TABLE OF CONTENTS Welcome Message
page 4
Introduction
page 5
Ageing
page 5
Aspects of Ageing
page 6
Significance of an Ageing Population The Public Health Perspective to Ageing Determinants to Consider for Ageing Significance of the Life Course Approach
Activities and Advocacy “How to Start”
page 12
Before starting an Activity Start giving your Activity a skeleton Now you are ready to get your Activity going! What you can do
Experiences
page 20
AMSI Ireland
Evaluate your work “How to End”
page 23
Feedback Data Gathering Measuring the change in participants’ Knowledge or Behaviour Measuring Impact on a higher level: how we measure impact as a Federation
Global Stakeholders
page 27
World Health Organization Governments NGOs
References
page 29
WELCOME MESSAGE Dear SCOPHeroes and Public Health Enthusiasts, We welcome you to this Manual on Ageing. Ageing has become a crucial Public Health Issue of the 21st century, increasing in magnitude, as life expectancy is increasing worldwide constantly. While this is a Public Health success it comes with responsibilities and changes that need to be made in order to ensure active ageing of the population which is infact a social and economic issue affecting our sustainable development. In this Manual you would find comprehensive knowledge on different aspects of Ageing. A step by step description on how to start, execute and end an activity for active ageing. It also contains an activity example and the important stakeholder and global processes on Ageing. Ageing has been a priority for the Standing Committee for Public Health for two years for the Asia Pacific Region, IFMSA also have a policy document on active ageing and life course you can read here. We as the medical students and future healthcare professions are responsible for tackling with ageing, we hope this manual gives you the knowledge and skills to be able to be aware of the Ageing as a Global Health Issues and the work that is being done as well as empower you to pick up projects and advocacy in the pursuit for a world which believes in active ageing and life course approach.
Happy Reading!
Coordinator: Nishwa Azeem SCOPH Director
Co-coordinator: Sheharyar Zameer NPO IFMSA-Pakistan
Contributors: Sheng Alex Yang SCOPH RA Asia Pacific
Publications: Katja ÄŒiÄ? GA SCOPH
Sanne De Wit Liaison Officer for Public Health Issues
INTRODUCTION For the first time ever, we can expect to live above the age of 60 and beyond. This is one of the greatest achievements of Global and Public health. In 25 years, there has been an increase of approximately 20 years in the individual’s life expectancy. The world demographics show that the elderly population is dramatically increasing, making it the most rapidly growing population, with numbers increasing from 8.5% (2015) to 16.7% (2050) of the total world population. Where one congratulates world leaders, health-care professionals and community developers on this great achievement, one also realizes that it brings a great shift of dynamics to our communities, not only in health but economics, legality and virtually all aspects of the society. But here’s the thing that needs to be realized: these extra years of life actually bring a great quantity of unprecedented opportunities that impact on our lives. Older people are a precious, often ignored resource that makes an important contribution to the fabric of our societies. If these years are lived in disability and decline due to diseases, the implications on the society will be extremely negative. Although people now live longer there is little evidence to support that they’re experiencing better health in their old age compared to their parents.
WHAT IS AGEING? ACTIVE AGEING
LIFE COURSE APPROACH
Active Aging is “the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.” It refers to continuing participation in social, economic, cultural, spiritual and civic affairs, not just the ability to be physically active or to participate in the labour force even for those that are ill or live with disabilities.
Effective developmental systems for the implementation of Active Aging systems are sustainable only through the ‘life course’ approach.
[4]
A life course approach refers to an approach that deals with any aspect of an individual's life by considering the structural, social, health and cultural,etc contexts of that individual's life. [3]
Nations can only then afford to get old if governments, international organizations and civil society enact “active ageing” policies and programmes that enhance the health, participation and security of older citizens. In all countries, and developing countries in particular, measures to help older people remain healthy and active are a necessity, not a luxury. The time to plan and to act is now.
The Life course approach takes into consideration previous researches according to which, if this approach is inculcated in the economic, health and care-service models of nations its would result is a drastically better health of its people with the healthy life expectancy predicted high, as shown. (Healthy life expectancy is the commonly used synonym for “disability-free life expectancy”.) [4]
ASPECTS OF AGEING SIGNIFICANCE OF AN AGEING POPULATION By the time we reach mid-century, the elderly Population will continue to be the fastest growing population. India and China will have the highest number of elderly people. The countries with the highest Geriatric Populations in terms of their percentage will be Japan, Italy, Germany, Greece, Spain, Belgium, UK, Netherlands and France respectively. Brazil, Qatar, Saudi Arabia, Costa Rica, Colombia, Singapore, Turkey, Bangladesh and many other nations will have doubled their 60+ populations and quadrupled their 80+ populations. For the first time ever we will see a significant 100+ population. Not only will elderly populations continue to rise but, the pediatric and adolescent populations will continue to fall attributed to the declining fertility rates. With these populations declining and the socioeconomic trends continuing, the geriatric population will grow at an even faster rate.
I. The Economic Imperative:
III. Inadequate Care-Systems:
One of the biggest problems for the geriatric populations is the failure to design economic models that are age-friendly. The economic analyses of models that are often used for geriatric populations today show that they lead to inappropriate responses. One commonly used economic indicator is the OldAge Dependency Ratio, which has been defined as the ratio of the Older Population (65+ years old) to the working-age population (15–64 years old). This model of measurement fails because it doesn’t consider that Age is not a perfect marker of behavior and assumes that everyone above the age of 65 is dependent.
Health services are not adequately integrated with long-term care systems. This leads to costly acute services being used to meet chronic care needs and a failure to fully foster the functioning of older people receiving long-term care. This in turn requires the establishment of increased care service centers for the increasing geriatric population and a workforce trained in geriatrics and gerontology.
