Healthy Ageing
Cities’ Action for Healthy and Active Ageing
Baseline Study
by Fiorenza Deriu (LE)
15th March 2014
2
FOREWORD
The older population in Europe is growing at a
considerably faster rate than that of the world’s total
population. The number of older persons in Europe
has tripled over the last 50 years and will more than
triple again over the next 50 years. The older
population is also undergoing a process of
demographic ageing: the most rapidly growing
group is that aged 80 years and over. The shift in
population age structure, due to the combined effect
of both increasing longevity and decreasing fertility,
has a profound impact on a broad range of
economic,
political
and
social
conditions.
Demographic ageing is at the same time a
challenge and an opportunity in a society that is
changing its ‘face’: fewer young people and young
adults, older workers, increasing number of
pensioners and very elderly people.
Within this framework people’s needs as well as
older people’s expectations on life quality
opportunities change. Hence, new forms of solidarity
and of intervention must be developed promoting
cooperation between generations. Cooperation
based on both mutual support and exchange of
experiences and skills is welcome.
This well-known global trend is also ongoing in Italy
and the city of Udine has given special attention
to developing policies aiming at active ageing with a
particular attention to citizens’ engagement and
intergenerational initiatives within a deliberative and
participative methodological perspective.
The first step to move to cope with these changes
and to provide effective services is an overall
understanding and analysis of the local context and
the living conditions of citizens, in particular
vulnerable groups. Focusing on older age, different
approaches have been combined to raise
awareness of demographic ageing and better meet
citizens’ needs through more effective strategies
and health policies.
Much has been done in Udine to promote
healthy lifestyles and health literacy within the
community to increase awareness on the
importance of an active and healthy ageing.
This experience will be fully put at partners’
disposal within this transnational network.
The State of the Art
3
General presentation
Over the last decades increasing longevity
throughout the countries of the European Union
(EU) has resulted in a higher number of individuals
reaching old age. This trend is mainly due to two
factors: the low mortality recorded among those
people born after the Second World War and the
improvement in life expectancy of those aged 65
and over. These trends have led to an increase in
the number of the oldest old population (aged 80
and years and over) (Oeppen and Vaupel, 2002;
Rau et al., 2008; Meslé and Vallin, 2011; Marc Luy
et al., 2011; Crimmins et al., 2011).
At the same time, the steady decline in fertility,
which started in different periods and proceeded at
different paces among European countries, has had
a significant impact on the decrease of the young
below the EU-27 average (18.2%); immediately
followed by France with a percentage of over 65 at
17.6%, very close to the EU-27 level. On the other
hand, Italy records the highest percentage of over
65 (21,2%) in 2013, more than one fifth of the total
population. Lithuania is currently in line with the
European average (graph. 1).
Graph. 1 - Proportion of population aged 65 and
over - % of total population – 2009 and 2013
population. The combined action of increasing
longevity
and decreasing fertility
has driven a common growing trend in aging, in
relative terms, in almost all EU-27 countries1
(National Research Council, 2001; Gaymu et al.,
2008; Christensen et al., 2009).
This ongoing process has led to major changes in
economic and social relations, impacting on growth
and public spending, making it difficult to maintain
sound and sustainable public finances in the long
term (Zaidi, 2010; Deriu, 2011). Oldest-old aging
societies are pressing governments “to implement
health and social policies specifically
aimed at coping with the fast growing number of
people in their ‘third’ and ‘fourth’ age” (Caselli et al.,
2003:45-46).
If we look more specifically at the countries involved
2
in the “Healthy Ageing” Project , it is
worthwhile noting that they are not homogeneous
when considering both their population trends and
demographic structure.
Actually, if we move on consider the proportion of
people aged 65 and over in 2013, we can observe
on the one hand, that United Kingdom has the
lowest percentage (17.2%), one percentage point
1
Austria, Belgium, Denmark, Finland, France,
Germany. Iceland, Italy, Greece, Luxembourg,
Netherlands. Norway, Portugal, Spain, Sweden.
2
The city partners of the project are Brighton &
Hove and Edinburgh for the United Kingdom;
Klaipeda for Lithuania; Grand-Poitiers for France.
Udine, a city of the Northern Region of Italy, is the
Lead partner of the transfer network.
Source: Eurostat Indicators Database
The pattern becomes more critical if we consider the
proportion of the oldest old population (80 years and
over) that since 2000 in the EU-27 has risen
considerably from 3,3% up to 5.1% in 2013. Italy
represents the oldest country in Europe with a 6.3%
figure - well above the European average - while
United Kingdom and Lithuania record lower
percentage levels (4.7% and 4.8% respectively).
France (5.6%) is in the middle according to the data
shown in graph. 2.
The combined effect of increasing longevity and
decreasing fertility is impacting on population
structure resulting in an unbalance between adult
and elder generations so that the economic burden
of an increasing amount of elderly people (persons
aged 65 and over) is sustained by a diminishing
population aged 15-64. This is the reason why old
age dependency ratios are steadily growing all over
Europe. In 2013 the average level of this indicator
was at 27.5: it means that for every four adults there
is an older person to be sustained. Most of the
European countries are experiencing this trend and
recent projections have foreseen a fast increase in
the old-age dependency ratio that will reach in 2070
in the EU-28 the 49,35 threshold (graph. 3).
Graph. 2 - Proportion of population aged 80 and
over - % of total population – 2009 and 2013
4
Graph. 3 - Old age dependency ratio trend and
projection – 2009 – 2070 by selected countries and
EU-28
60
50
40
30
20
10
0
2009
2010
2011
2012
2013
2030
2050
2070
EU (27 countries)
25,7
26,1
26,3
26,9
27,5
39,01
49,43
49,35
France
25,4
25,6
25,9
26,7
27,5
39,05
43,78
44,21
Italy
30,9
31,2
31,3
32
32,66
40,79
52,92
53,59
Lithuania
25,4
25,6
26,6
26,9
27,2
47,34
51,88
34,47
United Kingdom
24,3
24,6
24,9
25,6
26,37
34,86
40,6
42,43
Source: Eurostat Indicators Database
Among the countries involved in the “Healthy
Ageing” Project, at that date Italy will be the only
one to be far above that EU-27 threshold, reaching
a 53.59 old age dependency ratio. France and
United Kingdom will register figures quite below the
EU-27 average (respectively at 44.21 and 42.43).
Lithuania will be the only country of this group where
in 2070 a significant decreasing on this indicator
could be registered.
The main factors driving population ageing
EU population ageing is the result of two underlying
trends:
a)
b)
low fertility rates
(1,58 children
born per female in 2012 in the EU-27
countries on average);
increasing life expectancy
for both males and females (77.5 and 83.1
in 2012 in the EU-27).
As far as the first point is concerned, the fertility rate
pattern among the countries involved in the “Healthy
Ageing Project” is quite different. Italy has one of the
lowest fertility rates and it is still far from reaching
the EU-27 threshold even if its trend is steadily
increasing. France and United Kingdom report the
best figures with respectively 2.01 and 1.92 in 2012
(close to the level of population replacement);
Lithuania is in the middle with a 1.60. It is well
known that France provides women with services
supporting the work-life balance according to a
system of social policies based on a gender
mainstreaming approach. In UK, according to a
strategy more oriented to the market, services
supporting family choices are actually available for
women.
Projections by 2030 point out a steady increase in
total fertility rate (TFR) all over the EU countries.
Anyway, according to recent projections, these
positive trends in TFR do not seem to be able to
contrast the population ageing process.
This question is considerably related to the levels of
longevity
reported in these countries. In fact, it
is worth noting that a general increasing trend in life
expectancy levels is ongoing all over Europe even if
in Lithuania figures are far below the EU-27 average
fixed in 2012 at 83.1 years for women and 77.5 for
men. Lithuania reports a life expectancy of 79.6
years for women and 68.4 for men, 3.5 and 9 p.p.
respectively under the European threshold. Italy
shows the best performance in longevity if
compared with France and United Kingdom but the
best case of female longevity is France (tab. 1).
Table 1 – Life expectancy in selected countries 2012
European
Life
Life
expectancy
countries
expectancy
(Females)
(Males)
EU-27
83.1
77.5
Italy
84.8
79.8
France
85.4
78.7
Lithuania
79.6
68.4
United
82.8
79.1
Kingdom
Source: Eurostat Indicators Database
Life expectancy data should be analysed alongside
figures on healthy living in later years (e.g.: at 65
years). In fact, population ageing is expected to
considerably increase the need for care services
among elderly people if ageing is not accompanied
by preventative actions and initiatives aimed at
maintaining people mentally and physically active.
Healthy Life Years
(HLY) at age 65 measures the number of
The
indicator
years that a person at age 65 is still expected to live
5
in a healthy condition. HLY is a health expectancy
indicator, which combines information on mortality
and morbidity. The data required are the agespecific prevalence (proportions) of the population in
healthy and unhealthy conditions and age-specific
mortality information. A healthy condition is defined
by the absence of limitations in functioning/disability.
rest of his or her life to the current mortality
conditions (Eurostat Indicators Database –
Metadata).
Graph. 4 - Healthy life years at age 65 - disabilityfree life expectancy (DFLE) by selected countries
Italy is the only country among those considered
a)
women live longer
but not in better health than
men. For this reason, planning policies oriented
According to the data shown in the graphics above,
even if Italy is the country where the life expectancy
of women reaches the highest value, it does not
mean that the years gained are lived in good health.
in this analysis, where the healthy life years at 65
indicator is lower for women than for men (7 years
vs almost 8). So,
ITALY
M
to support ageing among women represents a
F
means that healthy ageing should represent a field
in which experience new solutions for improving life
conditions in later ages. France and United Kingdom
are two best performing countries, where HLY
indicator varies between 9 and 11 years. Anyway,
b)
FRANCE F
France
while the female HLY indicator is
improving, that for males is
decreasing; in United Kingdom
both women and men HLY are
decreasing converging to a common figure
the data show quite different trends. In
M
c)
F
LITHUANIA M
d)
F
UNITED KINGDOM In Lithuania
the HLY indicator is particularly
low: it is 5.5 for men and about 6 for women. It
priority for local governance.
