​Interview with Thiago Hérick De Sá, PhD., Demographic Change and Healthy Ageing Unit, World Health Organization (WHO)
1. Starting from the beginning, what is an Age-friendly environment?
An Age-friendly environment (AFE) is any environment which allows people to live, grow, have fun, teach, work, age well... A world in which everyone would like to grow older! As highlighted by the UN Decade of Healthy Ageing (2021–2030), we need to create environments which foster the abilities of older people and allows each and every one of us to live better, healthier lives, not just longer lives per se. We have succeeded in living more, now the challenge is to ‘add life’ to those additional years.
2. Recently, a new guide from the WHO was published to encourage the creation of ‘National programmes for age-friendly cities and communities’. What was the reason for this guide, why did WHO take this initiative?
Good question! Let me share with you a bit of history. In 2007, WHO launched the first guide on this issue - Global age-friendly cities: a guide - created with older people from all around the world. From asking older adults what would be for them an age-friendly city, eight main domains came out (see figure on the right).
Then in 2010, WHO created theGlobal Network for Age-friendly Cities and Communities together with public bodies in charge of its implementation, to connect people, exchange experiences and inspire each other, and it was a success. Finally, in 2015-2016, we started to notice that there was a lot to be done at local level, but there is a limit to it: without the support of regional and national programs, the actions of local communities were limited. In reaction, the WHO created a space for affiliated programs supporting the development of AFE in regions or countries and we noticed that they made a difference, promoting the creation of such environments. Hence, we developed the guide - the ‘National programmes for age-friendly cities and communities’ - to support countries in creating or strengthening existing national programs, which can also be applied to sub-national programs as well (e.g. in regions or provinces).
3. In your opinion, what is the role of technology when reaching the goals of the age-friendly cities and communities’ movement?
Back in 2010, ICTs were specially contemplated in the ‘Communication and information’ domain and identified by older adults as important for ageing well and for creating an age-friendly environment. But technology is also supporting other domains of action. You have for example, technology that brings health closer to people - assistive technology; tech that innovates housing; transports…
Unfortunately, when speaking about the role of technology in age-friendly environments, people tend to ignore social technologies. And they should not, because they are so important for example to foster intergenerational contacts, to combat ageism, to improve the social and civic participation or to reduce unintended loneliness.
In a nutshell, technology has a very important role in so many levels. And of course, there is a very important role of the local, regional, and national age-friendly cities and communities’ programs in foster the development of technology to address and starts from the needs of older people. Because sometimes they are developed with a complete disregard of what older people think, need, and want.
4. We hear a lot about how technologies are also adding some complexity to our daily lives. How can Age Friendly Environments ensure technology solutions are both accessible and inclusive?
Technology can be accessible and not inclusive and the other way around. First, we need to guarantee the basics: infrastructure (e.g. access to internet) and affordable hardware/software. Then, a key to make technology inclusive is that it is designed and created with older people and with their community. Unfortunately, it is still common to think older people as a silent beneficiary and that is a mistake. We should see them as decision-makers, changemakers and leaders in the design, deployment and expansion of such technologies. Municipalities should invest time and energy to listen to older residents and involve them in all the stages. And then, ensure that the technology arrives to the hands of all those who need them.
5. How might artificial intelligence and the recent technological developments impact the design and development of age friendly environments?
First, we need to create evidence around technology to know if it works or not, around efficacity and impact. Artificial intelligence can reproduce messages that are ageist and work against the development of age-friendly environments. If technology, no matter which, is not developed together with people, in a participative way, person-centred, it can cause harm. Recently, WHO launched a policy brief on ageism in artificial intelligence for health, pointing out the tendency to design on behalf of older people instead of with older people. To ensure that AI technologies play a beneficial role, first ageism must be eliminated from their design, development and use.
And one last aspect that I would like to highlight is that technology must be followed with capacity-building to guarantee the best use of it, not only of the user as well of, in case of older people, paid and unpaid caregivers and all the professionals involved or required in the process of expanding that technology.
6. In your experience over time, how are members of the Global network of AFE integrating technology to make age-friendly environments? Are policymakers motivated to do so?
I think there is an increased awareness and action to use technology to promote age-friendly environments. There is a lot going on! I encourage everyone to go to our WHO Global Database of Age-friendly Practices to get inspired and also to contribute with knowledge. You don’t need to be a member to submit good practices. URBANAGE is an example that could be submitted.
There are a lot of knowledge in our network, not only regarding the design of technology but also in the implementation and evaluation. For example, cases of use of smart tech in communities all around the world for remote monitoring and care; implementation of sensors to detect falls, well-designed and delivered wheelchairs… In the national guide, one of the example we gave was ‘The Avatar for Global Access to Technology for Healthy Ageing’, co-developed by the WHO Regional Office for the Western Pacific and the China Academy of Information and Communications Technology, that exemplifies the co-development of technology with older people, which resulted in a versatile, age-friendly platform for health promotion. Older people were engaged in discussions from the design stage.
7. What role do you see technology playing in the future of age-friendly environments, and how is WHO preparing for new developments in this field?
My point of view is that technology will always be crucial for the development of age-friendly environments, from assistive technology to social technologies to any other type of technology involved in the eight domains of action. I think that today we can count with concrete lived experiences of good and bad design, deployment and use of technology in creating age-friendly environments which is important and adds responsibility. We must continue to assess their impact in a systematic way. I consider assessment is a key step, we need to be rigorous and criterions in this evidence gathering throughout all the stages. Not only in their design or in their later use. And of course, we must have people’s engagement, meaningful engagement of older adults, their families, their communities. Any other way, we risk to harm with technology.
So as long as we start from engaging older people, understanding what is meaningful to them, and involving them throughout the process, we will most likely foster all the benefits of technology to make the world a better place to age for the generations of today and tomorrow. I think there is energy, experience, and capacity to transform the way we develop, deploy and use technology with older people and their familiar at the center.