Meeting Report Prepared by the WHO Centre for Health Development, Kobe, Japan

2nd WHO Consultation on Developing
Indicators for Age-friendly Cities
8 SEPTEMBER, 2013, QUÉBEC CITY, CANADAEXECUTIVE SUMMARY
This consultation is part of a series of consultations, started in 2012, organized by the WHO
Centre for Health Development (Kobe, Japan) in an effort to develop new technical guidance on
monitoring age-friendliness of cities. The objective of this consultation was to obtain expert
opinion on how to advance the development of an Age-friendly City monitoring framework andcore indicator set.
Fourteen international experts and seven WHO officers, representing five of the WHO regions,gathered for this one-day meeting. The main inputs for discussion were a draft monitoring
framework and the preliminary results from a pilot study. Twenty cities from seven countries
had participated in the pilot study which involved an evaluation of 61 indicators considered
critical for monitoring age-friendliness of cities through previous consultation with officials andexperts. The indicators were ranked by value scores assigned by local health officials andcommunity representatives participating in the pilot study, and a short list of high-ranking
indicators was constructed. During the meeting, the experts engaged in group work to provide
specific feedback on the framework, the short-listed candidates for the core indicators andtheir proposed definitions.
The outcomes of the meeting suggest possible modifications to the structural and visual aspectsof the framework, a narrower set of core indicators, and the development of an assessment
tool that would help users apply the framework and core indicators to their own local context.
Additional inputs will be sought before finalizing these products through further consultations
with relevant experts as well as with local health officials and community representatives inMember States.

BACKGROUND
The WHO Centre for Health Development in Kobe, Japan (WHO Kobe Centre) initiated thedevelopment of globally applicable core indicators for assessing the “age-friendliness” of cities
in 2012, employing its expertise in urban health metrics development and drawing upon thefoundation which had been laid by WHO in developing the Active Ageing policy framework and,in particular, the Global Age-friendly Cities Guide. The core indicators are intended to provide
direction for any area interested in evaluating and monitoring their age-friendliness including,but not limited to, members of the WHO Global Network of Age-friendly Cities andCommunities; the Healthy Cities; and other cities engaged in developing healthy ageing profiles
or otherwise investing in the use of indicators for planning, monitoring, and evaluation.
The first step in the development process was to conduct a comprehensive review of existing
indicators related to issues of ageing, health and the urban environment to generate a masterlist of 195 indicators. As a second step, the first expert consultation was held in St Gallen,
Switzerland in August 2012, where a group of experts short-listed 61 indicators from the masterlist as candidates for the core indicators. Since then, as a third step, those indicators have been
evaluated in a pilot study by local government and community representatives of cities (i.e.
target end-users) in Australia, Canada, China, Ireland, Japan, Korea, Sri Lanka, UK and USA.
The main aim of this second consultation was to obtain another round of feedback fromexperts on the candidates for the core indicators taking into consideration the preliminary pilot
study results. This meeting was organized as a pre-conference meeting to the 2nd International
Conference on Age-friendly Cities, 9-11 September, 2013, Québec City, Canada.
OBJECTIVES
To generate recommendations from an expert group on how to further develop and refine thecore indicators and framework.
METHODPARTICIPANTS
The meeting was attended by 14 international experts and 7 WHO staff members. All WHO
regions, except for the Eastern Mediterranean region, were represented. The full list of official
participants is included as Annex 1.
BACKGROUND PAPERS
Three background papers were distributed in advance: 1) the summary report of the First
Consultation held on this topic in St Gallen, Switzerland in August 2012; 2) a document
describing a newly drafted framework that places the core indicators into context; and 3) apreliminary report on the indicator pilot study results. The pilot study report was preliminary1because the pilot study data collection was still ongoing at the time and not all responses had
been analyzed yet.
All three papers are available from the WHO Kobe Centre (wkc@who.int).
MEETING PROCEDURES
The meeting comprised three plenary sessions and two group work sessions. The group work
sessions were designed to enable in-depth discussions about the issues of main interest,
namely the framework and the core indicators, and PowerPoint slide templates were provided
for recording the group work results.
During the first plenary, the WHO Kobe Centre presented the objectives and methods for the
meeting, an overview of the progress to date in developing the indicators, the newly draftedframework, and the preliminary results of the pilot study.
The participants were divided into three groups for the group work sessions. The first group
work session elicited feedback on the new framework (see Figure 1). Each group was asked to
identify positive attributes of the framework, as well as aspects of the framework they thought
should be modified, specifying the proposed modification.
The second session focused on the 21 short-listed indicators based on the preliminary results ofthe pilot study (see Table 1). The groups were asked to review the list of 21 indicators andpropose any changes (e.g. deletion, modification, replacement) to the indicators, theirdefinitions, or both, as appropriate. The groups were provided with five resource documents
for this session: 1) qualitative feedback received in the pilot study on the 21 short-listed
indicators, 2) a matrix which maps the 21 indicators onto 11 other relevant indicator projects(e.g. Active Ageing Index, Livable Community Indicators) to highlight commonly used indicators,
3) a list of possible definitions for each of the 21 indicators taken from existing sources, 4) acomplete list of the 61 indicators evaluated in the pilot study along with their ranking results,
and 5) a list of all alternative definitions proposed in the pilot study for any of the 61 indicators.
Each group work session was followed by a plenary session during which the group work results
were shared and discussed with the entire group.
The meeting was conducted in English.

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Figure 1. Draft monitoring framework for Age-friendly Cities (Focus of Group Work Session 1)

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Table 1. List of short-listed indicators from the preliminary pilot study results (Focus of GroupWork Session 2)
DomainOutdoor Spaces andBuildings

Indicator and Definition Accessibility – Access to toilets: Number of older residents who perceive that public toilets
are accessible when outside

Transportation

 Quality – Public transportation vehicles are physically accessible (A): Number of buses thatare accessible for people with different disabilities
 Quality – Public transportation vehicles are physically accessible (B): Number of older
residents who feel public transportation stations/stops are far away from home Priority Parking – Availability of adequate, designated priority parking for individuals withmobility challenges

Housing* Accessibility – Policy exists to guide the planning of new housing construction that ensures
accessibility

Respect and Social
Inclusion Ageism – Older people's perception of negative attitude on the basis of their age (A):
Number of older residents who reported feeling alienated "sometimes", "often", or"always"

Civic Participation and
Employment

 Volunteering – Engagement in volunteer activities (A): Number of older residents who
engage in volunteer activities
 Volunteering – Engagement in volunteer activities (B): Number of older residents whoreport feeling satisfied with availability of volunteer opportunities

Social Participation

 Culture and Sports – Participation in cultural activities, arts, and sports (A): Number ofolder residents participating in sports activities within a specific time period
 Frequency of participation – Number of older residents who engage in social activities
daily, weekly or monthly Life-long Learning – Number of older residents who enrolled in formal education in thepast year

Community and HealthServices Accessibility – Home-based care/chronic home care (A): Number of older residents who
received care/assistance for domestic tasks within last 12 months

Communication andInformation

 Information – Resource guide of leisure-recreation programs for older persons
 Information – Information about employment and volunteering opportunities for older
persons Availability – Source of information about health concerns and service needs of older
persons Accessibility – Internet access (A): Number of older residents with internet access at home
 Accessibility – Internet access (B): Number of older residents who feel satisfied withcomputer and internet access in public spaces

Health Risk Factor – Physical activity: Number of older residents who engage in daily or weekly
physical activity
 Quality of Life – Proportion of older residents with high QOL (subjective wellbeing) (B):
Number who rate overall QOL "very good" or "good"

Economic Security* Financial Protection – Financial protection for healthcare needs: Number of older people
who have health insurance

Governance* Resources – Amount of local government budget allocated to health*There were no indicators in these domains that consistently ranked within the top two quartiles across all four ranking categories (i.e. thecriterion for short-listing); thus, the indicator with the highest average score indicator was short-listed as an alternative.

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OUTCOMESKEY THEMES FROM PLENARY DISCUSSIONS
Several key themes emerged from the plenary discussions as important considerations fordeveloping the core indicators. These issues, summarized below, highlight some of the tensions,or trade-offs, between contrasting dimensions and values that must be considered in theprocess of selecting a small set of core indicators. In fact, many of these issues were alsobrought to light through recent experiences with other related initiatives which involved
indicator selection, namely the Active Ageing Index1 and the Global Ageing Index2. These
discussions also have broader implications for the development of the monitoring frameworkand other supplementary resources, such as the assessment tool, as well as for the technicalsupport that WHO will offer to Member States to facilitate the uptake and implementation of
the indicators.
PROCESS VS OUTCOME
The original objective of Age-friendly Cities is to facilitate the process of Active Ageing.3
Emphasis is placed on creating physical and social environments that are viewed by older
persons and their caregivers as desirable conditions for realizing Active Ageing (i.e., thosefeatures described in the Age-friendly City Guide4), rather than on producing specific outcomessuch as improved health. It was suggested that the core indicators reflect this fact by focusing
more on those descriptive aspects of the physical and social environment which Age-friendly
City initiatives are expected to directly affect, and relatively less on the distal, evaluative
outcomes related to health, safety, or security (i.e. the three pillars of Active Ageing), which
may be indirectly affected through influence on the process of Active Ageing.
As a means of monitoring progress and evaluating achievements, the core indicators should
ideally include short- or medium-term process indicators as well as long-term outcome
indicators. Also, preference is given to indicators which are sensitive to incremental change (i.e.
indicators that can be measured on a scale rather than binary indicators). Process indicators
monitored on a regular basis are important to demonstrate systematic progress directly related
to Age-friendly City initiatives which, in turn, can help to sustain political commitment and1

Zaidi, A., K. Gasior, M. M. Hofmarcher, O. Lelkes, B. Marin, R. Rodrigues, A. Schmidt, P. Vanhuysse and E. Zolyomi. Active Ageing Index 2012.
concept, methodology, and final results. Methodology Report, UNECE /European Centre Vienna/ European Commission, 2013(http://www.euro.centre.org/data/aai/1253897823_70974.pdf).
2

Global AgeWatch Index 2013: purpose, methodology and results. Paper prepared by A. Zaidi, Centre for Research on Ageing (University ofSouthampton, UK), with contributions from B. Azad, S. Beales, M. Gorman, A. Kulcsar, C. Knox-Vydmanov, A. Mihnovits, E. Mikkonen-Jeanneret,
P. Ong, J. Scobie and M. Skinner. London, HelpAge International, 2013 (http://www.helpage.org/download/524457e340b61).
3

Active ageing: a policy framework. A contribution of the World Health Organization to the Second United Nations World Assembly on Ageing,
Madrid, Spain, April 2002. Geneva, World Health Organization, 2002 (http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf).
4

Global age-friendly cities: A guide. Geneva, World Health Organization, 2007(http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf).

