policies relate to the two relevant commitments of the Regional Implementation Strategy: commitment 4 and commitment 7. Commitment 4 This commitment contains four policy objectives. (1) Preserve and strengthen the basic objectives of social protection, namely, to prevent poverty and provide adequate benefit levels for all The most fundamental related question is whether countries of the UNECE region will be able to enact changes in their pension and social protection systems now so that the future solvency and ability to pay adequate benefits to future 74 generations will be guaranteed. Raising the retirement age and ending age discrimination are important policy directions in this regard. Raise the retirement age. Within the last four to five decades, citizens of the UNECE region have increasingly used early retirement schemes to withdraw permanently from the labour force by age 60 or even younger. The large numbers of workers – men and women – exiting the labour force before the legal retirement age has been driven by a number of factors: generous unemployment benefits; easier access to disability pension benefits; the lowering of the early retirement age in the old-age pension system for older workers and the long-term unemployed; and a readiness on the part of employers to encourage early retirement as a way of restructuring their workforce. More recently, however, the trend toward early retirement has gradually been reversed, as countries are tightening eligibility requirements for early retirement. This could imply new elements such as improved health status for older workers, more adjustments to the needs of older workers in the workplace, or a growing insecurity on the part of older workers with regard to the adequacy of their future retirement income. End age discrimination. Many experts would claim that age discrimination is by far the greatest obstacle for older workers to remain in the labour force. The question arises why older workers are far less likely to benefit from either employer-provided training or to participate in active labour market programmes. Also, the question needs to be raised as to what are the true costs to employers encouraging early retirement while recruiting younger and less experienced workers? (2) Adapt existing social protection systems to the demographic transition and changes in family structures Among the recommendations that may be considered here are raising the statutory retirement age and adjusting the social protection system to reflect changes in family structures and gender differences. Raise the statutory retirement age. In line with the constant gains in life expectancy, working longer could be a realistic expectation of all citizens in the future. However, this awareness is IV : Keynote papers not yet evident throughout the UNECE region. Only a few countries (e.g. Sweden) have already abolished the concept of a fixed retirement age in favour of a more flexible approach which determines retirement age in relation to future gains in life expectancy. Adjust social protection systems to reflect changes in family structures and gender differences. Many countries in the region went through improvements of their social protection systems by taking into account family structure changes in society. Measures have been adopted which aim at giving equal rights to men and women in situations such as divorce and survivorship, providing benefit entitlements for men and women for parenting or caregiving periods during wage-earning years, or for those living in diverse forms of households. Yet, decades of efforts to adapt laws and regulations in many countries of the UNECE region have shown that changing the legal provisions has only partly achieved more social equity between men and women in contemporary societies. Poverty remains mainly a female issue, especially among older women, and measures to fight poverty must begin at birth and continue throughout the life course. (3) Establish or develop a regulatory framework for occupational and private pension schemes While specific technical recommendations to implement this commitment are best left to the pension specialists at International Labour Organization, the World Bank and other expert bodies, significant changes have already occurred in Central and Eastern Europe, where State pensions formerly provided almost the total retirement income. The restructuring of the economies of this region has focused on building the financial institutions and markets to encourage the development of private pension and retirement savings arrangements. Building an adequate retirement income through individual savings takes many years of effort of at least one generation. Will public pensions be adequate for those generations of workers who have been unable to build adequate retirement savings accounts on their own? Will State regulations of the banking and insurance sector provide adequate protection against mismanagement and market failures which may occur in spite of the responsible behaviour of individuals? Will an adequate safety net be IV : Keynote papers 75 available to the older members of society who for reasons largely beyond their control (unemployment, illness, disability, etc.) render it unrealistic to expect sufficient income in very old age? (4) Pay special attention to the social protection of women throughout their life course What will be the impact of the abovementioned changes on the social protection system for women? Changes in the retirement age or particularly on the level of the guaranteed minimum old-age benefit have in general a more direct impact on women than on men. The reasons relate to the different life and work patterns of women, whose careers often suffer from interruptions due to family responsibilities. The results are often less pay and frequent discrimination in the workplace. Yet women generally live longer than men and many rely on the minimum old-age benefit. Poverty among older women persists even in the most generous welfare states of the UNECE region, and the rates rise significantly with age. How can the UNECE countries address this problem of persistent poverty among older women? What are the life-course policies that could attenuate poverty among older women? The considered: following proposals could be • Caregiving credits for pension calculations • Minimum benefits provided within the contributory old-age and disability social insurance programmes • Re-examining the important anti-poverty role played by survivors’ and dependents’ benefits • Introduction of non-contributory age-related “social pensions” • Eliminating the dual discrimination based on age and sex, particularly in the workforce, by implementing anti-discrimination legislation and undertaking effective public education campaigns. Commitment 7 Commitment 7 recognizes that the high overall level of health of the population is vital for economic growth and for the general development of societies. It contains four broad policy objectives. (1) Promote health and well-being over the entire life course by mainstreaming health through intersectoral policies The life-course approach recognizes that individual differences in health status tend to increase with age. What factors influence health? According to WHO, the determinants of health, beside gender and cultural issues, include economic, social, physical, personal and behavioural factors as well as access to quality care over the entire life course (WHO, 2002a). Evidence suggests that interventions and investments in health promotion activities such as improving dietary habits, engaging in physical activity and raising awareness about the negative impact on health of tobacco use as well as the misuse of alcohol are effective for people of all ages (WHO, 2005). Among the recommendations to further this commitment could be the following: • In the areas of prevention and health promotion. Debunk the argument that investments in health promotion activities for older people come too late and are not cost-effective. Research conducted in Sweden and elsewhere has demonstrated that health promotion and prevention programmes targeting older people often led to improved quality of life and a decrease in health-care consumption (Swedish National Institute for Public Health, 2006) • Physical environment. More attention must be given to the physical environment and its impact on the health of older citizens, including access to affordable transportation, adequate housing, clean water and safe air. In the UNECE region as elsewhere, the majority of older persons live in cities. The recently published WHO Age-friendly guide draws attention to the needs of older persons living in cities, but also provides a set of interventions with respect to social and civic participation, personal mobility and transportation, housing, community support and health services (WHO, 2007). (2) Ensure equal access to health and social services including long-term care for persons of all ages 76 Chronic non-communicable diseases, many of which afflict older people, represent one of the principal health policy challenges facing the region. Much of this challenge will need to be managed through the primary health-care (PHC) system, a system which is for the most part still oriented towards care for acute, episodic conditions (WHO, 2002b). Chronic conditions require extended and regular health-care contacts instead of the find-it and fix-it model of acute care. The PHC system must therefore be better equipped to prevent and screen for chronic conditions (WHO, 2005). It is recommended that PHC providers should become more familiar with geriatric care, diagnosis and management of geriatric conditions (especially falls, incontinence, immobility and confusion) in order to improve older persons’ lives (WHO, 2004). The needs for long-term care (LTC) will increase throughout the UNECE region, based on the simple fact that more individuals are expected to live to older ages than in the past. Research in some countries in the region has also shown a certain compression of morbidity until very old age and more research is necessary to uncover the causal links for such trends. Further, information and experience sharing in LTC in the region would benefit LTC outcomes, financing and delivery. Diverse options for financing have been adopted through social insurance or through taxation, primarily local and regional. Financing is, however, only a part of the challenge. It must be considered that LTC recipients are not only older persons but disabled persons of all ages, and that only a minority of the population requires LTC for a relatively short duration of a few months during the life course. LTC needs should be oriented towards maintaining and/or increasing the ability to perform activities of daily living and quality of life, rather than exclusively performing medical functions. The challenge of LTC is linking healthcare partners: the health-care system, the social services delivery and family support, while respecting individual choices. Finally, LTC policies must take into account the gender component of ageing, i.e. as the age of recipients increases, so does the proportion of women among those recipients. Special attention should therefore IV : Keynote papers be given to the fact that the older the person, the greater the probability that the LTC recipient will be a woman alone, widowed, divorced or never married. (3) Ensure appropriate financing of health and social services for persons of all ages In a recent publication, the European Commission reports that ageing of the population is not the most important factor in the health spending increase. The main factors of increased health expenditures are national policies relating to universal access, developments in health technology and rising demands from citizens for better quality care (EC, 2006). The report concludes that