On the other hand, Models set by the World Economic Forum show that by implementing correct policies for the establishment of age-friendly economic system that run for the entire life-course, lead to a huge contribution of the geriatric population towards the national economy.
Long-term care and support can ensure that they live dignified lives with opportunities for continued personal growth. Yet, unhealthy behaviors remain prevalent among older people, health systems are poorly aligned with the needs of the older populations, in many parts of the world it is unsafe and impractical for an older person to leave their home, caregivers remain untrained, and at least 1 in 10 older people is a victim of some form of elder abuse. The ageing of populations thus demands a comprehensive public-health response.
II. Failing Health Systems:
IV. Ageism:
Health systems today are designed to cure acute conditions better than to manage and minimize the consequences of the chronic states prevalent in older age.
Ageism is the discrimination against an individual or generalized stereotyping of a group based on their age. Ageism can take place in many forms, most important of which is practices that perpetuate stereotypical beliefs. Negative ageist attitudes are widely held across societies and researchers suggest that ageism may now be even more intense than sexism and racism.
Moreover, these systems are often developed in professional silos and so address each of these issues separately. This can lead to polypharmacy, unnecessary interventions and care that is less than adequate. What needs to be done is that a system of evidence based health policies be introduced, based on the life course framework through an interdisciplinary approach.
EvenEven the notion that old people can’tpeople take carecan’t of the notion that old themselves; or can’t do new things work;do or play; take care of themselves; oratcan’t new or should accept illness as a necessary part of aging, things at work; or play; or should acceptis ageing in its essence.
illness as a necessary part of aging, is ageing in its essence.
Ageism becomes self-fulfilling by promoting in older people stereotypes of social isolation, physical and cognitive decline, lack of physical activity and economic burden.
V. Untrained Professionals: There is a great need for the inclusion of geriatrics in the curriculum of all medical schools as an essential part along with updating the researches on the geriatric population with better means because in more than 130 nations of the world we lack health-care professionals trained to deal with old people.
THE PUBLIC HEALTH PERSPECTIVE TO AGEING Non Communicable Diseases: As individuals age, noncommunicable diseases (NCDs) become the leading causes of morbidity, disability and mortality in all regions of the world, including in developing countries, as shown. NCDs, which are essentially diseases of later life, are costly to individuals, families and the public purse. But many NCDs are preventable or can be postponed. Failing to prevent or manage the growth of NCDs appropriately will result in enormous human and social costs that will absorb a disproportionate amount of resources, which could have been used to address the health problems of other age groups. If the global trends continuing as such, along with the demographic shift an accompanying Epidemiological Transition will follow where the major category of disorders of global health will be Non-Communicable diseases becoming common enough that NCDs would become even common among adolescents and adults. At the end it will be the life course approach that will affect the likelihood of these disorders including tobacco use, exercise, diet, etc. Ultimately, the worldwide shift in the global burden of disease toward chronic diseases requires a shift from a “find it and fix it� model to a coordinated and comprehensive continuum of care. This will require a reorientation in health systems that are currently organized around acute, episodic experiences of disease. The present acute care models of health service delivery are inadequate to address the health needs of rapidly ageing populations.
Mental Health: Mental health services, which play a crucial role in active ageing, should be an integral part of long-term care. Particular attention needs to be paid to the under-diagnosis of mental illness (especially depression) and to suicide rates among older people. Long-Term Care Systems: Long-term care includes both informal and formal support systems. The latter may include a broad range of community services (e.g., public health, primary care, home care, rehabilitation services and palliative care) as well as institutional care in nursing homes and hospices. It also refers to treatments that halt or reverse the course of disease and disability. Physical Activity: Participation in regular, moderate physical activity can delay functional declines. It can reduce the onset of chronic diseases in both healthy and chronically ill older people. For example, regular moderate physical activity reduces the risk of cardiac death by 20 to 25 percent among people with established heart disease. It can also substantially reduce the severity of disabilities associated with heart disease and other chronic illnesses. Healthy Eating: Eating and food security problems at all ages include both undernutrition (mostly, but not exclusively, in the least developed countries) and excess energy intake. In older people, malnutrition can be caused by limited access to food, socio economic hardships, a lack of information and knowledge about nutrition, poor food choices (e.g., eating high fat foods), disease and the use of medications, tooth loss, social isolation, cognitive or physical disabilities that inhibit one’s ability to buy foods and prepare them, emergency situations and a lack of physical activity. Oral Health: Poor oral health – primarily dental caries, periodontal diseases, tooth loss and oral cancer – cause other systemic health problems. They create a financial burden for individuals and society and can reduce self-confidence and quality of life. Studies show that poor oral health is associated with malnutrition and therefore increased risks for various non communicable diseases. Oral health promotion and cavity prevention programmes designed to encourage people to keep their natural teeth need to begin early in life and continue over the life course. Because of the pain and reduced quality of life associated with oral health problems, basic dental treatment services and accessibility to dentures are required. Alcohol: While older people tend to drink less than younger people, metabolism changes that accompany ageing increase their susceptibility to alcohol-related diseases, including malnutrition and liver, gastric and pancreatic diseases. Older people also have greater risks for alcohol-related falls and injuries, as well as the potential hazards associated with mixing alcohol and medications. Treatment services for alcohol problems should be available to older people as well as younger people. Medication: Because older people often have chronic health problems, they are more likely than younger people to need and use medications – traditional, over-the-counter and prescribed. In most countries, older people with low incomes have little or no access to insurance for medications. As a result, many go without or spend an inappropriately large part of their meager incomes on drugs. In contrast, medications are sometimes over prescribed to older people (especially to older women) who have insurance or the means to pay for these drugs. Adverse drug-related reactions and falls associated with medication use (especially sleeping pills and tranquilizers) are significant causes of personal suffering and costly preventable hospital admissions.
Adherence: Access to needed medications is insufficient in itself unless adherence to long-term therapy for ageing-related chronic illnesses is high. Adherence includes the adoption and maintenance of a wide range of behaviours (e.g., healthy diet, physical activity, not smoking), as well as taking medications as directed by a health professional. It is estimated that in developed countries adherence to long-term therapy averages only 50 percent. In developing countries the rates are even lower. Such poor adherence severely compromises the effectiveness of treatments and has dramatic quality of life and economic implications for public health. Iatrogenesis: Health problems that are induced by diagnoses or treatments – caused by the use of drugs is common in old age, due to the interaction of drugs, inadequate dosages and a higher frequency of unpredictable reactions through unknown mechanisms. With the advent of many new therapies, there is an increasing need to establish systems for preventing adverse drug reactions and for informing both health professionals and the ageing public about the risks and benefits of modern therapies. Tobacco Use: Smoking may interfere with the effect of needed medications. Exposure to secondhand smoke can also have a negative effect on older people’s health, especially if they suffer from asthma or other respiratory problems. Most smokers start young and are quickly addicted to the nicotine in tobacco. Therefore, efforts to prevent children and youth from starting to smoke must be a primary strategy in tobacco control. At the same time, it is important to reduce the demand for tobacco among adults (through comprehensive actions such as taxation and restrictions on advertising) and to help adults of all ages to quit. Studies have shown that tobacco control is highly cost-effective in low- and middle-income countries.
DETERMINANTS TO CONSIDER FOR AGEING Active ageing depends on a variety of influences or “determinants” that surround individuals, families and nations. Understanding the evidence we have about these determinants helps us design policies and programmes that work.
o Culture: Culture, which surrounds all individuals and populations, shapes the way in which we age because it influences all of the other determinants of active ageing. o Gender: Gender is a “lens” through which to consider the appropriateness of various policy options and how they will affect the wellbeing of both men and women. o Health and Social Service Systems: To promote active ageing, health systems need to take a life course perspective that focuses on health promotion, disease prevention and equitable access to quality primary health care and long-term care. o Behavioural Determinants: The adoption of healthy lifestyles and actively participating in one’s own care are important at all stages of the life course. One of the myths of ageing is that it is too late to adopt such lifestyles in the later years. On the contrary, engaging in appropriate physical activity, healthy eating, not smoking and using alcohol and medications wisely in older age can prevent disease and functional decline, extend longevity and enhance one’s quality of life. o Personal Factors: Diets high in (saturated) fat and salt, low in fruits and vegetables and providing insufficient amounts of fibre and vitamins combined with sedentarism, are major risks factors for chronic conditions like diabetes, cardiovascular disease, high blood pressure, obesity, arthritis and some cancers. o Physical Environment: Physical environments that are age friendly can make the difference between independence and dependence for all individuals but are of particular importance for those growing older. o Social Environment: Social support, opportunities for education and lifelong learning, peace, and protection from violence and abuse are key factors in the social environment that enhance health, participation and security as people age. o Economic Determinants: Concentrating only on work in the formal labour market tends to ignore the valuable contribution that older people make in work in the informal sector (e.g., small scale, selfemployed activities and domestic work) and unpaid work in the home.
SIGNIFICANCE OF THE LIFE COURSE APPROACH A Life Course approach to policy and programme development has the potential to address many of the challenges of both individual and population ageing. When health, labour market, employment, education and social policies support active ageing there will potentially be: Fewer premature deaths in the highly productive stages of life; Fewer disabilities associated with chronic diseases in older age; More people enjoying a positive quality of life as they grow older; More people participating actively as they age in the social, cultural, economic and political aspects of society, in paid and unpaid roles and in domestic, family and community life; o Lower costs related to medical treatment and care services. o o o o
ACTIVITIES AND ADVOCACY
»HOW TO START« Before starting any Activity: a. Before starting any Activity ask: “Is the issue you are about to tackle, really an issue?” We want to make sure there is a need and the activity would not be a waste. Asking this would determine if unhealthy aging really a problem and if it is a Public Health issue in one’s country/city/locality.
Example of Answers:
o Yes, it is a good start and that your efforts will not be meaningless. Statistics in this manual and further research can help you to further prove that Unhealthy Aging and Lack of systems based on Life-Course truly are Global Public Health issues also if present in your country. o No, you need to broaden your search, find more sources, reconsider the topic you are working on altogether.
b. To Identify the reasons why you are addressing the issue ask: Why are we tackling Unhealthy Aging and Why are we organizing it during International Day for Older Persons? Answering the ‘Why’ questions can be one of the hardest parts of your Activity, but once you have, you will have a clearer perspective on the Activity you want to organize.
Example of Answers:
o Why Unhealthy Aging: Because it is a major Public Health concern in my country and globally. o Why organize an Activity during IDOP: Because on this day multiple stakeholders as well as colleagues are also celebrating the event, and by organizing the event together, we have a louder voice and stronger impact. o Why we are tackling it as Medical Students: Because we are following a vision to make this world a healthier place as the IFMSA Vision/Mission or Because we are health leaders of tomorrow and we care about the health of the societies we will work in as doctors.
c. To define a Vision for your Activity ask: What is the ideal situation that you would like to be in, about the topic you are tackling? A vision is a seemingly idealistic statement, which constitutes the core of why you are doing something. The ‘why questions can help you identify the vision.
Example of Answers:
o General: We believe in a world where in which every person ages healthy and nobody is ever affected by Ageism and older people are a productive and integrated part of the society. o More Specific: We believe in a world in which each individual is provided the services and environment to age healthy and measures are taken against Ageism in all forms and older people are provided the opportunities to become more inclusive and useful parts of the society.
