Good Health and Well-Being

Diverse demands and needs regarding care along with demographic change call for new care arrangements to better respond to individual needs. Too often older people are left out of decision-making processes and forced into a passive role when it comes to care. The central aim of this Policy Brief is to present innovative and empowering strategies for care that give the user more influence and power. The inclusion of new and empowering strategies into the care setting broadens the scope of care, increases care coverage and improves quality, efficiency and target group orientation. The aim is to help older persons remain active as they age and to enhance their quality of life and overall well-being with care services tailored to their needs.

Worldwide, populations are ageing rapidly due to gains in life expectancy and declines in fertility. The trend towards a growing number and share of older persons is projected to continue in the foreseeable future. As the number of older persons grows, their socioeconomic and demographic characteristics will evolve as well, with implications for economies, societies and public budgets. While long-term trends are hard to predict, assessing the characteristics of current and future cohorts of older persons provides important insights into the future of our ageing world. On the one hand, future cohorts of older persons are likely to be healthier and more educated—and therefore more productive—than those of today, despite the impact of the Covid-19 pandemic. Continuing scientific and technological innovations, including medical and pharmaceutical advances, will allow many to enjoy healthier and longer lives. On the other hand, the information presented in this brief indicates that successive cohorts of youth and adults are increasingly insecure in the labour market and more and more unequal in both developed and developing countries with available data. Without swift and bold policy action to counter this trend, future cohorts of older persons may be more unequal than those of today.

The population of countries in the UNECE region is ageing, which is leading to the increase in the number of the oldest old — a group with a higher probability of becoming in need of long-term care. At the same time, the number of those making up the working age population, who will be able to provide care, will decrease. UNECE member States have committed themselves to coping with this growing demand in care services while securing quality and choice for patients and their families. Financial sustainability of long-term care systems and a qualified work force are key elements in securing a high quality of long-term care and protecting human dignity in an ageing society.

The way how persons age is determined by a variety of factors: biological pre-conditions, social circumstances, attitudes towards ageing, and life-style. The manner how an individual person ages may contribute to how long a person will live and how fit a person might be in the late period of life. Current policies on ageing may perceive 'old age' as a status rather than the result of a process. Some ageing policies may be aimed at providing services within this status rather than at empowering older persons to live independently. Here, a change of paradigm is needed. In order to gain the ability to remain active, the individual needs to invest in this process throughout the life course. Appropriate societal structures, incentives and awareness-raising would enable persons to live an active life-style as long as possible. Current societal and legal infrastructures may not fully provide those opportunities for active ageing.

While people are living longer, it is important to improve the quality of every stage of life. Therefore, UNECE member States have committed to implement health policies ensuring that increased longevity is accompanied by the highest attainable standard of health1. In the coming years and decades, the number of elderly people in the region of the United Nations Economic Commission for Europe (UNECE) will rise sharply, challenging societies’ ability to care for those in need.

Realizing a society for all ages is the declared goal of Governments in member States of the United Nations Economic Commission for Europe. To this end, achieving the integration and participation of older persons in society are important elements. This policy brief outlines the main strategies that may be considered to increase participation of older persons in political and economic life and to improve their access to transport, appropriate housing and cultural activities. It highlights the importance of balanced intergenerational relationships based on mutual respect. Efforts may be made to reduce ageism and to destigmatize old age. The potential of volunteering may also be used – both in support of older generations and by the older generations themselves.

The UNECE region is experiencing a steady increase in the number and diversity of retired labour migrants and migrant eldercare workers. The international mobility of older persons is also on the rise. Yet the participation of migrants in the host communities and their access to welfare remains a challenging issue. Compared to native-born peers, older migrants are often more vulnerable to poor socio-economic and health status, social isolation and exclusion. Lower income, poorer working and housing conditions, including their concentration in low-income neighbourhoods, are among the factors affecting the life trajectories of many migrants. Migrant elder carers – independent of their age – often work informally without proper employment contracts and with limited access to health and social protection. There is, however, heterogeneity and variation in older migrants’ vulnerabilities and needs across and within ethnic groups, with consequent important welfare implications, which call for targeted policy responses at local, national, and international levels. A sound evidence base for such policy responses is lacking as older migrants are often overlooked in research, mainly due to a lack of data.

The economic and societal implications that result from demographic change may have an impact on how certain generations or age-groups are perceived by the majority of the population or community. Often older family members or neighbours are respected and well integrated members of their community. They also often dispose of a considerable knowledge, experience and consumer power through life-long accumulated savings. Older persons are thus able to assist younger family members and their community with advice through gained experience. But in some cases older persons are faced with neglect and negative stereotypes. A displacement of older persons into segregated communities, an undervaluing of their contributions to society, and negative media portrayals, contribute to a decrease in face-to-face contact with older persons, foster the growth of a gap between generations and a general lack of empathy towards people of different age-groups.

