Heart Valve Disease: Harnessing Innovation to Save Lives, Mitigate Costs, and Advance the Healthy Aging Agenda
2023
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Taking On Longevity with Market Innovation
We develop initiatives that focus on meeting the challenges of worldwide aging with groundbreaking market solutions and progressive public policies.
Through our white papers, roundtables, webinars, presentations to third parties, and other communications materials, we are leading the global aging dialogue and providing public education designed to enable healthier and more active aging.
2023
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In December of 2022, Global Coalition on Aging and Global Heart Hub jointly convened a roundtable of global, multi-disciplinary experts from healthcare, patient advocacy, policy organizations, and the private sector to discuss the challenge of heart valve disease in the context of aging societies and their evolving needs.
This position paper, Heart Valve Disease: Harnessing Innovation to Save Lives, Mitigate Costs, and Advance the Healthy Aging Agenda, is the result of the roundtable discussion and consultation with additional global experts. These experts identified critical issues to address, as well as a need for greater urgency to ensure patients and families, health systems and societies reap the full benefits of innovation, requiring:
2023
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Two global trends are on a collision course to upend decades of medical progress and health outcomes: Antimicrobial resistance, or AMR, and our rapidly aging society.
The current trajectory for AMR is bleak: AMR pathogens are estimated to kill 700,000 people globally each year and the United Nations forecasts that AMR could kill up to 10 million people annually by 2050 and push 24 million people into poverty by 2030. Meanwhile, our antibiotic innovation pipeline is bare, and we are losing the ability to treat infections daily.
On the other hand, the UN recently announced the Decade of Healthy Ageing to complete its sustainable development goals and become the global framework for transforming the 20th century miracle of longevity to our 21st century’s era of healthy longevity. While AMR presents a significant global health problem of the first order, its effects are disproportionately burdened on older adults, a group that is rapidly increasing in proportion. For example, a study showed that of deaths in the U.S. due to infection with the most common AMR pathogens, approximately 40% occur in people aged 65 and older, but this age group only accounts for 15% of Americans. Further, older adults disproportionately suffer from diseases where AMR-resistant strains already exist, such as pneumonia and urinary tract infections.
As is, antibiotics have added an estimated average of 20 years to the human lifespan, but if the incidence of multi-drug resistant pathogens continues to increase, the drugs that have unlocked this longevity miracle will no longer be effective. This is already the case in long-term care facilities, which have been called “reservoirs of resistance.”
As discussed in Health Affairs this year, AMR not only impacts the usage of antibiotics – it can also turn presently treatable ailments deadly. Additionally, the availability and effectiveness of independence-promoting procedures – like hip and knee replacements, heart valve replacements, and even chemotherapy – all stand to change drastically as we know it. A procedure as simple as a catheter insertion may find itself deadly to a given patient because of the risk of infection without an effective antibiotic treatment. If left unaddressed, AMR will undoubtedly have a profound effect on our ability to achieve healthy aging goals, while also putting our newborns at risks unseen since a century ago.
Over the first half of 2022, we conducted a series of surveys and qualitative interviews with more than 1,500 clinicians across the globe – including in the U.S., Japan, and Europe – and from various specialties to understand if and how AMR has affected their practice and clinical decision-making. Further, we wished to elucidate the attitudes and general sentiments of clinicians towards AMR.
Often, clinicians are the most responsible for decisions that will impact or be impacted by AMR because they must weigh the risks of AMR-related infections against the benefits of important interventions like heart valve and knee replacements, or even stays in hospitals. However, there have been relatively few recent qualitative studies examining the perspectives of clinicians towards AMR. Those that exist show that the wider, population-based implications of AMR may not be given appropriate consideration when treating an individual and consequently, prescriptions for antibiotics are commonly given unnecessarily. Further research has also shown that clinicians often appreciate that AMR is a significant issue, but do not apply that macro view in how they conduct their own medical practice, and that knowledge, attitude, and practice regarding AMR remains a fundamental challenge in antimicrobial stewardship.
Here are some of the insights we gathered:
There’s a wide gap between acknowledgement of the issue and understanding of the issue.
This trend of “not in my clinic” has been demonstrated before in the literature – a previous study in the United States found that 94% of survey respondents agreed AMR was an issue in the United States, but only 55% agreed that it was in their own practice. In our study, only about 20% of health professionals surveyed indicated that they had a “fair amount” of knowledge about drug resistance issues and the ways in which it affected their decisions. Interestingly, those surveyed tended to rank their own knowledge and awareness of AMR highly and tended to rank their colleagues’ lower.
