Specific information regarding the country context, as well as key points pertaining to each plan’s development, goals, and implementation, are outlined in the Database.
These plans, policies, and strategies were assessed with regard to 19 key themes addressed within MIPAA’s three pillars and across the UN Decade of Healthy Ageing’s action areas. (See Figure 5 and Appendix B for definitions and reasons for inclusion.)
While the approach of the more recent UN Decade of Healthy Ageing highlights four key policy action areas and promotes multisectoral action for aging populations, MIPAA has acted as a foundational resource and norm-building framework for countries seeking to mainstream the needs of older persons across a wide range of policy areas since its publication in 2002. This includes promoting the adoption of national action plans on aging. Every five years, an MIPAA review is conducted by United Nations Regional Commissions. These reviews take stock of country progress toward MIPAA goals as defined in their respective MIPAA Regional Implementation Strategies, including tracking the development of national action plans on aging. As a result of these reviews, governments continue to draw on MIPAA and utilize its framework when developing and implementing plans, as several UN Regional Commissions ask countries to report progress on national plan development and implementation.
Of the plans reviewed here, 33 of 60 (55 percent) explicitly mention MIPAA as being an inspiration for their plan or acknowledge that it directly supports the goals and themes laid out in MIPAA, including those that were developed a decade or more after its release, affirming that MIPAA remains a hallmark of international policy on aging. MIPAA is also the most mentioned international policy document across the 59 plans, followed by the United Nations Principles for Older Persons (1991), which is referenced by 14 plans (28 percent). Of the 33 plans released or updated since 2020, only one-third reference the UN Decade of Healthy Ageing.
As Figure 5 illustrates, the MIPAA and the UN Decade goals broadly relate to promoting social development and protection, ensuring access to quality care, and building enabling environments for older persons.
Most plans cited MIPAA and the Decade of Healthy Ageing as inspiration for their targets.
Policy Alignment with MIPAA and the UN Decade Themes Is Significant but Incomplete
When accounting for the MIPAA themes and the UN Decade Action Areas, Barbados and Portugal have the most comprehensive plans of those evaluated, incorporating 16 of 18 total themes, followed by Argentina, Bosnia and Herzegovina, Cambodia, Guatemala, Ireland, Kazakhstan, Lebanon, and Uruguay, with 15 of the 18 themes. These plans are both comparatively broad—covering many types of issues that can impact health, enabling environments, and development outcomes for older persons—and relatively robust, as each policy issue includes at least one actionable objective, identifying a clear target and policies by which to achieve it. Plans from Antigua and Barbuda, Barbados, Egypt, Ireland, and Jordan cite other plans, including plans from Australia, Canada, Chile, Kuwait, Malta, New Zealand, Saudi Arabia, Singapore, and Wales, as sources of inspiration for plan development. These referenced plans are comparatively narrower in scope but have proven effective in implementation.
Across the 60 plans and supporting documents reviewed in this analysis, none of the MIPAA themes or UN Decade Action Areas was present in every single plan. The most prevalent were training care providers and health professionals, social protection and financial security, and education and training. (See Figure 7). Conversely, plans were least likely to address the themes of HIV/AIDS, emergency response and disaster planning, and rural development. Only six of 60 plans (10 percent) addressed HIV/AIDS, 10 (17 percent) included targets relating to emergency response, and 17 (28 percent) addressed rural development. HIV/AIDS is a major health challenge in certain countries, particularly in the sub-Saharan Africa region. Accordingly, Ethiopia and Kenya’s plans both incorporate relevant targets. Kenya’s plan includes the decentralization of health care—including care for HIV/AIDS—to be accessible to older adults in all parts of the country, and the funding of more geriatric research, while Ethiopia’s plan includes targets to improve information on, and decrease stigma around, HIV/AIDS among older adults, and provide financial support to those diagnosed. However, many of the countries where HIV/AIDS is of particular concern do not yet have robust aging plans or frameworks, as their populations tend to be younger. As the United Nations 2020 Decade of Healthy Ageing report highlights, while older adults are disproportionally negatively affected by disasters and emergencies, they are often overlooked in emergency planning due to ageist attitudes that lead to the neglect of older persons and the specific risks they face. Aging plans that incorporate a focus on emergency planning, if implemented, can help to mitigate risks to, and better identify the needs of, older adults. France’s plan, for instance, mentions climate disasters while Barbados’ plan, published in September 2022, addresses the potential impacts of disasters and other extreme events—including pandemics—on older adults. The Barbados plan’s recommendations include the development of a national disaster preparedness plan for older adults and enhanced training initiatives for emergency situations.