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support. The distal outcomes desired by Age-friendly City initiatives, such as those related toolder people’s welfare, may be measured at longer intervals to identify long-term impact.
UNIVERSAL VS CONTEXTUALThe primary purpose of the core indicators should be to facilitate self-monitoring andevaluation by the cities and communities themselves, and not necessarily for comparison or
benchmarking against all other cities. As such, the core indicators should be adaptable to local
contexts, including the general sociocultural context as well as the specific goals andinterventions adopted by the local community. Given that many of the indicators underconsideration are not commonly used or standardized internationally, the operationalization ofsuch indicators is best done locally.
At the same time, universality or comparability of indicators would also be desirable as it will
permit comparisons and monitoring of progress across a meaningful set of cities orcommunities. While cross-city comparisons will not be the primary objective for using theindicators, it could be useful for promoting healthy competition, mutual learning andbenchmarking. This may be of particular interest to the Global Network of Age-friendly Cities
and Communities and its affiliate networks at national or regional levels.
Process indicators will tend to be context-dependent because they will be closely linked tobaseline conditions, the goals and interventions that are adopted, and contextual factors thatstrongly influence the intervention process; whereas it may be possible to have more universal
indicators to measure higher-order, long-term welfare outcomes.
CONVENTIONAL VS ASPIRATIONAL
The choice of “conventional” indicators for which data are readily available from existingsources, such as routine administrative surveys, can be more desirable considering that thevalidity and reliability of those indicators are likely to have already been established, and alsothat additional resources would not be required to gather the data. However, there is also
value in selecting indicators that are most pertinent to the issue for which data will need to be
newly generated, for example, using a new survey. Such indicators will be more challenging tomeasure given resource constraints and possible technical limitations (e.g. lack of standardized
indicators), but adopting them can help spur desirable change and resource allocation toward
those indicators which cities aspire to influence.
SUMMATION VS DISAGGREGATION
Indicators that are representative at the city level can be most useful in characterizing theoverall age-friendliness of a city. However, these summative indicators at the macro level havea tendency to conceal disparities within a city which are important to identify and address. Thus,“distribution-sensitive” indicators, or indicators that can be disaggregated by social stratifiers(e.g. gender, age, socioeconomic status, neighborhoods/small geographic units) are needed inorder to capture social inequities within cities.
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STABLE VS DYNAMIC
In general, revisions to an indicator hamper comparisons over time and are costly to implement.
Thus, indicators and their operational definitions should be kept unchanged for a time.
However, there will also be a continuous process of feedback and learning from theparticipating communities and other stakeholders, which may make it necessary or appropriate
to revise the indicators over time to reflect new conceptual framings, new ideas about causesof problems and appropriate interventions, and changes in health information systems.
DEVELOPED CONTEXT VS DEVELOPING CONTEXT
The chosen core indicators will have to be relevant not just for the developed countries but also
for the less developed countries, especially in light of the fact that the trends of urbanizationand population ageing are increasingly affecting low/middle-income countries. Just as theperspective of developing countries was taken into account in developing the WHO Agefriendly Cities Guide, the development of core indicators should also ensure applicability andrelevance to developing contexts. Vastly different baseline conditions (e.g. public
transportation systems are underdeveloped in general, not to mention being fitted for theelderly or disabled) and social concepts about “health-promoting/supportive” factors (e.g.
physical activity among the elderly in developed contexts is likely to be voluntary and healthpromoting, while in developing contexts it may be involuntary physical labor which ispotentially harmful to their health) need to be taken into account. An indication was made thatsince the urban environment is barely “human friendly” in some developing contexts, theapplicability and relevance of even conventional concepts and indicators need to be examined
carefully.
OUTPUTS AND RECOMMENDATIONS FROM GROUP WORK 5 ABOUT THE FRAMEWORKOVERALL, THE DRAFT FRAMEWORK WAS FAVORABLY REVIEWED. ITS MAIN
STRENGTHS ARE THE FOLLOWING.
1

It elaborates the “mechanisms for local age-friendly initiatives”, which are essentially the
key success factors, or enabling factors.

2

It provides focus on specific domains, and links them to actions/interventions.

3

It allows for local adaptation.

4

It is simple, logical and intuitive while also being comprehensive.

5

It makes a clear and simple distinction between “physical environment” and “social
environment”, which together comprise the original 8 domains for Age-friendly Cities.

5

Note: Outcomes and recommendations from group work listed here do not imply consensus among all meeting
participants. They are the outputs of at least one of the three small groups which undertook the work.

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THE FOLLOWING ARE PROPOSED MODIFICATIONS TO THE FRAMEWORK.
1

Incorporate an equity dimension/perspective into the framework as a guiding principle.

2

Modify the arrangement of columns in the framework.

3

2.1

Interventions could be placed between Columns 2 and 3 as a separate, stand-alone
column.

