Journal of Social Work Practice

Psychotherapeutic Approaches in Health, Welfare and the Community

ISSN: 0265-0533 (Print) 1465-3885 (Online) Journal homepage: http://www.tandfonline.com/loi/cjsw20

Age and the Environment: The Global Movement

Towards Age-Friendly Cities and Communities

John R. Beard & Basant Montawi

To cite this article: John R. Beard & Basant Montawi (2015) Age and the Environment: The
Global Movement Towards Age-Friendly Cities and Communities, Journal of Social Work
Practice, 29:1, 5-11, DOI: 10.1080/02650533.2014.993944

To link to this article: http://dx.doi.org/10.1080/02650533.2014.993944

Published online: 26 Jan 2015.

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 Journal of Social Work Practice, 2015
Vol. 29, No. 1, 5–11, http://dx.doi.org/10.1080/02650533.2014.993944

John R. Beard and Basant Montawi

AGE AND THE ENVIRONMENT: THE

GLOBAL MOVEMENT TOWARDS
AGE-FRIENDLY CITIES AND COMMUNITIES
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Populations around the world are rapidly ageing, with some of the fastest change occurring
in less-developed countries. One of the key determinants of the capabilities of older people,
and whether they can achieve the things that are meaningful to them, is the environment in
which they live. There is growing interest globally on how to foster “age-friendly”
environments, and the World Health Organization’s Global Network of Age-Friendly Cities
and Communities now includes over 250 member cities with responsibility for around 100
million people. This paper outlines the background to the Network and describes some
innovative strategies being adopted by members in different parts of the world.

Keywords ageing; elderly; environment; cities

Background

Populations around the world are rapidly ageing, with some of the fastest change
occurring in less-developed countries (UNDESA, 2007). This presents society with
both challenges and opportunities.
Much of the political debate that has arisen in relation to this demographic
transition has focused on the potential negative impacts of population ageing (Sikken
et al., 2009; Bloom et al., 2010). Yet, older people comprise a substantial, and often
overlooked, human resource, and strategies that nurture and draw on this human capital
can have very significant benefits for society (Biggs et al., 2012). Furthermore, ensuring
that the most vulnerable older people have access to the care and support they need is
likely to have powerful benefits in terms of social cohesion, since all members of society
will know these same resources will be available to them if ever they are needed.
Ageing is a complex process, involving an interplay over an individual’s life
between their genes, their environment and their free choice. One consequence is that
heterogeneity is one of the hallmarks of ageing, and chronological age is thus a very
poor measure of the functional capacity of any individual (Vasto et al., 2010; Steves
et al., 2012). For example, while one 80-year-old may be fit, well educated and keen to
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 6 JOURNAL OF SOCIAL WORK PRACTICE

continue in the workforce, another may be suffering from severe functional limitation
and require significant social and medical support. Policy to address population ageing
must therefore consider the needs of a very diverse target group.
This heterogeneity also reflects the cumulative impact of multiple inequities across
life. Thus, the frail 80-year-old is also more likely to come from a more disadvantaged
background, have lower educational levels, less financial security and less adaptability
to their changing social circumstances. This makes policy-making even more difficult,
since strategies that advantage one older person may have negative consequences for
another.
Many of these inequities will relate to the physical or social environment in which
an older person lives or has lived (Beard & Petitot, 2011). Indeed, older people may be
particularly sensitive to environmental influences (Bowling & Stafford, 2007). The
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environment can act by providing resources that help build and maintain capabilities at
any point in life, or by limiting the development of these capabilities either by
presenting barriers (for example, mandatory retirement can prevent workforce
participation), or through more direct negative influences (for example, through
injury, bereavement or exposure to indoor air pollution) (Ross & Mirowsky, 2001;
Schulz et al., 2006). The environment is also a crucial determinant of whether an older
person with a given level of functional capacity can undertake the activities that are
important to them (Beard, Blaney, et al., 2009; World Health Organization, 2001).
Since the environment does not tend to distinguish between individuals in its
effects, environmental strategies to foster healthy and active ageing can be intrinsically
equitable. For example, disabled access makes it easier for everyone to use public
transport, but is particularly beneficial to the disabled. Environmental strategies
targeting disabled populations or disadvantaged communities may therefore be an
effective way to overcome some of the cumulative inequities experienced by residents
during their lives.
While the evidence base remains thin, many environmental characteristics have
been proposed as possible determinants of well-being in older age. For example,
neighbourhood socio-economic disadvantage (as distinct from household or individual
socioeconomic disadvantage) has often been shown to be associated with a range of poor
health outcomes (Beard, Cerda, et al., 2009). This might be due to greater likelihood of
experiencing acute personal stress events such as trauma or unemployment (McLeod &
Kessler, 1990), or more chronic stress from urban decay, physical disorder and high
levels of crime (Ross & Mirowsky, 2001; Schulz et al., 2006). Neighbourhood
disadvantage might also impede the development of the social networks that may buffer
individuals from the stressors they face on a daily basis, (Lin et al., 1999) make it less
likely that an older person would have access to resources such as health care facilities,
and limit access to healthy foods. Negative cultural norms may also have an impact,
steering residents to unhealthy behaviours and outcomes (Ostir et al., 2003).
On the other hand, a positive residential environment may foster healthy and
active ageing by providing social resources that buffer the impact of life stressors
(Wheaton 1983, 1985; Fitzpatrick & LaGory, 2003), fostering a sense of well-being
and providing a recuperating environment that supports resilience. Good urban design
may encourage older people to participate in their local community, maintain
supportive social networks and remain physically active (King et al., 2000, 2005; Booth
et al., 2000; Wilcox et al., 2003).
 AGE AND THE ENVIRONMENT 7