Start giving your Activity a skeleton: Goals and Objectives are the “What” and “How” of your Activity. They will help you know exactly what is going to happen and help when you will evaluate your Activity. a. Define Goals A Goal embodies “How” you will follow your vision. You have already defined that Unhealthy Aging is a global health issue, that as a medical student you believe in making the world healthier place. You have to keep in mind the resources (human, financial, etc.) you have for your Activity so you do not shoot way higher than you can reach. A series of Goals which have unity between them will give shape to your Activity. Your Goals could be endless and span from: o Raising awareness about Active Aging and Life Course o Consulting older people in designing care systems for them o Advocate for theoretical and practical training in geriatrics and gerontology in medical schools o Campaign against Ageism in all its forms o Campaign for the utilization of Life-Course in Health policies to achieve active ageing b. Identify Objectives Objectives are the specific list of “What” you are going to do to achieve your Goals. Defining a list of Objectives related to each Goal is a crucial point of activity planning it can make all the difference between complete success and failure. Objectives have to be based on what your resources are and how much time you have to achieve your goals. To define your objectives with the SMART acronym; objectives have to be: S: Specific (Key Questions: “who”, “what”, “when”, “where”, “how”) • WRONG: Talk to people about ageing [unclear exactly what we want these people to do.] • RIGHT: Talk to at least 60 adults aged between 35-75 about practices for active ageing for 4 hours to spread awareness on the on Active Aging. [Here it is very clear what is going to happen.] M: Measurable (Key Question: Start thinking about how you are going to be measuring these) • RIGHT: Talk to at least 60 adults aged between 35-75 about practices for active ageing for 4 hours to spread awareness on the on Active Aging [Easily measurable - we just have to count.] A: Attainable • WRONG: Talk to at least 3000 adults aged between 90-95 about practices for active ageing for 1 hours to spread awareness on the on Active Aging. [Define an objective that you will be able to obtain within the time you have and the resources you have.] • RIGHT: Talk to at least 60 adults aged between 35-75 about practices for active ageing for 4 hours to spread awareness on the on Active Aging. [This is more realistic than the previous objective.]
R: Relevant • WRONG: Get at least 60 adults aged between 35-75 to draw 1 picture of a fish during IDOP day. [This has nothing to do with tackling our issue!] • RIGHT: Talk to at least 60 adults aged between 35-75 about practices for active ageing for 4 hours to spread awareness on the on Active Aging. [Physical activity helps lower blood sugar, and prevent Diabetes. Teaching people about it can help them develop this habit, this would be relevant] T: Time Bound • WRONG: Talk to at least 60 adults aged between 35-75 about practices for active ageing. [When? In how long will this Activity last a month, a decade, 2 hours?] • RIGHT: Talk to at least 60 adults aged between 35-75 about practices for active ageing for 4 hours to spread awareness on the on Active Aging on IDOP. [Knowing by when you have to be done will aid you in effectively organizing your activity as well as measuring your results at the end]
Take Home Message: o Identify the issue [Is it really an issue?] o Ask yourself why? [Why this? Why you?] o Define your Vision [What do you believe in?] o Set Goals and Objectives [How and What are you going to do to follow your vision?] Other important preparations that can help you: o Timeline: Define a specific timeline for all the elements of your Activity including preparation time, the activity itself and the follow-up period. o Stakeholder: Create a stakeholder map to identify the people and organizations that could help you or hinder you in your Activity. o Risk Management: Evaluate all the risks tied to the planning and executing of your activity example if you need a sunny day or if your colleagues could get sick or if your main sponsor could pull out at the last moment. Recognizing what would the consequences be and as a follow-up, for each risk, consider firstly, how likely it is to happen and secondly, how much damage it would make if it did happen. Finally plan what you can do to both prevent it, or handle it if it happens. o Resource Management: For each SMART objective you will swiftly be able to determine and list what resources you need. Subsequently you can make a plan to obtain them and then you can start your Activity! Additionally, needed resources can also be less tangible things, like “obtaining permission from the City to set up a stand in the main square”, or “obtain permission from the school to not attend classes on the day of your Activity”.
Now you are ready to get your Activity going! What you can do a. Prevention Promoting awareness can have a strong impact. The awareness can be directed towards changing people’s Knowledge, Behavior or Perception of an issue. All of these domains can contribute to people developing healthier lifestyles, and paying attention to the risk and other factors of diseases. Awareness is therefore a close synonym to Prevention. In a strategic Activity design it is important to keep these three domains in mind when defining objectives and when defining evaluation methods so we can impact people holistically. Examples of these changes: o Knowledge: Following your activity, a person learns about the methods to age actively. o Behavior: Following your activity, an older person develops the habit of exercising and participating in social and economic activities regularly. o Perception: Following your activity, a person does not consider ageing synonymous to isolation and decrease in productivity.
Examples of Activities:
1. IDOP Information Stand Distribute flyers, stickers, pins and information about Active aging and Life course, either in your University or City. For this kind of an event, a solid evaluation system is essential to measure the impact you have. Performing a pre- and post- questionnaire to evaluate people’s knowledge before and after you in tract with them, will help evaluate your activity. Ideas you can include: o Measure BMD or other Screening criterions for aging o Inform people about the contribution potential of elder people to the society. o Encourage activities with social inclusion of elder people o Encourage physical activity among older people o Encourage medical students to learn more about geriatrics and gerontology o Challenge people to solve a quiz about the topic you are promoting
TIPS o Create eye-catching infographics for flyers you could try using piktochart.com or canva.com. o Choose few messages, but very clear ones that you want to share with your target group. o Join the fight against stigma, by also about letting people know about what it means to be an active person of age, and the related social issues that can arise as consequence like stereotyping, discrimination, lack of work. o Encourage people to take picture be active on social media and use relevant campaigns.
2. IDOP Party Organizing a party at your university will help both raise funds and awareness about your cause. It can be the perfect prelude to the organization of a conference or recruitment of motivated students who could help you with your project in the future. o Make the theme of the party clear. o Inviter elder people to interact with the younger people and have entertainment for them. o Give the guests something creative to promote your theme (e.g. Posters of legendary old actors, “60’s” party theme etc.). o Make sure your theme has thematic props, and a photo corner, so you will be able to promote the success of your party also after the event, and market it in the future. o Ensure you have a solid strategy, planning and timeline for follow-up. 3. IDOP Conference A Conference’s target group will be smaller compared to that of an Information Stand, but would be advantageous as more information can be transmitted to the participants. Inviting medical students and elder people can help both increase visibility of your NMO within the student community as well as recruit motivated students to take part in other interventions you will be organizing. It also gives a chance for increased interaction between elder people and medical students and a forum for voices of older people to be heard and inculcating a sense of relevance for them. By inviting important members of your community, you can increase the visibility of the event, and make some noise for a follow-up Activity such as an Info Stand. 4. IDOP Online Campaign The main benefits of an Online Campaign are that the potential outreach of a single post can be gigantic, and the efforts put into it can be minimal, compared to other Activities. A Media Campaign can help have a greater impact in terms of visibility of your message, or can simply help you create an atmosphere of cohesion between you and your team, if everyone is participating. It can also aid the international work of multiple organizations, if you take part in their Media Campaign, instead of organizing your own e.g. Selfie Apps, Facebook Frames, Challenges to make photos with and use them as Profile Pictures. This Activity could be a good choice if time is limited, as well as other resources. Any of these can either be made by you, or you can share ones already created by someone else. What you can post on Social Media, to promote your campaign: o Photos o Videos o Articles o Posts (Facebook, Twitter, Instagram etc.) o Polls
TIPS o
o o
Some videos and images are protected by Copyright! Make sure you check the sources of all of your materials to make sure that uploading them yourself will not lead to problems for you. Very often you can check Copyright terms by scrolling to the very bottom of websites and clicking on “Terms of Use”. There are strict rules about how IFMSA logos can be used. Please consult the IFMSA Corporate Identity Manual to make sure you are not using Federation logos the wrong way. Choosing to organize a Media Campaign as an Activity alone does not mean that you do not need a Vision, Goals and clear Objectives - these are always useful and crucial to a successful Campaign!
b. Advocacy Lifestyle ad behavioral changes determine health of individuals but there are numerous factor we cannot control and thus we advocate for them. Advocacy is a crucial and integral pillar in Public Health work, as it can bring to positive change, supported by decision making bodies. When people think about advocacy, they think about the kind of activities that an organization or group of individuals can undertake. These could include: Press conference, Strike March, Court cases, Poster campaign, Round table, Pamphlets, Survey/Opinion Poll, Theatre Workshop, TV or radio drama, Letter writing, Petitions, Public forum, Conference, Press release, Policy research, Exposure tour, Lobbying, Flyers, Website Networking, Coalitions or networks, Newsletters etc. When pursuing advocacy, it is especially important to define clear and impactful answers to the “why” questions, for instances why does the issue exist. The entities or individuals you approach will want to know why you are pursuing a certain goal. Planning: It is also important to know which factors determine or influence the issue, which ones can be changed, and which ones cannot. It is important to define who your potential “allies” can be such as producers of sports gear while promoting physical activity as well as who the potential “enemies” could be such as a Fast Food industries, while you are promoting Healthy Diets. To have a clear overview of your potential supporters you can create a Stakeholder Map. Plenty of How to guides and Stakeholder Map models can be found online. When it comes to Advocacy, there are many different people you can spread your message to. Of all the ones who support you though, probably not all of them will be able to help you in the way you expect. This is why it is important to define who the key players are in every situation, especially in situations you are attempting to influence. Accordingly, you will have set your priorities of how to meet them, talk to them, and present your case in the hopes of convincing them of the change you seek. Key Questions: There are five key questions to ask when thinking about advocacy and developing an advocacy strategy: A. What do you want to change? B. How will change happen? C. What is your core argument/message? D. How are you going to win the argument or deliver the message? E. How will you know if you are making progress or have succeeded?
Proposing Solutions (Change): Proposing solutions in general, when engaging in advocacy it is difficult to meaningfully engage in influencing change by just pointing out what is wrong with the current situation (the problem). It is helpful to have a proposal for change; a solution or recommendations. If you are going to engage in discussions with decision makers around your solution it can be important to ‘test’ it for any weaknesses. Key questions: o Is your solution/recommendation realistic? o Can it be implemented without much expense? o Is your solution simple and easy to understand? o Could your solution/recommendation achieve tangible results in a short period of time? o Who will oppose your solution/recommendation or be sceptical about it? Why? o Will decision-makers like your solution/recommendation? Why? Why not? o Are there other solutions to the problem that are more practical than your initial idea, and that will be more appealing to the decision makers? What are these solutions? Momentum of Change: How change happens is context (and issue) specific so it is important to think about what you know about the context for change (whether at the international, national or local level). Key to understanding how change will happen is knowing who has the power to make decisions in relation to your issue and who influences them. It is also important to reflect on the role that your individual organization can play in influencing change. 1) Understanding the context for change A very simple way to think through your context and make sure you are taking it into consideration in relation to your advocacy strategy is to use the PESTLE framework. This is often used in strategic planning processes. PESTLE stands for the (P)olitical, (E)conomic, (S)ocial, (T)echnological, (L)egal and (E)nvironmental context. It can also be useful to add in an extra ‘I’ (PESTLEI) which covers the (I)nternational context – the involvement of international donors or agencies in your context. In turn think about each element of the context (the political, then the economic…) and think about how it affects your issue. Example: There may be elections coming up (political context) or there may be a high rate of inflation which affects the price of food (economic context). Once you have been through each of the elements (PESTLEI), sit back and reflect on what it tells you about your context and what you need to consider in relation to your advocacy strategy. For example, election time can potentially be a good time to advocate as political parties may want to include your ideas in their manifestos but also on the other hand there may be greater instability, politicians may be distracted and civil society space may be constrained. 2) Understanding who will be involved in change First list all of the potential stakeholders that are involved your issue currently and would need to be involved in the change you want to see. You will probably need to do some research in order to identify individuals within organizations as we influence people not institutions. Having the stakeholder analysis can be useful but it is difficult to visualize and understand how the various stakeholders relate to each other and also how your organization or you as an individual can actually influence the decision-maker either directly or indirectly. For example, there could be a range of different ways to influence the decision-maker.
