Environmental and policy change to support healthy aging

Given the growing evidence of the influence of the environment on older adult health, the need to design and implement effective environmental policy around healthy and vital aging is urgent. This article describes issues amenable to improvement through policy change, evidence supporting specific policy approaches and outcomes, and promising strategies for implementing those approaches. Key areas of focus are neighborhood design and safety, housing, transportation, and mobility. Strategies to build capacity for policy change are also addressed. Our goals are to foster greater attention to environmental change in support of healthy aging and to illuminate directions for policy change.     

Evaluation of public health professionals' capacity to implement environmental changes supportive of healthy weight

Community-based interventions to promote healthy weights by making environmental and policy changes in communities may be an important strategy in reversing the obesity epidemic. However, challenges faced by local public health professionals in facilitating effective environmental and policy change need to be better understood and addressed. To better understand capacity-building needs, this study evaluated the efforts of the Healthy Start Partnership, a university-community project to promote healthy weights in young families in a rural eight-county area of upstate New York. Qualitative interviews (n=30) and pre/post surveys (n=31) were conducted over three years of the intervention. Challenges faced by partners significantly slowed progress of environmental interventions in some communities. First, many partners did not feel their "regular" jobs afforded them sufficient time to do community work. Second, many partners did not feel they had the personal political power to work on broader environmental, policy, or system change issues. Third, facilitating and policy change and reaching out to non-traditional partners, like businesses, required developing a new set of public health skills. Fourth, the long-time frame of environmental and policy work meant that many efforts would exceed the grant period. Building local public health leaders for environmental and policy change necessitates that these challenges are acknowledged and addressed.     

Evaluating Potential Environmental Variables and Active Aging in Older Adults for Age-Friendly Neighborhoods in Malaysia

As Malaysia's population is aging rapidly, and since there is no specific housing policy for the elderly, it is vital that neighborhoods meet the different needs of elderly for active aging to maintain their quality of life. This study aims to investigate the neighborhood environmental variables, the outcome active aging, and potential variables that inhibit active aging in the elderly that lead to their quality of life. It examined quality-of-life determinants that are influenced by the existence of certain neighborhood characteristics. In the study, 385 older adults aged 60+ years residing in two different cities in Malaysia were surveyed. Multiple regression was used to explore how much variance in active aging variables the neighborhood environmental factors explained as a group. The results showed that permeability, accessibility, and facilitators to walking are key determinants of active aging. There is a need to improve the physical design of the neighborhoods with regard to these three factors.     

Smallholder Preferences for Agri‐environmental Change at the Bhoj Wetland,India

Incentive‐based approaches have gained policy interest in linking change in agricultural land management with environmental conservation. This article investigates how scheme design influences smallholder farmers' decisions to switch to organic farming to reduce water pollution, drawing on a study at a Ramsar wetland site providing water for the city of Bhopal. Results from a choice experiment suggest that transitional payments are necessary to overcome farmer constraints to adopt organic farming, and that effective land certification has the potential to act as a self‐enforcing mechanism linking farmer incomes with wetland conservation benefits.     

Sustainable lifestyles for all? Disability equality,sustainability and the limitations of current UK policy

In recent years, various environmental threats have been highlighted in relation to disability. Growing knowledge of the effects of climate change and particular impacts on disabled people have been highlighted by a number of authors, including a recent critique of disabled people’s ‘vulnerability’ with respect to environmental hazard. This article focuses on the issue of citizen involvement with climate change mitigation – and more broadly individual and household-level efforts to reduce our impact on the environment. These more mundane aspects of climate change mitigation, for example through transitions to more sustainable lifestyles, also have significant implications for disabled people. The article argues that disability equality is a key component of sustainability. Limitations are demonstrated in policy designed to address these issues using the example of current UK policy, and it is suggested that policy approaches to sustainability should also be a concern of disability studies.     

Swimming upstream: The challenges and rewards of evaluating efforts to address inequities and reduce health disparities

Racial and ethnic disparities in the health of Americans are widespread and persistent in the United States despite improvements in the health of Americans overall. Increasingly, strategies for reducing disparities have focused on addressing the factors that contribute to – if not fundamentally underlie – health disparities: social, economic, and environmental inequities, which limit access to resources and cause unhealthy exposures. As public health shifts to interventions that seek to improve the circumstances of disproportionately affected populations and achieve equity through policy change, alternative methods to evaluate these efforts are also required. This paper presents an example of such approaches to addressing asthma disparities through Regional Asthma Management and Prevention's (RAMP) programmatic efforts and an evaluation of these activities. The paper describes RAMP's targets and strategies, as well as the specific evaluation methods applied to each, including activity tracking, observations, surveys, key informant interviews, and case studies. Preliminary evaluation findings are presented, as are lessons learned about the efficacy of the evaluation design features – both its strengths and shortcomings. Findings discussed are intended to contribute to the growing literature that provides evidence for the application of emerging approaches to evaluation that reflect non-traditional public health and support others interested in expanding or replicating this work.     