Plans Ensure Older Persons Benefit from Economic Development
The first MIPAA pillar recommends that governments act to ensure that older persons share equitably in the benefits of a country’s economic development. Forty-seven of 60 plans reviewed (78 percent) included targets around improving older persons’ financial security and other social protections, 46 plans (77 percent) mention targets related to providing education and training, and 39 (65 percent) included targets to build intergenerational solidarity. Plans tend to reflect the national context and issues of greatest concern and priority. For example, Bulgaria’s plan, the National Comprehensive Strategy for Active Ageing (2016–2030), has a heavy emphasis on employment—particularly on retraining and retaining older adults in the workforce, as the country will soon experience the world’s steepest decline in working-age population. The case studies in the Database provide contextual information specific to each country alongside the goals and principles driving ongoing and forward-looking reforms.
Many developing countries, particularly those that are lower-income, have a strong focus on social development and protection, often through filial support laws. These laws require close family members—most often adult children—to provide financial and material support to aging relatives. Laws that stipulate that family members have a legal duty to care for relatives effectively largely shift the responsibility and funding for care and protection from the state to families. Filial support laws are common in developing countries, particularly in the Asia Pacific and Southeast Asia regions, as policymakers in the 1990s drew upon cultural norms of filial piety and reciprocity to fill gaps in care. Cambodia’s National Ageing Policy 2017–2030, for example, explicitly connects the ideas of filial piety to social development by incorporating “Raising awareness and encouraging adult offspring who are able to provide financial support … in order to fulfill their filial duties” as one of three strategies for that country’s policy social development objective. Cambodia’s National Ageing Policy also identifies intergenerational connection and joint family structures as a hallmark of Khmer society.
Some Western countries or jurisdictions also incorporate filial laws into their legal systems of care. As of 2018, 29 U.S. states had filial support laws, although they are rarely enforced. These laws also tie into improving state support for informal caregivers, which is a feature in 32 out of 60 (53 percent) of the analyzed plans, including, for example, in Bosnia and Herzegovina, Brazil, Ireland, Singapore, Jamaica, Fiji, Minnesota, and Panama’s plans, and is included as a policy issue under MIPAA’s third pillar (called “Ensuring enabling and supportive environments”). Governments have long relied on families to fill gaps in care, and now many are planning or working on providing expanded support to caregivers, as well as acknowledging caregivers as essential stakeholders of healthy aging agendas. Such acknowledgment has driven the inclusion of caregiver support in healthy aging strategies, including Ethiopia’s National Plan of Action on Older Persons 1998–2007 EC (2006–2016 Gregorian calendar), which seeks to shore up and support traditional familial mutual support systems by providing educational and training opportunities to informal caregivers, respite services such as community-based care programs, and more holistically improving household income and well-being to build the economic capacity of the family. The complementary Healthy Ageing Strategy 2020-2025 additionally seeks to better integrate home-based, institutional, and long-term care with health services tailored to the needs of older adults. Several countries have even developed independent strategies, which are not discussed in this report. Examples of independent strategies include New Zealand’s Mahi Aroha–Carers’ Strategy Action Plan 2019–2023, as well as the United States’ 2017–2018 RAISE Act, which directs the development of an independent Family Caregiving Strategy to support informal caregivers.
More Can Be Done to Mainstream Health Targets
Of the three MIPAA pillars, the second, “Advancing health and well-being into old age,” was least prioritized in the sample of 60 plans analyzed in this report. All of the plans have at least one health-related target, but many are not comprehensive across the spectrum of MIPAA’s health-related themes. This trend does not appear to be related to country development status. For example, the plans of Austria, California, Finland, Ghana, Indonesia, Nepal, Nigeria, Ukraine, and Vietnam all address only one aspect of health rather than taking a more comprehensive approach to healthy aging, while Brazil, Costa Rica, and Peru’s plans do not address any of the health policies under this MIPAA pillar. However, we recognize that these gaps may be sufficiently covered in other policy documents beyond the scope of this analysis; for example, national health and social protection plans.