The kinds of organisations/institutions you may want to include are: o National Government o Local Government o Orgs working for elder people’s rights o Medical Schools and Institutes o Business and the private sector o Non-governmental (Civil society) organisations o Professional bodies such as physicians, veterinarians, etc. o Religious or community leaders o Media o International donors and international organisations Example: if you identify that the Daily National Newspaper is an important media stakeholder, you may need to think about who at the Daily Nation Newspaper you need to influence – is it the Editor, the health columnist or the opinion page editor? Once you have identified the individuals, you may want to gather other information which helps you to understand their interests so that you can better target your advocacy and understand whether they are allies or opponents of your ideas. 3) Understanding multiple paths to influence: The most effective advocacy strategy might be to use a combination of all the below approaches in order to develop momentum and pressure for change. o You could request a meeting with the public health minister directly. o You could focus on increasing press coverage that will influence the Minister. o You could engage with the parliamentary committee on health who would produce a report that would be sent to the Minister. o You could engage religious leaders within the Catholic Church who may be able to influence the Minister. o You could form an alliance with the professional association (community developers, gerontologists, Public Health Workers, Family Doctors, etc). 4) Understanding importance of Advocacy in Aging: o Is the health care system in your country oriented towards care for elder people? o Is there a policy in your country which could be modified in regards to Life Course? o Are services and opportunities for healthy ageing available for all citizens in your country? o Do geriatric patients have access to affordable medications? Is there access for everyone affected, or is it limited to specific conditions? Example: o University: Does your medical school train their medical student theoretically and clinically in geriatric care? Taking advantage of the celebration of the IDOP can be a good starting point to open a conversation with various departments in your university and start provoking change for your student colleagues. o Community: Each community has weak spots, some which you could impact as future health professionals! Start a conversation with local officials to have a stronger influence on health where you live.
Advocacy might not cause overnight change that might seem ineffective to you, but this is completely normal! Revise your strategy, your approach to the different stakeholders, and keep trying. Often, it will not be enough to explain the Why of the issue to the parties you approach. It important to be able to explain Why changing the issue in your favor could also be beneficial for the people and practical for them (e.g. prevention is less expensive than treatment, therefore the Government would save expenses if they invested more in prevention).
Advocacy Take Home Message: o Be well informed about the issue you are fighting to change o Define a Stakeholder map o Create a clear, evidence-based message that will support your cause o Find support from relevant parties o Keep your interests in mind, but also evaluate what interests others may have in your action, to improve your chances of finding support o Never forget to define your Vision, Goals, Objectives.
EXPERIENCES Dean Athru 2017/18 Project Summary Dean Athru, is a national NMO advocacy project being organized by the Association of Medical Students Ireland (AMSI) each year. In 2016/17 Dean Athru was on the subject of Mental Health, and was awarded the Rex Crossley Award. This year’s 2017/18 theme will be on the subject of “Ageing in Ireland”. This idea came about when AMSI’s president, Dr Kevin McMahon, identified a very large need for the medical profession to engage with the elderly population. In 2013, 12% of the total population was over the age of 65. This is set to rise to 22%, by 2041 (Central Statistics Office, 2013).
Dean Athru, is a national NMO advocacy project being organized by the Association of Medical Students Ireland (AMSI) each year. In 2016/17 Dean Athru was on the subject of Mental Health, and was awarded the Rex Crossley Award. This year’s 2017/18 theme will be on the subject of “Ageing in Ireland”. This idea came about when AMSI’s president, Dr Kevin McMahon, identified a very large need for the medical profession to engage with the elderly population. In 2013, 12% of the total population was over the age of 65. This is set to rise to 22%, by 2041 (Central Statistics Office, 2013). The target audience of this project will be Irish citizens aged 65+, as well as concerned NGOs. The enablers will be medical students. The following are goals set: o To consult older people on what we should be working on about the topic o To allow older people to become more involved in their care. o To enable older people to see how they may be able to keep themselves healthier at home o To provide a platform for communication between healthcare students and older people outside of the healthcare setting o To enable younger people to gain an insight into the fears and expectations of older people from a Bio/Psycho/Social standpoint o To allow healthcare professionals to have a partnership with older people outside of the professionalpatient relationship o To foster community, government, and private sector partnerships to support the needs of older people. o To raise funds for resources focussed on the older person o To assess how the elderly view their localities and how well they are able to access supports for their activities of daily living, and to advocate on their behalf with municipal governments/planners. The campaign will consist of events, advocacy and surveys.