M
The indicator is also called disability-free life
expectancy (DFLE). Life expectancy at age 65 is
defined as the mean number of years still to be lived
by a person at age 65, if subjected throughout the
(about 10.5 years).
Even if in these countries the life expectancy in
good health at age 65 is higher than in Italy and in
Lithuania they are actually facing new challenges
that call for new solutions and interventions.
The “Healthy Ageing” Project provides these
countries, and more specifically the city partners in
the pilot transfer network, with the opportunity to
share experiences and to find out new ideas for
improving life quality at later ages.
It is quite clear that policies priorities and
approaches are different in these four contexts.
Anyway, there is a common denominator affecting
Grand Poitiers, Brighton & Hove and Klaipeda: the
weak commitment of managing authorities, public
managers and politicians on this issue and in
particular on older people’s needs. In light of a
general public spending retrenchment, managing
authorities seem to be more keen on investing on
policies oriented to young generations. So, in all
these three cities it is becoming increasingly
important motivating managing authorities to
support initiatives based on intergenerational
approaches. This is the case of Grand Poitiers, that
6
is particularly interested in transferring the microproject “move your minds…minds on the move”; the
case of Brighton which is interested in new
experimental forms of Urban Gardens to involve
students and sustain the intergenerational
exchange.
It is quite different the situation in Edinburgh where
a wide and well articulated action plan on active and
healthy ageing is already ongoing, offering a variety
of opportunities and services to older people.
Anyway, Edinburgh is actually interested in finding
out new ideas as well as experiencing new
methodologies at work for activating innovative
services to cope with new challenges in a more
effective way.
Udine, a city of the Eastern Region of Italy, is the
lead partner within this network, having
implemented a number of activities and
experimented new methodologies that have
significantly contributed to improve active ageing at
local level. This project represents also for Udine an
occasion for learning from other cities innovative
solutions for increasing the supply of services for the
active and healthy ageing of older people.
7
THE GOOD PRACTICE OF UDINE
DESCRIPTION OF THE MAIN ACTIVITIES TO BE TRASFERRED IN THE RECEIVING
CITIES
UDINE: Description of the good practice
Background information on the
«giving» city: the Municipality of
Udine
Udine is a small city of Friuli Venezia-Giulia, a
region located in north-eastern Italy in the South of
Europe. It has a population of almost 100,000
inhabitants in an area of 56,81 square kilometres
(fig. 1).
Fig. 1 – City of Udine
In 2013, elderly people were 25.5% of total
population and the dependency ratio (people aged
<15 plus people aged over65/people aged 15-65)
was 58.96 (tab. 1).
Tab. 1 – Indicators on population ageing in Udine
(compared to Italy) – 2012
The Population in Udine has undergone a constant
demographic ageing trend in the past decade, which
has had an impressive impact on the population
structure, since the traditional population ‘pyramid’ is
now supplanted by a population ‘mushroom’, with
more older citizens than young people (fig. 2).
Today in Udine there are 210 over 65 citizens for
every 100 under 14 and 0.06% centenaries.
Moreover, there are 49,000 families, of which
34,000 are single component families and 8,800 of
them are over 65, mostly women.
Fig. 2 – Snapshots of demographic change in Udine
The Municipality of Udine is strongly committed on
the theme of healthy and active ageing. In fact, the
city of Udine also decided to join the Healthy Ageing
Sub-Network within Phase IV and Phase V of the
WHO Healthy Cities European Programme to
improve its actions and develop new policies for
older people.
The city joined the WHO “Healthy Cities”
Project on March 2nd 1995 and WHO notified the
designation of Udine for Phase III of the Project
(1998-2002) with other four Italian cities (Bologna,
Milan, Padua and Arezzo) in 1999. A Steering
group, made of a significant number of both
stakeholders and managing authorities, was set up.
It included representatives of the city government for
the sectors involved (City counsellors for
environmental protection and Hygiene, Urban
planning, Social and Health care services and
8
Education) as well as institutions, authorities,
organizations and private associations (Local Health
Agency, Pharmacies’ Association, University of
Udine, local Caritas Office, trade unions,
environmental organisations, etc.) working at local
level. The first step was to work at building a City
Health Profile to start a process of social healthplanning, where the population and private
associations were directly involved and all
components of the community took their own share.
The City Health Development Plan of Udine,
that came right after the City Health Profile, is rooted
in this process and represents the starting point of a
wide number of projects implemented in the
following years. In such a long period the staff and
the experts involved in the numerous activities have
acquired a clear vision on processes, conditions and
actors needed to achieve the results that we are
going to describe in the following pages. By working
within the WHO Network of Healthy Cities, Udine
has also developed a number of guides and
manuals which are actually very useful tools to be
shared with the receiving cities of the Urbact
Project to favour and support the transfer of the
good practice.
Udine has also joined the WHO Age-Friendly
Cities Project. The story began in 2005 when the
WHO initiated a global, collaborative project
involving 35 cities in 22 countries all over the world
to identify the key features of an age friendly city.
Udine was one of them.
The WHO, in cooperation with a group of advisers
who had expertise in policy, community action and
qualitative research, designed a protocol of a
standardized method, the so-called Vancouver
Protocol, that was reviewed and finalized at a
workshop held in Vancouver, Canada, in March
2006 (L.Plouffe and A. Kalache, 2010). All the cities
involved in the Who Age-Friendly Cities Project,
included Udine, adopted this methodology to assess
their community’s age-friendliness and identify
areas of remedial action. This experience is also
part of the practice that Udine is going to share with
the “receiving” cities of the Urbact Project.
The practice of Udine does not require huge funds.
The funding of all the activities described below has
been covered by the Municipality for a total amount
of about 100,000 euros.
Practice description and
implementation
The rationale underlying the development and the
implementation of the practice of Udine concerns a
better understanding and analysis of the local
context and the living conditions of elderly people;
the provision of more effective services to better
meet citizens’ needs; the increase of awareness on
healthy ageing lifestyles, encouraging the
participation of older persons in initiatives promoting
a more healthy and active life.
The experience of Udine is described in a number of
publications such as:
-
The «City Health Profile of Udine», edited
in 2002 as a first result of the participation in the
WHO Healthy Cities Project, then regularly
updated until 2009 and finally integrated in the
annual catalogue of data collected by the
municipal Statistics Department. In this report the
following results are presented: a set of
indicators describing the city from an
environmental, health and social point of view,
the presentations of needs and services, the
expenditure on services, some indication for
future local planning;
-
The «Udine City Health Development
Plan», edited in 2003, is the result of a
participative planning process – using the focus
group technique – that provided insight in the
needs perceived by citizens, by identifying their
living conditions, access to health care services,
quality of environment, priorities and strategies
for actions according to different population
groups, included the elderly;
-
The «Udine – Il profilo di salute della
popolazione anziana» - The health
profile of elderly people in Udine -, edited
in 2008, combining together both a city health
profile of the older people in Udine and the
results of the community age-friendliness
assessment of the Vancouver Protocol, aimed at
recording the perceptions and needs of citizens
as well as at collecting suggestions from a
number of other stakeholders.
The most important actions undertaken by the
Municipality of Udine have been:
a) the production of a Healthy Ageing Profile
of the city, whose goal is to allow an overall
understanding of the local context and to
provide evidence for promoting health at the
local level, create new opportunities for
intersectoral
work
and
community
involvement and act as a basis for setting
priorities and taking decisions. The Health
Profile is an important step to start a process of
social health-building, where the population and
all components of society (public institutions,
private organisations, third sector, NOGs) take
their own share. The profile is based on 22
indicators grouped in three main thematic areas
9
concerning the population profile (Section A),
the access to health and social support services
(Section B), the socioeconomic portrait of the
local context in terms of vulnerabilities and
strength points (Section C) (tab. 2). The first two
groups
have
been
built
upon
basic
demographic, morbidity, mortality and access to
services information; the third group relates to
the determinants of health on the basis of a lifecourse approach;
b) building a Mapping System matching the
distribution of the elderly on the city territory to
the provision of public, health and social
services offered at local level (using GIS) (fig.
3). This research has been carried out in
collaboration with the Statistics Department of
the University of Udine for the production of a
number of “City Health Maps”. These maps
analyse the distribution of older people and the
accessibility of a number of services such as
health structures, general practitioners, postoffices, bus stops, free-time opportunities, care
centres, chemist’s, etc., and show where
services should be more implemented in the
urban environment.
Tab. 2 – List of indicators of the Healthy Ageing
Profile
Fig. 3 – Mapping of population and services
distribution at local level
c) deploying the Vancouver Protocol within the
WHO project Age Friendly Cities to record the
experiences and needs of older people through
a consultative process with citizens, caregivers
and providers of services in the public, private
and voluntary sector to discover the existing
“age-friendly” urban features as well as the
barriers to active ageing. Starting from the WHO
statement, a City is Age-Friendly when it
recognizes the importance of elderly people and
respects their decisions; encourages their
participation and involvement in community life;
faces at needs of ageing in a flexible way;
promotes physical and societal environment
supporting active ageing. At a first step 5 focus
groups were held: 4 with older people aged
60-74 and >75 (fig. 4) and 1 with carers. In a
second phase, 3 more focus groups were
added: 1 with public service providers and 1
with the private ones; 1 with volunteers. In each
focus group 8 topic areas (fig. 5), illustrated
below, were addressed in order to put into
evidence barriers and gaps but also to collect
suggestions for improvement.
Fig. 4 – Older people Focus Group in Udine
Fig. 5 – Age-Friendly Cities topic areas (Who,
Geneva 2007)
Fig. 7 – Walking group Project
10
Fig. 8 – Gentle fitness
d) promoting opportunities for older people to
remain physically, mentally and socially
active as long as possible through actions and
initiatives at the local level. The city of Udine
has tried to create supportive environments and
established patterns for healthy living through
food and mobility policies oriented to the elderly.
A number of micro-projects have been started to
enable and encourage increasing physical and
mental activity among population in later years
as a very effective way of preventing and
lowering the high costs associated with health
and social services.
