Aging and proximity policies

One of the most visible signs of the aging of our societies is that there are more and more centenarians and, among the longest-living age groups, women significantly predominate. At the same time, and for various reasons, fertility rates have fallen sharply, which also leads to an increasingly aging society. This increase in life expectancy and the feminization of aging mark the way for the future of public policies. As has been reiterated, demographic change is expressed in opportunities and advantages, but also in needs that will become more acute in the future.

To address the aging process, it is necessary to expand the social and care agenda, providing resources to the institutions closest to citizens. In short, the social agenda and the local agenda should be strengthened and converged, thus concretizing the right to the city that incorporates the United Nations New Urban Agenda (UN, 2021).

Democratize the healthcare system

Usually, reference is made to three major transitions in our societies: the digital, the ecological and the demographic. Transitions to which we can add a "feminist revolutionary wave" that demands, among other demands, the democratization of the healthcare system.

Joan Tronto, a leading political scientist, links the crisis of democracy with the crisis of care. That is, to strengthen democracy we must strive to build a society where care is central and no longer invisible. Taking care of oneself and others should be guaranteed as a fundamental right . Following Tronto's thesis, it is essential to strengthen public policies aimed at care and, in this way, institutions must have the responsibility (democratic, collective and through a broad social agreement) to guarantee that everyone can have a dignified life and care when they need it for whatever reason.

It is clear that the care system goes beyond aging policies, as it is about moving towards another model of society that places the dignity and care of people at the center.

Promoting healthy aging: a challenge for everyone

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Diversity of aging and inequalities: responses from proximity

The debate about how we want to age is relevant, a debate that must necessarily be collective and intergenerational: it is an issue that concerns all people, regardless of their age. We also start from the observation that aging processes are very diverse , since older people are not a homogeneous group and ages also make great differences. Homogeneous solutions, therefore, no longer work: situations of inequality in which age intersects with axes of exclusion and discrimination such as gender, origin, having an illness or disability, different sexual options, etc. force us to rethink public policies. It is necessary to combine services and devices for all life stages, designed (collectively) and applied from proximity, which address diversities and inequalities.

The aging processes are very diverse and homogeneous solutions, therefore, no longer work. Situations of inequality force us to rethink public policies.

Cities are demonstrating greater capacity to face challenges on a global scale and are doing so in a more flexible and innovative way. The global and local connection in an interdependent world is not a new phenomenon, but it is intensifying rapidly. The motto "think global and act local" emerges in ecological transition policies, in feminist practices or in the model of social and economic development. Faced with the challenge of aging, the local scale is also presented as the most appropriate to face it. Thus, various strategies are being promoted on a global scale that are concretely reflected in the promotion of aging policies on a local scale .

The paradigm of active aging and Age-Friendly Cities

Under the umbrella of the World Health Organization, initiatives have been promoted to address the demographic challenge and care for older people. On the one hand, Age-Friendly Cities strengthen local authorities and communities in the face of the challenge of aging. This network, which brings together more than 500 cities and communities, is a space to identify and develop urban improvements aimed at older people.

On the other hand, the paradigm of active ageing , promoted by the WHO, has been consolidated as a strategy at the international level from a perspective of prevention and social inclusion (WHO, 2002). It is a concept that generates consensus, but, as with all interpretative frameworks, approaches can be diverse. In other words, they can emphasize various aspects such as health, the sustainability of the system and participation in the labor market or the promotion of the rights of older people and their social participation. These approaches to active ageing are relevant, since they condition the emphasis and orientation of policies for older people (Ezquerra et al, 2016).

The European Commission's Green Paper on Ageing

The European Commission has provided proposals on the demographic challenge with the Green Paper on Ageing with a long-term perspective in which, in particular, it considers how to address care and pensions (European Commission, 2020). Active and healthy ageing is a priority and it is committed to lifelong learning policies linked to knowledge and skills, including digital skills, for all ages.

The active aging paradigm, promoted by the WHO, has been consolidated as a strategy at the international level from a health perspective. prevention and social inclusion.

These two policy concepts - active ageing and lifelong learning - are the starting point for future European policies. However, the role of towns and cities is rather absent, although depopulation and the specific problems of rural areas are mentioned. An omission that is relevant as local policies for older people have been active, with very diverse themes to respond to diverse and increasing needs.

European cities facing the challenge of aging

Many cities are working with innovative approaches on topics such as lifelong education and culture, work skills and the contribution of older people, integrated social and health care, new forms of shared housing or home care, community support or the fight against isolation and unwanted loneliness (Ezquerra et al., 2016; Martí and Rosetti, 2021).

Based on the European network of cities Eurocities, a study on local policies facing the challenge of ageing was promoted, within the framework of the ESPON programme. The European project ACPA ( Adapting European Cities to Population Ageing: Policy Challenges and Best Practices ) has mapped some of these initiatives to strengthen this sector of public policies in the future . Analysing the case of eight European cities, guidelines and good practices were detected, some of which are collected in the following table.

These experiences show the diversity and innovation in many areas of local public action in which older people are also incorporated for co-production.

Another key issue for older people is housing , especially when support is needed. Until now, the alternatives when older people had problems with autonomy were a nursing home or waiting at home with public support usually very limited, leaving this issue in the hands of families and the market. Between the two traditional models, aging at home or in a residence, there are also alternatives: examples are co-housing , shared housing or housing with services and supports (initiatives promoted by the Barcelona City Council, for example). Cooperative housing or co-housing is a model where spaces and care can be shared, with successful experiences throughout Europe and which actively involve the people who live there (Mogollón and Fernández, 2019).

A community-based and personalized approach to care is needed so that each person can decide on their life project. This implies placing active and healthy aging as a priority.

The preferences of older people – as confirmed by surveys and studies – are to stay at home, in their community and neighbourhood. Recently, the deinstitutionalisation strategies that governments are promoting, as in the Spanish case , are a step forward in placing preferences and attention centred on the person. The aim is to achieve a community and personalised approach to care so that each person can decide on their life project. The “good life in community” implies a cultural change and prioritising preventive resources , placing active and healthy ageing as a priority. Once again, proximity becomes a value and local institutions and community networks acquire a fundamental role.

The importance of urban environments in aging processes

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Right to the city for all stages of life

Recovering the concept of Henri Lefebvre, claimed by urban social movements, the right to the city and to habitat becomes a reference for defending just and inclusive societies. After a wide debate not without controversy, the right to the city was finally included in the United Nations New Urban Agenda , approved in Quito in 2016, the global roadmap that advocates for strengthening local authorities and communities. A good example of this leap of the right to the city to the institutional sphere has been its incorporation into local policies. Along these lines, the Strategy for Demographic Change and Aging (2018-2030) of Barcelona City Council takes as its starting point the right to the city throughout life and promotes strategies for active aging, a friendly city and intergenerational coexistence.

To guarantee the right to the city, we certainly need stronger municipalism , with more powers and resources to collectively plan local policies on key issues for aging, such as housing and care. Political discourses may proclaim that care work must be valued and aging policies must be strengthened, but without the active role of local institutions in developing these policies it will be very difficult to make them effective. Even so, there are already many initiatives in the field of aging at a local level that demonstrate great dynamism and creativity. But there is still a need to delve deeper into participatory dynamics so that they have an impact on public policies and that, from the paradigm of active aging, the capacity for self-organization and agency of older people is recognized, as demonstrated by the pensioner tide that broke out in Spain in 2018.

As a matter of social and gender justice, public policies must be useful for transformation and should always count on the active participation of the people they are aimed at, incorporating and promoting experiences of community strengthening.