Targets relating to the health care workforce were the most common MIPAA policy issues to be included in the plans. Of those analyzed, 47 out of 60 (78 percent) included targets to train care providers and health professionals. However, the January 2025 update represents a notable decrease in the number of plans including targets to prevent noncommunicable diseases (NCDs), which are the leading causes of death and disability worldwide and disproportionately affect older adults. Forty out of 60 plans (67 percent) address NCDs, compared to 82 percent of plans in the previous December 2023 DAPA update. Importantly, such measures are often mere targets that do not offer a policy solution or funding to realize these goals.
Two of the United Nations Decade action areas—improving access to and quality of (1) long-term care and (2) integrated care—are themes that are relevant to the MIPAA health pillar. Among health-related UN themes, providing, expanding, and improving long-term care is the most likely to be included in national plans, with 43 of 60 plans (72 percent) including targets to those ends. This emphasis on long-term care is important because currently only 5.6 percent of the world’s population lives in countries that mandate full, universal access to long-term care through national legislation. Providing older persons access to long-term care options can reduce the burden of care on families and allow older adults to choose how and where they wish to grow old, which in turn can improve older persons’ well-being.
Creating Age-Friendly Environments Important to Enhance Older Persons’ Quality of Life
The third MIPAA pillar emphasizes the promotion of enabling and supportive environments, corresponding with the fourth UN Decade of Healthy Ageing action area promoting “Age-friendly environments” and additionally aligning closely with the WHO’s Age Friendly Cities and Communities program. Supporting enabling environments for older persons includes ensuring access to quality housing and infrastructure as well as tackling ageism, neglect, and abuse, which can shape how older persons function and their overall well-being, both physically and mentally. Among the national plans analyzed, 32 out of 60 (53 percent) reported targets for protection from neglect, abuse, or violence. Elder abuse is prevalent globally, with one in six people over the age of 60 reporting abusive behavior in a nursing home or community setting, and around 64 percent of nursing home or long-term care staff surveyed have reported that they had committed some form of abuse in the past year. Abuse can all too often occur in home care situations, yet only 32 of the 60 national plans (53 percent) identified the provision of additional support to informal caregivers, many of whom are family members, as a priority to combat caregiver burnout and lessen the incidence of abuse.
Eradicating ageism is another key target to promote an enabling environment for older persons and was included in 31 out of 60 plans (52 percent). According to the WHO’s 2021 Global Report on Ageism, roughly half of the world’s population holds ageist attitudes. An ageist environment that does not support the needs of older persons is associated with older generations dying 7.5 years earlier, making the reduction of ageist attitudes an important consideration for country plans. Plans that included a focus on combatting ageism generally recommended the creation of positive-images-of-aging campaigns as well as legislation that prohibits discrimination based on age. To combat abuse and ageism, many country plans aim to address and improve the quality of life of older persons holistically, as well as focusing on the protection of older persons and improving intergenerational solidarity.
Finally, 38 out of 60 (63 percent) plans in the Database identified improving housing availability, quality, and affordability, and a similar proportion highlighted expanding older persons’ access to transport and public spaces as priorities. New Zealand’s Better Later Life Strategy (2019–2034), for example, identifies the creation of functional, safe, and affordable housing for older people as one of five key priorities, with a particular emphasis on providing an option for older persons to remain independent and age in place in their home communities, as does Slovenia’s Active Aging Strategy (2017). Malta expanded its National Strategic Policy for Active Ageing (2014–2020) to include a free transportation service called the Silver-T, which assists older people in independently conducting daily activities and errands. A number of plans, including Queensland’s Healthy Ageing—A Strategy for Older Queenslanders (2019) in Australia, Panama’s National Plan for the Elderly (2022–2025), the Republic of Korea’s 4th Basic Plan for a Low-Birthrate and Aging Society, the United States’ Aging in the United States: A Strategic Framework for a National Plan on Aging, and Portugal’s National Strategy for Active and Healthy Aging (2017–2025), highlight the WHO Age-Friendly Cities framework and commit to a series of adaptations to support aging in place.
.