One of these Projects is named “Walking
groups”: it involves three times a week groups
of about 15-20 older people who meet at a
station point for a walk of 10-15 km a day in a
green park (fig. 6 e 7). It is an occasion to meet
one other, to socialize, to exercise and remain
physically active. There are six walking groups
in Udine in different city districts. They are
combined with another indoor physical activity
programme of gentle fitness (fig. 8).
Fig. 6 – Walking group Project
There
is
another
very
interesting
intergenerational project, thought to make
young and elderly generations working together.
It is named “CamminaMenti” - Move your
minds… minds on the move and it
provides elderly people the opportunity to
participate into a cycle of seminars and
laboratories hosted by the city districts (fig. 9).
There are several topics of interest: memory,
popular
traditions,
foreign
languages,
intercultural laboratories, wellbeing, spice lab,
botanical and cooking, unusual tours in the city,
music, etc.
Fig. 9 – Move your minds…minds
move…Camminamenti Project
on
the
Each topic is developed along 8 seminars or
labs lasting 3 hours. The Project has been
organized with the cooperation of a group of
students attending an advanced degree in
Nursery at the University of Udine.
11
Fig. 10 – The walking group members together with
the city partners representatives – Study Visit in
Udine 5-7 March 2014
The products of the plots represent also a
significant saving in money for conductors on
their expenditure for vegetables.
There are currently 4 Urban Gardens in Udine:
each one is made of about 20 plots managed by
schools free of charge and, at a fee of 4 euros a
month, by families, individuals and associations.
The plots are allocated according to a public call
launched every 5 years by the Municipality and/or whenever a number of plots becomes
free.
Political and strategic context
Another important initiative that enforces an
independent life among the elderly is concerned
with the “Urban Gardens”: an occasion of
socialization and aggregation of people of
different ages. Green areas where people of all
ages start rebuilding relationships and
socialization spaces (fig. 11). Families, single
individuals, schools, associations meet each
other and exchange experiences and skills on
farming and raising plants, vegetables and any
kind of botanical herbs; they cooperate to create
a network of solidarity and mutual help in
managing and caring their plots.
Fig. 11 – Urban gardens - Study Visit in Udine 5-7
March 2014
The practice of Udine is mainly focused on social
inclusion and active participation of elderly people
into the life of the city. In such a sense, this practice
is coherent with the objectives of the flagship
initiative called “European Platform against poverty
and exclusion” which falls under the inclusive growth
objective of the EU 2020 Strategy. In particular it
matches with at least 3 over 5 areas of action: a) a
more effective use of EU funds to support social
inclusion; b) the promotion of consistent evidence of
what does and does not work in social policy
innovation; c) the work in partnership with civil
society
to
support
more
effectively
the
implementation of social policy reforms.
Moreover, this practice is fully consistent with the
Strategic Implementation Plan for the European
Innovation Partnership on Active and Healthy
Ageing (Brussels, European Commission, 2011).
Through this Strategy the European Commission
aims to enhance European competitiveness and
tackle societal challenges. In this framework active
and healthy ageing represents a major societal
challenge common to all European countries, and
an area which presents considerable potential for
Europe to lead the world in providing innovative
responses to this challenge.
In addition to that, it is worthwhile noting that Udine
has been the leading city of the Healthy Ageing
Sub-Network within the WHO Healthy Cities Project
for several years, gaining experience by working
with WHO experts and advisors and by getting in
contact with plenty of initiatives and actions
organized by other cities to promote the quality of
life of older people.
This experience will be fully put at
partners’
disposal
within
this
transnational Urbact network.
12
The involvement in Healthy Cities and the strong
commitment to the theme of Healthy and Active
Ageing have also contributed to a re-definition of
priorities at the local level and a re-organisation of
services.
By this way, the City of Udine has developed a
Health Development Plan, a global
intersectoral plan where all planning and operational
tools are mutually connected, and the public and
private bodies directly or indirectly address the
citizens’ health problems.
Finally, the planning activity of the Municipality of
Udine is also rooted in another strategic project for
sustainable planning: the Agenda 21, an Action Plan
promoted by UN to start sustainable development in
the 21st century. The Local Agenda 21 is a plan
to translate the general objectives of Agenda 21 into
concrete objectives at the local level. The Agenda
has been defined by the Department of Urban
Planning of the City of Udine and many connections
have been activated between Agenda 21 and
Healthy Cities.
In this stimulating and well connected context the
good practice of Udine has flourished.
Monitoring and evaluation
system
The various activities implemented in Udine with
respect to this project have been monitored and
evaluated by using different tools.
For what the Healthy Ageing Profile and the
Vancouver Protocol are concerned, the results
achieved by Udine in implementing the
corresponding activities have been annually
evaluated by the WHO staff. As a matter of fact,
being part of the WHO European Healthy Cities
Network implies some mandatory steps for cities
during the process of developing and implementing
activities at the local level. Udine has produced
every year an Annual report following the standards
given by the WHO Guidelines concerning both
objectives of the interventions and the methodology
adopted to carry them out. The Report prepared by
the City of Udine has been assigned for evaluation
to some advisors, external to the staff and experts in
the core themes.
The City of Udine is considered a lead Municipality
in developing this good practices because it has
reached success where other cities have failed. This
has happened because Udine has been able to
activate processes at various levels: at citizens’
level, at meso-level, and at political level. The
political leadership and governance has played a
crucial role in this experience of building
success , favouring a more fluid communication
between
public
administration,
different sectors
of the civil society
and
citizens
themselves.
The
evaluation
activity has been also carried out with regard to the
experience of the “Move your minds…minds on
move” Project. A pre and post-test tool has been
implemented and submitted to the participants to the
seminars and laboratories held at district level for
being filled in. Through this tool the staff of the
Project has tried to “evaluate” changing in mood,
cognitive skills or in some aspects of the everyday
life among those who had participated into the
Project.
At the end of the experience, participants seemed to
be more stimulated to work in a team, to make
proposals for the future, to do outdoor activities
and/or sports, to go outside and meet new people
and get new friends.
These data suggest that the project “Move your
mind…mind on move” has got a positive effect on
the participants helping them to fight solitude and
isolation. The high level of satisfaction with the
topics addressed during the seminars and labs as
well as with the activities and the clarity of the
teachers, suggest that the organisational team was
efficient in planning and implementing the project.
Important documents that represent all the knowhow produced by the experience of Udine will be
used as a toolkit for the transfer of the good
practice within the Urbact Network. Here below the
most relevant ones:
-
-
-
-
the Guidance for producing local Health
Profiles of older people, which provides
quantitative and qualitative information on the
health and the living circumstances of older
people, made of three parts: population, health
and social care systems, social picture;
the Age Friendly Cities Guide, which
presents the objectives, methodology and
results of a consultative process with older
people, carers and providers of services in the
public, private and voluntary sector, to discover
the existing “age-friendly” urban features as well
as the barriers to active ageing;
the description of the methodology followed
for producing the health maps with regard to
the population distribution on the city territory
and the evaluation of the demand and provision
of public, health and social services offered to
the community;
pre and post-test questionnaires for
evaluating
participants’
satisfaction
with
-
13
seminars and labs aimed at improving a
mentally active ageing;
an observational grid to study the dynamics
ongoing in the working groups of elderly people
participating into these projects.
Fig. 12 – Model of integrated governance
Innovative elements and novel
approaches
One of the most important strengths point of the
good practice of Udine, in a whole perspective, is
the strong political will to make actors work together
in an integrated way.
Hence, the model of integrated governance
represents the most challenging factor of success of
this good practice where three levels of governance
have effectively cooperated towards the same goal
(fig. 12):
a) at micro-level, individuals and their families;
b) at meso-level, associations, public bodies,
and agencies;
c) at macro-level, the Municipality through its
administrative and political representatives.
The City government has promoted a participative
process that has favoured the engagement of
citizens and of other stakeholders animated by
different interests.
Hence, the two main values in which this method is
rooted are: the intersectoral cooperation and
the community empowerment.
Anyway, the most innovative aspect of this practice
is the methodology and the close connection
among all the interventions put into action.
There is a strict linkage between the
Health Profile, the Health Maps, the
Vancouver Protocol, the Health Plan
and the activities and micro-projects
started.
The Health Profile has determined the starting
picture, in both qualitative and quantitative terms, of
the population’s health and the factors that are likely
to influence it at local level (Who Handbook, 1995);
the Health Maps have integrated this first city
picture matching the population distribution to social
and socio-health services on the territory. Anyway,
even when the picture is rich of details the decision
makers could not be able to meet people needs.
In fact, there are three crucial points to consider with
this respect: a) the demand does not always
correspond to the needs, as people who apply for
services are not always the same who need them;
b) there is an implicit demand for services; c) the
same need can be faced by different kind of
services. The use of the Vancouver Protocol
methodology has enabled the City to involve citizens
and local actors contributing to clarify the terms of
the demands of social and socio-health services as
well as to empower community itself. The qualitative
approach of the focus groups is particularly effective
in a field where building alliances between citizens
and city government is really challenging. The focus
groups have given voice to people, service
providers, volunteers, favouring the meeting of
responsibilities as well as the integration of technical
and professional demands with social and political
demands.
The last phase of this virtuous circle is concerning
with the redaction of a Health Plan, a strategy for
a healthy city, where a number of projects, services
and interventions are put into action to meet people
need and priorities.
Funding
Although it is not easy to define the exact amount of
funding necessary to cover all the different actions,
the total cost of this project is estimated to be about
70,000-100,000 euros. Most of the activities have
been carried out with professional resources already
in charge to the city administration, to local health
agencies, to sectoral Departments.
There are also some internal and external subjects
that play a crucial role in this practice: e.g. the
Department of Statistics of the Municipality; the
University, in order to acquire experts able to
analyse data collected via ad hoc evaluation tools;
the public health agencies, to get professionals with
experience in social research, etc.