Comparative analysis of aging policy reforms in Argentina,Chile, Costa Rica,and Mexico

This investigation uses case studies and comparative analysis to review and analyze aging policy in Argentina, Chile, Costa Rica, and Mexico and uncovers similarities and relevant trends in the substance of historical and current aging policy across countries. Initial charity-based approaches to poverty and illness have been gradually replaced by a rights-based approach considering broader notions of well-being, and recent reforms emphasize the need for national, intersectoral, evidence-based policy. The results of this study have implications for understanding aging policy in Latin America from a welfare regime and policy makers’ perspective, identifying priorities for intervention and informing policy reforms in developing countries worldwide.     

Human mobility in the context of environmental and climate change: Recent data collection tools from the International Organization for Migration to address key methodological and conceptual issues

This paper outlines recent data collection tools and methodologies that the International Organization for Migration (IOM) has been using in order to gather information on human mobility as influenced by environmental factors and their impacts. It looks at alternative ways for collecting and analysing data in the face of methodological challenges related to the multicausality of movements, the voluntary/involuntary continuum in human (im)mobility decisions in the context of environmental and climate change, and the policy and epistemological imperative from viewing migration as an adaptation strategy. The paper finds that certain data collection approaches can be quickly deployed in rapid-onset disasters as well as applied in contexts of gradual, slow-onset environmental change to provide information useful for operational responses to immediate crises and/or for developing policies in response. Some of the tools can be useful in both contexts and may support both immediate and long-term operational, policy and research objectives.     

Commentary: The Emergence and Application of Active Aging in Europe

Active aging is established as the leading global policy strategy in response to population aging. In practice, however, the term active aging serves as a convenient shelter for a wide range of policy discourses and initiatives concerning demographic change. The twin purposes of this article are, first, to examine its European origins and how it has been applied in the world's oldest region. This policy analysis illustrates the contrast between the primarily European discourse on active aging, which emphasizes health, participation, and well-being, and the U.S. discourse that prioritizes productivity. The application of active aging in Europe has, nonetheless, been predominantly in the productivist mold. The examination of the emergence of this key policy concept in Europe is contextualized by an outline of the changing politics of aging in this region. The second purpose of the article is to set out a new, comprehensive strategy on active aging that is intended to realize the full potential of the concept. Understanding of the need for this broad vision of active aging is facilitated by the historical policy review.     

Public interest or private agenda?: A meditation on the role of NGOs in environmental policy and management in Australia

Non-government organisations (NGOs) have come to assume an important role in environmental policy in Australia. This paper considers the institutional impacts of an enlarged and formal role for NGOs in environmental governance. To foreground the analysis that follows, the paper theorises: (i) the structural democratisation of western societies which provides the preconditions for civic approaches to environmental governance; (ii) civil society organisations as political actors; and (iii) the link between non-state associations and democracy. Against this background, the paper surveys some of the ways in which NGOs are being formally involved in environmental policy and management in Australia. The paper proceeds to identify a series of risks associated with these approaches. The paper concludes by calling for a more nuanced and critical appraisal of the role of NGOs in environmental policy so political space might be reserved for the public interest and to ensure that the democratic effects of civil society are not diminished.     

As good as it gets? Rethinking old age

Although approximately half of aging Americans will probably not be able to live independently after retirement age, there is a greater focus on end-of-life matters, such as living wills, than on exploring creative long-term care models that promote healthy aging. With more Americans aging healthfully, now is the time to look at innovations in long-term care that will not only provide safe housing, but will also focus on the trajectory from healthy aging to end-of-life care, including health promotion and even reversal of disabilities incurred in the aging process. Nurses and other health care professionals need to rethink how those they care for will live out their later years and explore creative approaches for extending living options that foster autonomy.     

Housing for the aging population

Based on the concept of ‘aging in place,’ design of houses in the past years are explored. Design features in the built environment become barriers for aging people with functional limitations. Initially, houses were designed according to the required needs of the user with the physical limitations. Later, adaptable house design was introduced that allows the house to meet the specific needs of the user, while maintaining the appearance of the house until more obvious accessibility features are needed. Today, ‘design for all’ is recognised as a tool for ensuring physical accessibility for aging people. The holistic perspective embedded in the universal design theory should be systematically and consistently developed during the design process.     