demand for health care in an aging population depends ultimately on the health status of all citizens, both young and old, and not on age per se. Healthier senior citizens will consume less health care than citizens with chronic diseases and disabilities, regardless of their age. This assessment is therefore an overwhelming argument in favour of effective policies for health promotion and prevention. (4) Enable people to make healthy choices This policy objective very appropriately comes at the end of commitment 7 and does not require much further elaboration. The remarks made regarding the importance of health promotion apply here. The use of the word “enable” instead of “promote” healthy choices is of great importance, as enabling people to make healthy choices would also include the pricing and labelling of healthy food and creating an environment conducive to healthy behaviours such as cycling, walking, and exercising as well as access to affordable and effective health care. Conclusion Promoting an informed public debate about achieving commitments 4 and 7 will be necessary in all of the countries of the UNECE region. This debate will revolve around two major policy axes that will shape the future course of policies affecting the situation of older persons in society. As the aging of the population proceeds and newly emerging needs for income security, health care and long-term care become more acute, the public debate will turn to the fundamental question of how much can a society devote to these policies while IV : Keynote papers meeting its other requirements to provide education, ensure security internally and externally and, more generally, foster economic development. While it may not be possible to achieve all of the objectives contained in commitments 4 and 7 in a steady and equal manner, it will be essential to ensure that public debate facilitates decisionmaking on the basis of empirical research and evidence-based practices as well as on the majority 77 views of the citizens concerned. This raises the second issue that will preoccupy much of the future public debate: How do we ensure that the resources for achieving these commitments are evenly distributed across all of the generations? Thus, the importance of the active participation of all the generations, including older people, in making these choices is obvious. References Commission of the European Communities (1999). “Towards a Europe for All Ages – Promoting Prosperity and Intergenerational Solidarity”, COM (1999) 221 final, Brussels 21.05.1999. Ervik R. (2006). Pitfalls and Possibilities of Active Ageing – Conceptualizations and Policies. Paper presented at a conference in Brussels in 2006 European Commission (2006). Special Report No 1 The impact of ageing on public expenditure: projections for the EU-25 Member States, 2004–2050. OECD (2000). Reforms for an Ageing Society, Paris, OECD. Robert Wood Johnson Foundation (2001). National Blueprint Increasing Physical Activities Among Adults 50 and Older. The Swedish National Institute for Public Health (2006). Healthy Ageing – A Challenge for Europe. WHO (2002a). Active Ageing – A Policy Framework. WHO: Geneva. WHO (2002b). Innovative care for chronic conditions. WHO: Geneva. WHO (2004). Towards Age-friendly Primary Health Care. WHO: Geneva. WHO (2005). Preventing chronic diseases—A major investment. WHO: Geneva. WHO (2007). Age-friendly guide. WHO: Geneva. 79 V. Summary of Contributions Panel A: Creating integrated approaches to mainstream ageing Mainstreaming ageing is an important dimension of ageing-related policies and a crucial element in the Madrid International Plan of Action on Ageing (MIPAA). It can be defined both as a strategy and a process leading to a greater social integration of older persons and to the inclusion of ageing into all aspects of social, political, economic and cultural life. The inclusion of older persons in policy implementation and evaluation allows them to become full partners in development. Thus, mainstreaming is also seen as a policy tool. However, mainstreaming should not be seen as an attempt to create separate or new programmes where implementation becomes hindered by lack of resources. Rather, it should integrate ageing into existing and future development planning and include older persons in policy design, implementation and evaluation. In the UNECE Regional Implementation Strategy (RIS) of the MIPAA, a specific commitment is made to mainstream ageing concerns into all policy fields with the aim of securing gender-sensitive and evidence-based integrated policies to bring societies and economies into harmony with demographic change. The essential prerequisites of successful mainstreaming include: (a) well-founded knowledge, or evidence base; (b) political and public visibility of proposed policy measures; (c) sufficient resources; (d) monitoring and assessment of the mainstreaming process; (e) a multilevel and multisectoral character of policy measures; and (f) collaboration of different stakeholders as well as coordination of their activities. To mainstream ageing into policy debate and action, several policy areas have a particular relevance, including health and social care, social protection, employment, education, economy and migration. Mainstreaming should be undertaken at different levels. The traditional level of mainstreaming efforts is national policy development. To succeed in mainstreaming, it needs to be designed as an inclusive process. Simultaneous actions should be pursued by Governments, civil society and enterprises as well as by individuals throughout their life course. International organizations have an important role to play in integrating ageing issues into their programmes and projects and contributing to monitoring of the implementation of the RIS. While promoting mainstreaming, it is important not to lose sight of the specific needs and expectations of older persons. Mainstreaming must not mean diminishing the funding of specific ageing-related programmes or reducing attention to the situation of older persons. A twin-track approach to policy and programmes on ageing is required that (a) addresses older persons’ specific needs by designing ageing-specific measures, and (b) simultaneously fosters mainstreaming as an integrative approach. Examples of mainstreaming efforts were presented during the session by contributors from Austria, Estonia, Serbia, Turkey, the European Commission and an NGO from Serbia. Efforts undertaken by UNECE member countries covered a wide array of issues, such as generating attention to the ageing, advocacy, awareness-raising and public education in order to promote the conviction that a sensitive approach to mainstreaming the concerns of older persons will benefit all age groups in society. Mainstreaming has proven to be a valuable approach for countries at different stages of their economic advancement and social development. Meanwhile, to mainstream ageing in developing countries and countries in transition, additional efforts are required to overcome certain limiting factors such as the low priority of ageing issues on the national policy agenda and, most significantly, insufficient national capacity to address ageing issues. Countries in transition may have to address particular challenges, as these countries’ older persons face high levels of poverty because they have not always been able to save for old age. Mainstreaming efforts are thus particularly necessary during the demographic and socioeconomic transitions currently under way in some parts of the UNECE region. 80 UNECE countries have, albeit to different degrees, implemented international strategies on ageing into overarching national plans and strategies and accumulated valuable experience in mainstreaming ageing and concerns of older persons into their national policies and programmes. In Austria, for instance, national surveys have included data collection and analysis on the issues of intergenerational relations and capacity-building initiatives have targeted decentralized levels, i.e. provinces and local communities. Media campaigns have been conducted to “rethink” the image and role of older persons in Austrian society, lifelong learning has been promoted, and measures have been taken to improve the representation of older persons. The inclusion of ageing issues in the national social budget, which has referred to older persons as social capital, can be considered a significant advancement. Attempts have been made to postpone early retirement by rewarding enterprises that support the employment of older persons. Equally, workplaces have been targeted to combat discrimination on the grounds of age. Older persons are also promoted in their positive roles as consumers or volunteers. Estonia emphasized the role of the national focal point on ageing in coordinating mainstreaming efforts. Particular attention has been paid to improving the image of older persons through a very successful project to “share a picture of your grannies”. In Serbia, issues of ageing have been incorporated into policy measures aimed at implementing national poverty eradication strategies and education and employment strategies as well as the EU accession strategy. Issues of concern have been the reform of the pension system and the social welfare and health systems as well as the issue of addressing the changing disease portfolios that come with transforming age patterns in society. NGOs have played a major role in designing and advocating new strategies on ageing. In terms of international collaboration, it was highlighted that the UNECE plays an important role in mainstreaming ageing into different policy fields in its member countries and in enhancing interaction between member States and also in increasing access to data. V : Summary of contributions Visions for the future include hard and soft measures such as the review of all drafted legislation with respect to age sensitivity and age discrimination and the extension of campaigns to destigmatize ageing in society. In some areas, more funding and better coordination have been called for, as have a sensitization of decision makers and the more systematic inclusion of civil society. Panel B: Participation and social inclusion Participation and social inclusion of older persons are important elements of a comprehensive strategy that addresses population ageing, since meeting the challenges of an ageing world requires involvement of all generations. Participation in society means being involved, responsible and informed. The empowerment of older persons and the promotion of their full participation are essential elements for active ageing. The abilities, experiences, expert knowledge and special skills of older persons are needed in society, and their potential should be used productively and seen as an opportunity for the societies they live in. The involvement of older persons in their communities is not just an asset to society in general, it also improves older persons’ quality of life. A wide array of aspects pertains to participation and social inclusion. These aspects include an environment free of discrimination as well as political participation that goes beyond voting in elections. Older persons should be integrated into politics and political decisionmaking through suitable formal structures such as advisory bodies and consultation processes. Above all, older persons should be involved in processes that concern them. Older members in parliament can be assets in all the political domains, enriching the discussion with their experiences and perspectives not just in relation to ageing policies. Apart from the political domain, participation can be achieved through the extension of working life beyond retirement or by being active in the voluntary sector. Another aspect is emancipation and gender equality. Dialogue between generations should be