5 Sep, 12 | by BMJ Group
St Gallen is a fascinating small city in the north-eastern corner of Switzerland. Famed for its fabulous rococo monastic library (including the earliest extant manuscript of the Nibelung legend), the manufacture of sophisticated textiles, and one of the leading business schools in Europe, it is also the home to an intriguing initiative on ageing.
For the last eight years, at the end of August, the World Demographic and Ageing Forum (WDAF) has brought together leaders in the areas of business, government, academia, and advocacy for a unique forum to re-think ageing and the future. A number of features mark this meeting out from other gerontological conferences.
Perhaps the most notable is the close link with the business school at St Gallen, making it the first premier business school to engage seriously with the concept that the collective ageing of our populations is an exciting phenomenon. This is in turn makes space for a vision of the longevity dividend, a concept that has been well described, but struggles to find space against the absurdly negative rhetoric of demographic burden.
Such a recalibration allows a focus on the possibility of new markets created by ageing to later life, well above and beyond those related to healthcare: but for this to happen, business, and industry need to recognise and shake off their gerontological illiteracy which has up to now tended to lazily dichotomise older people as “just more adults,” or else as dependent and disabled. In the WDAF Ageing and Technology session with which I was involved, the example of the raku-raku phone in Japan provided a wonderful example of what to do (and not to do) in terms of designing products for older people.
Designed as a simple phone for older people, it was a commercial disaster. However, another company bought the idea, designed a slick and attractive case, and marketed it as the simple smart phone for everybody: it is now the second-best selling phone in Japan with a high market penetration among older people! A sensible corporate gerontologist would have alerted the first company to a range of issues, from ageism through fears of social exclusion to universal design, which would have prevented their costly hiccough, and made them bucket loads of money—a win-win-win situation for older people, the general population, and business alike.
The WDAF is also notable for a global perspective, understanding that for over a decade the largest number of older people in the world is now in low and middle income countries. A number of sessions covered migration, food security, and a comparison of ageing in India and China. I was very impressed by the session on ageing in Africa, with a sense that the Madrid International Plan for Action on Ageing (MIPAA, the UN blueprint on ageing since 2002) is beginning to develop some traction. This is in stark contrast to some “developed” countries such as Ireland where a decade after MIPAA was developed, no trace of an official response can be detected.
That gerontological illiteracy—and its unhappy consequence, over-simple solutions to a complex issue—can be tackled through forums such as the WDAF, can be seen by the sea change in approach in the scientific level of successive reports from the World Economic Forum. The first report was written in 2011 with little evidence of gerontological insight: the second, from June of this year, while not perfect shows substantive improvement in this regard.
Changing minds and attitudes does not happen overnight, and some sessions in this WDAF still displayed low levels of gerontological awareness, particularly one on the hugely important issue of non-communicable disease (NCD) and the related recent political declaration from the UN. To be fair, the panel did accept, in discussion from the floor, that not only were NCDs of particular relevance to older people, but also that a gerontological/geriatric medicine approach had already trail blazed the methodology to respond to these illnesses which generally occur in the context of multi-morbidity.
A particularly encouraging event at WDAF was the official launch of the new Age-Friendly World website. This remarkable programme, ably directed by the ageing and life course programme at the WHO in conjunction with the International Federation on Ageing, is a fast growing initiative whereby city councils and planners are proving themselves more open to an age attuned approach to their services than are many health services. There are likely to be many benefits for the health services, as most of these programmes realise the benefit of dialogue with health and social services in providing age friendly cities and communities, and in so doing will generate gerontological literacy and articulacy.
Finally, the forum also provides a window into the issues of ageing in the Germanic speaking countries, a perspective often dimmed by linguistic barriers. As German is the most widely spoken first language in Europe, and as these countries have among the higher proportions of older people as well as highly developed economies, this is a rich field for contemplation and action.
Through generous coffee and lunch breaks, aided by the friendly and enthusiastic volunteer staff from St Gallen, there is extensive cross-fertilization of ideas and mutual learning in the most pleasant way possible. For all those with an interest in developing a world whereby the longevity dividend will be maximized through a gerontologically informed approach, a rendez-vous in St Gallen in August 2013 should prove rewarding.
Desmond O’Neill is a consultant physician in geriatric and stroke medicine in Dublin, and has been a member of the International Advisory Panel of the WDAF since August 2011: the opinions expressed are personal.