2.2

A fourth (final) column could be added to indicate distal outcomes (see 2.7.1.3
below).

Modify Column 1.
3.1

Modify the wording of key terms.
3.1.1 “Mechanisms for local age-friendly initiatives” to “Success/Enabling factors for
local age-friendly initiatives” (to make the term more simple, intuitive, andattractive).
3.1.2 “Intersectoral collaboration” to “Collaborative intersectoral planning” (so that it
encompasses both intersectoral collaboration as well as the development of aplan of action). Explain “intersectoral” in a footnote or other accompanying text
(not in the figure itself) to clarify whether it refers to government sectors; private,public, civil society, etc; or both. Expand the concept to account for actors likeprivate foundations.
3.1.3 “Civil society involvement” to “Multistakeholder involvement”. Explain“multistakeholder” in a footnote/accompanying text and give examples, such ascity administrators, researchers, civil society, faith-based organizations), etc.

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3.2

Include two additional factors in Column 1 – “Resourcing strategy” (both human andfinancial) and “Education/Sensitization” (of stakeholders).

3.3

Add indicators to measure the degree of success/enabling factors in place (i.e. input
indicators).

Modify the domains of intervention.
4.1

In general, there was little support for keeping the domains of “Governance”,“Economic Security” and “Health” under Column 2 along with the original 8 domainsof AFC. One proposal was to redistribute them as follows.
4.1.1 Remove the domain of “Governance” from Column 2. Aspects of governance areencompassed in the factors listed under Column 1. “Economic security” could beconsidered a domain of distal outcomes rather than a domain of intervention.

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4.1.2 Remove the domain of “Health” from Column 2. Health-specific interventions areencompassed in the domain of “Community and Health Services”. “Health” could
be considered a domain of distal outcomes rather than a domain of intervention.
4.1.3 Indicators for “Economic security” and “Health” could be placed in a fourth/final
column (to be added to the framework) which shows distal outcomes of agefriendly initiatives.

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4.2

Create higher-order or cross-cutting domains such as “Accessibility” “Security” and“Inclusion” in order to allow communities that do not have the capacity to measureprogress in specific domains to at least measure progress at these higher-order levels.
(Note, however, that suggestions were not made about how these cross-cutting
domains can be represented in the framework nor how they can be measured withindicators.)

4.3

Make the links between the domains/interventions and the indicators clearer.

Distinguish input, process, and outcome indicators, and give examples.

OUTPUTS AND RECOMMENDATIONS FROM GROUP WORK 6 ABOUT THE CORE
INDICATORS AND DEFINITIONS 7
As a general principle, it was proposed that a uniform descriptive/conceptual definition beprovided for each indicator, while leaving the specific operational definition to be determined
locally (for example, the operationalization of terms like “adequate” or “accessible”). It wassuggested that examples of operational definitions for the indicators be provided in an
assessment tool (to be developed). It was also suggested that the response format for each of
the indicators be scalable (for example, a 5-point Likert-type scale) instead of a binary measure(i.e. ‘yes’ or ‘no’).
While inter-city comparisons should not be the main objective - rather, the focus should be on
evaluating progress against one’s own past performance or on monitoring intra-city inequalities,
cities should be encouraged to use consistent operational definitions and response formats
whenever possible in order to improve comparability across time, between geographic subunits within the city, or between different cities within a country or region, or internationally.
Specific recommendations for the core indicators and their definitions are the following.

6

Note: Outcomes and recommendations from group work listed here do not imply consensus among all meeting
participants. They are the outputs of at least one of the three small groups which undertook the work.
7

See Table 1 for the list of 18 indicators which were short-listed as candidates for core indicators based on the
preliminary results of the pilot study.

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OUTDOOR SPACES AND BUILDINGS
1

None of the groups were in favor of the indicator on access to public toilets because of its
narrow scope. The suggestion was to replace it with an indicator that is broader and covers
accessibility of all “public buildings (and spaces)”, which would include public toilets as wellas sidewalks and buildings. The concept of “accessibility” would need to be operationallydefined, for example, in terms of the extent to which they comply with Universal Design
guidelines.