Urban initiatives to foster healthy ageing

In recent years, a number of interventions have been developed to shape residential
environments to better foster health and participation in older age (Partners for Livable
Communities, 2007a; Partners for Livable Communities, 2007b; Kochera et al., 2010;
National Council on Disability, 2004).
The World Health Organization (WHO) has established two complementary
programmes of work in this area. Healthy ageing was identified as one of the core
themes in Phase IV (2003 – 2008) of the Organization’s European Healthy
Cities Network and continues to be a focus of many of the Networks’ member
cities (http://www.euro.who.int/en/health-topics/environment-and-health/urban-
health/activities/healthy-cities/who-european-healthy-cities-network).
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More recently, WHO has developed a programme on Age-Friendly Cities and

Communities (http://agefriendlyworld.org/). The programme commenced in 2006
with a project to subjectively identify the characteristics of the urban environment
that might encourage “active ageing by optimizing opportunities for health,
participation and security in order to enhance quality of life as people age”. The
project drew on academic partners in 33 cities around the world who convened
focus groups of older people, sometimes supplemented by meetings with groups of
caregivers and service providers. The eight domains considered comprised
transportation, housing, social participation, respect and social inclusion, civic
participation and employment, communication and information, community and
health services, and outdoor spaces and buildings. They thus consider features of a
city’s physical environment that may have an influence on personal mobility, safety
from injury, security from crime, health behavior and social participation; different
aspects of the social environment and of culture that may affect participation and
mental well-being; characteristics that foster communication and access to
information; and community support and health services.
In 2010, the WHO established the WHO Global Network of Age-Friendly Cities
(subsequently extended to include Communities http://www.who.int/ageing/age_
friendly_cities/en/). The Network is designed to link participating municipalities,
foster the exchange of experiences, strengthen the evaluation of age-friendly initiatives
and provide technical support. When WHO recontacted the 33 participants of the
original project four years later to determine progress in this area, very few were still
active. The Network, therefore, also emphasizes action and requires members to
formally commit to a process of continual improvement that is integrated into
municipal decision-making.
Currently, the WHO Global Network of Age-Friendly Cities and Communitiesq
has 250 members across 23 countries worldwide with responsibility for around 100
million people. Members of the Network are of different capacities and in countries at
various stages of economic development. However, they all share a commitment to
create urban environments that foster healthy and active ageing.
New York City was the first to join the Network (http://www.nyam.org/
agefriendlynyc/). Their work in this area is extensive, and started with a city-wide
assessment of ageing-related issues in 2008 which included community consultations in
14 neighbourhoods in five languages with thousands of older adults. Since then, the city
 8 JOURNAL OF SOCIAL WORK PRACTICE