Event There will be one large, day-long event - in the form of a forum, on campus, where the local elderly will be openly invited to a day filled with entertainment, discussions and food. The aim will be to create a safe space for them to share their feelings about healthcare and ageing in Ireland. They will be able to engage in discussion with attending physicians and medical students, as well as NGOs, to voice their concerns. The following subjects will be addressed through workshops or presentations, a) Medical lingo...“scans”, “tests” - what do they actually mean? b) How to encourage a more positive experience in hospitals, through understanding how the system functions c). Tea and Talk with healthcare students d) from various standpoints such as nutrition - how to remain healthy outside of hospital using a multidisciplinary team approach. Each AMSI Local Committee will hold their own event. Survey A survey regarding what the elderly are afraid of within the health service will be distributed at the event, and also around local care homes. Advocacy We also aim to advocate for more funding to be allotted toward the ageing population in Ireland. In particular, we would like to stand against the privatisation of home care and nursing home care. The population is drastically ageing as people are living longer and healthier lives. AMSI would like the governments to act accordingly, to ensure no senior citizen has to live in poverty after retirement. The advocacy will be done in the form of a social media campaign and press releases.
Encouraging healthy lives Aside from listening to and understanding the elderly’s concerns with regards to healthcare, AMSI will also attempt to promote healthy aging through suggestions. Through evidence-based medicine and looking at the biopsychosocial model, we will urge them to take ownership of their health and proactively make holistic changes that they can make themselves to ensure they remain healthy over the ensuing years. This will be in the form of workshops and infographics. Assisting NGOs AMSI will engage with NGOs dedicated to improving the life of the elderly in Ireland. We shall assist by providing medical student volunteers to help with outreach - through home visits, nursing home entertainment, etc. The purpose of this year’s Dean Athru, aside from fundraising, is to spark the awareness among medical students and the wider community, that the voices of those Ageing in Ireland should be heard, and listened to. Email Rosie at loph.amsinuig@gmail.com for more information.
EVALUATE YOUR WORK
»HOW TO END« Evaluating your projects is crucial in order to compare the results with the initial objectives and measure the impact created. It is useful to know the things that have worked, and the things to be changes for the next time.It is important to include the members who took part in preparing your activity in the evaluation process, as the lessons learnt from this project will serve as a basis for future ones. In 3 key points, it is important to perform an evaluation about your Activity: o So you know if you are making an impact o So you are aware of unintended outcomes o So to build organizational resilience within the team o So you can improve your Activity in the future Provide evidence of impact is essential for successful organisations. This can be done by gathering, analyzing and presenting scientific data which prove that work was performed, activities implemented and a difference was made in society through it.
Proof of Impact can be achieved in multiple ways:
1. Feedback is a subjective way of gaining important information about the design, implementation and impact of your Activity from the population’s perspective, from the organizers, the collaborators and others. When gathering feedback from the public, they generally feel comfortable with medical students as a model for health promotion and do not have difficulties in sharing their thoughts and engaging in campaigns.Also consider adding an open question to your feedback survey, giving participants space to share anything they might feel they want to add and let you know about what they think.
To add ‘qualitative’ rather than ‘quantitative’ evaluation information about your Activity, you can also randomly organize slightly longer interviews with certain members of your Target Group. This will allow you to explore the opinions of your participants or collaborators more in-depth, and can result in very useful information to improve your Activity in the future. Example of Questions: o Do you feel like you learned valuable information about Active Aging? Yes / No o Do you feel like you have learned about the principal factors influencing Aging? Yes/No o Do you think you will change something in your lifestyle after experiencing this Activity? Yes/No o Please rate from 1 to 10 how important you thought awareness about Active Aging was before experiencing this Activity o Please rate from 1 to 10 how important you think awareness about Active Aging is after experiencing this Activity o Do you have any comments you would like to share with us? TIPS o
o
When you create feedback surveys, make sure they are adapted to the people you are presenting them to (a survey for your colleagues might have to be different than a survey for participants!). Do not include too many questions in your survey, and keep the questions short (also ask questions that can have short answer)! People do not like to spend more than 1-3 minutes on a survey. Limit the number of questions to the strict essential, less is more!
2. Data gathering
is an objective method of evaluating your Activity. It will give you a clear idea about the magnitude of your Activity, and help realize whether you have met your objectives or not. If you are to organize massive outreach campaigns targeting the general population (e.g screening campaigns), you can analyze the data collected in a form of a retrospective study that will show correlations in the results found, but also provide recommendations for further campaigns in the methodology used. Examples of Data Gathering: o Number of people who participated in your Activity o Number of people who answered your surveys o Number of screening tests performed o Number of flyers distributed o Screening values 3. 3. Measuring the change in the participants' Knowledge or Behaviour is also an objective method of evaluating your Activity. Often evaluating knowledge can be easier than analyzing behavioural changes. There are however multiple difficulties tied to both types of this evaluation.
Methods:
“Pre-” and ”post-” surveys
For any Activity you conduct, you can perform this type of evaluation. If you are to conduct workshops or conferences, it would be good to share pre-surveys to assess the preliminary knowledge of participants related to the topic of the event. At the end, assess if their opinion and responses have changed following the event, to evaluate the level of comprehension and whether the take-home messages were impactful. The questions included in the Pre- survey, have to be the same as in the Post- survey, so you can evaluate the difference in response, and therefore the difference in knowledge. The distance between a Pre- and Post- survey can vary between a few minutes and months. They can be delivered right at the start and then the end of your Activity, or can be sent to your participants 1 month before, and then again 1 month after the Activity. How this happens will depend on the number of participants, your contact with them, and the objectives of your Activity. To include behavior in this type of evaluation you can include questions like: Example of Questions: o Describe your dietary habits and your physical activity routine o From 1 to 10, how much attention do you pay to buying healthy food? o How many times a week do you perform sports? TIP To effectively evaluate changes in knowledge and behavior, it would be ideal to plan a considerable distance between your Pre- and Post- survey. Answering a knowledge survey 5 minutes after hearing information is not the same as having to answer the same survey 2 weeks later. Similarly, it takes time to modify habits, and evaluating behaviour changes can be a lot more meaningful if it is done a few weeks after the Activity.
