Endorsement of the Lisbon Outcome Statement and Launch of a National Programme for Age-Friendly Cities and Communities in Portugal

Abstract

Portugal is one of the European Union countries with the highest rates of people aged 65 or more. The old-age dependency index is the third highest in Europe. Longevity is a remarkable human achievement but without a comprehensive approach to fostering healthy ageing over the life-course, the burden on health and care systems and social services will increase. This issue is compounded as life expectancy rises, but many of these additional years are not lived in good health. Promoting healthy ageing is an essential political and moral strategy for the well-being both of individuals and societies. Concerning this, Portugal endorsed the Lisbon Outcome Statement drawn up based on the 2023 Regional Summit on Policy Innovation for Healthy Ageing and made its commitment for the creation of age-friendly environments. The National Programme for Age-Friendly Cities and Communities in Portugal is one of the first concrete steps to fulfill that endorsement.

The European population is ageing, and Portugal is one of the European Union countries with the highest rates of people aged 65 or more. The old-age dependency ratio in Portugal, which is the ratio between the number of people aged 65 or over and the number of active people, aged between 15 and 64, is the third highest in Europe. ¹ Longevity is a remarkable human achievement, but it also presents a significant social challenge. Without a comprehensive approach to fostering healthy ageing over the life-course, ² the burden on health and care systems and social services will increase. This issue is compounded as life expectancy rises, but many of these additional years are not lived in good health. Promoting healthy ageing is an essential political and moral strategy for the well-being of both individuals and societies. ³

Concerning healthy ageing, Portugal has sought to fulfill the political commitments made as a member state of the United Nations and European Union. ⁴ The first national health program on ageing in Portugal was launched in 2004, following the Political Declaration and Madrid International Plan of Action on Ageing. ⁵ The National Programme for Older People’s Health was in force until 2016 when an interministerial working group was nominated to co-develop a National Strategy for Active and Healthy Ageing ⁶ following the latest international guidance regarding healthy ageing, namely the World Report on Ageing ⁷ and Health and the Global Strategy and Action Plan on Ageing and Health 2016 to 2020. ³ Currently, Portugal, like other members of the World Health Assembly, adopted the Decade of Healthy Ageing 2021 to 2030 ⁸ and is also committed to the Green Paper on Ageing proposed by the European Union in 2021. ⁹ Both commitments are reflected in the new National Health Plan 2030, approved in May 2023, in which the promotion of active and healthy ageing is a proposed intervention strategy. ¹⁰

Regarding healthy ageing international policies and initiatives, the launch of the Global Network for Age-friendly Cities and Communities in 2010 is an important milestone. This World Health Organization (WHO) initiative aims to connect cities, communities, and organizations around the world with the common vision of making great places to grow older in. In response to global population ageing and rapid urbanization, the Network’s mission is to stimulate and enable cities and communities around the world to become increasingly age-friendly, focusing on action from the local to the national levels to ensure the meaningful engagement of older people in community life and ultimately promote healthy ageing. ¹¹

Developing communities in ways that foster the abilities of older people through the WHO Global Network is 1 of the 4 action areas proposed by the Decade of Healthy Ageing 2020 to 2030 to support optimizing the levels and distribution of healthy ageing within and across countries. ⁸ Since 2010, fourteen Portuguese cities and communities have joined the Network. In 2013, the Ageing@Coimbra initiative was launched as a consortium of key stakeholders from academia, healthcare, industry, and civil society, aimed at addressing the multifaceted challenges of an ageing population. The initiative fosters a collaborative “quadruple helix” model, integrating these sectors to advance healthy ageing across various domains. The accompanying report highlights numerous best practices, adopted both regionally and internationally, with a focus on enhancing healthcare systems, driving technological innovation, and encouraging social participation. Noteworthy projects include efforts to improve adherence to medical treatments among older adults, elevate the quality of healthcare, and foster autonomy through community engagement initiatives.^12,13

Considering the importance of accelerating Age-friendly Cities and Communities development to meet the aspirations of the Decade of Healthy Ageing, Portugal took on the challenge of developing its National Programme for Age-friendly Cities and Communities. The initiative was launched in October 2023 by the Directorate-General of Health (DGS), during a technical meeting that was followed by a Regional Summit on Policy Innovation for Healthy Ageing in the WHO European Region. ¹¹ Based on the WHO Global Network guidelines for inspiring, connecting, and supporting, ¹⁴ during the next 3 years, a working group coordinated by the Directorate of Disease Prevention and Health Promotion at DGS, in partnership with WHO, will follow the steps proposed in the Guide and Toolkit to National Programmes for Age-friendly Cities and Communities, ¹⁵ including to:

• ● Map and contact existing members of the Global Network and support new memberships, also leading the creation of a Portuguese Network for Age-friendly Cities and Communities;

• ● Establish a working group, composed of DGS representatives, city and community leaders, older persons, representatives of related National Programmes, academics, and other stakeholders, to develop the National Programme for Age-friendly Cities and Communities that will be launched at the beginning of 2025;

• ● Support the capacity development and dissemination of local initiatives within the scope of Age-friendly Cities and Communities;

• ● Collaborate with the Global Network for Age-friendly Cities and Communities, namely, to organize meetings and conferences at local, national, and international levels.

Recognizing the invaluable contributions of older people and their caregivers to our societies and advocating for a life-course approach to healthy ageing, ensuring that no one is left behind, Portugal endorsed the Lisbon Outcome Statement drawn up based on the 2023 Regional Summit on Policy Innovation for Healthy Ageing in the WHO European Region ¹¹ and made its commitment to creating age-friendly environments. The National Programme for Age-friendly Cities and Communities in Portugal is one of the first concrete steps to fulfill that endorsement.