Several respondents indicated that they placed the needs of their individual patients above the risk of widespread AMR. One physician in palliative care noted “These infections unfortunately happen and are devastating when they do. But I’m not aware of anyone prospectively forgoing needed surgery because of them. We may not recommend [a surgery] due to fragility, comorbidities, etc., with the exception of someone already chronically infected (with an AMR or other pathogen).”
Another physician working in infectious disease acknowledged the significance of AMR, but noted that the needs of the individual patient were always put first. “The risk of AMR leads me to think carefully about providing the narrowest possible antimicrobial coverage that still adequately treats a patient’s infection. In general, I do not prescribe less aggressive treatment or forgo procedures if they are necessary for the patient’s care because of the risk of AMR.”
For the majority, the consideration from the clinical standpoint seemed to be against the risk of widespread AMR, and not within a given patient. In older adults and the medically fragile, groups who are more prone to infection with AMR pathogens, the growing AMR crisis will increasingly necessitate some form of risk consideration for a given procedure at the individual patient level.
There is a risk that the proliferation of AMR will lead to non-essential, but life-quality improving procedures not being available, such as elective knee surgery to increase or maintain mobility, because the risk of infection with an AMR pathogen is too great. Our survey responses indicated that this phenomenon may already be occurring: approximately 27% of clinicians said they had recommended more conservative treatment or withheld necessary procedures from a patient due directly or indirectly to the risk of infection with drug-resistant organisms in the past five years, and about ¼ indicated that their colleagues had done so.
The survey responses, however, seemed to trend more heavily towards more conservative care decisions that reflect greater antimicrobial stewardship efforts rather those that reflect withheld procedures due to fear of untreatable infection. More research is needed in this area, but our preliminary research further suggested that AMR stewardship measures were oftentimes viewed among clinicians as public health imperatives misaligned or even in direct opposition to the needs of the individual patient.
In our survey, we found differing levels of AMR consideration by specialty. Interviews with several clinicians revealed the presence of an unspoken “hierarchy” of which specialists and what procedures merited consideration of AMR. One interviewee, a hepatologist in California, gave little indication of implicating AMR into their clinical decisions. Although not explicitly stated, the impression given was that AMR was perhaps something for others to worry about. On the other hand, more than half (55%) of cardiologists and internal medicine specialists (51%) report impact on treatment.
If indicative of a wider trend, this mindset may jeopardize access to treatments and procedures that may improve quality of life, but are not considered essential, in favor of those that very much are. This sort of triage would be incredibly difficult to coordinate at a large scale and would likely lead to differing access to medical care at a national and global level, where those poorest in society or in low or middle-income countries have access to far fewer “non-essential” treatments. This also has potential implications for healthy aging: while a hip replacement may not be an immediately life-or-death situation, it is a procedure that can drastically improve mobility, overall quality of life, and therefore, longevity.
Not enough is known, and what we don’t know may be the most devastating. Our survey indicates that standardized guidance and clinical protocols surrounding treatments that may be impacted by AMR could be improved.
One hospitalist discussed that in their role, they went through various infectious disease trainings with some emphasis on AMR, but they were unsure if this was the case for all specialties and other organizations. This general lack of knowledge among providers further suggests large differences between hospitals and medical specialties with regards to consideration of AMR in clinical decision-making, furthering the case for standardized training.
AMR is already a top 10 global public health threat according to the WHO, but its silent or unrecognized effects on treatments could lead to even further issues during the Decade of Healthy Ageing: cancers undiagnosed, diabetes untreated, cardiovascular disease undetected. We saw this phenomenon during Covid, where risk of exposure to a doctor’s office or hospital led to clinical actions needed but not taken; the same is increasingly true for AMR risk in a world without effective antibiotic treatment. The untreated may soon be the crisis we missed.
Our findings that clinicians see AMR as a problem for others and not themselves is in line with previous qualitative research on clinician sentiments towards AMR. This attitude of dissonance is dangerous and should be addressed through educational programs and increased AMR stewardship programs at the hospital level, which will require additional funding at the state, provincial, or federal level.