Anyway, it is possible to estimate the following costs
in detail:
14
1. Health Maps: 2 professionals (1 professor and 1
collaborator); 10,000 euros for 2 months of
work. Funded on the budget line of “Città Sane”
WHO Project. Partners have to consider that the
University of Udine had got the GIS software
and the data needed for mapping population
and services were free of charge. So, it could
happen that in some receiving cities the data
must be bought or acquired in some way;
2. Vancouver Protocol and the facilitation of 8
focus groups: 2 professionals internal to the city
administration;
3. Urban gardens: starting a green area made of
18/20 plots costs 50,000 euros. The
maintenance is at zero costs because
conductors pay a fee of 4 euros a month and
take care of the plot assigned. Each plot has a
surface of 30 mq and its production can get rid 1
family of 5 people for 1 year of buying
vegetables. A money saving of 1,000 euros a
year has been estimated. A part of the costs
have been covered by 5‰ funding coming from
citizens tributes destinated to the Municipality
for social services;
4. “Move your minds…minds on the move”. The
costs are estimated to 25,000 euros a year and
they are covered by the 5‰ of citizens tributes
destinated to the Municipality for social services.
Project assessment
Most of the activities described in these pages are
still ongoing and the city governement is willing to
continue funding them in the next years.
Obviously not all the actions follow the same pace.
At the moment the Municipality is not planning to
renew the participative process based on the
Vancouver Protocol to raise problems, identify
priorities and suggestions for action because the
informative potential of this first wave of action is still
valid and effective. There are plenty of activities and
micro-projects that are going to start on the basis of
the information collected through this methodology
and probably it will take some years before
renewing the consultation process of elderly people
and social actors.
On the other side, there are activities that need
much more continuity. This is the case of the City
Heath Profile. The Office of Statistics of Udine will
update the indicators needed for building the City
Health Profile and according to the most recent
population Census data a revision of elderly people
distribution on the territory will be carried out in
cooperation with the University of Udine. The
Healthy Ageing Profile (HAP) represents also the
first step towards the development of a Healthy
Ageing Observatory, following the idea of matching
the indicators build for the HAP with the Active
Ageing Index, which is a measurement system
designed by the European Union. At the moment
Udine is collecting plenty of information regarding all
the aspects of the quality of life for older people in
Udine: such as employment, health and care
services, lifestyles, institutionalization, participation
in voluntary associations, social inclusion in terms of
participating in local events and initiatives organized
by the community.
The Municipality is also studying a way of mapping
accidents occurred in the city to elderly people, in
order to plan interventions for a more age-friendly
urban environment. Other social and socio-health
services are under decision for future mapping (e.g.:
architectural barriers, crossing lines etc…).
Most of the micro-projects activated in a preventive
perspective, to maintain people mentally and
physically active in later ages, are going to be
continued and further developed.
The Walking groups are at their fourth stage;
“Move your minds…minds on the move” is at its
second edition; the Urban gardens are going to
start with the fifth area in the city and have also
gained funding to develop a mobile “App” to create a
real interaction between citizens and public
administration to add value at the environment
discovering of forgotten places and routes to be
returned to collective memory. It would be a good
way to address the issue of the digital divide among
the elderlies, giving them the opportunity to
recuperate to the City memory landscapes ignored
by most of the people.
Main issues and problems
The main issue of the good practice of Udine is its
integrated model of governance. It is at the same
time a strength point and a challenging barrier to the
transfer of this practice in other contexts.
As prof. Geoff Green has shown in his presentation
during the study visit in Udine, the WHO is strongly
committed in spreading the adoption of a social
model of health, mainly based on getting over the
conventional “Silo” accounting in favour of a more
dynamic and integrated one (fig. 13).
Fig. 13 – Domains of Municipal influence – Healthy
cities intersectoral approach to health development
– prof. Geoff Green, WHO Expert – Study visit 5-7
March
15
The rationale of this model is mainly based on an
integrated model of governance where each
Department invests economic resources in actions
impacting on different fields increasing the economic
return as well as the social remuneration of the
investments done. This model offers concrete
evidence of how the well known approach of “social
investment” can be put into practice (Hemerijck,
2013; Palier, Palme, 2010).
This is the model adopted by the Municipality of
Udine to implement the activities described above.
Anyway many difficulties and obstacles had to be
overcome to get the expected results.
The first barrier that Udine has faced at concerned
the difficulty encountered by the actors of health
policies in working with those committed in other
spheres of intervention.
How this main obstacle has been overcome?
First of all, decision makers, politicians and public
managers engaged in different fields of action were
sensitised to focus on the health impact of their
decisions. Enlarging the horizon of their decisions
they were enabled to look at problems from a
different perspective and to consider alternative
investments opportunities. They were involved in a
training session and submitted to a pre and post-test
assessment process (WHO DeciPher Project). So,
the first challenge was to convince these
professionals in getting active part of this change of
“paradigm”.
At the same time, the City has worked hard in
engaging people, citizens, and all those other actors
that could participate in the deliberative process
aimed at defining the Health Plan of Udine.
This is another crucial issue in the transfer of the
good practice of Udine. In fact, it has not to be taken
for granted that cities succeed in engaging people
and stakeholders in public discussion on a specific
topic. Probably, the most challenging factor in the
transfer of the good practice of Udine in the
receiving cities will be the possibility to make all
these actors work together according to a more and
effectively integrated model of governance.
Udine has overcome this obstacle through a capillar
communication plan that has actually favoured the
involvement of politicians, stakeholders and citizens
on a discussion on healthy ageing. The municipality
has not limited its action to contacting local
associations and organizations but it has spread out
information on the opportunity to take part in the
health planning of the city involving medical
practitioners, chemists, social operators in order to
reach as much people as possible. Hence,
information has been further spread by word of
mouth among people who experienced the
participation into the focus groups (Vancouver
Protocol).
Coming to more specific problems, one difficulty that
some receiving cities could encounter, concerns the
mapping of population by the GIS system. At this
regard it is worthwhile pointing out that two out of
four cities (Brighton & Hove and Klaipeda) have
already developed at local level a mapping system
of a wide number of services available for elderly
people (fig. 14 and 15).
Fig. 14 – Maps of services in Klaipeda
What is still lacking is the matching between these
maps and the distribution of elderly population on
their territory.
This is the most challenging point in the transfer of
GIS practice.
In fact, census data on individuals and their location
are needed for implementing GIS mapping. Not all
the cities involved in this network have got these
data.
Fig. 15 – The map of services in Brighton & Hove
In order to solve this problem, during the study visit
in Udine, the cities have agreed with the lead
16
partner a plan of action: they will firstly check the
availability of data as well as the way they have
been collected in order to identify with the support of
the scholars of the University of Udine the best way
to use them for mapping. As an example, the
experts in GIS of the city of Klaipeda have already
contacted the prof. Fornasin, of the University of
Udine, to assess the effective possibility to
implement the GIS with the population data at their
disposal. This support is guaranteed to all the city
partners.
To sustain the work of cities in reviewing data
needed for building the City Health Profile as well as
for mapping, they have been provided with the list of
the 22 indicators (and their formulas) and a “data
sources check list” in order to get a clear picture of
the most critical points.
Success factors, lesson learned
and transfer conditions
In conclusion the following success factors can be
highlighted:
1. the strong political will and the Mayor’s
commitment into the implementation of the good
practice;
2. the commitment of the City of Udine in
other projects and networks working on healthy
ageing at WHO level (Who “Healthy Cities
Project”, Who “Age-Friendly Cities Project”, the
“Vancouver Protocol network” etc..);
3. the adoption of the UN Agenda 21
Action Plan for sustainable development that
has led Udine to define the Local Agenda 21;
4. the adoption of a model of integrated
governance based on an intersectoral
cooperation and community empowerment;
promotion of a participative and
deliberative process that has favoured the
5. the
engagement of both citizens and other
stakeholders at local level (associations,
organizations, public agencies, local bodies
etc…)
According to these success factors, some lessons
learnt are listed below:
1. decision makers, politicians, public managers
and professionals engaged in different fields of
action should be sensitised to focus on health
impact of their decisions at the aim to consider
alternative investment opportunities and to work
together;
2. methodologies, such as the Vancouver
Protocol, oriented to sustain the engagement of
a wide number of stakeholders should become
an ordinary tool for building knowledge on
healthy ageing and on age-friendly cities;
3. the
information
on
both
population
characteristics and socio-health services
represents a key starting point for health
planning. Anyway, data collection and reporting
is not enough because it is their matching to
make the difference. The integrated GIS system
of the City of Udine is an example of how the
integration of different kind of data can provide
policy makers with useful information for
decision making;
4. good practices do not necessarily need plenty of
funding to be implemented. The experience of
Udine shows that it is effectively possible to
develop a wide number of initiatives starting
from a very modest investment (about 70,000 –
100,000 euros in all)
Finally, what are the key conditions that would need
to be present in the receiving cities for transferring
the practice of Udine?
The cities have already set up a Local Support
Group (LSG) that is working on how to implement
the plan of activities agreed during the kick-off
meeting in Paris and in occasion of the Study visit in
Udine (5-7 March 2014).
The LSGs have a strong commitment to influencing
politicians, public managers and professionals
decisions with respect to the transfer of the good
practice of Udine. In the next pages of this baseline
study, it will be better outlined how the processes of
transferring are ongoing at local level.
The partners have been provided with guidelines
and tools explaining the methodology to be
followed to implement the City Health Profile as well
as the community engagement through the
Vancouver Protocol. Assistance will be
provided by the Lead Expert of the network in
order to favour the process of transferring of these
methodologies. Moreover, the staff of the City
who has managed the focus groups with elderly
citizens, services operators and volunteers is
strongly committed
transferring process.
in
supporting
the
An in depth analysis of the implementation of a
number of micro-projects aimed at keeping elderly
17
people mentally and physically active in later ages
(walking groups, Move your minds, urban gardens
etc…) has been carried out. The site visits have
favoured the exchange of experience and animated
a discussion on how implementing these activities in
the other cities.
In order to favour the assessment of the
actions carried out, the city of Udine has shared
with the partners a number of tools, already tested,
to evaluate the impact of the projects put into action
(questionnaires for pre and post tests; an
observational grid for studying the intragroup
dynamics etc…).
The working groups
The partners and the “walking group”
Finally, the network is confident with the possibility
to transfer most of the activities run in Udine.
