What is an Age Friendly City?
The World Health Organisation (WHO) Age-Friendly Cities programme is a global movement aiming to improve the experiences of older people living in cities around the world.
The WHO AFCC approach focuses on features of a city’s structures, environment, services and policies that impact on older residents’ experience of ageing. The features which impact on ‘Age- friendliness’ are presented in eight ‘domains’ as petals of a flower, at the centre of which an individual experiences the city as more (or less) Age-friendly (WHO 2007: Fig 6).
Since each domain encompasses a wide range of factors, the WHO flower indicates that each of these ‘determinants’ can be variously and simultaneously involved in making the city more or less Age-friendly. In a similar vein, the WHO concept of Active-ageing suggests that the potential of Age-friendliness is defined by the ability of older people to individually and collectively infl uence or control the impact on their experience of the city of some or all of the factors across the domains of the Age-friendly flower.
From Age Friendly Cities to Integration of Health and Social Care
The key imperatives of increasingly aged and growing urban populations are often seen against a background of national and international reductions and reorganisations of state provision of health and social care services in response to banking crises and growing debt. Across the world, but specifically in the UK, these factors have led to increased expectations of the necessity of community action in social provision. While this is clearly an urgent, growing and wide-ranging societal challenge, approaches to this agenda are currently under-explored both in terms of individual disciplines and collectively between disciplines.
Increased valuation of the importance of community contribution and activity is predicated on the assumption that they are able to ameliorate currently intractable health and social care problems (for example by improving measurable outcomes and reducing budgetary pressure for institutional providers). However, there is currently a lack of coherent methodological and experimental explorations of these complex situations – both in terms of practically achieving these kinds of community-led holistic interventions and how we are able to account for their failures and successes.
The key issues arising from a locality-based community-led health and integration agenda relate both to how we achieve and account for the following issues.
- The activation and development of communities.
- What potential this can have for health and well-being outcomes,
- The relationship of the above to place and environment.
- The relationship of the above to the production of policy and evaluation.
- The structure and performance of institutional actors.
These issues can be framed as research questions as follows:
How can Health and Well Being provisions be inclusive for ageing populations and integrated within communities?
- Health and Social care integration appears to be positively related to place based structures of working because the ‘needs’ and impacts of Health and Social care are experienced and understood in service delivery – the location of integration is the ‘patient’ or citizen.
- Community involvement has become a central narrative (big society etc.) but in health care terms there has been little planning for or evidencing of the affects of these kinds of systemic integration on even non-clinical hard-nosed metrics such as ‘reducing inappropriate A&E appointments’ or probably even more significantly ‘reducing discharge delays’.
How can we develop holistic / systemic community-led Health and Well Being interventions?
- The Manchester Age Friendly Neighbourhood project (MAFN) has established resident-led groups working across a neighbourhood with multiple stakeholders focussed on interventions reducing social Isolation
How can we establish evidence bases for community-led interventions across Medical, Social and Holistic evaluations?
What is the role of the specificity of place in evidence bases, policy frames and intervention propositions?
- MAFN has developed a mixed-methods research methodology with a place-specific emphasis involving a multi-disciplinary examination of place and community
- PHASE is developing a conceptual framework for Age Friendly Cities and Neighbourhood research using a capability model and a theory of affect.
What is the role of individual (community and institutional) agency in evidence bases, policy frames and intervention propositions?
- MAFN is working with transformative community development techniques alongside developing a theory of change /affect research methodology as part of a multi-stakeholder partnership working at local, city, regional, national and international scales.
- The Old Moat Pilot project document has been cited as best practice at the UN and is available online from a range of esteemed institutional sources including the International Federation on Ageing, the UK Housing Lin.
- The development of shared knowledge platforms between these multiple stakeholders so they can work and plan together appears to be an essential component of research and communication
- Any theory of change or affect has ultimately to attempt to link systemic changes intended through community-led / place-based working to the evidentiary and economic levers of institutional providers to enable responsive and progressive reallocation of resources and resource allocation powers.
How do these issues relate to the wider population and individual disciplines?
- These research questions are theoretically applicable to any demographic group similarly excluded or associated with societal challenge. While all of these issues are related to Age and Ageing, the Who ‘capability’ conception of Age Friendly Cities opens these problems out across the whole life-course and by so doing strategies both research and policy avenues over time rather than only tactically focussing in a particular demography.
- The WHO AFC model explores a range of determinates in eight domains and the interrelation between them. As each domain addresses multiple specific disciplines the WHO integrated approach is required to address the models and evidentiary frameworks of Medical, Social and Ecological approaches.
Old Moat in an Age Friendly Manchester
In 2012, the ‘Old Moat in an Age Friendly Manchester’ project was commissioned by Southway Housing Trust (a community based housing provider and social enterprise that owns and manages half of the stock in the area) in partnership with the Manchester City Council (MCC) ‘Age Friendly Manchester’ programme (AFM).