One potential avenue for this is to use push incentives to reward hospitals with additional funds for actively pursuing good AMR stewardship. This could take the form of additional funding for locations that have low levels of antibiotic over-prescription and conducting robust surveillance activities. The proposed Pasteur Act in the United States includes similar strategies, with grant funding available for hospitals who are “judicious” in their AMR stewardship. Of course, such a program would require checks and balances to ensure that hospitals are not penalized for taking on patients at higher risk for infection with an AMR pathogen, such as older adults.
Incentives could also be targeted at the individual level. Physicians have noted that publishing AMR patterns at a localized level would be a strong way to incentivize AMR stewardship, which would enforce social norms and have the potential to shift physician attitudes towards AMR.
Incentives are already happening to some extent in select countries. One interviewee, a physician from Turkey, mentioned that hospitals in their area could be rewarded and penalized for their performance in AMR stewardship, and the NHS in England has required hospital trusts to submit yearly antibiotic consumption data, with additional payment for submission. There is broader political will for such an initiative: the Organisation for Economic Co-operation and Development (OECD) has advocated stronger economic incentives to promote better AMR stewardship, and in the May 2022 meeting communique of G7 Health Ministers, support for LMICs to develop national investment cases on AMR response was given.
A 2018 study found only 94 educational opportunities on AMR targeted at healthcare workers worldwide, very few of which were accredited for professional continuing education credits. The same study referenced the need to improve education and uptake in AMR and antimicrobial stewardship, including at the medical school level. Administrative healthcare workers could also be encouraged to partake in professional development courses to help strengthen their ability to administer a robust AMR stewardship program at the hospital or clinic level.
We encourage medical education to highlight the disproportionate effects of AMR on older adults and the medically fragile, as well as the increased risk of infection faced by groups living in and out of long-term care homes.
Conduct more research into the unintended and hidden decisions resulting from the fear of AMR.
This research is a first step towards building a literature on the impact of AMR on clinical decision-making, and the attending enormous implications for patients, the practice of modern medicine worldwide, and the future of healthy aging itself. More research is needed to better understand nuances in this impact, track its evolution over time, and point to additional solutions both in policy and practice. Specifically, more extensive research on clinical decision-making, AMR incentives, and healthy aging is required to further understand this phenomenon and to shape comprehensive policy solutions that will provide the opportunity for change.
AMR is an increasingly catastrophic public health issue that threatens healthy and active aging worldwide and has the potential to increase disparate access to care. The risk-benefit analysis must shift to reflect the reality of our aging era, where functional ability as we age is as much a public health goal as the absence of disease. The forgone knee or hip implant can have a huge impact on the quality of life as measured by functional ability for 60-, 70-, 80- and 90-year-olds. These are not small things in a world where there are more old than young – we’ll soon have more than 2 billion people over 60 on the planet.
Here, we give insight to the general sentiments that healthcare professionals hold towards the AMR crisis, and how clinical decision-making has been affected among our respondents. Additionally, we offer some potential strategies and solutions to approaching this progressively urgent issue from a communications, education, and awareness standpoint, and all of these efforts must be met with corresponding strategies to replenish our dwindling pipeline of new antibiotics.
The antibiotic revolution barely a century ago inspired and fueled the miracle of longevity that the 20th century bequeathed to our current century. Now, we need antibiotic innovation to not only continue the drive for longevity, but extend it to create healthy and functional longevity.
Authors’ Note:
The authors’ work in this article was supported by funding from Pfizer Global Medical Grants. The views presented in this article are those of the authors.
Michael W. Hodin, PhD, is CEO of the Global Coalition on Aging, Managing Partner at High Lantern Group, and a Fellow at Oxford University’s Harris Manchester College. He has spoken internationally on the topic of aging, including at G20, APEC, Davos, and the World Knowledge Forum (WKF). Hodin holds a BA, cum laude, Cornell University, MSc in International Relations from The London School of Economics and Political Science, and MPhil and PhD in Political Science from Columbia University.
Susan Wile Schwarz, MPH, is the Director of Communications for the Global Coalition on Aging and Senior Director at High Lantern Group. She holds a BA from Columbia University and an MPH from Emory University’s Rollins School of Public Health.
Olivia Canie has a BA from McGill University and is an MPH candidate at the Yale School of Public Health.
2022
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In December 2022, the Global Coalition on Aging announced the release of its roundtable report, “AMR & Japan’s G7 Presidency: A Call for Pull Incentives to Drive Innovation.” The report is based on a small, private roundtable of leaders from the United Kingdom, the United States, and Sweden, alongside Japanese decision-makers and experts.