Study Visit 5-7 March 2014
The partners and Urban gardens
The representatives of the Urbact Transfer Network
Healthy Ageing – The House of Peasanty
Products of the
Urban Garden
The discussion
Brighton & Hove: engaging elderly people against
solitude and isolation
18 The local context and the policy
challenges
The City of Brighton & Hove (UK) has a population
of 482,6about 270,000 (ONS, 2011) living in a
boundary which covers 31,5km2. It is located in
South East England.
Udine has demonstrated good practice in i) data
analysis and GIS mapping; ii) preventative services
for older people; iii) consultation and engagement
with older people, which can be shared.
Edinburgh has also demonstrated through recent
work on implementing an Age Friendly city approach
in B&H, networking with other Age-Friendly Cities
through the UK Network that it wants to learn from
other cities and apply learning to how services for
older people are planned, developed and delivered.
Table 1: Population by age and gender as a % of total population (number of people in brackets) ‐ Mid Year Estimate 2011 All people Independence is important to older people; older
people’s home care services are increasing in line
with a decrease in care home placements. Assistive
technology
is
being
actively
promoted
demonstrating positive outcomes; however there are
risks of increased isolation which can affect older
people’s wellbeing.
England South East 273,000 53,107,000 50% (136,800)
51% 51% Males 50% (136,200)
49% 49% 0‐15 16% (44,500)
19% 19% 16‐64 71% (192,700)
65% 64% 13% (35,800)
16% 17% Working age 69% (187,300)
62% 61% Pensionable age 15% (41,200)
19% 20% Source: Office for National Statistics (ONS) Mid Year Estimates
2011 available from http://www.ons.gov.uk/ons/publications/rereference-tables.html?edition=tcm%3A77-262039
Fig. 1: Population pyramid, 2011 Mid Year Estimate
and 2021 projection, Brighton & Hove
The City is currently a high user of care homes but
is
committed
to
providing
alternative
accommodation options, in particular extra care
housing. Ideally new models will include provision
designed by older people, keeping them active and
less socially isolated.
Baby boomers have different aspirations and are
keen to lead service design, which could lead to
innovative and inclusive solutions for older people.
(Brighton & Hove JSNA 2013, Ageing Well,
available at www.bhlis.org/jsna2013).
Source: Office for National Statistics
3
Office for National Statistics. Interim 2011 based sub national population projections. http://www.ons.gov.uk/ons/publications/re‐
reference‐tables.html?edition=tcm%3A77‐274527 [Accessed 12/06/2013]
8,652,800 Females 65+ Although the proportion of older people living in the
City has fallen in recent years, the population aged
65 years or over is predicted to increase and
become more ethnically diverse. The largest
projected increases are in the 70-74 and 90 and
over age groups (fig. 1).3
Brighton & Hove According to the three different lines of transfer of
this Network, Brighton has identified specific policy
challenges, briefly summarized below.
19
1. Healthy City Profile e the GIS
mapping
Mapping the distribution of older people and
matching the population with provision of services
will enable analysis of service accessibility and
identification of gaps and overlaps in provision. This
will improve future commissioning.
The city council is data rich but information is in
different places and based on different data
sources. Hence, there is limited use of GIS
currently. The City is working towards being a WHO
Age Friendly City, but political and senior
management commitment is low. Older people are
seen as dependent –and a drain on public services
– not as a resource.
2. Vancouver Protocol
The local NHS and Brighton & Hove City Council
(BHCC) both fund ‘gateway’ organisations to ensure
older user voices inform decision making, including
BME elders. There are many older people user-led
organisations /groups. The voice of older people is
also evidenced in the Place Survey and Brighton &
Hove Age UK/Brighton University Wellbeing
research published in 2012, “Well-being in old age:
findings from participatory research”. However this
research was small-scale and we would like to
involve a wider range of ‘voices’, using an evidence
based methodology.
The Vancouver protocol is an evidence based
research methodology for running focus groups. It
will help us to gather the qualitative information
needed to inform our Healthy Ageing Profile.
3. Preventative activities to remain
elderly
people
mentally
and
physically active in later ages
Many of the services delivered to, for and with older
people in the city are rather traditional. Brighton
wish to learning and transfer good practice from
other cities.
New services and strategies have also undertaken
Equality Impact Assessment in order to provide
excluded groups with adequate support.
Taking part in this Urbact Transfer Network is
expected to favour learning from the best practice of
Udine and other European partners as a mayor way
to add value to the process of designing an action
plan to improve the age friendliness of the city and
make the city more attractive and socially cohesive.
Political and strategic context
Brighton & Hove became and Age-Friendly City on 5
April 2013. A decision supported by all political
parties in the Council. The participation into this
Urbact Transfer Network represents a further step to
building age friendliness and active ageing into
Brighton & Hove city policies and so become a city
fitting for all ages.
The normative and strategic framework in which this
project is rooted start from the National Health
Service, that has branches at local level, to local
action plans such as the City Plan, the Health and
Wellbeing Strategy, the Adult Social Care
Commissioning Prospectus.
On these fields many groups, boards and
stakeholders are working: eg., the B&H Clinical
Commissioning Group, the Health and Wellbeing
Board, the Local Strategic Partnership – family of
partnerships, the local NGO “Community Works”.
The motivation for being a partner city is to learn
from best practice and to share our experience from
Brighton & Hove. Being part of the programme will
assist in the ongoing education and awareness
raising of local stakeholders including Elected
Members about the benefits of a preventative
approach.
Implementation of the good
practice at local level
Many stakeholders are going to be engaged in the
programme including Elected Members of the City
Council and Senior Managers from statutory,
voluntary and independent sector organisations.
The Age Friendly City Steering Group (AFC) will
provide the overarching steering group for the
work.
The AFC Steering Group will be a key monitoring
group and will receive regular progress reports
throughout the project. Committee Reports will also
be produced. Project reporting to the Secretariat will
take place in September 2014 and at the end of the
project.
Annie Alexander, Public Health Programme
Manager, Brighton & Hove City Council is the lead
senior officer and local co-ordinator participating in
the transfer network (fig. 2). Annie Alexander will
lead the Public Health Team, with the support of the
Local Support Group.
Jane McDonald is a representative of the Brighton
& Hove City Council.
Brighton & Hove hopes to include as wide a range
as possible of stakeholders in the study visits and
transfer activities to ensure the maximum benefit
from being a partner is achieved.
20
Fig. 2 – The Brighton & Hove and Edinburgh staff –
Study Visit in Udine – 5-7 March 2014
working with older people, as well as Adult Social
Care.
Residents will be involved via the Older People’s
Council, the Age Friendly City Forum and via the 3
Locality Activity Hubs. Brighton & Hove is also
considering to transfer the practice of LOOP forums
(Local Opportunities for Older People) recently
established in Edinburgh, which bring together local
organisations, with a role in developing innovative
ways of identifying isolated older people.
According to the different working lines of this
project, the City of Brighton & Hove has already
defined some specific aspects of the transfer
process. A brief summary is shown below:
The local stakeholders to the project are the Age
Friendly Steering group, made of:
Annie Alexander, Public Health Programme
Manager (Chair)
Lizzie Ward, University of Brighton
Mark Dunford, University of Brighton
Caroline Ridley, Impact Initiatives
Jane Macdonald, Adult Social Care
Penny Morely, Older People’s Council
Becky Woodiwiss, Public Health Team
Sue Barton, Department of work and Pensions
Tracy Maitland, The Fed
Julie Stacey, Sports Development Team
Jessica Sumner, Age UK
Kathy Murphy, Alzheimers Society
Sarah Tighe-Ford, Equalities Team
Liz Whitehead, Fabrica & Arts Commission
Fig. 3 – Partners at work – The Brighton & Hove
Staff - Study Visit in Udine – 5-7 March 2014
The Age Friendly Steering group meets quarterly.
Brighton & Hove has a lot of experience with multiagency partnerships, including EQUAL, WHO
Healthy Cities, ESF etc.
Co-production with older people will be managed
via the Steering Group, which includes
representation from the major NGOs in the city
1. Healthy City Profile e the GIS
mapping
The main objectives and expected results from the
GIS mapping in Brighton concern the improvement
of available information (possibly in an integrated
way); making visible the political and strategic
commitment; improvement of services better suited
on older people needs.
Brighton & Hove has already developed a GIS
mapping system of services and opportunities for
people in the City, but these information are not
matched with those on population, and more
specifically, with those on elderly population.
Fig. 4 – The GIS Mapping in Brighton & Hove Study Visit in Udine – 5-7 March 2014
Brighton & Hove finds in the good practice of Udine
new ideas that could be will be transferred.
Specifically:
21

GIS Mapping principles and techniques – apply
to local context
◦ Mapping of population data and services,
such as:
- Physical environment including bus
stops, parks, shops; etc…)
- Day activities for older people
- Arts and culture
- Health including pharmacies, GPs etc

Development of Healthy Ageing Profile
◦ Current and new data
◦ Consultation and survey
This work will help the City to develop its own
Healthy Ageing profile including profiles of the
localities; to involve community members as active
participants in the process of building knowledge; to
identify strengths and weak spots; to inform service
delivery for the future.
The development of a community profile including
geographic, demographic, social and economic
characteristics of the city will provide politicians but
also services providers with useful information for
decision making.
The Health Profile will include data on:
• location, size and topography of the district;
• number and density of residents;
• social, ethnic and economic characteristics;
• numbers and proportion of older persons (60-74
and 75+);
• housing type and tenure;
• distribution of public, commercial and voluntary
services.

Additional indicators eg., PH outcomes, Health
Counts

Staff resource – PH Intelligence, existing
staffing, AFC S/G, universities
Healthy Ageing Profile - June – September 2014,
with the Profile ready for Older people’s Day in
October
2. Vancouver Protocol
Brighton & Hove is particularly interested in the
implementation of the Vancouver Protocol even
because in 2013 have joined the WHO Healthy
Ageing Network it is fully engaged in the process of
developing its own Age Friendly city profile. A
healthy ageing approach, promoting independence
and activity is an important ethos within many of our
services.
Day Services for Older People have been
redesigned into 3 ‘activity hubs’ from 1st April 2014,
which offers potential for improved partnership
working at locality level and offering a consistent
range of services to older people across the city.
This methodology encourages long term support
and engagement by older people.
For this reason the Steering Group has decided to
undertake 5 Focus groups to explore what it is like
to be an older person in the city (age and income
will be used for the selection of participants). The
focus groups will be also undertaken with carers.
The possibility of conducting an online survey of
people aged 65+ in the city will be also explored.
The Local Co-ordinator of the project will ensure
key deadlines are met; the attendance on study
visit and transfer visits, producing reports, meetings
of Local Support Group, and the communication
activities requested by the project.
Outputs that demonstrate the transfer will include:
adoption of tools, techniques and ideas and
verification of current practices. Outcomes that
demonstrate the achieved results include: new
approaches
to
engagement,
informed
understanding of what services to commission
achieved from GIS work, informed understanding of
what services to commission achieved from focus
groups and surveys, improved partnership working
between public and voluntary sector organisations,
better engagement by politicians.
Tangible examples will be recorded on how the
learning has been applied and gain feedback from
stakeholders to demonstrate impact. The main
evaluation approach will be a self evaluation, based
on the evaluation methodology being developed for
the new Adult Social Care Commission for Day
Activities. A combination of outputs and outcome
measures will be used. Evaluation will be
undertaken by the Project Team and led by the
Local support Group. The work will be undertaken
using the staff time of the Project Team.
Innovative capacity
The most innovative aspects of this Transfer
Network for Brighton & Hove rely on:
1. Implementation of an Age Friendly City
approach;
2. Apply GIS/ Health Profiles principles and
techniques to the local context;
3. Development of preventative services for
older people – exchange ideas with other
partners and apply these to developments
4.
22
5.
6.
7.
underway in Brighton & Hove and to bring
new ideas;
Engagement with older people – all cities
face the challenge of how to hear the voice
of older people and how to ensure that this
voice is a representative as possible exchange ideas with other partners and
apply these locally represents a very
innovative way of improve knowledge;
Integration of Arts and Culture in citywide
strategies for engagement and involvement
of older people;
Linking the Digital offer of the city – new
technology /assistive technology – to
address local issues, specifically around
independence of older people;
Political buy-in to issues of ageing.
The project is about sharing innovative projects and
approaches. Brighton & Hove wishes to develop
further best practice in analysis and planning
services, preventative services and engagement of
older people.
The city has a good track record and wide
experience of innovation.
Funding
The URBACT Healthy Ageing project has allocated
€51,080 to Brighton & Hove. Staff time dedicated to
the project work will be recorded and charged from
the project budget where appropriate. The City is
committed to providing the 30% match funding
needed to take part in the pilot.
The project will also benefit from related
developments already underway which are funded
from a variety of sources including mainstream
budgets.
Adult Social Care has recently refunded its
support for Day Activities for Older People and
Citywide Coordination. While the funding for this is
fully allocated, there is the potential to steer the
work programme to take account of lessons learned
during the Urbact project.
In addition, Public Health has a small budget for
older peoples work.
There is also a potential through the new 20142020 ESF programme, which is overseen
regionally by the Local Enterprise Partnership,
which has a proportion of its budget reserved for
social inclusion projects.
There is also the possibility that this will be cofinanced by Big Lottery funding. Projects on social
inclusion are likely also to be eligible through the
Interreg IVA Two Seas Programme and the
Interreg IVA Channel Programme for which
Brighton & Hove is in the eligible area.
Success factors and lessons
learned
The challenges faced by Brighton & Hove mirror
those faced by Udine and other partner cities.
Therefore the success factors that Udine is working
towards (ie increasing healthy life expectancy,
reducing social isolation and supporting older
people to live independently in the community) are
relevant to Brighton & Hove and other cities.
Even if Brighton is part of well established
networks, services and strategies there is still
a too low commitment at political level on the
healthy ageing issue. Anyway, the coordinator of the
project is working to raise the interest of decision
makers, public managers and politicians on this
Project.
In fact, Brighton is keen to partner Udine in its work
to raise awareness of demographic ageing and
promote opportunities for older people to remain
physically, mentally and socially active as long as
possible.
Brighton has also experienced in previous years
plenty of pilot and community initiatives that will
contribute to the success of the transfer. As an
example, it has participate into the Joint Strategic
Needs Assessment 2013; into the Age Friendly City
Assessment, using WHO framework; into the
Wellbeing in Old Age – report of local participatory
research undertaken by Age UK Brighton & Hove
and Brighton University. An Annual Report of the
Director of Public Health, 2010 (Resilience) has
been published.
Brighton & Hove will apply learning from Udine and
other cities, taking account of the local context. This
will include ‘lessons learned’, and knowledge and
practice transfer. The Local Support Group will be
involved in considering whether the challenges and
issues faced by Udine apply to the local context and
identifying how to apply them locally.
Transfer conditions
There may be areas where implementation is easier
in Brighton & Hove (for example, senior manager
support for ‘prevention’ is well established) but also
areas where additional challenges are faced (for
example political and cultural aspects)
With respect to the transfer of the practice
concerning the City Health Profile and the GIS, the
following steps will be undertaken:
23
1. adoption of the WHO methodology
(Guidance for producing local Health
Profiles);
2. check of the feasibility of building the 22
indicators in the WHO list;
3. identification of new indicators best suited
for the specific knowledge needs of
Brighton;
4. check of the feasibility to map elderly
population distribution on the territory of
Brighton;
5. check of new data availability and review of
new data sources at the local level.
Brighton, differently from other cities
(Edinburgh and Grand Poitiers) has already
developed a GIS mapping of services
offered by the territory. Anyway, local
stakeholder could have interest in mapping
also other services within a GIS more
focused on older people needs;
6. involvement of the Statistical Office of the
Municipality or of other expertise from
University;
7. consultancy with the staff of the University
of Udine to plan data organisation for
building maps (Prof. Fornasin of the
University of Udine);
8. production of both population and WHO
indicators for matching information by
mapping;
9. Reporting
10. Assessment by Udine staff and Lead Expert
Brighton is also interested in the Vancouver Protocol
for both gathering qualitative information needed to
complete the Healthy Ageing Profile and promote
active citizenship and active ageing among older
people.
Edinburgh: Mapping “the life in your years”
24
The local context and the policy
challenges
The City of Edinburgh Council (UK) has a population
of 482,640 (source: GRO projection 2012) living in a
boundary which covers 264km2.
Over the next 20 years, large increases are
expected in Edinburgh in the number of people in
each of the following older persons age groups:
65-74, 75-84 and 85+ (fig. 1). In particular, the
number of persons in the 85+ age group is
expected to almost double by 2032, moving from
the present number of 11,040 in 2012, to 19,294.
In contrast, the traditional working age population
will remain comparatively steady, increasing by
only about 15%, which will have an impact on
funding available through income tax.
The main areas of intervention included in the
agenda of the Municipality of Edinburgh are the
following:
1. shifting the balance of care
2. reducing social isolation
3. increasing healthy life expectancy
Like many other cities in Europe, Edinburgh faces
policy challenges related to demographic change.
Whilst demographic change presents challenges
for health and social care services, it also offers
many opportunities. Advances in health care and
healthier lifestyles mean that people are living
longer generally and almost 90% of people over 65
years are not in the care system at all.
The growing number of older people, many of
whom are increasingly fit and active until much
later in life, can be regarded as a significant
resource, with a great contribution to make to
society.
However, with increasing age there is also an
increase in the number of people living with longterm conditions, disabilities and complex needs.
The Scottish Government has indicated that one in
three people over the age of 75 years will have two
or more long term conditions.
Fig. 1 – Edinburgh’s changing population
1. Shifting the balance of care
In order to achieve the aim of the national
“Reshaping Care for Older People” strategy, to
optimise the independence and wellbeing of older
people at home or in a homely setting, a shift in the
focus of care from institutional settings to care
provided at home is required.
Significant progress has been made in Edinburgh
to achieve this shift in the balance of care. The
percentage of older people with high level needs
who are cared for at home has increased from
14% in 2002 to 30% in 2012. This result has been
reached through investment in community based
services and by changing the way that services are
provided to benefit more older people. The target
for 2018 is to have a balance of care of 40%.
2. Reducing social isolation
Research demonstrates that loneliness has a
significant effect on mortality.
Evidence suggests that the impact of loneliness on
health and wellbeing is significant, with links to
increased blood pressure, depression and a 50%
decreased likelihood of survival for older adults
without significant social relationships, which is
comparable with well-established risk factors for
mortality such as smoking and obesity. A study from
the University of Chicago found lonely individuals
are more than twice as likely to develop symptoms
of Alzheimer’s disease as those who are not lonely
(Windle, K, Francis, J, Coomber, C. Preventing
loneliness and social isolation: interventions and
outcomes, Social Care Institute for Excellence,
2011)
3. Increasing healthy life expectancy
25
With growing numbers of older people, more of
whom are living in the community, the policy
challenge is to extend the healthy life expectancy,
to support older people to live independent, active
and good quality lives for as long as possible. This
policy challenge is reflected in the WHO Active
ageing framework.
Udine has experience in analysis and planning
services and activities for older people and this is
relevant to transfer to Edinburgh.
Udine has developed good practice in i) data
analysis and GIS mapping; ii) preventative
services for older people; iii) consultation and
engagement with older people, which can be
shared.
Edinburgh has shown through recent work on the
Change Fund for Older People and its
engagement in the UK Age-Friendly Cities Network
and other examples, that it wants to learn from
other cities and apply learning to how services for
older people are planned, developed and
delivered.
Edinburgh is particularly interested in transferring
the following aspects along the three main lines of
action of the network:
1. GIS/ City Health Profiles – Edinburgh
wishes to apply principles and techniques to
the local context, and especially:



Mapping of population data and services
e.g. homecare, day services for older
people;
New developments in mapping existing
dementia services, informing about new
dementia services e.g. location of dementia
cafes;
Additional indicators such as the use of
health and social care services;
2. Preventative services for older people –
the city wishes to exchange ideas with other
partners and apply these to developments
underway in Edinburgh and to bring new ideas.
An example from Udine that could be
transferred includes a focus on mental agility
and cognitive skills within public community
settings;
3. Engagement with older people –
Edinburgh has examples to share with other
cities of how it has successfully engaged older
people in the planning of services. All cities
face the challenge of how to hear the voice of
older people and how to ensure that this voice
is as representative as possible.
To address these objectives the city partners have
set up a Local Support Group made of a wide
number of stakeholders including older people and
carers representatives, volunteering organizations,
private sector care agencies, Health and social
Care Committee, Housing Committee, National
Health Service and ED leisure representatives. In
setting up the LSG, Edinburgh has also taken into
account the mainstreaming of gender equality
and non discrimination. In fact, Edinburgh has
innovative practice supporting Lesbian, Gay,
Bisexual and Transgender (LGBT) and Black and
Minority Ethnic (BME) communities which can be
shared. The Local Support Group represents
interests from different equality groups. An
Equality and Rights Impact Assessment
was undertaken as part of the development of ‘Live
Well
in
Later
Life’
Edinburgh’s
Joint
Commissioning Plan for Older People.
Edinburgh is also going to host the second
Transnational Thematic Exchange Meeting that will
be jointly organized with Brighton & Hove in the
first week of October 2014.
Anyway, wider learning and transfer will continue,
aligned to the action plan for the joint
Commissioning Strategy 2012-22. Edinburgh is
currently working on a 3 year action plan (201215), for the 10 year strategy.
Political and strategic context
There are two main strategies at national level
relevant for the transfer of the practice of Udine in
Edinburgh:
1. the national strategy for older people named
Reshaping Care for Older People
(2011-21) which aim is to support older
people to live independently at home/ in a
homely setting;
2. the strategy for shaping local service
developments
in
Edinburgh
named
Scotland’s National Dementia Strategy
(2013-16).
These strategies are accompanied at local level by
a key local programme named Live Well in
Later
Life,
Edinburgh’s
Joint
Commissioning Plan for Older People
2012-22. The vision of this strategy has been
developed in consultation with older people, and is
summarized in the following statements:
“In Edinburgh, we value older people and respect their
dignity. Our vision is that older people:

26
feel safe, feel equal and are supported to be as
independent as possible for as long as possible

can participate
communities

are involved in the development of services

can access and receive quality care and support that
takes account of their needs and preferences.”
in
and
contribute
to
their
Edinburgh has actively promoted the interests of
older people across all aspects of city life for many
years, through the ‘A City for All Ages’ programme.
actions to progress the work. A Local Support
Group has been established including older
people and equalities groups.
The diagram in fig. 3 shows an outline structure for
governance, reporting and communication for the
project. This builds on existing groups, structures
and existing channels. New developments that are
already underway to engage older people and
other key stakeholders, for example forums,
newsletters, web content, media/ social media etc.
will be utilised.
Fig. 3 – Diagram on the model of governance of the
project adopted by Edinburgh
Implementation of the good
practice at local level
The motivation of Edinburgh for being a partner city
within this Urbact Transfer Network is to learn from
good practice and to share experience with other
cities. Being part of the programme will assist in the
ongoing education and awareness raising of local
stakeholders about the benefits of a preventative
approach.
At this aim, as already pointed out above, many
stakeholders have been involved and others will be
engaged in the programme including Elected
Members of the City Council and Senior Managers
from statutory, voluntary and independent sector
organisations. The Edinburgh Joint Older People’s
Management Group will provide the overarching
steering group for the work.
Tricia Campbell, Senior Manager for Older People
will be the lead senior officer participating in the
transfer network (fig. 2). Caroline Clark, Planning
and Commissioning Officer for Older People’s
Services will be the Local Co-ordinator (fig. 2).
Fig. 2 – Edinburgh and Brighton & Hove staff –
Study visit in Udine – 5-7 March 2014
There is a lot of experience of multi-stakeholder
groups and partnership working in Edinburgh.
Examples include: Live Well in Later Life, which is a
joint plan between 4 partners. The Change Fund
has involved 4 partner sectors (NHS, Council,
voluntary and independent sectors). A Checkpoint
Group has been established for areas of policy
change/development, involving older people and
interest groups. The “A City for All Ages Advisory
Group” is a long standing older people’s forum
which aims to ensure the voice of older people and
it is heard in a wide range of policy areas.
Co-production is an approach being explored and
developed in Edinburgh – a new outcomes focused
assessment tool aims to develop in partnership with
the service user innovative ways to meet their goals.
This will be implemented in line with the new
legislation for ‘Self-Directed Support’ from April
2014.
As a matter of fact, the active ageing issue
is clearly a key point in policy planning in
Edinburgh.
A Project Team made up of key members
including Older People’s Services, Research &
Information, voluntary/ independent sector and
communications officers will plan and deliver the
In fact, many projects and programmes are already
ongoing at local level. A study to analyse and
assess the needs of older population has already
been undertaken as part of the “Live Well in Later
Life Programme”. Moreover, Edinburgh has recently
implemented a programme of projects as part of the
national “Change Fund for Older People”. Part of
this included the establishment of an “Innovation
27
Fund” for voluntary sector organisations to deliver
innovative community based services and activities
for older people.
A
healthy
ageing
approach,
promoting
independence and activity is an important ethos
within many of our services. For example, ‘Reablement’ is an approach which focuses on
supporting people to do things for themselves,
rather than a traditional approach of many services
which did things for people. Homecare services in
Edinburgh were transformed from 2008 to be built
around the Re-ablement approach and it is now
being developed within “Day Services for Older
People”.
Work is underway in Edinburgh to develop a
dementia friendly city. This provides an
opportunity to engage with the business community,
retailers and organisations we have had little
engagement with previously.
LOOP forums (Local Opportunities for Older People)
have recently been established, which bring
together local organisations, with a role in
developing innovative ways of identifying isolated
older people.
Anyway, how analyse data, using GIS mapping and
other tools to inform service planning, is something
that has not yet been applied in Edinburgh and that
the City would like to transfer.
The Local Co-ordinator will ensure key deadlines
are met. Staff time dedicated to the project work will
be recorded and charged from the project budget
where appropriate. The steering group will consider
further options for example, the recruitment of an
intern with specialism in GIS, employed for 3
months to produce the maps.
To guarantee the transfer of the good practice of
Udine, in particular with respect to the GIS system
on population/services mapping, political support is
in place for the “Live Well in Later Life plan”, aimed
at the promotion of independence, healthy ageing
and prevention.
The Councillor Ricky Henderson, Convenor of the
Health, Social Care and Housing Committee will be
the key political link for the Healthy Ageing project.
An initial Committee report about Edinburgh’s
involvement in the project was agreed in January
2014.
The JOPMG will be a key monitoring group and will
receive regular progress reports throughout the
project. Committee Reports will also be produced.
Project reporting to the Secretariat will take place in
September 2014 and at the end of the project. The
Project Team will also produce a “project diary”
that will record all the activities developed at city
level. The project diary will be a useful tool for
sharing with other cities partner progresses in
transfer, problems, obstacles encountered and
possible solutions.
The Project Team of Edinburgh will include
members of the Change Fund Evaluation Group.
Their role concerns the monitoring and evaluation of
Change Fund projects and the Healthy Ageing
project will be added to their remit/agendas. They
will provide information for consideration by the
Local Support Group and the Joint Older People’s
Management Group.
Project outputs will include attendance on study visit
and transfer visits, producing reports on meetings of
Local Support Group, communication activities and
outputs.
Outputs demonstrating the transfer of the GIS in
Edinburgh will include the adoption of tools,
techniques and ideas based on the Guidance for
producing local Health Profiles of older people
as well as on the advices of the staff of the
University of Udine that has developed the model.
Outcomes of the achieved results will include new
approaches to engagement, informed understanding
of what services to commission achieved from GIS
work. Edinburgh will record tangible examples of
how the learning has been applied and gain
feedback from stakeholders to demonstrate impact.
Self evaluation will be the main evaluation
approach, based on the Evaluation Framework used
to evaluate the Change Fund programme. This
includes a combination of outputs and outcome
measures, and this will be undertaken by the Project
Team and led by the Steering Group. The work will
be undertaken using the staff time of the Project
Team.
Innovative capacity
The project is about sharing innovative practices
and approaches. Edinburgh wishes to develop
further good practice in analysis and
planning services, preventative services
and engagement of older people.
Edinburgh is keen to promote innovation as is
demonstrated through recent Innovation Funds
being made available. The City Council has
recently launched the BOLD (Better Outcomes,
Leaner Delivery) programme, to promote
innovative, new ways of working within the context
of financial constraints. Edinburgh also recently
applied to the Mayor’s Challenge, with an
28
innovative proposal developed in partnership with
Edinburgh University.
Edinburgh is keen to learn from good practice of
other cities. In fact, it was the first area in Scotland
to develop the Re-ablement Service, based on
best practice from other parts of the UK. Edinburgh
was also a national pilot site for implementing the
Integrated Resource Framework, which
aims to help NHS and Council partners to better
understand how resources are used.
Funding
€49,080 have been allocated to Edinburgh from the
URBACT Healthy Ageing project. The project will
also benefit from related developments already
underway which are funded from a variety of
sources including the Change Fund and mainstream
budgets.
The budget for older people’s health and social care
services in Edinburgh is around £217m per year.
The Change Fund has provided an additional £8m
per year to support shift in balance of care and
promotion of prevention.
Success factors and lessons
learned
Most of the challenges faced by Edinburgh are
shared by Udine and other partner cities
participating in this Network. Therefore the
objectives that Udine is working towards are
relevant to Edinburgh and other cities: e.g. the
efforts aimed at increasing healthy life expectancy,
reducing social isolation and supporting older
people to live independently in the community.
With respect to the success factors identified in the
good practice of Udine, Edinburgh is in a very
favourable condition.
It comes into evidence that in Edinburgh there is a
strong commitment on the healthy ageing issue
at political level as many Elected Members of the
City Council and Senior Managers from statutory,
voluntary and independent sector organisations are
effective members of the Steering group meeting of
the project. This fact meets the first success factor
of the transfer shown at pag. 11.