promoted. Furthermore, participation policies should include mobility, housing, education, fiscal and economic policies. Reducing poverty also means reducing the exclusion of older persons. The V : Summary of contributions potentials of technology should be used to enhance inclusion of older persons. Inclusive health and pension policies are important components of participatory approaches. Healthy environments should be established, involving physical, mental, and social activities as well as healthy nutrition. A policy for senior citizens has to maintain and increase the competence of senior citizens to prevent dependency and to secure healthy ageing with a high degree of quality of life. In particular, the deinstitutionalization of care is considered desirable. Social inclusion of older persons may help prevent isolation and at the same time help improve their public image. Productivity, participation, responsibility and the feeling of being needed have a favourable effect on health and quality of life. UNECE countries have implemented several strategies to improve participation and social inclusion. Examples were presented from Bosnia and Herzegovina, Greece, Ireland, Portugal, Romania, The former Yugoslav Republic of Macedonia, the United Nations Population Fund, Fédération européenne des retraités et personnes âgées (based in Belgium) and the Resource Centre for the Elderly (Kyrgyzstan). Greece, for example has two programmes (“Against Asylums”, part of the National Plan of the Ageing Population, and “Help and Care in the House”) that focus on social and financial support to medical services for older persons. Furthermore, the Greek Ministry of Health and Social Solidarity has established a solidarity network to coordinate the initiatives of different sectors working to promote social inclusion and participation of older persons. In Ireland, multiannual macroeconomic and social policies have been developed through a programme of consensus-building between the Irish Government and civil society partners (e.g. employers, trade unions, the community and the voluntary sector) since 1987. The social partnership agreement “Towards 2016” outlines a new framework within which key economic and social challenges will be tackled using a life-cycle approach. While previous social partnership agreements placed a limited emphasis on older people, the groups identified for the current agreement include children, persons of working age, older persons and persons with disabilities. 81 The partnership agreement acknowledges the importance of alleviating poverty in older age and overcoming the challenges of ageism and negative stereotypes concerning ageing. Portugal has set up a National Action Plan for Inclusion 2006–2008. It constitutes a strategic instrument to promote the social inclusion of all citizens by ensuring access to resources, rights, goods and services needed for participation in society as well as by participation in the labour market and fighting poverty and exclusion. Alleviating poverty at old age is also a central goal in Bosnia and Herzegovina, where two strategy documents are under development: the National Development Strategy 2008–2013 and the Social Inclusion Strategy. These mainly address the areas of economic development and poverty reduction, with older persons as a main target group. Romania has set up the National Council of Older Persons, an autonomous and consultative body with the main objective of institutionalizing social dialogue between public authorities and older persons. The Council is designed as an umbrella body for 12 organizations, associations and federations of older persons. It is financed by the constituent organizations and by public funds from the national budget. The former Yugoslav Republic of Macedonia envisages reforms in the social protection system focusing on further improving non-institutionalized care and setting measures to increase the capability of older persons. Another aim is to enhance strategic planning aiming to improve social-service centres and the care of frail persons in their own homes. Fédération européenne des retraités et personnes âgées has developed a “Charter of demands for the rights of older people”, which contains a catalogue of rights pertaining to, inter alia, the economic conditions of pensioners and older persons. The Charter also refers to the older people’s right to housing and, more generally, their rights to public services, to access credit and to health. As an agenda to promote participation in the future, speakers called for lifelong learning and active ageing strategies. They advocated the enhanced use of modern information and 82 communication technologies to achieve civic participation. To address the needs of older persons as consumers, architects and designers are encouraged to develop strategies for an ageing world. Industry is called upon to acknowledge the ageing society and change some of its products to assist senior citizens in maintaining independent lives and to help facilitate their participation in society. Among the key future challenges will be reducing poverty amongst older people and combating negative attitudes and practices, both of which represent barriers to the full integration of older persons into society. Panel C: Towards a balanced care strategy The main function of care is to ensure that increased longevity is accompanied by the highest attainable standard of health, which must be understood not merely as the absence of disease or infirmity, but also as the state of complete physical, mental and social well-being. Issues of special concern are the demographic, economic and social pressures on the traditional family and the incurring challenges that come with the provision of care. While ageing increases pressure on the health-care system, longer lives are, at the same time, the result of better health-care services, higher standards of living, heightened health awareness and longer life expectancy. Issues of common concern in most UNECE countries – as presented during the session – include the development of care services to address the special needs of older persons. These measures should complement family care and reduce the burden on the family. Unless family traditions of mutual aid and support are strengthened, a vast service infrastructure will be required to complement informal caregiving. Other discussed items included the rights, obligations and protection of care users and care providers as well as the monitoring and evaluation of care services. Within the UNECE region, the general trend is moving away from institutionalized care towards care within the community. Studies show that older persons prefer to continue living in their own environments. Thus, older persons who depend on care should have the possibility to choose between different options of long-term care. When institutional care becomes unavoidable, V : Summary of contributions dignity of the older person should be respected. At the same time, education and training programmes should be made available to them, and also healthcare professionals. Strategies to deal with the challenges of ageing populations in the field of care were presented by representatives from the Czech Republic, Israel, Spain, Sweden, the United States and ZIVOT 90, a Czech NGO. Israel has established a special ministry dedicated to the issue of older persons. The Czech Republic prioritizes the development of human resources, the adaptation of health-care systems to meet the needs of frail older people and the transformation of residential facilities as well as the prevention of human rights abuses. ZIVOT 90 presented the AREÍON Emergency Care project as an example of good practice. The project offers services 24 hours a day, seven days a week to senior citizens or disabled persons living at home by themselves, linking health and social care and also providing emergency care if necessary. The Minister of Labour and Social Affairs of Spain presented the Act on the Promotion of Personal Autonomy and Care for Dependent Persons. The system set up for its implementation is expected to create 300,000 jobs, to be deployed gradually, and thereby also contribute to the social cohesion of Spanish society. The Swedish Government has been promoting quality of care through investments in the education and employment of more doctors with geriatric skills. The country has also made efforts to improve collaboration between social and health-care services. The speaker from the United States reported on activities with respect to modernizing and rebalancing the long-term care system in preparation for the baby-boom generation. The Department of Health and Human Services administers three of the four cornerstones of the U.S. public health and long-term care systems: Medicare, Medicaid and the Older Americans Act. A nationwide network of 29,000 public and private organizations is responsible for coordinating and providing direct community-based human services to help older people to maintain their independence and dignity and to remain in their own homes and communities. A leitmotif for future action was the reconciliation of the needs of dependent older V : Summary of contributions persons with the needs of those who provide care, together with the idea of providing more support to relatives who care for their family members. Informal care was mentioned repeatedly at the session as an important pillar for supporting family carers without forcing anyone to take responsibility for ageing relatives. Other points raised from the floor included the issue of migrants and whether Governments are adequately prepared to deal with elderly persons coming from a different cultural background, architectural measures in residences to address the special needs of older persons and actions to help the mentally ill and those suffering from dementia. Another subject was the importance of considering older persons not only as receivers of care, but also as caregivers. Lastly, the importance of the NGO sector was discussed with reference to its flexibility with respect to service provision and its ability to link social and health-care services. The main future challenges raised by speakers included financing, integration and sustainability of long term care and the issue of finding and recruiting the right persons to work in the caring field as well as their training and retraining. Other challenges concerned the standards of care and the provision of good-quality care, of dignified care as well as of protective care for older persons and also for those with special needs such as the disabled, the mentally ill and those with dementia. Further issues of concern were the question of how to address abuse of older persons and how to ensure improved coordination between care providers, i.e. government, the private sector, the family and civil society. Panel D: Living longer – working longer: Challenges for education, the labour market and social protection Gains in life expectancy should be shared between employment and retirement, aiming at an ageing process with dignity and purpose. In order to achieve this, strategies should pertain not only to adjustments in the labour market itself to better integrate older persons, but also to pursuing a more holistic approach, including issues such as education and social protection systems. After several decades of consensus on encouraging early retirement, often promoted as a 83 coping strategy with unemployment, the current challenge in many countries is keeping older workers in employment to relieve the strain on the social security and pension systems. A combination of different strategies can help increase the number of older persons in the labour market: • Rewarding work, e.g. subsidizing the salaries of older workers or reducing the social security contributions • Restrictive policies, e.g. raising the retirement