AMR is a crisis for all of society, but older adults are most at risk, making AMR a critical priority for super-aging Japan, where close to 40% of the population is over 60. Experts at the roundtable identified four critical actions that Japan must take to urgently address AMR as Japan assumes the 2023 G7 Presidency.
2022
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In November 2022, the Global Coalition on Aging released its compendium, “Business Leadership in the Decade of Healthy Ageing: Compendium of Best Practices Across the Private Sector,” to highlight actions of the business community to advance the goals of the UN Decade of Healthy Ageing. While conventional perspectives on aging tend to focus on rising costs and pressure on our healthcare system, innovation across a variety of sectors are helping to shift the role that our aging population plays across society. The report details nine key areas critical to the healthy aging initiative:
The Compendium builds on the GCOA’s earlier report, “Decade of Healthy Ageing Demystified,” which aims to clarify the opportunities for the business community to engage in and help advance the goals of the Decade of Healthy Ageing. The report offers key questions and opportunities for business leaders to formulate and execute upon their aging strategies. These are organized according to the Decade’s four core action areas: combatting ageism, integrated care, age-friendly environments, and long-term care.
2022
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GCOA and Home Instead, the world’s largest home care network for older adults, published a global report on November 2, 2022, titled Key Insights & Proposed Solutions from the Future of Care and the Caregiving Workforce: Lessons and Insights from the COVID-19 Experience.
The report, based on a workshop of more than 100 global leaders from over 20 OECD member states, spotlights the challenges facing the long-term care workforce, including insights from the COVID-19 pandemic, unprecedented demand brought by the aging demographic shift, and prevailing work conditions and perceptions.
The report suggests three top priorities to grow the care workforce to meet current and future care needs:
2022
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In October 2022, GCOA’s Bone Health Initiative (BHI) launched two white papers outlining key imperatives for advancing bone health in the Decade of Healthy Ageing.
More Than Just a Fracture: A Call to Action on Osteoporosis and Bone Health in the Context of Healthy Aging calls for a new approach to osteoporosis diagnosis and for the WHO to drive efforts to update the way in which fragility fractures are identified and therefore how osteoporosis is acted upon globally. In doing so, the WHO — with partners in the bone health and aging spaces — has the potential to dramatically improve the quality of life for tens of millions of people worldwide as they age and reduce the soaring costs to health care systems through more effective attention to osteoporosis-related fragility fractures as an indicator of osteoporosis. The paper calls on the WHO to create a code in the International Classification of Diseases 11th Revision (ICD 11) for osteoporosis-related fragility fractures describing fractures related to deteriorated bone structure.
Healthy Bones for Healthy Aging: How the Integrated Care for Older People (ICOPE) Model Can Leverage Bone Health to Improve Well-Being, Sustain Independence and Support Health Care Financing calls attention to the importance of integrated care for older people in relation to bone health. Integrating bone health into ICOPE can revolutionize how osteoporosis is treated regarding patient outcomes and health care savings. Doing so can also help ensure a person-centered approach to osteoporosis and help prevent millions of primary and secondary fragility fractures – adding healthy life years for every affected older person. The paper outlines that a new strategy to address osteoporosis and bone health through integrated care will help empower healthy and active aging.
Through communications, education, and advocacy, the BHI focuses on aligning policy change and healthcare practices in line with 21st-century healthy aging realities to ensure the highest quality of life possible for those with or at risk of osteoporosis and, at the same time, reduce the costly impact of osteoporosis and fragility fractures on our health systems.
2022
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On Thursday, September 29, 2022, Global Coalition on Aging, in partnership with GCOA Member Amgen, presented the Asia-Pacific Healthy Aging Summit: Advancing Disease Prediction and Prevention, which brought together leaders from the region with global leaders to find the policy solutions necessary for a healthier and more active aging across the region.
Speakers included Naoko Ueda of OECD, Roxana Widmer-Iliescu of ITU, Alana Officer of WHO, and Ryoji Noritake of Health and Global Policy Institute among many other esteemed experts and thought leaders.
2022
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GCOA, in partnership with Renmin University, convened the first-ever China Healthy Aging Cities Forum, on July 28, 2022. The Forum highlighted positive policy actions in Beijing and other Chinese and global cities to support healthy aging, with adult immunization generally and COVID-19 vaccination success for older adults in particular as key examples.