Populations in the UNECE region are ageing rapidly. To maintain economic growth and standard of living, people would need to work longer before they can retire. Regarding people who are currently in their working age, demographic change may require to include those into the labour market who were previously not fully integrated, such as early school leavers, women and migrants. In a knowledge society, this all requires a good standard of basic education as well as vocational training, tertiary education, information and communication technology (ICT) and language skills.

In many UNECE countries the average actual retirement age is below the statutory retirement age, which means that the labour market is losing a great deal of resources in terms of experience and labour capacity of older workers. Ageing societies, however, cannot afford to lose the highly valuable resource of older workers. If there are people aged 55 years or older who want to work, but cannot due to unfavourable conditions in the labour market, UNECE member States may wish to address this issue.

Policy responses to population ageing to date have primarily focused on adapting welfare systems to the challenges of demographic change. Much less attention is being paid to the opportunities and potentials that living longer holds for individuals, economies and society at large, and to tackling the barriers that currently hinder their full realization. Perceiving longevity mainly as a fiscal pressure and an obstacle to economic growth may trigger reforms that result in rising inequalities. This can occur when the cumulative disadvantages stemming from difficulties in transitions over the life course, ill health and disability and unpaid caregiving are insufficiently addressed. It also feeds into age-based stereotypes and negative attitudes towards older people. To change this, it is essential to better recognize the potentials of ageing societies and to enable people to live active and fulfilling lives as they age.

The concept of volunteering has many aspects. Across the UNECE region there is no unified definition of volunteering in terms of pay, duration of activity, or content of work. In this context a clear distinction between regular employment and volunteering must be drawn, which must go beyond the mere presence or absence of remuneration. Benefits for volunteers need to be clearly outlined, e.g. training opportunities, social participation and inclusion, as well as other aspects. Older persons benefit from volunteering both as providers and as recipients. Promoting these activities is therefore in the interest of every government. Such promotion can be achieved by offering support to organizations and volunteers through the strategies outlined in this policy brief.

Rural and remote areas in many countries experience more pronounced population ageing than urban areas and subsequently, have a higher share of older residents. Lower population density and more geographically dispersed populations make it more difficult and expensive to create and maintain a comprehensive service infrastructure as common in urban areas. Consequently, rural populations have less access to services and activities and their situation may aggravate further when combined with poorer socio-economic conditions. This puts rural populations at a disadvantage compared to urban ones and can be particularly problematic for older people who may face a greater risk of social isolation, reduced mobility, lack of support and health care deficits as a result of the place in which they live.

With less than seven years left to the 2030 deadline, progress towards the Sustainable Development Goals (SDGs) has been limited. But, at the SDG Summit in September 2023, Member States of the United Nations committed to bold, ambitious, accelerated, just and transformative actions to achieve the 2030 Agenda for Sustainable Development. For Governments, strengthening relationships and earning public trust is pivotal to realizing the changes required for more sustainable and resilient societies. While the COVID-19 pandemic significantly hindered advancement towards the Goals, and in some cases reversed progress, it also sparked innovation and experimentation in public institutions and in the way they interact with one another and broader society from which lessons can be drawn to reinvigorate efforts.

En este documento se presentan nuevas evidencias sobre los efectos de la pandemia mundial del COVID-19 en la economía de los cuidados. Como complemento de otro documento de políticas de ONU Mujeres, “Abordar las consecuencias económicas del COVID-19”, en este se destaca un conjunto de medidas clave para abordar el incremento del trabajo de cuidados no remunerado derivado de la pandemia, garantizar una compensación adecuada y condiciones de trabajo dignas para quienes se desempeñan en este sector de manera remunerada, y permitir la participación de quienes prestan cuidados remunerados y no remunerados en las decisiones políticas que les afectan. También, se brindan recomendaciones que podrían considerar los actores interesados, desde gobiernos hasta organizaciones internacionales y el sector privado, con ejemplos de algunas medidas ya adoptadas.

As the rate of new COVID-19 cases accelerates across the developing world, it exposes the potentially devastating costs of job losses and income reversals. Unconditional emergency cash transfers can mitigate the worst immediate effects of the COVID-19 crisis on poor and near-poor households that do not currently have access to social assistance or insurance protection. This paper provides estimates for a Temporary Basic Income (TBI), a minimum guaranteed income above the poverty line, for vulnerable people in 132 developing countries.

Low health system capacity makes developing countries highly vulnerable to the novel coronavirus. The 20 most vulnerable countries in the world will run out of ICU beds if, on average, just 0.04% of their population is actively infected. The Imperial College estimates that 2.5% of the population will be actively infected at the peak of the pandemic. This brief sketches the possible dimensions of that crisis and the challenges it represents to the health and socio-economic response.

