In her editorial, EuroHealthNet Director Caroline Costongs explains how upbringing, living and working conditions shape the way we age, and why investing in healthy ageing across the life course matters for Europe. She draws on the new WHO/Europe “Ageing is living” strategy and highlights five messages that run through the eight articles in this edition.
Growing old is part of life. We experience it with our family, friends and ourselves. A look in the mirror, changing hormones, less muscle strength, a worse memory, or just more tiredness: these are my own daily reminders of ageing. I feel very fortunate, however, to see my parents, who are in their mid-eighties, still active and healthy. Of course, ageing doesn’t come without ailments, but they enjoy living in their house and garden, and take part in community activities. They move around a lot, play music, have friends, and support each other with whatever daily issues they face.
It pains my heart to see many other older people, often already only in their sixties or seventies, who are restricted in living the lives they want because of physical or mental health problems. I know they could have had a much longer, more fulfilling life if they had not faced the many unfavourable conditions and risk factors for poor health that they did. Of course, ageing is a biological process, but overwhelming evidence shows that upbringing, living and working conditions affect health and quality of life in older age, and that health outcomes across the life course are poorer for people facing disadvantage and lower socio-economic circumstances. Homelessness is a stark example: people who die while homeless in England and Wales do so at a shocking mean age of 45 for men, and 43 for women, and studies in Spain put this figure at around 50.
There is also evidence that more people than ever are living with cardiovascular diseases, diabetes, cancer or chronic respiratory diseases, and with demographic change the prospects do not look good. These numbers reflect not only the personal grief of people unable to grow old and live independent, fulfilling and dignified lives, but also an economic burden: ageing in poor health carries a high cost for our economies.
Investing in healthy ageing across the life course is therefore a smart way forward if Europe wants to be a resilient and socially cohesive society. 60% of the chronic disease burden is linked to preventable causes such as tobacco and alcohol use, high blood pressure, unhealthy diets, obesity and physical inactivity, all of which can be addressed through stronger governance for health. In this respect, WHO/Europe has just adopted a timely strategy, “Ageing is living”: a strategy for promoting a lifetime of health and well-being in the WHO European Region 2026–2030, in Copenhagen. It contains 24 actions across four areas: (1) preventing ill health and maintaining capacity throughout life; (2) transforming health and long-term care; (3) creating age-friendly environments; and (4) challenging ageism. EuroHealthNet provided feedback on its implementation, suggesting that countries set national targets for healthy life years with equity breakdowns, explore innovative investment approaches such as pooling budgets across health, social care and housing, and build on the announced European Care Deal in the European Union.
I am delighted with this new edition of the EuroHealthNet Magazine. The eight articles move from the WHO Ageing is Living Strategy, to local practice, then to the settings and risks that shape how we age: cities, pollution, schools, workplaces, life after cancer and technology. They all bear important key messages, and the following five cross-cutting topics across the articles can be identified:
1. Healthy and active ageing requires a whole-of-government approach. Housing, transport, schools, workplaces, urban design and pollution all shape how we age, so health authorities must bring together, influence and work with other sectors.
2. Healthy ageing starts long before old age, and even before birth. Childhood schooling, working life, exposure to pollutants and a cancer diagnosis in mid-life all shape later health. Measures across the life-course are an important way forward.
3. Responsibility sits with systems, not only individuals. Several authors move the burden for action from the person to the school, the health system, technology, the community, or to national authorities. Creating age-inclusive environments, for example, is a key systemic policy measure.
4. Social inequalities in health outcomes become more prominent when people age. Heat, contamination, access to services and technology fall unevenly, and prevention can widen gaps if it ignores the equity dimension of healthy ageing.
5. National policies are important, but we also need local action and people's own voices to drive change. Neighbourhoods, cities, and affected residents turn policy into practice, and vice versa, and older people and communities must be treated as contributors, not recipients.
Ageing may be inevitable, but how we age is something we can shape. I hope the articles in this edition give you inspirationinspire you and spark ideas for action. Enjoy the read!
Caroline Costongs
Caroline Costongs is Director of EuroHealthNet and expert in public health and health promotion. Caroline leads a multi-disciplinary team working on European and (sub)national policy, advocacy, research and capacity building addressing health inequalities. Caroline is active in various EU and WHO fora, Advisory Boards and various EU projects, and is a member of the ICC – International Council for the European Public Health Conference.