age • Improving employability, e.g. training • Changing employer practices, e.g. promoting age diversity • Regulatory means, e.g. introducing and implementing regulation against discrimination based on age • Changing public perceptions, e.g. through positive image campaigns. Moreover, the labour market should be adjusted to react to the needs of ageing workers more flexibly. A more gradual transition between active work life and retirement should be achieved and a voluntary postponement of the effective retirement age supported. At the same time, strategies should be inclusive of all ages and the extension of the work life of older workers should not be at the expense of the career opportunities of younger workers. To prolong working life, coherent complementary policies to those directly concerning the labour market are needed. To improve employability of older persons, lifelong learning should be supported. This should include not only the updating of skills, but also facilitating the learning of new competences as well as providing education to people who have not obtained any degrees before. Furthermore, social protection systems must be adjusted to encourage prolonged work lives. Incentives for early retirement should be replaced by policies to reduce unemployment of older persons. At the same time, social security policies need to be used as means of stabilizing our societies and of dealing with some of the extreme effects of an ageing society. Social protection systems – and pensions systems in particular – 84 have to be consolidated to make the pension system sustainable for the long term. Participation of older persons should be encouraged. Mechanisms should be found to favour flexibility and choice in how older people structure their work arrangements in relation to other commitments such as family or education. In the UNECE region, trends towards entering the labour market later and leaving it earlier have been observed over the past few decades, while lives have become longer during the same period. Although a growth in employment and migration may offset some of the consequences of these developments in the medium term, it is estimated that after 2018 the ageing effect will become dominant throughout region. Robust progress regarding the commitment on labour markets has been reported. There has been a wide mobilization of all sectors, including government, business and civil society, towards a holistic response. However, the degree of activity still varies widely throughout the region. Some countries have proven to be exemplary, and others may learn from their experiences. During the session, representatives from Cyprus, Lithuania, the Russian Federation and Spain presented their approaches, as did representatives of OECD, the International Social Security Association (ISSA) and AARP International, an NGO from the United States. Research results cited for the G7 by the NGO representative indicated progress on combating age discrimination and on promoting equality of treatment and opportunity in Italy, Germany and the United Kingdom, which have all implemented a related EU directive. Similarly, progress is reported on participation of older persons in the labour force. In France, Germany and Italy, measures to increase the minimum retirement age and reduce early retirement benefits either have been implemented or are envisaged. Spain reported on its support for workers who decide to continue to work beyond their retirement age with personal benefits. While the Russian Federation has decided not to raise the legal retirement age, it offers increased pension payments for older persons who decide to remain in the labour market on a voluntary basis. Several countries have integrated the demographic factor into their pension V : Summary of contributions calculation. Finland, Germany, Italy, Norway and Sweden, for example, have introduced mechanisms that dynamically adjust pension rights to life expectancy. Austria, Norway and Spain have recently introduced phased retirement systems. The most common type of intervention has been to reform the pension system through policies that seek to cap expenditure by measures which are essentially restrictive and which have only a marginal impact on employment sector policies. Positive examples are also coming from employers such as Deutsche Bank or Air France that have changed their organizational culture and have become active in hiring older employees. Several countries have embarked on lifelong learning campaigns to improve employability of their workers. Scandinavian countries have achieved rates of up to 32 per cent (Sweden) of participation in lifelong learning training and education programmes. In addition, a number of countries have launched public information initiatives to change age-related prejudice in the workplace and in society. Speakers agreed that a comprehensive approach covering all involved policy areas must be envisaged. A response to population ageing cannot be limited to changing the retirement system. Interventions can be punitive but should above all function as incentives. An innovative approach to the new life course is needed that leaves room for the individual needs of older workers reflecting different educational and personal backgrounds as well as health and family situations. Enterprises can play an important role in encouraging older workers to stay in employment thus building a balanced workforce. Panel E: Intergenerational collaboration Intergenerational collaboration could be defined as three or more generations combining efforts for the benefit of three or more generations. The concept pertains to families as well as the society at the local and national levels and it is multidimensional, i.e. it affects everyday lives in all areas, including financial, emotional and social aspects. Intergenerational collaboration stimulates active ageing, reduces social exclusion and age discrimination and mitigates the demographic challenge of ageing societies. Intergenerational V : Summary of contributions collaboration is vital in support of the currently needed adjustments of social protection systems; it fosters social cohesion and helps to make best use of the potentials of older persons. Nevertheless, intergenerational collaboration is under strain, even in countries where it has traditionally been very effective, due to changes in family patterns, poverty, conflicts and social protection systems. However, there is strong evidence to indicate that solidarity within the family exists, both financial and in kind, in the form of childcare or care for older persons. However, traditional solidarity patterns are coming under pressure with changing dependency ratios, which may be a source of tension between the younger and the older generations in the population. There may be a danger of older persons being seen as a burden in terms of finance, care and support, which may thwart intergenerational solidarity in practice. Examples of policies and good practices to deal with this situation have been presented from Belgium, Hungary, Malta, the Netherlands, the Council of Europe and the United States-based OASIS Institute. The Belgian experience shows that up to age 75, older persons are themselves care providers rather than care receivers. They give instrumental, financial and emotional support to their children and provide a significant share of childcare. However, they also have an important share in intragenerational solidarity. Belgium is extending the possibilities of gainful employment and education in old age. In addition, there have been attempts to improve public opinion about the older population by providing unbiased information. Positive examples were also given by the Dutch delegation on how to strengthen social cohesion through intergenerational collaboration based on research by the Dutch Scientific Council for Government Policy. The Netherlands are currently pursuing a reintroduction of intergenerational and social cohesion aspects into their policy portfolio after a period in the past where insurance and care aspects of welfare were given priority. The aim is to withstand the danger of overly focusing on one part of the population (i.e. older persons) at the expense of other parts. However, it is acknowledged that government policy has to have a more facilitative character 85 while the actual intergenerational solidarity has to be expressed on an individual level. Malta strongly relies on the family as a principle provider of care. Families are assisted in this role by complementary policies such financial assistance for persons taking care of a sick or needy older relative. Other services include meals on wheels or day-care centres. The NGO sector in Malta is large, diverse and very active. Hungary offers a childcare allowance not only to parents but also to grandparents, and there is a care allowance available for family members who take care of a chronically ill person within the household. Furthermore, the country has a Silver Programme Fund for supporting intergenerational micro-projects. Hungary also organizes annual forums on the area of innovative intergenerational activity for clients of social services, and has distributed a best practice edition on this. The Council of Europe focused on the human rights perspective of intergenerational collaboration and the protection of older persons, as reflected in the European Social Charter, discussing the right to social services and fostering intergenerational links as a way to improve social cohesion and access to social services for older persons. More specifically, the Council of Europe is offering a number of legal instruments and recommendations to facilitate the promotion of laws and social policies in favour of older persons. The not-for-profit organization OASIS, founded in 1982, is dedicated to enriching the lives of older Americans. It focuses on lifelong learning, health promotion and disease prevention as well as civic engagement and volunteerism. For example, OASIS maintains an intergenerational tutoring programme in which older persons function as tutors in elementary schools to improve the reading and writing skills of children not at grade level. Other examples include the Active Generations Programme, in which older persons help combat childhood obesity by teaching healthy habits, and the Vital Visionaries programme, developed in partnership with the National Institute on Ageing. The aim of the latter programme is to bring medical students together with healthy older persons to improve their attitudes towards this age group, which will make up an increasing proportion of their future patients. 