The ‘Old Moat in an Age Friendly Manchester’ project was undertaken by the Centre for PHASE at the Manchester School of Architecture, working with the Manchester Institute for Collaborative Research into Ageing (MICRA). It followed the research framework, conceptual principles and practical design guidance of the WHO AFCC programme, working with the local community to make the Old Moat neighbourhood more Age-friendly.
In Manchester, older people form a smaller than average proportion of the population and the number of people aged 65 and over is currently decreasing, set against an above average number of young adults. This is a combination of natural losses and emigrants not being replaced by a large enough cohort of late middle-aged people and older people moving into the city. While there are some settled communities of older people, many live in areas where they are isolated or living in poverty.
With the 2011 Census showing even lower numbers of people aged 65 and over than predicted, it would seem logical to assume health and social care needs will be reduced; however, evidence shows the reverse is true. The characteristics of Manchester’s older residents mean that they are more likely to place high demands on hospital emergency and mental health services and suffer from long term limiting illnesses at an earlier stage in their old age than nationally.
However, there are specific areas and pockets with higher concentrations of older people.
Old Moat is a ward of Manchester City with around 14,000 people with about 13% of its population over 55 years- old. While this is well below the Manchester average (circa 20%), a large student / younger population, concentrated around the district centre on the eastern edge, leads to much higher percentages of older people to the west, reaching 40% in some parts. In UK terms, there are high levels of deprivation and life limiting illnesses as well as low life expectancy.
The Age Friendly Old Moat project undertook both research and design activities seeking to discover how Age-friendly the area is now and develop activities to make it more Age-friendly
Our interdisciplinary research and design team used expertise from architecture, urban design, sociology, gerontology and community development, to consider both social and physical aspects of the neighbourhood. We engaged with the local community to explore Age-friendliness across the WHO domains in order to design interventions which would increase Age-friendliness.
A key enabling objective of our approach was to increase resident participation across a range of circumstances and improve engagement between residents and city stakeholders (e.g. transport and service providers). In an area previously without an enduring, constituted group of residents or tenants of any age, the objective was to improve both the reception of, and resident involvement in, decision-making in the neighbourhood.
The project attempted to do this through the co-creation of a neighbourhood ‘action plan’ involving both residents and institutional stakeholders in its preparation and implementation. This ‘action plan’ was a device developed to gather and reconcile explorations into the lived experience of older residents from across multiple WHO domains so that findings could be discussed and shared and developed into proposals for interventions.
Rather than a process of ‘consultation’, the co- production of this action plan enabled residents to be active in designing a programme of improvements that responded to their actual, specific experiences within the neighbourhood. A range of resident involvements instigated during the project continue at the time of writing and the Capability methodologies of the pilot are now being tested at a larger scale in the Greater Manchester ‘Ambition for Ageing’ project for which the MSA PHASE research team are contributing as ‘Local Delivery Leads’ in Manchester.
Age Friendly Manchester
Manchester City became a member of the WHO Age Friendly Cities network in 2010, committing to improve social participation of older residents, and improve the quality of local communities for older people.
Age-Friendly Manchester (AFM) is a partnership involving organisations, groups and individuals across the city playing their part in making Manchester a great place to grow older. Working alongside a board of older residents, a dedicated AFM team in the Council works toward influencing and educating organisations across the city and the wider public about how they can contribute to this aim (including the Council itself). This work is in line with the World Health Organisation’s concept of age-friendliness, which relates to “policies, services and structures related to the physical social environment that are designed to support and enable older people to ‘age actively’ – that is to live in security, enjoy good health and continue to participate fully in society.”
The AFM strategy (the ten year Manchester Ageing Strategy published in 2009) sets out the City’s plan to address these issues by developing local networks of services and promoting public health services, in conjunction with City-wide reform as set out in the ‘Our Manchester’ programme. These initiatives are key to reducing the high demands on services but the approach taken is focused on building on existing strengths to improve the quality of life of Manchester’s older population.
- Support older people to deliver and participate in community projects and activities.
- Promote local social, cultural and leisure opportunities that support good health and wellbeing.
- Reduce the risk of social isolation and loneliness.
- Increase awareness and application of the AFM’s Older People’s Charter
- Increase economic and cultural participation among older residents.
- Improve the health and wellbeing of older residents.
Communication and involvement
- Enhance opportunities for older people to participate in and influence AFM
- Increase age-friendly communications Knowledge and innovation
- To complete a needs and assets assessment of the city’s older population.
- To agree a new set of indicators to measure progress for Age-Friendly Manchester.
- Deliver research projects that make a difference to the lives of older people.
- Increase recognition of age-friendly approaches in local, national and international strategies and funding programmes.
- To strengthen Manchester’s collaborative partnerships locally, nationally and internationally.
For more information about the AFM work, please contact firstname.lastname@example.org.