Evaluation Strategy: It is crucial t to define an evaluation strategy before you start your Activity. To ensure it is clear how you will measure whether your objectives have been reached or not. Example: If your objective is “Talk to at least 60 adults aged between 35-75 about practices for active ageing for 4 hours to spread awareness’ , you will have to make sure to put someone in charge of counting participants, asking them their age, and someone keeping track of time. You will also have to make sure there is a way for you to easily access this information after the Activity. For each objective, analyze what evaluation tools you can and will use, and make sure to prepare for them carefully.Remember to plan a timeline also for the evaluation and follow-up of your Activity - do not forget that quality evaluation can take time.Once your evaluation is complete, make sure you can use the analysis of your data to improve your Activity in the future, as well as approach other parties with the proof of your impact, to increase the support you will have in the future. Be sure to plan a solid evaluation strategy.
Take Home Message: o Plan your evaluation strategy before the start of the Activity o Consider multiple types of evaluation methods, to gain a full picture of the impact of your activity o Carefully analyze all the data you have gathered so you can present it to future collaborators, colleagues, external organizations. o Use your data analysis to also improve the Activity design for the future.
4. Measuring Impact on a higher level: how we measure impact as a Federation Centralizing activities: The IFMSA NCDs and Healthy Lifestyles Program Programs in IFMSA exist in order to help you set the basics for your Activity in terms of project management, to help you measure the impact on the federation level and to showcase your activity with the NMOs and potentially to externals. Programs represent a series of platforms, each gathering all the Activities related to specific topics. In this context, Active Aging falls under the Healthy Lifestyles and Non communicable Diseases Program whose Program Coordinator is appointed to gather all the Activities, projects and actions , as well as analyzing the data collected. The Program Coordinator can also provide you with best examples of Activities performed in this domain as well as give advice on project management. b. How to enroll your Activity in the Program? To enroll your activity, you have to send the Candidature Form, signed and stamped by your NMO president and complete the Enrollment Form with basic information about your Activity. You can contact the Program Coordinator or visit ifmsa.org to get the Enrollment and Candidature Forms to allow your NMO to include all their Activities into the Program. After your Activity, you have to submit the Report Form (also supplied by the Program Coordinator) to show how your activity was conducted, and supply IFMSA with data about its impact. This is how we can review your Activity and measure the impact of it, of your NMO and adding up the single impacts of all the enrolled Activities, we can finally evaluate the impact we have as a Federation. If you want to know more about Programs consult the Programs Toolkit. Receiving support from the Program Coordinators One of the most important things Programs are here for, is to teach coordinators how to conduct and evaluate Activities. Program Coordinators can support members both with Activity enrollment as well as with the content of the Activity itself, the starting resources, structure, etc. IFMSA Programs will be effective and gain more visibility only when all the IFMSA members are well introduced to the work of Programs and are aware about how to participate in them. Fortunately, it is simple and we look forward to gathering all the events being done for International Day for Older Persons in our Program. For any support feel free to send an Email to the NCDs and Healthy Lifestyles Program Coordinator (ncd@ifmsa.org)
GLOBAL
STAKEHOLDERS The IFMSA at the moment does not formally collaborate with any externals solely regarding aging, but below you can find some stakeholders to think of and a short summary of their work.
World Health Organization All work done on ageing within the WHO is coordinated by the Department of Aging and Life-Course. The WHO adopted the Global strategy and action plan on ageing and health in 2016. This strategy aims to promote healthy aging and ensure health systems that can meet the needs of older adult as an investment in a future where older adults will have the freedom to be and do what they value. The strategy has set 10 indicators to track progress of countries towards these goals. In May 2018 the mid-term progress report was published, in which you can find how your region is doing. Find all information on WHO’s work on ageing here: http://www.who.int/ageing/en/ In addition to the Global Strategy, the WHO WPRO region has a developed and adopted a Regional framework for action on ageing and health in the Western Pacific (2014-2019) during the Regional Committee in 2013. This framework offers members states evidence-based guidance on actions for achieving progress on ageing and health. Find the framework here: http://www.wpro.who.int/topics/ageing/regional_framework_final.pdf?ua=1&ua=1
Governments National Focal Points on Ageing and Health One of the indicators set in the aforementioned Global strategy and action plan on ageing and health is for countries to appoint a National Focal Point on Ageing and Health in their Ministry of Health. 82% of countries in SEARO region and 41% of countries of the WPRA region have indeed appointed such a Focal Point. A National Focal Point is, among others, responsible to identify relevant stakeholders in the country. If your country has a National Focal Point this person would be key to address when you want to advocate for action and awareness on healthy ageing and want to be recognised as a stakeholder yourself.
Non-Governmental Organizations (NGOs) There are numerous non-governmental organisations working regionally, nationally or locally on healthy ageing. Below are just a few examples. o International Federation on Ageing The international Federation on Ageing was founded in 1973 and works across 70 countries around the world. They envision a world where the health, rights and choices of older people are protected and respected. They carry out several projects as well as advocacy campaigns. They also have a lot of resources available. You can find more about their work on: https://www.ifa-fiv.org/
o Older People Associations (OPAs) OPAs are community-based organization of older people formed with the aim to improve the wellbeing of older people, their families and communities. In general, OPAs deliver services, provide social support and can act as a safety-net for people in need. They can be in charge of improving access to primary care and other health needs. o HelpAge International Since 1988 HelpAge International has worked across Asia to promote the wellbeing of older men and women. The organization currently has 5 country offices in the region and a network of 40 organisations across 12 countries. To find out about their work visit: http://ageingasia.org/
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