2

Consider a walkability indicator as another core indicator to represent this domain.

TRANSPORTATION
1

2Slight modifications to the definitions of the two indicators on transportation quality were
proposed.
1.1

The first indicator could be “Percentage of public transportation vehicles that is
physically accessible for people with different types of disability”. In general,
percentages are more comparable than raw numbers. Public transportation vehicles
would include but not be limited to buses.

1.2

The second indicator can be “Percentage of older people who feel public
transportation stops are too far from home”. “Too far” can be defined in terms of thetime required to travel the distance or the actual distance (geographic density) ofsuch stops. However, such a definition may fail to capture access to public
transportation options that offer door-to-door service. Ways to account for suchservices need to be considered. Another suggestion was for this indicator to beeliminated from the core list and placed in a second-tier list.

The third indicator on accessibility of priority parking areas is very relevant but only inlimited contexts (i.e. developed countries where personal car use is high). Thus, this is notsuitable for a core indicator but may be important to list as a second-tier/optional indicator.

HOUSING
1

Alternative definitions for the “housing accessibility” indicator were proposed which
focused on the “percentage of new (and/or existing) housing that are, or can be, adapted
to the changing needs of an older person”.

2

An additional indicator on “housing affordability” was also suggested with “affordability” tobe locally defined (for example, in terms of proportion of income being spent on housing).

RESPECT AND SOCIAL INCLUSION
The indicator of ageism was suggested to be defined in terms of feelings of “(dis)respect”
rather than “alienation”. A possible definition could be a positively-worded one such as,
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“percentage of older adults who feel respected and included”, with the response measured
on a Likert-type scale.
CIVIC PARTICIPATION AND EMPLOYMENT
1Opinions were in favor of keeping “engagement in volunteer activities” as a possible core
indicator, but not the one on “satisfaction with engagement in volunteer activities”.

2

However, “engagement in volunteer activities” is more appropriate as a core indicator of“social participation” (or “civil participation”) rather than “civic participation”. A core
indicator for “civic participation” should actually measure civic involvement in decisionmaking, and not volunteer activity.

3

It was suggested that “employment” can be reflected in the indicators for the domain of“economic security”.

SOCIAL PARTICIPATION
1

It was suggested that the indicator on “frequency of participation in social (and cultural)
activities” be kept in the core list, while the indicator related to participation in sports
activities be dropped. Both “frequency” and “social/cultural activities” will need to be
defined.

2

Views were mixed regarding the indicator on “lifelong learning”. Some regarded it as a very
important indicator to include in the core list. Others were not in favor of it because of the
difficulty in defining and measuring it. Suggestions were made to remove the restriction to“formal education” and broaden it to “learning activity”, or to include “training activity” aswell. Even then, the lack of conceptual clarity and the difficulty in making it adaptable andrelevant to both developed and developing contexts remain a challenge.

COMMUNITY AND HEALTH SERVICES
1

Selecting a core indicator for this domain was found to be particularly challenging given thecomplexities and variability of community and health services. For example, the indicator
and its definition would need to take into account the distinctions between medical careand social care, and between formal care and informal care.

2

There were suggestions to select an indicator that addresses the availability of services, or
the responsiveness of the services to the needs of older people, rather than on the actual
number/percentage of older persons who receive care.

3

Coverage of financial protection for receiving such services was also suggested as a possible
additional core indicator.

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COMMUNICATION AND INFORMATION
1With regard to the three indicators related to information provided by the local
government, the recommendation was to develop an indicator that takes the perspectiveof the older adults (i.e., availability and accessibility of information) rather than that of thegovernment (i.e. provision/publication of information). It is also important to account for
the wide range of possible information sources instead of limiting it to the local
government. As for the type of information, the preference was for information on “healthconcerns and service needs” (over those on leisure/recreation or volunteer/employment
opportunities).