Re-assembling climate change policy: Materialism,posthumanism, and the policy assemblage

National and international policy-makers have addressed threats to environmental sustainability from climate change and other environmental degradation for over 30 years. However, it is questionable whether current policies are socially, politically, economically, and scientifically capable of adequately resolving these threats to the planet and living organisms. In this paper we theorize and develop the concept of a “policy assemblage” from within a new materialist ontology, to interrogate critically four policy perspectives on climate change: “liberal environmentalism”; the United Nations policy statements on sustainable development; “green capitalism” (also known as “climate capitalism”) and finally “no-growth economics.” A materialist analysis of interactions between climate change and policies enables us to establish what each policy can do, what it ignores or omits, and consequently its adequacy to address environmental sustainability in the face of climate change. None, we conclude, is adequate or appropriate to address climate change successfully. We then use this conceptual tool to establish a “posthuman” policy on climate change. Humans, from this perspective, are part of the environment, not separate from or in opposition to it, but possess unique capacities that we suggest are now necessary to address climate change. This ontology supplies the starting point from which to establish sociologically a scientifically, socially, and politically adequate posthuman climate change policy. We offer suggestions for the constituent elements of such a policy.     

Making the Right Moves: Promoting Smart Growth and Active Aging in Communities

This article describes an award program sponsored by the U.S. Environmental Protection Agency for excellence in smart growth and active aging. Having examined qualitative and quantitative data, we suggest that any community can foster changes to improve the health and well-being of its aging population. Diverse winners took unique paths to change their built environments and encourage physical activity. The policy changes undertaken by the award winners have both short- and long-term benefits that are important for persons of all ages, but especially for an aging society.     

Building Affordable Rental Housing for Seniors: Policy Insights From Canada

ABSTRACT

In the context of healthy aging, we explore newly constructed, unassisted affordable rental housing with respect to design, location, and the involvement of seniors in decision making. We do so from the perspectives of seniors and project sponsors. Overall, the themes that emerged from these two groups of participants diverge. Seniors spoke about the importance of shared space, design-related barriers to aging in place, and problems accessing transportation. They also expressed a range of views regarding participation in decision making, from conveying it was not necessary to requesting resident involvement. Project sponsors spoke about cost, feasibility, and, in certain cases, learning how to build housing; they also evinced disparate views about the nature of the housing they were providing and the importance of seniors' involvement. Recommendations include linking housing to health and social policy, implementing guidelines for sponsors related to design and location, and providing increased funding to offset new costs.     

Nursing home medicine--a gloomy profession?

By controlling life-style and environmental hazards and seeking appropriate medical care, many people can enjoy a healthy, independent old age; various psychological schema provide models for such "successful" aging. But we must turn to the humanities for a vision of aging that sees meaning in lives characterized by incontinence, immobility, and confusion.     

National policy approaches to social care for elderly people in the United Kingdom and Singapore 1945-2002

The authors compare policy approaches in the United Kingdom and Singapore on social care for older persons. The context of these approaches is discussed showing the development of policies, in each country from the aftermath of the Second World War to the present. Given that Singapore is a former British colony, it is of interest to scholars of social policy to examine its welfare approach as compared to the welfare state approach espoused by the United Kingdom. Both nations are faced with the challenges of an aging population, which necessitates handling similar problems with strategies that are in harmony with their respective economic, social, and cultural contexts. This paper considers their divergence of philosophies and policies, concluding with the recognition that the major difference lies in national and governmental expectations regarding the extent of the financial and regulatory responsibility for care for older people carried by the individual, the family, and the state.     

Thinking intergenerationally: intergenerational solidarity,health and active aging in Hong Kong

This paper intends to provoke thoughts into intergenerational relations and future policies that can strengthen solidarity within families and community in order to face the challenges of aging population. It first provides an overview of intergenerational relations and the efforts to promote intergenerational programs in the specific context of contemporary Hong Kong. Through a sociological lens, it draws on a theoretical framework that explains how intergenerational relations are constructed. It also sets out the factors leading to cohesive or conflicting relations at the individual, family and community levels. The paper concludes by applying this framework to inform intergenerational programming, and to suggest ways to promote IP and to take intergenerational perspective into policy design towards a healthy and intergenerational cohesive community.     

Federalism and aging policy in the 1980s: implications for changing interest group roles in the 1990s

Shifts in the American political landscape during the 1980s had impacts on aging policy and on the behavior of aging interest groups through that decade. But perhaps even more important are the likely effects of those changes on aging policy and on the roles of age-related groups in the 1990s--and probably beyond. First, some of the major policy trends of the 1980s are sketched out, especially the renewed emphasis on federalism. Then, an assessment of their effects on aging policy and aging interest groups is provided. Next, a rationale for focusing on state-level policy and a discussion of current aging interest-group mobilization at the state level are presented. Last, the prospects for aging interest-group influence in the 1990s--a period in which the prior decade's emphasis on dual federalism is likely to continue--is addressed.