has taken tangible steps to becoming more age-friendly, including the building of 3000
age-friendly bus shelters and 1000 age-friendly benches; the recruitment of 1000
businesses to participate in an age-friendly retail initiative and 40 colleges and
universities offering age-friendly programmes and resources; the designation of 14 age-
friendly public swimming pools, and the creation of five neighbourhood-level Aging
Improvement Districts and a major awards program recognizing age-friendly
workplaces.
Other examples of actions taken by members of the Network are quite diverse.
In a slum setting in New Delhi, older people identified safety as their key concern.
In response, the local age-friendly cities initiative worked with police to provide
individual older people with the personal telephone number of a specific police officer.
They were then helped to make first contact with the police officer, who had been
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trained to welcome this and encourage the older person to contact them again if they
had any concerns.
In Akita City, the capital of Akita Prefecture in northeaster Japan, over 34% of the
population will be aged 65 or above by 2025. Anticipating this change, Akita Age-
Friendly City Vision Promotion Group was set up in 2010. The group has made
proposals to the Municipality on four main issues: to change the negative image of older
people and an ageing society into the positive ones, promote a barrier-free society,
secure transportation and prevent the social isolation of older people. Early actions
include the creation of a subsidised public transportation scheme for older residents
aimed at helping older people travel and socialize more frequently. To provide
opportunities for older people to harness their experiences and skills, a system was also
created providing volunteer grants of up to 5000 yen (¼52 euro) a year for volunteer
activities in nursing homes. Trained “listening volunteers” were also provided to help
reduce social isolation.
Through the Aging in Place pilot project, the City of Edmonton and over 100
partners completed community initiatives to support older people in their homes. The
project targeted enhancing community bus services, access to frozen meals, increasing
the number of volunteer drivers and snow shovellers for the elderly and expanding
resource fairs and programmes.
Yet, while there has been significant progress globally in establishing the political
commitment to build cities and communities that are more supportive of older people,
and tangible steps are being taken to achieve this, key gaps remain.
Sustainability is a key issue, particularly given the political cycle which means one
Mayor’s priority may have less support from a subsequent administration. The WHO
Global Network of Age-Friendly Cities and Communities emphasis on integration into
municipal planning processes may foster a longer-term approach.
Just as importantly, the evidence base for the effectiveness of interventions is
extremely limited. Better documentation and evaluation of what is being attempted
are urgently needed. This is particularly crucial since some interventions (for
example, New York City’s “Safe Streets for Seniors”) have very significant financial
implications.
As part of their Network, WHO is currently undertaking a project to identify key
indicators of “age-friendliness” that might be used to monitor progress. However,
without the basic evidence for what works and what does not work, interpretation of
identified trends will be difficult.
 AGE AND THE ENVIRONMENT 9

Conclusion
Over the past 10 years, a global movement for the establishment of environments that
foster healthy and active ageing has emerged, and the momentum shows no sign of
slowing. While the evidence of impact remains limited, these initiatives offer great
promise in helping to ensure that older people, regardless of their functional capacity,
can continue to actively participate in, and contribute to, the communities in which
they live.

Disclaimer
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The authors are staff members of the World Health Organization and are themselves
alone responsible for the views expressed in the Article, which do not necessarily
represent the views, decisions, or policies of the World Health Organization or Taylor
& Francis Group.

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John R. Beard., MBBS, Ph.D., is Director of the Department of Ageing and Life Course
with the World Health Organization in Geneva, Switzerland, and Honorary Professor with
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the University of Sydney. He is the immediate past chair of the World Economic Forum’s
Global Agenda Council on Ageing Society. His recent publications include the following:
John R. Beard, David E. Bloom. Towards a Comprehensive Public Health Response to
Population Ageing. The Lancet. Published Online November 6, 2014 http://dx.doi.
org/10.1016/ S0140-6736(14)61461-6
Aboderin I, Beard J. Older People’s Health and Socioeconomic Development in sub-
Saharan Africa. The Lancet. Published Online November 6, 2014 http://dx.doi.org/
10.1016/S0140-6736(14)61602-0
Xing Lin Feng, Mingfan Pang, John Beard. Health system strengthening and
hypertension awareness, treatment and control: data from the China Health and
Retirement Longitudinal Study. Bulletin of the World Health Organization 2014;92:29 – 41 j
doi:http://dx.doi.org/10.2471/BLT.13.124495
Peter Lloyd-Sherlock, John Beard, Nadia Minicuci, Shah Ebrahim and Somnath
Chatterji. Hypertension among older adults in low and middle income countries:
prevalence, awareness and control. International Journal of Epidemiology 2014;1– 13
doi:10.1093/ije/dyt215.
Address: Department of Ageing and Life Course, World Health Organization, Avenue
Appia 20, 1211 Geneva 27, Switzerland. [email: beardj@who.int]

Basant Montawi, MBBS, is the CEO of Aspire for development in Cairo, Egypt. She has
previously worked with the Ageing and Life course department with the World Health
Organization in Geneva, Switzerland. Basant serves as a facilitator for the WHO Global
Network of Age-friendly Cities and Communities (GNAFCC).
Address: Department of Ageing and Life Course, World Health Organization, Avenue
Appia 20, 1211 Geneva 27, Switzerland. [email: basant_motawi@yahoo.com]