Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.
“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”
– Atul Gawande, Being Mortal: Medicine and What Matters in the End
Contemporary approaches to healthy living, with an increasing attentiveness to social determinants of health and the Vital Conditions for Health and Well-Being, hold potential — even real promise — to provide us with longer and greater-quality lives, especially through our later years. Focusing and sustaining meaningful action in support of that potential — that promise — requires a broader perspective on healthy aging and an open and inclusive conversation on the subject.
Just as our older adult population is expanding, so too ought the relevant questions about our conversations on healthy aging: How do you, as a health professional, talk about healthy aging? With whom and when? Are these conversations narrowly focused on older adults, or do they incorporate a longitudinal, whole-of-life perspective? What specifically are the issues discussed?
With these questions in mind, let’s talk about talking about healthy aging.
Health care access, quality, and costs — and other direct services specific to older adults — are likely the focus of most current conversations on aging. However, as I recently wrote in a blog post about social determinants of health, with the exception of access to quality health care, every determinant that affects our health and well-being — and our opportunity for healthy aging — exists outside the health care sector. Our discussions on healthy aging must therefore also reflect those varied social determinants and be inclusive of many diverse sectors.
Given these expansive social determinants — the conditions in the environments where people are born, live, learn, work, play, worship, and age — greater inclusivity in discussions on healthy aging becomes imperative. Who has a voice, what they discuss, and where discussions take place should all reflect this broad perspective. Beyond such discussions focusing on health care and social services, we must invite a broader representation of sectors — with perspectives, for instance, on lifelong learning, physical activity, spirituality, and entertainment. Such richer conversations create opportunities for improving what truly impacts the quality of older adults’ lives.
Aging is a gradual, lifelong process, although it may at times feel like it suddenly sneaks up on you. We know that healthy living throughout life contributes greatly to healthy aging in later years. We also know generally what happens to our bodies and minds as we age. And while advanced age is not guaranteed, there’s a general expectation that healthy aging is attainable.
Individual and collective awareness of the characteristics of healthy lifestyles and behaviors necessary to improve the chances for aging healthfully are key. From a public health and systems perspective, ensuring that policies and investments supporting opportunities for healthy living are proactive and focus on improving the Vital Conditions for Health and Well-Being are equally important. These considerations demand a perspective that healthy aging begins early in life and not with the onset of old age. The conversation about supporting healthy aging shouldn’t wait until then either — and it shouldn’t focus only on people older than 65 years.
The current state of healthy aging policies, funding, and community supports is one in transition. Some of this change is due to increasing attention on healthy aging in general, while also influenced by pandemic-related emergency programs coming to an end. Previously unaddressed inequities and disparities that the pandemic has exacerbated have played a role in the transition as well. These factors add weight to the idea that there is additional need for continued and expanded dialogue about what matters as people age. They also suggest that continued planning, innovation, and adaptation to support healthy aging is essential. All this being said, the answer to the question “When is the right time to talk about healthy aging?” is now.
How should we talk about healthy aging? At the most fundamental level, as with all conversation related to healthy living throughout the lifespan, it starts with understanding the needs of the individual and the resources of their community. Engaging in collaborative, cross-sector dialogue about healthy aging that supports the sharing of resource discoveries and successful innovations, as well as failures, is critical for creating beneficial change — as is advocating for healthy aging policy improvements at every turn. This calls for more connection, the formation and sustainment of networks to support one another and foster collaboration, and greater openness — particularly regarding equity. It calls for acting in accordance with the needs of older adults, as defined by older adults who have an active, empowered voice at the table. Such collaboration is the basis for an age-friendly ecosystem overall.
Admittedly, I’ve painted in broad strokes when outlining these conversations, emphasizing essential — if not general — concepts. There’s so much more nuance to the ways we need to talk about healthy aging than I can share in a single post.
With that in mind, I encourage you to open a dialogue among your colleagues and keep the discussion going as we work together, across new and expanded partnerships, to develop new and better approaches for prioritizing healthy aging. Keep asking questions of diverse sectors that expand our understanding of the implications for healthy aging. Keep drilling down on the answers to those questions with new conversations and exploration. And above all else, share what you learn with others working to meet the needs of older adults.
What concerns you in terms of healthy aging? Where have you found successes or innovated by connecting with others? How are you continuing to connect and communicate to provide for those you serve? How have your efforts evolved? Who is missing from the conversations? And critically, are the voices of older individuals with lived experience part of the conversation?
Bear in mind Gawande’s point that the priorities for older adults go beyond “merely being safe and living longer.” We must grasp the idea that “the chance to shape one’s story” and elevate the quality of one’s later years will become all the more important across our nation in the years ahead.
So, let’s talk more about talking about healthy aging!
Yours in health,
Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis