Ageism: a social determinant of health that has come of age
Authors: Christopher Mikton, Vânia de la Fuente-Núñez, Alana Officer, Etienne Krug
Journal: The Lancet (2021)

On March 18, 2021, the Global Report on Ageism1WHOGlobal report on ageism. World Health Organization, Geneva, Switzerland2021https://www.who.int/publications/i/item/global-report-on-ageismDate accessed: March 18, 2021Google Scholar was launched by WHO, the Office of the UN High Commissioner for Human Rights, the UN Department of Economic and Social Affairs, and the UN Population Fund. Combating ageism is one of the four action areas of the Decade of Healthy Ageing (2021–2030).2UNResolution A/75/L.47 United Nations Decade of Healthy Ageing (2021–2030). Seventy-fifth United Nations General Assembly, Dec 8, 2020. United Nations, New York2020Google Scholar Changing how we think, feel, and act towards age and ageing is a prerequisite for successful action on healthy ageing and for progress on the three other action areas of the Decade of Healthy Ageing: developing communities that foster older people's abilities, delivering person-centred integrated care and primary health services responsive to older people's needs, and providing long-term care for older people who need it. In the COVID-19 pandemic the vulnerability of older people has been highlighted. Not only has the pandemic taken the lives of many older people, it has also exposed ageism in different settings—eg, discrimination in access to health care, inadequate protection of older people in care homes and of young people's mental health, and stereotypical media portrayals that pit generations against each other. Consensus on the meaning of ageism has remained elusive and there is insufficient evidence on the topic. The Global Report on Ageism,1WHOGlobal report on ageism. World Health Organization, Geneva, Switzerland2021https://www.who.int/publications/i/item/global-report-on-ageismDate accessed: March 18, 2021Google Scholar to which we all contributed, offers a clear and widely supported definition of ageism as the stereotypes, prejudice, and discrimination directed towards people on the basis of their age. The report highlights that ageism can be institutional, interpersonal, or self-directed and summarises the best evidence on the scale, impacts, and determinants of ageism against both older and younger people and the most effective strategies to address ageism. Ageism is an important social determinant of health that has been largely neglected until now. The social determinants of health are the non-medical factors that influence health outcomes and include the conditions in which people are born, grow up, and live and the wider set of forces and systems that shape the conditions of daily life.3Solar O Irwin A A conceptual framework for action on the social determinants of health. World Health Organization, Geneva, Switzerland2010Google Scholar, 4WHOSocial determinants of health.https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1Date: 2021Date accessed: January 26, 2021Google Scholar Like all forms of discrimination, ageism generates divisions and hierarchies in society and influences social position on the basis of age. Ageism results in various harms, disadvantages, and injustices, including age-based health inequities and poorer health outcomes. Globally, ageism affects billions of people: at least one in two people hold ageist attitudes against older adults,5Officer A Thiyagarajan JA Schneiders ML Nash P de la Fuente-Núñez V Ageism, healthy life expectancy and population ageing: how are they related?.Int J Environ Res Public Health. 2020; 173159Crossref Scopus (12) Google Scholar with rates much higher in lower-income countries (figure). In Europe, the only region for which data about ageism are available for all age groups, one in three people have experienced ageism, with rates highest among 15–24 year olds.6Abrams D Russell PS Vauclair CM Swift H Ageism in Europe: findings from the European Social Survey. Age UK, London, UK2011Google Scholar, 7Ayalon L Feelings towards older vs. younger adults: results from the European Social Survey.Educ Gerontol. 2013; 39: 888-901Crossref Scopus (21) Google Scholar A strength of the Global Report on Ageism is the solid evidence base it draws on, including a series of systematic reviews.8Ayalon L Dolberg P Mikulioniene S et al.A systematic review of existing ageism scales.Ageing Res Rev. 2019; 54100919Crossref PubMed Scopus (31) Google Scholar, 9Chang ES Kannoth S Levy S Wang SY Lee JE Levy BR Global reach of ageism on older persons' health: a systematic review.PLoS One. 2020; 15e0220857PubMed Google Scholar, 10Marques S Mariano J Mendonca J et al.Determinants of ageism against older adults: a systematic review.Int J Environ Res Public Health. 2020; 172560Crossref Scopus (29) Google Scholar, 11Burnes D Sheppard C Henderson Jr, CR et al.Interventions to reduce ageism against older adults: a systematic review and meta-analysis.Am J Public Health. 2019; 109: e1-e9Crossref PubMed Scopus (110) Google Scholar However, given the restricted availability of evidence on all aspects of ageism and how to reduce it, two limitations that we note in the report are its disproportionate focus on high-income countries and on ageism against older rather than younger people. Ageism impacts all aspects of older people's health. For instance, it shortens their lifespan, worsens their physical and mental health, hinders recovery from disability, and accelerates cognitive decline.1WHOGlobal report on ageism. World Health Organization, Geneva, Switzerland2021https://www.who.int/publications/i/item/global-report-on-ageismDate accessed: March 18, 2021Google Scholar Ageism also exacerbates social isolation and loneliness and reduces access to employment, education, and health care, all of which impact health. As the Global Report on Ageism shows, ageism places a heavy economic burden on individuals and society, including in health-care costs. Annually, ageism accounts for US$1 in every $7—or $63 billion—spent in the USA on health care for the eight conditions with the highest health-care costs among people aged 60 years and older.12Levy BR Slade MD Chang ES Kannoth S Wang SY Ageism amplifies cost and prevalence of health conditions.Gerontologist. 2020; 60: 174-181Crossref PubMed Scopus (65) Google Scholar The evidence reviewed in the report shows that three strategies are effective to reduce ageism: policy and law, education, and intergenerational contact interventions. Policy and law can address discrimination and inequality on the basis of age and protect human rights. Educational interventions across all levels of education can correct misconceptions, provide accurate information, and counter stereotypes. Intergenerational contact interventions are among the interventions that work best to reduce ageism against older people and could also have a role in combating ageism against younger people. The Global Report on Ageism makes three recommendations for concrete actions that all stakeholders can take to combat ageism. First, invest in effective strategies to prevent and respond to ageism. Second, fund and improve data and research to better understand ageism and how to address it. Third, build a movement to change the narrative around age and ageing. The promise of the Decade of Healthy Ageing can only be fully realised if ageism is recognised as a social determinant of health and tackled. We all contributed to the WHO Global Report on Ageism that is discussed in this Comment. We declare no other competing interests.