The discussion, which brought together both Chinese and global experts, explored lessons learned from Beijing’s leadership and the changed landscape from Covid-19 vaccination and provided insights for a report on critical policy steps Beijing can take, what other Chinese cities can learn, and for application at the national level to enable healthier and more active aging, critical for a successful 21st century economy and society.
The China Healthy Aging Cities Forum and Report build on the framework of the WHO Global Network for Age-Friendly Cities and Communities and momentum from the UN Decade of Healthy Ageing, GCOA’s Silver Economy platform, and the China Development Forum interest in “Revitalizing Aging China.”
2022
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As our society ages, we need to ensure that older people are empowered to decide how they want to live, what they want to do, and what type of healthcare works best for their situation. Unfortunately, healthcare rationing by age, where patients are withheld access to treatments, is still one of the most widespread forms of ageism.
In September 2022, the Global Coalition on Aging and Nutricia presented a call to action to break with preconceived, ageist notions and lead to activities that empower individual healthcare engagement and decision-making regardless of age.
2022
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In September 2022, GCOA, Immunize Canada, and other leading organizations across Canada partnered on a unique public education campaign highlighting the need and opportunity for Canada’s caregivers to protect themselves against influenza.
The campaign featured an infographic and sharable social media materials, in both English and French, providing usable data about influenza and immunization – including where, how, and why to get vaccinated – directly to Canada’s 8 million caregivers. The infographics can be downloaded in either English or French using the buttons below, and the social cards are available for download in English and in French at those links.
The education campaign materials were developed in consultation with more than a dozen organizations across Canada, from caregiver and patient organizations, to academic and research institutions and private sector experts.
2022
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In August 2022, Georgetown University’s AgingWell Hub released its the first No Normal Retirement Journey Map and Guide, a practical and interactive tool for re-imagining and charting paths to and through retirement. The Journey Map draws on the expertise of twenty-nine of the world’s leading experts on life in retirement – including GCOA CEO Mike Hodin and GCOA members Bank of America, Home Instead, and Transamerica – as well as a comprehensive review and integration of findings from more than 200 pieces of research on the evolving nature of retirement.
This new resource offers individuals tools to visualize and plan the various stages, events and decision points along the retirement journey, and the personal, emotional, and financial consequences of each. The Journey Map illustrates how six primary levers—health, finances, learning, purpose, community, and resilience—can be used to navigate the journey to a happy, financially secure and fulfilled life after a full-time career.
The Retirement Journey Map was developed by the Georgetown AgingWell Hub, designed by Human Spark, and commissioned through the support of the Alliance for Lifetime Income’s Retirement Income Institute.
2022
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In April of 2022, Global Coalition on Aging convened a cross-disciplinary and cross-sector group of global experts to consider public policy changes necessary for continued biomedical innovation that will enable 21st century healthy longevity. The roundtable was convened by GCOA to take action in support of the global UN/WHO Decade of Healthy Ageing and in response to the proximate challenges to health and longevity highlighted by the COVID-19 pandemic. This roundtable and report were made possible by support from GCOA member Eli Lilly & Company.
The roundtable identified five key principles to frame how today’s and tomorrow’s health value propositions should be judged and four calls-to-action which would transform how health innovation is recognized and rewarded in order to foster healthy aging in the 21st century.
2022
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A June 2022 report from the Transamerica Center for Retirement Studies (TCRS) in collaboration with Transamerica Institute finds that fewer than three in 10 workers (29 percent) believe they are saving enough for retirement. The report, Emerging from the COVID-19 Pandemic: The Retirement Outlook of the Workforce, is part of TCRS’ 22nd Annual Retirement Survey, one of the largest and longest-running surveys of its kind. The new report examines the impacts of the COVID-19 pandemic, including the health and financial well-being and retirement outlook of the workforce. It highlights the urgent need to strengthen the U.S. retirement system and outlines recommendations for doing so.
The 22nd Annual Transamerica Retirement Survey polled a nationally representative sample of more than 10,000 people in late 2021. This report is based on 5,000+ people who self-identified as employed full-time or part-time by other, self-employed, or unemployed but looking for work.
2022
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In late 2021, GCOA convened a cross-sector group of Canadian and global experts and caregivers for a roundtable discussion to examine the critical importance of vaccinating Canada’s caregivers against influenza, current barriers, and opportunities for action to improve awareness and uptake of the vaccines. Following the roundtable, GCOA released a report, Tip of the Iceberg: Vaccinating Canadian Caregivers Against Influenza, which summarized the key insights and takeaways from the discussion.