Women face persistent structural challenges to decent jobs and economic independence. Now their livelihoods are even more vulnerable because of the economic impacts of the COVID-19 pandemic. This vulnerability is due in part to a system of gender inequality that imposes unpaid care and domestic work on women through socially constructed gender norms, and that deprives women of effective universal protection systems. How can we cushion the adverse effects during the COVID-19 crisis while paving the way for structural transformation? This policy brief, part of UNDP's Development Future Series, examines the most at-risk elements of women's income-generation capacity, presents the possibilities and estimated costs of a temporary basic income (TBI) for women's economic security across the developing world, and discusses options for long-term commitments of economic protection and gender equality.

This policy brief presents determinants and risk factors of poor mental health among older persons and provides a detailed overview of the prevalence of mental health disorders among older persons of different socio-demographic characteristics across the region. The policy brief highlights different policy strategies to promote, protect and care for the mental health of older persons, with examples contributed by Governments and civil society organizations across the United Nations Economic Commission for Europe (UNECE) region. The policy brief also offers a checklist of effective measures to promote and protect the mental health of older persons covered in this brief.

This paper reconstructs the full welfare distributions from household surveys of 160 countries, covering 96.5 percent of the global population, to estimate the pandemic-induced increases in global poverty and provide information on the potential short-term effects of income-support programmes on mitigating such increases. Crucially, the analysis performs a large-scale simulation by combining the welfare distributions with the database of social protection measures of Gentilini et al. (2021) and estimates such effects from 72 actual income-support programmes planned or implemented across 41 countries.

COVID-19 broke out at a time when Latin America was already experiencing significant social unrest, fueled to a large extent by growing dissatisfaction with the state of politics and the social contract more broadly. Given this context, how has the pandemic impacted citizens’ views of the public sphere and opinions about democratic governance? This brief presents the results of a survey commissioned by UNDP in 10 Latin American countries in September 2020. Self-ascribed social class is used as a lens to explore differences in the perception and evaluation of state performance in the face of COVID-19 with a focus on ‘middle-class’ perspectives. Some considerations are then offered on the steps required to enhance long-term democratic resilience in the region.

The COVID-19 pandemic is having a devastating impact on every aspect of life. Facing loss of livelihoods and inadequate safety nets, migrant workers in India constitute perhaps the most severely affected cohort of Indians. However, the socio-economic impact on these migrant workers has a gendered dimension to it too. A survey of 10,161 women migrant workers in India revealed that they were faced with the double burden of earning a livelihood and unpaid care work at home. In addition, their incomes fell by more than half during the pandemic compared to pre-pandemic levels. Against this backdrop, we present the importance of social protection measures for Indian women migrant workers along four dimensions, namely: food security, cash assistance, government health insurance, and protection against domestic violence.

Even though microenterprises in Colombia represent approximately 80 percent of the national productive sector, accounting for 33 percent of the labor force and approximately 5 percent of the aggregated value, the microenterprise segment has many problems in productivity, formality and innovation compared to its bigger brothers. This is a paradox of utmost relevance as these structural problems have greatly influenced the COVID-19 impact on microenterprise, one of the most affected sectors during the crisis. Taking advantage of a new, detailed national microenterprise survey (EMICRON), this document sheds a light on the structural and institutional problems that affect the wellbeing of microenterprises in Colombia and characterizes the junctural impact of the COVID crisis in the sector. This document indicates that the direction of the economic recovery should not only focus on overcoming the crisis but should incorporate long-term and structural policies.

In a post-COVID-19 Iraq, it will be impossible to achieve the Sustainable Development Goals (SDGs) or an inclusive development trajectory without tackling the multiple dimensions of fragility in the country. The fragility landscape in Iraq is challenging at best with all dimensions scoring on the high end of the scale. There is a strong imperative to work across the humanitarian, development and peace (HDP) nexus with UNDP as Fragility Integrator, together with all stakeholders, to sustainably address priority drivers and their effects on the social contract and ensure no one is left behind. This policy brief provides recommendation of how to create the enabling environment towards a fragility-based post-COVID-19 recovery.

At any age, intersecting factors such as poverty, disability, social isolation and exposure to abuse can increase the risk of vulnerability and weaken resilience in the case of adverse events. The COVID-19 pandemic, rising inflation, natural disasters, and war are examples of adverse events that have disproportionately affected vulnerable persons, including many older persons. Often, the capacities and vulnerabilities of older persons remain invisible as their voices are less heard and their needs less known due to a lack of data and research, and their insufficient involvement in decision-making. A key challenge, therefore, is to inform, design and implement comprehensive policies that protect vulnerable older persons from adverse outcomes, enhance resilience and allow them to fulfil their full potential in later life. The policy strategies presented in this Policy Brief cover the areas of income and housing, health and long-term care, prevention of violence, abuse and neglect, and social participation as well as the importance of adequate data and research and the involvement of older persons in decision-making.