2

As for the indicators on Internet access, some felt that these were only relevant indeveloped contexts and, thus, not suitable for a core indicator. At the same time, it waspointed out that Internet access will increasingly be an important information source andmedia for the older adult population, including in developed countries.

3

The key issue was seen as whether older adults had Internet access at all. Thus, thedistinction between having Internet access at home or in other places or people’ssatisfaction with Internet access were considered not as important.

4

It was pointed out that these indicators on access to information and the Internet address
the domain of “Information” but not “Communication”. A suggestion was made to remove“Communication” from the domain name and, instead, reflect it in the domain of Social
Participation. Depending on how it is defined, the indicator on Internet access may be
relevant to the domain of Social Participation and/or Information.

HEALTH
1

The Quality of Life measure was recommended as a core indicator of long-term, overall(higher-order) achievement outcome of Age-friendly initiatives.

2

Physical activity (as currently defined) may not be an appropriate indicator of desirable
behavior for an older adult in certain contexts (e.g. developing countries where older
adults have no choice but to engage in physical labor to make a living). Thus, it was notrecommended to be a core indicator but could possibly be an optional indicator withqualifications.

ECONOMIC SECURITY
The group was not in favor of the indicator on health insurance coverage as a core indicator forthis domain given that it is not relevant to countries with universal health coverage and that it
is often seen as being beyond the sphere of influence of local governments. Instead, preference
was given to a broader measure of economic security such as access to a pension or perceived
economic security. The core indicator for Economic Security was considered appropriate for along-term outcome indicator, along with the core indicator for Health.

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GOVERNANCE
The indicator for the amount of local government budget spent on health was not supported asa core indicator for this domain. As noted earlier, it was suggested that this domain be removed,
and, instead, incorporate aspects of governance in the “Mechanisms for local age-friendly
initiatives” within the framework (Figure 1).
ENABLING/SUCCESS FACTORS
Some suggested that the core indicators should also cover at least a few of the factors labeled“Mechanisms for local age-friendly initiatives” in the framework (Figure 1). For example, theindicators could be related to multi-stakeholder collaboration, resource commitment, politicalcomment, and engagement of older adults.
CONCLUSIONS
The inputs received in this meeting have implications for the further development of themonitoring framework and core indicator set. Specifically, they suggest the need to modify
some of the structural and visual features of the framework, and to further specify the list ofcore indicators while ensuring breadth, generalizability and contextual flexibility. In the followup to this meeting, the WHO will need to resolve some of the tensions/trade-offs highlighted in
the meeting, as well as some of the contradictions that exist between the recommendations
made in the meeting (which were not all based on consensus) through further external
consultations and internal decision-making.
Additional inputs that will inform the final version of the framework and core indicators include
further responses to the indicator pilot study (which were not yet received or analyzed at thetime of this meeting), ongoing consultations with external and internal (WHO) experts, and any
new developments in research and practice related to age-friendly environments and health.
Recommendations from this meeting also imply the need to develop an assessment tool, that is,a document that would describe how to apply the framework and core indicators in practice.
This tool could provide guidance on how to adapt the framework, select an indicator set, andoperationalize the indicators in order to optimize relevance to the local context while also
retaining some value for inter-city comparisons at national, regional or global levels.
Several participants mentioned that the cities engaged in age-friendly initiatives are seeking
further direction and technical guidance from WHO, and that the current work on developing amonitoring framework and core indicators responds to these expressed needs. At the sametime WHO needs to be aware of and accept the validity of recommended indicators that aredeveloped through appropriate processes at the country, regional, or community levels.
Finally, it was recognized that “Age-friendly Cities” is an evolving field of work which naturally
requires periodic review and updating of existing technical guidance to reflect changing needs
as well as new developments. These views lend strong support to the progress being made by
the WHO Centre for Health Development and its various collaborators on this project.
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NEXT STEPS Complete the analysis of the pilot study results
 Revise the framework and core indicator list in light of the outputs of this meeting and thefinal results of the pilot study
 Circulate the revised framework and core indicator list to relevant external and internal(WHO) experts for peer review
 Finalize the framework and core indicator list in light of the peer review outcomes Draft an assessment tool that explains how to apply the framework and core indicators topractice Pilot test the assessment tool in select cities/communities representative of WHO Member
States Finalize the assessment tool based on pilot test results and additional expert consultations