The report included three broad calls to action for Canada:
2022
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A new report by the Global Coalition on Aging, 21st Century Health System Resilience: Lessons From the Pandemic on Innovation and Healthy Aging explores the imperative for global health care systems to realign in order to accelerate innovation to meet the challenges – and opportunities – posed by the scientific miracle of longevity and the aging of society. The report was made possible through support from GCOA members and a generous sponsorship from Biogen.
The United Nations’ and World Health Organization’s recently launched Decade of Healthy Ageing is a welcome sign that global policymakers understand the need to make health systems more responsive to the demands of aging societies.
According to the report, “Fully aligning health care systems to a world with 2.1 billion people over age 60 by mid-century will require innovation on a massive scale that can only be achieved by fundamentally re-examining the way countries regulate and reimburse the treatments we will need to care for our growing aging populations.”
Most national health systems were created to provide and pay for acute care – where people are treated for brief but severe periods of illness. The “disease-cure” model worked when lifespans were short and diseases of aging were more rare. But it is not designed for a world where billions of people live for decades with steadily worsening conditions like Alzheimer’s disease, osteoporosis and cardiovascular disease.
The report outlines several potential areas of reform:
“Reimagining healthcare systems to meet the needs of healthy aging and an overall healthier society has been proven in times of crisis, such as the COVID-19 pandemic,” said Michael W. Hodin, CEO of GCOA. “Policymakers must recognize the value of these investments and the power that comes with enabling better prevention, diagnosis and treatment. In our aging world, to continually innovate must be a scientific, political and investment priority.”
2022
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For the third year in a row, GCOA partnered with ITU and the WSIS Forum to host the WSIS Forum Special Track on ICTs and Older Persons and again host the WSIS Healthy Ageing Innovation Prize in 2022. Throughout the first week of May, GCOA and WSIS organized a series of sessions examining the potential for digital technologies in an aging world, including how they can help combat age-based discrimination in the workplace, achieve healthier aging, build smarter cities, ensure the financial inclusion of older adults, and support millions of caregivers across the world and in digital inclusion across the generations to enable the Decade of Healthy Ageing. GCOA co-organized this special track in collaboration with stakeholders including Centre for Socio-Eco-Nomic Development (CSEND), E-Seniors, UN Agencies -ITU, WHO, UN DESA, and others.
The WSIS Healthy Ageing Innovation Prize recognizes and award the best digital technologies that support healthy and active aging for adults age 60+ in one of five categories:
The winner, HiNouNou, and 11 finalists were selected by a panel of international judges and announced the first week of June 2022. The winner and finalists receive a cash prize as well as recognition at the WSIS Forum.
Click here to see descriptions and watch video from each of the sessions ICTs and Older Persons track.
Watch Mike Hodin’s interview below on the significance of the WSIS Special Track on ICTs and Older Person in today’s world:
2022
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In April of 2022, Global Coalition on Aging (GCOA), in partnership with the Permanent Missions of Chile and the Republic of the Philippines, United Nations Department of Economic and Social Affairs (UNDESA), and the World Demographic & Ageing Forum (WDA Forum) Global Longevity Council, hosted an official side event of the 55th Session of the Commission on Population and Development at the United Nations in New York to launch “Living Longer Around the World: Opportunities and Challenges,” a new report authored by the WDA Forum Global Longevity Council. The report offers positions for policy makers and strategy planners based on age demographics to 2035 for 31 countries representing all levels of economic development, 70% of the global population, and 76% of global GDP.
The speakers from around the world included:
2022
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This document, Supporting Healthy Aging with a Hospitable Innovation Environment: Consensus on Policy Reforms and Actions, outlines a set of core policy principles to enable the advancement of innovation, but also to ensure broader, deeper and more equitable access to ongoing innovation advances. It is based on insights and consensus achieved at a multi-sector stakeholder roundtable organized by GCOA in late 2021. The roundtable dialogue considered the public policy and market shifts stemming from otherwise very different, but equally visible health crises over the past four decades – HIV, COVID-19, and noncommunicable diseases – and brought about a unique joint understanding of the innovation solutions that mitigated the crises, immensely improving lives, creating value for society and providing a basis for reducing the associated economic and fiscal burdens.