86 Speakers supported an international collaborative approach, facilitated by UNECE, the EU and the Council of Europe, to use synergies. The policy issues emphasized by speakers included a labour market for all generations, family-friendly policies as a way of reconciling family and professional lives, access to social services, exchange of good practices, involvement of civil society and local government, ensuring visibility to contributions of all generations and reshaping the attitudes of the media with the ultimate goal of combating ageism. Stimulating intergenerational collaboration is seen as a task for national and local government as well as civil society and individuals, who all have to take the initiative. Panel F: Focusing on opportunities: active ageing Active ageing has been defined as a process of optimizing opportunities for health, participating in social life and pursuing various commitments in retirement. Active ageing should follow the basic principles of individual choice, independence and dignity. The underlying idea is to redefine ageing as something positive and to start seeing retirement as a positive new beginning, one which should include plans for a new career, new opportunities and activities. Active ageing should involve all fields of life, including health (i.e. disease prevention, long-term care and better management of chronic conditions), housing, training and education, retraining and updating skills, financial security and self-sufficiency as well as active engagement. The latter may be achieved through creating movements and associations of older persons, volunteerism, culture, spiritual life or entertainment. Ageing policies should reflect the fact that ageing is a process and the ways in which persons pass through their lives shape their situations when they arrive at old age. Persons who are active earlier and ready to take responsibility are likely to continue doing so in old age. Therefore, a new lifecourse approach is suggested, whereby education, work and retirement are no longer seen as clearly defined periods in life. There is no longer one period of being a senior citizen. Pension age may begin with a period when older persons are still physiologically young and able to contribute in work and learning. As periods in life are becoming V : Summary of contributions less distinct from each other, approaches such as lifelong learning are being increasingly applied. In active ageing policies, it is considered important to take a comprehensive approach and to develop policies for all generations. Furthermore, local solutions are needed and implementation capacities of policies at the local community level should be enhanced. During the session, active ageing policies were reported by Denmark, Finland, France, Italy, Slovakia, WHO, the German National Association of Senior Citizens’ Organizations (BAGSO) and Second Breath for the Elderly (Balti, Moldova). In Denmark, for example, the Parliament has made a broad political agreement on welfare, with the main target of removing barriers to staying longer in the labour market. The agreement contained concrete proposals for an increase of the regular retirement age by two years over a three-year period from 2024. It has been recommended that a senior citizens’ council advise local government on ageing policy matters and enhance active ageing. Another positive example came from Finland, where the National Programme on Ageing Workers, launched in the 1990s, has made special provisions for improving the health and capability to work of ageing workers. The programme covers occupational health and prevention, in line with the idea that good health leads to increased labour productivity. The programme also works to promote favourable attitudes towards older employees, and aims to prolong working careers through a life-course approach and to delay retirement. The widely accepted long-term goal in Finland is to extend the average working life by three years. In this connection, the programme aims to modernize the pension system by improving the availability, quality and productivity of social and health-care services. Furthermore, a four-year policy programme for health promotion has complemented the National Programme on Ageing Workers. Active ageing policies have also played an important role in France following the Plan national d’action concertée 2006–2010, negotiated between the Ministry of Labour and social stakeholders with the aim of postponing retirement. France sees active ageing as a countermeasure to passive ageing, which is associated with a number of negative connotations, e.g. that older persons are V : Summary of contributions not productive, not able to adapt to the modern world and are a liability because of the costs for illness and dependence. In this connection, France has adopted a national plan (Bien vieillir 2007– 2009) reflecting a life-course approach. It is based on the idea that the situation of older persons is strongly related to the way they have experienced their work lives, i.e. whether they were satisfied and whether their transition to retirement was well prepared. In general, France encourages employers to employ older workers and promotes older persons’ participation in cultural, political and social life, and the country supports the creation of an environment favourable to older persons. Italy is also following the principles of a prolonged active life, an active retirement and a valuation of the resources presented by older persons. It is experimenting with a system of social credits which older persons can collect by doing social work and which give them access to other services either free of charge or at reduced rates. In this sense, the country is also seeking to strengthen the voluntary sector. The Slovak Republic is pursuing an active ageing policy with its National Programme for the Protection of the Elderly, which aims to present requirements for achieving self-sufficiency, social participation and integration of the older persons. Its major principles are those of independence, participation, care, self-fulfilment and dignity. Germany presented the programme of BAGSO, a national umbrella organization of 97 senior citizens’ organizations covering all aspects of ageing and giving advice and recommendations at all levels of welfare work and social affairs concerning the ageing population. BAGSO has been a strong advocate of ageing-related issues, demanding a comprehensive strategy, the participation and well-being of the ageing population and simultaneous operations at the individual lifestyle level, the organizational management level and the societal policy level. Among its activities is the organization of German Senior Citizens’ Days. Another NGO example was presented by Second Breath for the Elderly (Moldova). This organization has fostered active ageing approaches 87 by publishing a guidebook for developing and supporting older persons’ organizations as well as a best practice manual for the integration of older persons into Moldovan society. Second Breath for the Elderly has organized self-help groups and volunteer work (e.g. home visits and social support of older persons to older persons). Another initiative, the Grandparents and Grandchildren Organization, brings together older persons and younger children in a particular town. The latter has also taken part in the drafting of the Moldovan national strategy on ageing. Speakers agreed that all policy issues should be viewed through the lenses of gender and culture as well as intergenerational and multigenerational solidarity. This area was consistently highlighted as the key to building bridges among the generations, thus following a holistic approach that involves all stages of the life course. Ministerial panels Panel discussions in the Ministerial Segment of the Conference took place under two sessions: (1) A society for all ages: Challenges and opportunities; and (2) Adjusting social protection systems, work and education to population ageing. The two sessions are summarized below with outlines of the discussions on policy and good practice examples as highlighted by the speakers. In both sessions, speakers expressed their appreciation of international exchange of experience and cooperation in strategy development as an important means for adapting to ageing. Countries perceive international cooperation to be of vital importance in order to be informed, learn and undertake comparative analysis. Some countries have dedicated additional resources to international collaboration; for example, Austria has supported the international project on mainstreaming ageing, in which indicators for the evaluation of progress in the implementation of the RIS have been developed. Other countries have directly profited from assistance provided by international organizations, as in the case of Armenia and the United Nations Population Fund. 88 Panel 1: A society for all ages: Challenges and opportunities Policy trends This panel discussion included ministerial statements from Belgium, France, Italy, Lithuania, Serbia, Sweden, Switzerland and the United States of America as well as statements made on behalf of a minister from Israel, a minister from Portugal representing the European Union and by the Russian NGO Dobroe Delo. Ministers saw ageing as an important challenge for the future. In the area of coordination of ageing policies, they underlined the importance of developing national ageing strategies, institutional arrangements (e.g. ageing issues have been included into an inter-ministerial conference in Belgium) and taking steps towards improving coordination between the central, regional and local levels. General agreement was confirmed on the underlying values that should guide the development of ageing policies, reflecting the principles set out in the MIPAA RIS. There is broad subscription to the mainstreaming approach, i.e. the systematic integration of the ageing concerns in all policies. Respect for the rights of an individual, elimination of discrimination and maintenance of autonomy and independent living were all highlighted as priorities. Ideally, a society of all ages should be created and a concept of active ageing should be promoted, while at the same time, ageing in dignity should be ensured. Much attention was devoted to the positive aspects of ageing, for instance the contribution of older persons to economic and social development. New possibilities being generated by the ageing of the population and should be fully explored. The ministerial statements, however, also highlighted the challenges that ageing is posing in many areas. One is the need to adjust health systems and organize adequate health-care and social services for older persons who can no longer be selfsufficient. Some countries placed special emphasis on diseases such as Alzheimer’s. Other countries underlined the necessities of developing services according to individual needs and improving access to services in remote or otherwise disadvantaged areas. Still others emphasized prevention. V : Summary of contributions Another important policy area is the labour market. Here the stated goal is to increase the percentage of older persons in employment through a mix of employment and lifelong learning policies. There is a general trend towards making retirement processes more flexible according to the personal circumstances of the individual, which is complemented by a call for long-term family friendly policies to facilitate the reconciliation of work and personal life. More broadly, the economic implications of ageing and the maintenance of economic growth also need to be managed. Information policies and public campaigns to raise awareness are both high on the agenda. Furthermore, some countries have declared it their policy goal to make communication and information infrastructure accessible to older people at affordable prices, so as to use older persons’ own potential to improve their living conditions. Other policy areas highlighted in the statements were transport and housing. Some countries, in particular those in transition, stressed the issue of combating poverty among older persons. Others underlined the importance of gender-sensitive approaches as well as of the need for security in old age. Some countries have made special provisions to address migration trends in their ageing policies, while others support the promotion of research. Generally, intergenerational solidarity and better networking between the services related to older persons are being promoted. Dialogue with civil society and partnerships with volunteer organizations and trade unions are appreciated, and the volunteer work of older persons is encouraged. Good practice examples France has a programme of intergenerational living whereby students subscribing to a code of good conduct can live with older persons, creating a model intergenerational living community designed in a way that fosters exchange and mutual support. Young parents help older persons with simple tasks in everyday life, and in return the latter look after the young parents’ children. The United States also promotes housing for seniors with limited means, by supporting community-based living opportunities. V : Summary of contributions In the field of care and support, Sweden cited the example of an older migrant from the Islamic Republic of Iran who, after living in Sweden for 28 years, lost her knowledge of Swedish as a consequence of dementia. She would only recall her maternal language. Swedish authorities follow an approach of dignity in ageing, allowing persons such as this to choose a care person with whom he or she would be able to communicate. France has adopted a policy whereby employees can take time off to care for a dependent parent, and also offers training to people who perform care tasks in their families. In the field of work, Serbia has reformed its National Employment Service and established regional agencies that provide support to small and medium-sized enterprises. The reform is expected to affect the working situation of older persons in particular. In Switzerland, volunteer work of older persons involves transportation of patients, organized by the Red Cross, and providing language and conversation courses to migrants. The NGO representative highlighted the issue of poverty of older persons in some countries. He reflected on the evolving phenomenon of poverty of working people who do not earn enough to sustain themselves and retired persons with pensions that do not cover their needs. In his view, civil society has an important role in representing the interests of older persons to government when alternative structures to translate their interests into policymaking more systematically are not available. Likewise, the capacities of NGO coalitions to disseminate important skills among their members were highlighted, such as developing and sustaining a voluntary sector, defending the rights of older people and fundraising. Panel 2: Adjusting social protection systems, work and education to population ageing Policy trends The second ministerial panel included statements from Armenia, Austria, Kyrgyzstan, Liechtenstein and Moldova, one on behalf of the Bulgarian Minister, and statements from representatives of the International Social Security Association (ISSA) and HelpAge International. 89 The statements demonstrated an understanding that ageing in itself is not a problem, but its perception can be. It was considered important to appreciate the positive sides of ageing. Therefore, a positive image of older persons in society should be promoted; concurrently, the image older persons have of themselves needs improvement as well. Several underlying general values were emphasized as guiding principles of population ageing policies during the session. These included ageing in dignity, equal opportunities, the right of older persons to choose for themselves and cooperation rather than confrontation of generations. Overarching aims such as the reduction of mortality, the strengthening of the general health in the population, the strengthening of the institution of the family and the prolonging of an active life were emphasized. With regard to social protection systems, work and education, several interlinked issues were raised during the session. Countries see the economy, employment and social affairs as interrelated issues. Most have taken steps towards restructuring their social security systems to address demographic changes. A two-tiered strategy is being followed. On the one hand, the general aim is to find a balance between the number of working people and those in retirement in order to improve the dependency ratio in solidarity-based social security systems. Incentives for women to return to the labour market after childbearing and for people to work beyond retirement age were suggested as means for achieving this. In this context, the European Commission has produced a Communication on the common principle of “flexicurity” in employment and social policies. The “flexicurity” concept comprises lifelong learning features, less strict employment protection legislation, modernized social security systems and activating labour market policies. The overarching aim is to encourage hiring and to discourage early retirement and welfare dependency. The concept also aims to motivate people to choose healthy lifestyles and use preventive health-care services. On the other hand, while achieving a more favourable dependency ratio is one aim, steps are being taken to adjust social security systems so that they can handle the consequences of population ageing. Many countries have carried out pension 90 reforms that often involve extensive consultation processes, e.g. Malta. Countries are pursuing incremental and phased approaches and are making different arrangements for those age groups very close to retirement and others that can still make provisions for their pension periods. Similarly, those in manual labour who entered the labour market earlier may be allowed to retire earlier, for example once they have reached 40 years of pension contribution. Countries may also embark on a strategy to rely on second and third pillar pension investments more strongly. To prevent extreme hardship, means-tested minimum incomes are in place. Regarding provision of care, similar importance is attributed to preventive measures, ambulatory and stationary services. Prevention and needs-based ambulatory services should help to obviate or delay dependency, thus deferring or averting costly nursing home placements. Persons requiring care should have the opportunity to maintain their independence and should be provided with the opportunity to stay at home as long as possible. The family is counted upon to provide care with many countries making special provisions to families to enhance their abilities to do so. Some countries provide social protection for carers, who are mostly women and migrants. Steps have been taken to transfer jobs from the illegal to the legal employment market. Furthermore, NGOs which may be supported financially by the State play an important part in the provision of care. Where professional services are needed, attempts have been made to improve effectiveness through better networking and an interdisciplinary handling of the cases. The International Social Security Association called for a broader, more dynamic concept of social security based on proactive and integrated approaches and highlighted the need to invest in health through increased health promotion and an increased attention to prevention. Another issue of concern is the protection of older persons’ rights. This can be addressed through anti-discrimination legislation or by giving recipients of institutional care certain rights set out in a contract. HelpAge International raised the issue of older persons being disproportionately affected by poverty throughout the region, asserting that older persons may suffer more than average from the V : Summary of contributions restructuring of social service provision, e.g. in Eastern European transition economies, where they are sometimes not explicitly included in poverty reduction strategies. Women are considered particularly vulnerable, as they often take on care responsibilities within the family while not paying into the contributory schemes themselves. As a strategy against this and poverty of older persons more generally, HelpAge advocates universal non-contributory pensions. The advantages would be that such pensions reach everyone and avoid the high costs of administration for means testing. These programmes should be complemented by affordable health care and antidiscrimination legislation. Furthermore, HelpAge International considered Governments’ commitments to and implementation of MIPAA as critical for reducing poverty of older people across the region. Good practice examples References to several good practice examples illustrated that countries have already made considerable efforts to restructure social security systems as well as to adjust labour and education systems. Liechtenstein offers attractive packages of financial pension schemes. Andorra has developed a programme of benefits for older persons to guarantee the coverage of health needs and has introduced compensatory mechanisms in the pension system to guarantee equality in access to minimum income. Special efforts have been taken to avoid the social exclusion of older women. The Russian Federation is investigating financial incentives to encourage voluntary work beyond retirement, and in the field of health care, has established a national priority project (“Health”) for the development of the health-care system. Its priorities are the provision of preventive services, the availability of standard contemporary equipment and the fulfilment of high-tech medical services. As a result, access of older persons to such services has already improved. Armenia offers free services to persons aged 65 and over, to whom it also provides medicine at reduced prices. Increasingly, representatives of older persons are being included in policymaking processes on social issues. In Liechtenstein, for example, a senior citizen advisory council to the Government, consisting of senior citizens, was V : Summary of contributions created. Moldova made reference to an informal Council of Elders, which advises the prime ministers, as well as to intergenerational round tables. A number of initiatives have addressed the public perception of older persons. Moldova has introduced a public holiday, Grandmothers’ Day, to improve the image of older persons and to highlight the important role they play in consolidating and educating society. Poland has instituted a special week with the motto “50 plus – an asset for business” for awareness-raising purposes. In terms of educational policies, Slovakia has an education system for older persons in place, and a University of the Third Age attended by pensioners. 91 The EU reconfirmed its special commitment to the implementation of the Berlin Ministerial Declaration of 2002. Recent EU initiatives have supported this process, for example with the EU Communication, “The demographic future of Europe – from challenge to opportunity”, which builds upon the Lisbon Strategy and introduces long-term perspectives based on demographic ageing. To support the development of social protection systems, the EU has extended the Open Method of Coordination to the area of health and long-term care as an instrument to improve the quality and coverage of care in the future. 93 VI. Non-Governmental Organizations’ Declaration We non-governmental organizations welcome and appreciate this opportunity to address the UNECE Ministerial Conference on Ageing in León. We are grateful to the Kingdom of Spain for hosting this important event. We are pleased to be here to work and interact with the Governments. There are issues which we regard as critical which are not fully addressed. A “society for all ages”, which means a “society for all people”, has to embrace all generations, respect the autonomy of citizens and reinforce the imperatives of human rights, cooperation and mutual understanding. A society for all ages has to be dedicated to the development of a decent quality of life for everyone and must be based on a nondiscriminatory approach, without prejudice, inter alia, of economic class, gender, education or ethnic origin. We believe that the United Nations Principles for Older Persons are the basis for the realization of the human rights of older people. The Principles define the ethics of the recognition of older persons in society and therefore must be the basis for all policymaking on ageing. The 2002 Madrid International Plan of Action on Ageing represents a unique framework to include older people in national, regional and local strategies, as they are not directly targeted in the Millennium Development Goals. We present our point of view in the following statement: (a) Regarding monitoring: (i) In Berlin in 2002, we discussed the need for strong follow up to the commitments with a monitoring process and close working relationship between Governments and NGOs; (ii) This has not yet taken place. We are disappointed that only 31 out of 56 UNECE Governments submitted reports, out of which only 12 have carried out the necessary work. Monitoring of the Regional Implementation Strategy must be transparent and participatory. It should include contributions from NGOs and older people. It must be based on meaningful indicators mutually agreed upon with civil society. Monitoring must be adequately resourced as an integral part of the RIS; (iii) We believe that the “Task Force Monitoring RIS” in which Government representatives, NGOs, researchers and other experts have worked together most successfully, should be continued, and the León Research Forum Declaration should be supported; (b) Regarding poverty : (i) We are quite concerned that the focus has shifted away from certain essential elements of the 2002 Madrid Plan of Action, in particular the commitment to providing adequate pensions and to substantially reducing poverty. It is imperative that the emphasis on development and poverty eradication contained in the Madrid Plan of Action is recognized and explicitly reinforced; (ii) Due to demographic changes in the region of UNECE, it is especially important that Governments urgently address ageing within national poverty reduction and social protection strategies. It is equally vital to allocate dedicated budgets to ensure concrete action. In general, women will continue to be the major group of older persons, particularly the very old, being exposed to poverty; (c) Regarding less affluent regions: As recognized in 2002, the UNECE region is one of extremes, including a number of low- and middle-income countries. The RIS recognizes this diversity. These countries continue to be challenged by structural poverty and its consequences. It has to be acknowledged that they are in a period of political and economic transition and must be priorities for support and assistance; 94 (d) Regarding health, well-being and the life course: It is essential to provide universal access to good quality, affordable and sustainable health care, social services, education and preventive measures. This should commence at early ages in order to promote and enhance health and wellbeing into the older years; (e) Regarding the relationships between NGOs and Governments: (i) Social cohesion is an absolute prerequisite for an inclusive society for all ages. To achieve this, government action and NGO activities on the ground must be linked together in a constructive manner, as called for by the United Nations Commission for Social Development. To a large extent, NGO action rests on civic engagement and volunteer work; therefore, the necessary resources for this work need support by Governments and local authorities; VI. Non-Governmental Organizations’ Declaration (ii) In order to ensure that the best interests of older people are served, policymaking on ageing must have coherence among different levels of government, which must work in partnership with NGOs and older people themselves; (f) Regarding the bottom-up approach : (i) Governments are responsible for ensuring the right of full involvement of civil society and especially older persons in implementing the RIS and in developing plans and policies. In this respect, they are responsible for creating adequate conditions so that this can take place. (ii) As a pensioner from Central Europe recently put it: “We need information on international agreements and how our country is represented. We need to know what our Government is promising at an international level so that we can call them to account at home”. 95 VII. Main Conclusions and Recommendations of the Research Forum We, the participants of the Research Forum, held on 5 November 2007 in León, Spain, would like to express our appreciation to the Kingdom of Spain for hosting and supporting the Research Forum preceding the 2007 UNECE Ministerial Conference on Ageing. We wish to: Point out that the León Ministerial Declaration stresses the fact that research is vital to the development of effective policies and programmes, Underline that the Research Forum of León represents significant progress in different areas of research on ageing in the UNECE region, Acknowledge the important role of the European Research Agenda on Ageing developed during the Fifth European Congress of Gerontology (Barcelona, Spain, 2003) in bridging the gap between policy and research and in providing a common framework for studies on ageing in the UNECE region, Present our conclusions and recommendations as a discussion basis by the UNECE member States. Measures recommended at the strategic level: Strengthening cooperation among the policymakers, researchers, NGOs and the private sector; Promoting the exchange of research and training, within and among the countries of the UNECE region, especially among the Eastern and Western countries of the region; Establishing monitoring and assessing mechanisms for linking and adjusting future research and policies to the European Research Agenda on Ageing. Measures recommended at the operational level: Establishing a European Institute on Ageing and corresponding infrastructures, to work in close collaboration with the U.S. National Institute on Ageing and existing institutions in the UNECE region (research, training, exchange, databank and information management). Recognizing that Austria has supported the 1982 first World Assembly on Ageing as well as the current Regional Implementation Strategy (RIS), that Germany hosted the UNECE Ministerial Conference in 2002, and that Spain has not only hosted the Second World Assembly on Ageing in 2002, but has also been crucial for integrating research on ageing within the implementation process of the Madrid International Plan of Action on Ageing by supporting the 2002 Valencia Forum and the 2007 León Research Forum. In view of the above, (a) We suggest that the Spanish Government, with the support of other Governments, convene a committee to create a European Institute on Ageing, which would define its purpose, structure and management, and also update the European Research Agenda on Ageing to include the concern of the entire UNECE region. Specifically, in order to better invest in efficient policy research programmes, we invite member States of the UNECE region to: (a) Encourage and enhance national and regional research and training programmes promoting the multidisciplinary approach; (b) Integrate East-West collaboration in the UNECE region; (c) Contribute to the exchange of research information, best practices and guidelines as well as the exchange of students, academics and professionals for pre- and post-grade education and training, together with the establishment of a clearing house on ageing; (d) Promote as research priority themes some of the following: (i) Social exclusion, rights and participation of older persons in society; 96 VII. Main conclusions and recommendations of the Research Forum (ii) Data collection and analysis of poverty among the older population, and generation effects; (iii) Economic standards and income transfer programmes; genderrelated economies; (iv) Sustainability and adequacy of social security systems in a world of migration; (v) Caregivers, dependency and longterm care systems; (vi) Active ageing; mobility and environment, quality of life and healthy lifestyles; (vii) Lifelong prevention and promotion of physical, psychological, spiritual and social health; (viii) Biotechnological and technological innovation transfer for older persons in a “long-life society”; (e) Training priorities should include lifelong learning and continuous education, strengthening initiatives such as universities and schools for Third Age, and even the Fourth Age, and including the issue of ageing at all levels of the compulsory education system, as well as in professional and university curricula; (f) Establishment of monitoring mechanisms for the implementation of the European Research Agenda on Ageing. Reiterating that only a human rights-based approach and an ethical framework for research and its application can benefit older persons and a “long-life society’, We urge Governments to systematically include in all international and European ethical guidelines a section on “Ethics of research with reference to older persons” (for example in the CIOMS biomedical ethical guideline, UNESCO bioethics documents, etc.)13, in collaboration with the 13 Council for International Organizations of Medical Sciences (CIOMS): International Ethical Guidelines for Biomedical Research Involving Human Subjects; UNESCO: United Nations Educational Scientific and Cultural Organization National Forum of Ethics Committees of the European Union and of other regions; We urge member States to establish a stronger framework for the rights of older persons, as well as intergenerational legislation, taking into consideration the United Nations Principles for Older Persons, by (a) appointing a rapporteur at the Human Right Council on the neglect, abuse and ill treatment of older persons, and (b) establishing a working group, within the Human Rights Council, to draft a convention on the rights of older persons and to mainstream ageing into the agenda of the Council. Finally, we believe that in order to implement these proposals, we should join our hands in pursuing the following tasks and projects: • Convening a UNECE meeting of policymakers and researchers to identify measures for cooperation between research and policy development and for the consolidation of policy-related research on ageing • Exploring the feasibility of establishing a European Institute on Ageing for the countries in the UNECE region • Promoting and updating the European Research Agenda on Ageing, especially bearing in mind the concerns and priorities of the countries with economies in transition. Research being essential to implementing fully and adequately the UNECE Regional Strategy for the Madrid International Plan of Action on Ageing, the research community will lend its full support to the objectives of the León Ministerial Declaration. We look forward to strengthening research capacities on ageing in order to collaborate more fruitfully with policymakers. As researchers we believe in the role of science as a service to humanity. Science can significantly improve the well-being of older persons and thus promote “a society for all ages”. 97 VIII. Report of the Conference 14 Summary In the first five-year cycle of the global review and appraisal of the Madrid International Plan of Action on Ageing (MIPAA), the United Nations Commission for Social Development agreed on the modalities for the review and appraisal of the MIPAA (E/CN.5/2006/2), which invited the United Nations regional commissions to organize regional conferences of review and appraisal. The 2007 UNECE Ministerial Conference on Ageing took place from 6 to 8 November in León, Spain. Ministers and high-level officials from 45 UNECE member States and the European Commission, international organizations, non-governmental organizations and other stakeholders discussed progress achieved in the implementation of the Regional Implementation Strategy of MIPAA adopted at the 2002 Ministerial Conference in Berlin, future cooperation among member States and capacity development. The 2007 Ministerial Conference in León adopted the Ministerial Declaration “A Society for All Ages: Challenges and Opportunities”. The proceedings of the conference are reflected in this report, which has three annexes.15 Annex I includes the Ministerial Declaration, annex II the Chairperson’s summary of the Conference and annex III the list of speakers. Introduction 1. The 2007 Ministerial Conference on Ageing took place at the Parador de San Marcos, Leόn, Spain, from 6 to 8 November 2007, with the Ministerial Segment being held on 8 November. 