Foreward

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In November 2001, Health Canada's Division of Aging and Seniors convened experts, nongovernmental stakeholders and governmental representatives to a Workshop on Healthy Aging. The first part of the workshop – the object of this report – examined aging and health practices, while the second part (featured in a companion report) focussed on seniors and diabetes. Through the Workshop on Healthy Aging: Aging and Health Practices, the Division sought advice on strategic directions and priority areas for action on key issues contributing to healthy aging. The Workshop on Healthy Aging: Aging and Health Practices was a building block to the creation of new initiatives for seniors, itself built on more than a quarter-century of experience by Health Canada in the area of health promotion for older Canadians.

Many policy documents have helped shape the concept of healthy aging over time: from A New Perspective on the Health of Canadians (1974), which recognized that promoting health requires more than treating illness; through the Ottawa Charter for Health Promotion (1986) and Achieving Health For All: A Framework for Health Promotion (1986), which identified five key strategies for creating health; to Strategies for Population Health: Investing in the Health of Canadians (1996), which specified the importance of the broad determinants of health. In the context of these influential papers, Health Canada came to describe "healthy aging" as:

"Healthy aging" takes a comprehensive view of health. Using a population health approach, it examines issues in a synergistic fashion, by considering the full range of determinants of health instead of concentrating on individual risk factors. It fosters policies and interventions that reduce the difficulties of daily living, notably for most vulnerable populations. The positive health outcomes it seeks are: low risk of disease and disease-related disability, high mental and physical functioning, and active engagement with life.

The evolving concept of healthy aging has been implicit in the policies and programs undertaken by Health Canada in the area of aging and seniors issues, beginning with the introduction of the New Horizons program in 1972, and continuing into recent programming using the population health approach. All the while, the development of appropriate initiatives for older Canadians was being informed by the knowledge gained and successes met over the last thirty years. There was now a need for renewed action focussing efforts on the most crucial issues, answering emerging questions such as:

• How can Health Canada enable the achievement of healthy aging?
• What determinants of healthy aging can Health Canada most effectively address?
• What are the most effective approaches?

Starting in 1999, the Division of Aging and Seniors undertook a series of internal studies and investigations addressing these important questions and facilitating future priority setting processes in the area of healthy aging. Throughout the process, the Division solicited the expertise of issue specialists across Health Canada, and shared information with those undertaking other review and priority-setting processes.

In its main investigation, a Branch working group led by the Division of Aging and Seniors compiled lists of determinants of health based on the scientific literature, and identified a set of 34 key determinants that were the most pertinent to healthy aging. An in-house panel of experts was then asked to rate these 34 determinants based on criteria that would assess their importance for healthy aging, and the ability of interventions on each to produce positive health outcomes.¹ Following a diagnosis of the rankings, analyses of the higher-rated determinants, and further internal consultations, the panel found that four key issues had the greatest potential for changing or improving the current situation in the area of healthy aging: healthy eating, injury prevention, physical activity, and smoking cessation.

Evidence demonstrated that frailty in old age is largely preventable or reversible, and that as people age, genetic inheritance decreases in importance while environmental factors and lifestyle become more important to health. Evidence pointed to personal health practices, and more specifically to the four issues noted above, as making the most significant contribution to the prevention or delay of chronic diseases and the attainment of healthy aging. All older people, irrespective of age, have the potential to improve their health and well-being through behaviour change. Evidence also showed that focussing on behavioural risk factors could reduce or prevent the burden of chronic diseases such as cardiovascular disease, cancer and diabetes, as these diseases are extensions of lifestyle choices made during the life course. Often, the same lifestyle changes that reduce the risk of one disease will also reduce the risk or delay the onset of other diseases.

Physical activity, good nutrition, smoking cessation and injury prevention were found to be the four issues where intervention could make the most significant impact on health in later life. Existing research provided evidence of effective and promising interventions. However, the evidence was not sufficient to underscore the most appropriate interventions to be pursued in those areas, and to point conclusively to a course of action for Health Canada to follow.

The Division of Aging and Seniors thus sought to solicit the advice of experts and stakeholders on the development of an action plan on healthy aging. The Division organized a 1½ day workshop on healthy personal practices with expert presentations and group discussions on physical activity, nutrition, smoking cessation and injury prevention. Prior to the workshop, participants were provided with background papers on the four issues as viewed through a healthy aging lens, summarizing key knowledge and effective interventions related to aging and health practices. Participants were asked to comment on the papers, and revised versions are available as companion papers to this report. Through their discussions, workshop participants developed a series of recommended actions on healthy aging, identifying strategic directions, objectives and potential partners. Summaries of presentations and the results from group discussions constitute the main elements of this report.

Health Canada is committed to continuing its work in the area of healthy aging, building on its experience and successes over the past thirty years. As it moves forward, Health Canada will be able to base its policy and program development on a stronger conceptual foundation, and place the greater emphasis on the four cornerstone issues of: physical activity, healthy eating, smoking cessation, and the prevention of falls and injuries. The guidance provided by the Workshop on Healthy Aging: Aging and Health Practices will be significant in framing the development of new Health Canada initiatives and interventions that improve the health and quality of life of older Canadians by promoting key personal health practices and creating environments that support healthy behaviours.

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* The criteria considered by the in-house panel were: the magnitude of the impact on healthy aging; the proportion of Canadians affected; the quality of available evidence in association w ith healthy aging; the potential for effective modification by intervention; the availability of effective interventions to address the issue; and, the potential political/public support for intervention on the issue.

 

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