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ANNEX 1 List of Participants
Invited Experts
Jeanne Anthony, Senior Project Manager, AARP Livable Communities, Washington, DC, USA
Senarath Attanayake, Attorney-at-Law/Councillor, Uva Provincial Council, Wellawaya, Sri Lanka
Pierre-Marie Chapon, Research Director, ICADE, WHO AFC French Network Facilitator, Lyon, France
Josh Collett, Vice President for International Affairs, AARP, Washington, DC, USA
Clara Freire, Manager, Client Service Strategies, Strategic Community Initiatives Branch, Community andSocial Services, City of Ottawa, Ottawa, Ontario, Canada
Suzanne Garon, Professor, School of Social Work, University of Sherbrooke, Québec, Canada
Rodney Harrell, Public Policy Institute, AARP, Washington, DC, USA
Nadine Jodoin, Specialist, Strategic Programs and Projects, Strategic Community Initiatives Branch,Community and Social Services, City of Ottawa, Ottawa, Ontario, Canada
Margaret Neal, Director/Professor, Institute of Ageing, Portland State University, Portland, Oregon, USA
Junichiro Okata, Director, Institute of Gerontology, The University of Tokyo, Tokyo, Japan
Dominique Paris-MacKay, Director, Age Friendly, The Council on Aging of Ottawa, Ottawa, Ontario, CanadaLouise Plouffe, Associate, International Longevity Centre, Rio de Janeiro, Brazil
Sinead Shannon, Research Manager, Ageing Well Network, Dublin, Ireland*Ding Xiaocang, Vice-Director, Health & Family Planning Commission of Jingan District, Shanghai, China
Asghar Zaidi, Professor, International Social Policy, Centre for Research on Ageing/ESRC Centre forPopulation Change, University of Southampton, UK
WHO Secretariat*John Beard, Director, Ageing and Life Course, WHO Headquarters (Geneva, Switzerland)
Anjana Bhushan, Technical Officer, Health Care Financing, Regional Office for the Western Pacific (Manila,
Philippines)
Somnath Chatterji, Scientist, Health Statistics and Informatics, WHO Headquarters (Geneva, Switzerland)
Manfred Huber, Coordinator, Healthy Ageing, Disability and Long-term Care, Regional Office for Europe(Copenhagen, Denmark)Megumi Kano, Technical Officer, Urban Health, WHO Centre for Health Development (Kobe, Japan)
Khadidiatou Mbaye, Medical Officer, Family and Reproductive Health, WHO Regional Office for Africa(Brazzaville, Republic of the Congo)*Amit Prasad, Technical Officer, Urban Health, WHO Centre for Health Development (Kobe, Japan)
Alex Ross, Director, WHO Centre for Health Development (Kobe, Japan)
Lisa Warth, Technical Officer, Ageing and Life Course, WHO Headquarters (Geneva, Switzerland)*Unable to attend.

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ANNEX 2 Meeting ProgrammeTime

Session8:30-9:00

Registration

09:00-09:15

09:45-10:15

Welcome remarks
Introduction and overview
Presentation of indicator development process
Presentation of indicator framework and pilot study results
Q&A discussion

10:15-10:30

Coffee break

10:30-11:30

Group work on refining the framework and indicator domains

11:30-12:00

Report back to plenary

12:00-12:30

Plenary discussion on the framework and indicator domains

12:30-13:30

Lunch

13:30-15:00

Group work on refining the core indicators and definitions

15:00-15:15

Coffee break

15:15-16:00
16:00-16:30

Continue group work on refining the core indicators anddefinitions
Report back to plenary

16:30-17:30

Plenary discussion on the core indicators

17:30-18:00

Conclusions and the way forward

09:15-09:45

16