2. Ministers and representatives from 45 UNECE member States participated in the Conference. The following member States were represented : Albania, Andorra, Armenia, Austria, Azerbaijan, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kyrgyzstan, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, the Netherlands, Poland, Portugal, Romania, the Russian Federation, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, The former Yugoslav Republic of Macedonia, Turkey, Ukraine, the United States of America and Uzbekistan. 3. The European Commission was also represented. 4. Holy See participated as an observer State. 5. Representatives from the Food and Agriculture Organization of the United Nations (FAO), the United Nations Department of Economic and Social Affairs (UNDESA), the United Nations Economic Commission for Latin America and the Caribbean (ECLAC), the United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations Population Fund (UNFPA), the United Nations International Institute on Ageing, the Council of Europe, the European Centre for Social Welfare Policy and Research, the European Economic and Social Committee, the International Social Security Association and the Organisation for Economic Co-operation and Development (OECD) participated. In total, 11 intergovernmental organizations participated in the Conference. 6. Representatives of 39 non-governmental organizations (NGOs) participated in the Conference. The total number of participants was 285. The full list is available on the Conference website at: http://www.unece.org/pau/age/ConferenceonAgeing_2007. _____________________________ 14 ECE/AC.30/2007/2 15 The annexes to the report are published in this volume as Part I: Ministerial Declaration, Part II: Chairperson’s Summary and Part IX List of Speakers. 98 VIII. Report of the Conference Opening of the Conference and adoption of the agenda 7. Ms. A. Valcarce García (State Secretary for Social Services, Family and Disability, Ministry of Labour and Social Affairs, Spain), Mr. K. Bärlund (Director, Environment, Housing and Land Management Division, UNECE) and Mr. F. Fernández (Mayor of León) opened the meeting and welcomed the participants. The Conference elected the State Secretary for Social Services, Family and Disability of Spain as Chairperson for the first two days of the Conference (the Chairperson for the Ministerial Segment was elected on the third day; see para. 11). Overview of the ageing situation in the UNECE region 8. In the framework of preparations to the Conference, 31 member States submitted their country reports on the implementation of the UNECE Regional Implementation Strategy for the Madrid International Plan of Action on Ageing (MIPAA), based on the guidelines provided by the UNECE secretariat. The secretariat presented a summary of these country reports (ECE/AC.30/2007/4). Panel discussions 9. Six panel discussions were held on a broad range of issues related to the topic of the Conference, “A Society for All Ages: Challenges and Opportunities”: (a) Creating integrated approaches to mainstream ageing; (b) Participation and social inclusion; (c) Towards a balanced care strategy; (d) Living longer – working longer: Challenges for education, labour market and social protection; (e) Intergenerational collaboration; (f) Focusing on opportunities: Active ageing. The panel discussions are summarized in annex II;16 the composition of panels is provided in annex III.17 Opening of the Ministerial Segment and election of its Chairperson 10. The State Secretary for Social Services, Family and Disability of Spain and the Mayor of León opened the Ministerial Segment on 8 November. An introductory speech was given by the Executive Secretary of the UNECE, Mr. M. Belka. The Conference elected the State Secretary for Social Services, Family and Disability, Ministry of Labour and Social Affairs, Spain as Chairperson of the Ministerial Segment, and Mr. E. Buchinger (Federal Minister of Social Affairs and Consumer Protection, Austria) and Ms. L. Glebova (Deputy Minister of Health and Social Development, Russian Federation) as Vice-Chairpersons. Presentation of the NGO Declaration and of the Research Community Declaration 11. The NGO declaration was presented by Ms. G. Abdykalykova (HelpAge International, Kyrgyzstan) and Ms. A. Stuckelberger (University of Geneva, Switzerland). Presentation and discussion of the draft Ministerial Declaration 12. The Chairperson summarized the main points of the declaration and the panel discussions of the first two days. 16 17 Part II: Chairperson’s Summary in this volume. See also Part V: Summary of Contributions Part IX: List of Speakers in this volume. VIII. Report of the Conference 99 Ministerial panels 13. The panel discussions are summarized in annex II;16 the composition of panels is provided in annex III.17 Adoption of the Ministerial Declaration 14. The Conference adopted the Ministerial Declaration given in annex I.18 Closing session of the Conference 15. Following the statements made by the Director of Environment, Housing and Land Management Division of the UNECE and by the Mayor of León, the closing session included interventions about the followup process to the Conference by Switzerland, Finland and Spain. After this, the Chairperson thanked the participants and closed the Conference. 18 Part I: Ministerial Declaration in this volume. 101 IX. List of Speakers Panel (a): Creating integrated approaches to mainstream ageing Chair and Moderator Mr. Aurelio Fernández López, Spain Rapporteur Mr. Alexandre Sidorenko, United Nations Department of Economic and Social Affairs Keynote speaker Mr. Johan Schölvinck, United Nations Department of Economic and Social Affairs Panellists Ms. Erika Winkler, Austria Ms. Kristina Täht Estonia Ms. Lidija Kozarčanin Serbia Mr. Yusuf Yüksel Turkey Mr. Detlef Gerhardt European Commission Ms. Sanja Miloradovic Lastavica (Serbian NGO) Panel (b): Participation and social inclusion Chair and Moderator Mr. Dirk Jarré Expert on NGO issues Rapporteur Ms. Anneke Augustinus Netherlands Keynote speaker Ms. Ursula Lehr University of Heidelberg (Germany) Panellists Ms. Azemina Vukovic Bosnia and Herzegovina Ms. Kallirroi Nicolis Greece Ms. Gabrielle Jacob Ireland Ms. Odete Severino Soares Portugal Ms. Ileana Carmen Manu Romania Mr. Zoran Vucev The former Yugoslav Republic of Macedonia Ms. Siri Tellier United Nations Population Fund Mr. Bruno Costantini Fédération européenne des retraités et personnes agées (Belgium) Ms. Svetlana Bashtovenko Resource Center for Elderly, affiliate of HelpAge International (Kyrgyzstan) 102 IX. List of speakers Panel (c): Towards a balanced care strategy Chair and Moderator Ms. Vappu Taipale STAKES, Finnish National Research and Development Centre for Welfare and Health (Finland) Rapporteur Mr. George Pavia, Malta Keynote speaker Mr. Joseph Troisi, International Institute on Ageing, UN-Malta Panellists Mr. Petr Wija Czech Republic Ms. Galina Balmos Moldova Ms. Miriam Bar-Giora Israel Ms. Ignacio Robles Spain Mr. Niclas Jacobson Sweden Ms. Josefina G. Carbonell United States of America Mr. Oldřich Stanek ZIVOT 90 (Czech Republic) Panel (d): Living longer– working longer: Challenges for education, labour market and social protection Chair and Moderator Ms. Anahit Martirosyan Armenia Rapporteur Ms. Kristina Täht Estonia Keynote speaker Mr. Bernd Marin European Centre for Social Welfare Policy and Research Panellists Ms. Toula Kouloumou Cyprus Mr. Teodoras Medaiskis Lithuania Ms. Irina Bondarenko Russian Federation Mr. Octavio Granado Spain Mr. Roland Sigg International Social Security Association Mr. Asghar Zaidi Organisation for Economic Co-operation and Development Ms. Line Vreven AARP International (United States) Panel (e): Intergenerational collaboration Chair and Moderator Mr. Niclas Jacobson Sweden Rapporteur Ms. Marie Keirle, France Keynote speaker Ms. Charlotte Höhn, Federal Institute for Population Research (Germany) IX. List of speakers 103 Panellists Ms. Lieve Vanderleyden Study Center of the Flemish Government (Belgium) Ms. Judit Ágnes Szabó Hungary Mr. George Pavia Malta Ms. Anneke Augustinus Netherlands Mr. Vladimir Tchernega Council of Europe Ms. Marylen Mann OASIS Institute (United States) Panel (f): Focusing on opportunities: Active ageing Chair and Moderator Ms. Astrid Stuckelberger, University of Geneva (Switzerland) Rapporteur Mr. Edwin Walker, United States of America Keynote speaker Ms. Irene Hoskins, International Federation on Ageing (United States) Panellists Mr. Anders Lynge Madsen, Denmark Ms. Marja-Liisa Parjanne Finland Ms. Anne-Marie Tahrat France Ms. Franca Donaggio Italy Dr. Louise Plouffe World Health Organization Ms. Ruth Brand BAGSO – German National Association of Senior Citizens Organizations (Germany) Ms. Irina Baicalov Second Breath for the Elderly from Balti (Moldova) Ministerial panel 1: A society for all ages: challenges and opportunities Chairperson Mr. Erwin Buchinger Federal Minister of Social Affairs and Consumer Protection, Austria Rapporteur Ms. Vappu Taipale Director-General, STAKES – National Research and Development Centre for Welfare and Health (Finland) Panellists Mr. Emir Kir Minister for Social Policy and Family Affairs, Cabinet Commission Française, Belgium Ms. Franca Donaggio Under-Secretary of the Ministry of Social Solidarity, Italy Ms. Vilija Blinkevičiute Minister of Social Security and Labour, Lithuania Mr. Zoran Martinovič State Secretary of Labour and Social Policy, Ministry of Labour and Social Policy, Serbia 104 IX. List of speakers Ms. Maria Larsson Minister for Elderly Care and Public Health, Ministry of Health and Social Affairs, Sweden Ms. Manuela Weichelt-Picard Minister of Home Affairs of the Canton of Zug, Switzerland Ms. Josefina G. Carbonell Assistant Secretary for Ageing, United States Department of Health and Human Services, United States of America Mr. Eduard Kariukhin Director, Dobroe Delo (Russian Federation) Ministerial panel 2: Adjusting social protection systems, work and education to population ageing Session A Chairperson Ms. Lyubov Glebova Deputy Minister, Ministry of Health and Social Development, Russian Federation Rapporteur Mr. Bernd Marin Executive Director, European Centre for Social Welfare Policy and Research Panellists Mr. Aghvan Vardanyan Minister of Labour and Social Issues, Armenia Mr. Erwin Buchinger Federal Minister of Social Affairs and Consumer Protection, Austria Ms. Abdullaeva Uktomhan Minister of Labour and Social Department, Kyrgyzstan Mr. Hugo Quaderer Minister of Environment, Social Affairs and Education, Liechtenstein Ms. Galinas Balmos Minister of Social Protection, Family and Child, Moldova Mr. Hans Horst Konkolewsky Secretary General, International Social Security Association Mr. Richard Blewitt Chief Executive, HelpAge International (United Kingdom) Session B Chairperson Ms. Amparo Valcarce García, Secretary of State of Social Services, Families and Disability, Ministry of Labour and Social Affairs, Spain Rapporteur Mr. Asghar Zaidi, Principal Administrator (Pensions), Directorate for Employment, Labour and Social Affairs, Organisation for Economic Co-operation and Development Panellists Ms. Montserrat Gil Torné, Minister of Health, Family Welfare and Housing, Andorra Ms. Valérie Letard Secrétaire d’Etat chargée de la solidarité, Ministère du travail, des relations sociales et de la solidarité, France Ms. Helen D’Amato Junior Minister, Ministry of Health, Elderly and Community Care, Malta IX. List of speakers 105 Mr. Kazimierz Kuberski Under-Secretary of State, Ministry of Labour and Social Policy, Poland Ms. Lyubov Glebova Deputy Minister of Health and Social Department, Russian Federation Mr. Batirzhan Bakiyevich Alimukhamedov Deputy Minister of Labour and Social Protection, Uzbekistan