The second factor of success is met, too. In fact, as
shown above, Edinburgh has well established
networks, services and strategies in place to
support the experience of transfer of the good
practice of Udine, including the “A City for All Ages”
and the “Live Well in Later Life” strategies. The City
is also part of the WHO network on “Age-Friendly
Cities” and, more in general, has a wide experience
of European projects.
Hence, Edinburgh is keen to partner Udine in its
work to raise awareness of demographic ageing and
promote opportunities for older people to remain
physically, mentally and socially active as long as
possible.
Edinburgh is also strongly committed on investing in
preventative approaches in order to improve health
and well being and delay the need for older people
to access higher levels of care. The numerous
activities and services offered to elderly people in
Edinburgh show that the model of governance
is strongly oriented to an integrated
approach. The “Get Up & Go Guide to
What’s on in Edinburgh” is a clear example of
how Councillors of different Departments can
actually and effectively work together. The activities
provided offer encouragement to lead a more active
and healthy lifestyle and include: allotment
programmes, cycle skills and bike loan, walking,
buddy swim and gym, dancing, seated exercises,
new age indoor kurling, photography & knitting,
singing etc…
Edinburgh will apply learning from Udine and other
cities, taking account of the local context. The Local
Support Group will be involved in considering
whether the challenges and issues faced by Udine
apply to the local context.
Transfer conditions
There may be areas where implementation is easier
in Edinburgh (for example, political and senior
manager support for ‘prevention’ is well established
in Edinburgh) but also areas where additional
challenges are faced (for example the weather, food
and cultural aspects in Edinburgh need to be
considered as they differ from the Udine
experience).
With respect to the transfer of the practice
concerning the City Health Profile and the GIS the
following steps will be run:
11. adoption of the WHO methodology
(Guidance for producing local Health
Profiles);
12. check of the feasibility of building the 22
indicators in the WHO list;
13. check of the feasibility to map elderly
population distribution on the territory of
Edinburgh;
14. check of data availability and review of data
sources at the local level;
29
15. involvement of the Statistical Office of the
Municipality or of other expertise from
University;
16. consultancy with the staff of the University
of Udine to plan data organisation for
building maps;
17. production of both population and WHO
indicators for matching information by
mapping;
18. Reporting
19. Assessment by Udine staff and Lead Expert
Anyway, Edinburgh is also interested in
strengthening actions engaging elderly people in
the planning of services, voicing their needs and
suggestions on possible solutions to daily life
difficulties.
Fig. 3 - Edinburgh staff at the Kick-off meeting in
Paris – 29-31 January 2014
Partners at work – Study visit in Udine 5-7 March
2014
Working groups – Study visit in Udine – 5-7 March
2014
Grand-Poitiers: towards an intergenerational approach
30
The local context and the policy
challenges
Grand Poitiers counts 142,537 inhabitants. It is an
association of 13 metropolitan areas. Poitiers is the
main city of this urban community with 90,625
inhabitants (fig. 1).
Fig. 1 - The Urban community of Grand Poitiers –
the 13 municipalities
In Gran Poitiers, nearly 15% of the population is
aged more than 65, which is almost the national
average. However, it is worthwhile noting that nearly
60% of the population aged 65 and over is aged 75+
years. At the same time, Poitiers shows the
strongest rate of 15-29 years people within the cities
of more than 50,000 inhabitants (demographic data
of 2006). According to these data, Grand Poitiers
has started working on promoting and supporting
intergenerational actions on its territory since
2008. The overall philosophy driving these actions
was to enhance the wellbeing at all ages through
innovative ideas for “living together”. Hence, the
relationships between generations represent a
question of particular concern for the decision
makers of Grand Poitiers.
The city is currently facing at this issue under the
joint impulse of the Council for Sustainable
Development
(Conseil
de
Développement
Responsable) and the Agency of Times (“Agence
des Temps”), which are working along the following
three main lines of action:
1. associative life and intergenerational approach
2. housing and life environment
3. citizens involvement in intergenerational projects
The main problem is that these lines of action
should be more integrated one each other, in order
to create a more stable local policy in this field.
The task is not easy, because actions are
developed looking at single sectors of intervention
following a “silo” model where each actor invests
financial resources in activities impacting single
lines of action. Hence, the advantages that could
come
from
a
more integrated and
intersectoral model of action and planning
are inevitably lost.
Healthy Ageing concerns various domains like
outdoor space & buildings, housing, employment,
civil participation, communication and information,
transportation, social participation, community
support and health services etc…
Numerous activities and a huge debate is ongoing
on these areas of action in Grand Poitiers. Anyway,
activities and new ideas seem to remain isolated
experiences. Much more effort should be done to
integrate these lines of intervention to develop a
more integrated strategy of action.
Even the local community should be more
committed on supporting active ageing for
strengthening social cohesion. The participation of
Grand Poitiers in the Urbact Network on Healthy
Ageing will enhance the experience of the city in
the field of participative processes. At the
same time, the support coming from the use of new
tools for profiling the elderly population and their
needs will improve the capacity of the Municipality
to generate public interventions effectively based
on the comprehension of older people needs.
This is a challenge that the representatives who will
win the elections of next March 2014 will have to
face at.
The recent involvement of Grand Poitiers in the
European URBACT Transfer Network on “ Healthy
Ageing” (support to active ageing) led by Udine
(Italy– lead partner), in partnership with Edinburgh,
Brighton & Hove (UK) and Klaipeda (Lithuany),
should help creating a necessary public and
integrated model of policy making, that numerous
local actors are ready to enhance.
Political and strategic context
At national level a really ambitious Alzheimer
Plan has been launched to better understand,
better diagnose and better manage the disease.
31
Over a period of five years (2008-2012), it
represents a cumulative effort of 1.6 billion euros,
financed by the state and by insurance including
medical deductibles. In September 2013, the
government launched works to develop the new
plan of "neurodegenerative diseases".
On the issue of Ageing there is not a national
strategy: the topic is pretty new. The Prime Minister
has launched the preliminary consultations in the
development of the law on the adaptation of the
ageing society, which should be voted in late 2014.
At the local level, in Grand Poitiers, there is not yet
a plan. The City can count on the current
assistance system (only financial support to access
home services) provided by the County council of
Vienne (lost of autonomy).
However the municipal elections of March might
allow the development of a stronger political support
about intergenerational questions.
Fig. 2 – Grand Poitiers staff – Kick off meeting in
Paris – 29-31 January 2014
Implementation of the good
practice at local level
Fig. 3 – Grand Poitiers staff – Study Visit in Udine –
5-7 March 2014
Within the wider framework of Intergenerational
policy, Grand Poitiers aims at implementing tools
that may allow the City government to generate
public interventions more based on an effective
comprehension of the needs of the elderly
population.
More in detail, there are two different levels of
interest of Grand Poitiers in this transfer experience:
-
The knowledge of new practices concerning
participative processes and elderly people
profiling tools (Healthy Cities Profiles and GIS
mapping);
-
The implementation of a concrete public policy
around the intergenerational approach as
a core element of active ageing
The first step was to set up the Project staff to
whom all actions are referred. Noëlle Billon is the
key contact person at the local level to ensure that
all necessary information is provided to both the
lead partner and the managing authority (fig. 2).
Mrs. Mireille Terny (site and communication
manager) is in charge of the implementation of Time
and Intergenerational policies actions in Poitiers,
included the coordination of the stakeholders. Mr.
Dominique Royoux is the Director of Prospective
and Territorial cooperations Department and of the
“Agence des Temps” (Agency of Times) of Grand
Poitiers. He is also the supervisor of the “Conseil de
Développement
responsable”
which
is
a
consultative and participative instance (fig. 3).
There is currently a strong political interest of the
elective representatives in charge of the elderly
policies in the Urbact Healthy Ageing Project. .
At the moment, the representative actors
involved in the project are the following:
a) The Sustainable Development Council (le CDR,
Conseil de Développement Responsable)The
Development Councils are citizen advisory
councils that improve the reflection of elective
representatives about what is at stake on the
territory. Their composition and their functioning
are free. In Grand Poitiers, the CDR is
composed of different stakeholders: elective
bodies, institutional bodies, associations,
citizens.
b) The Agency of Times (L’Agence des Temps)
This structure is interested in rhythms of
citizens’ life and keeping with those rhythms,
the existing services on the territory. National
agencies of Time are gathered together within
the association Tempo territorial.
The Agency is supported in its reflection and its
actions by the group Grand Poitiers/Temps
which is made of two elective representatives
for each municipality within the urban area.
Animation of the CDR and the Agency of Times
is carried out within the unit Prospective and
Territorial Cooperations Department of Grand
Poitiers.
32
The staff of the Project has also worked at setting
up a Local Support Group that will accompany
all the phases of transfer of the Project.
The LSG members will be either in charge of
implementation of the activities (self funding and
inspirational/creative contributions) or recipients
(eg.: the activity is “physically” implemented within
their structure).
The Prospective and Territorial Cooperations
Department of Grand Poitiers who coordinates the
Local Support Group is competent for implementing
innovative political policies by animating in an
integrated way different structures.
The actors currently engaged in the LSG are:
a) L’AFEV – Association Fédération des Etudiants
pour la Ville
An Association financed by the State. The aim
is sustaining students in addressing concrete
actions for the development of neighbourhoods;
b) Le CCAS – Centre Communal d’action sociale
It is a city centre whose action concerns three
different sectors of intervention: early childhood,
elderly people, and disabled persons;
c)
Le Centre Socio-Culturel des 3 Cités
(Neighbourhood
house)
and
Le
Local
(Neighbourhood house)
These social-cultural associations are financed
by both the city of Poitiers and the Region. Their
objective is to contribute to the harmonious
development of the neighbourhoods.
d) Le réseau gérontologie Ville/Hôpital de Grand
Poitiers (gerontology network of Grand Poitiers
hospital and the city)
The network facilitates the entire, individual and
multidisciplinary care of older persons who are
more than 60 years old and who are in difficulty
and need delicate medical and social
assistance.
The network does not replace the offer of
treatment and other existing help services; it
improves the efficiency, the orientation of the
patient among the health disposals etc…
e) SIPEA – Organisme Public de Logement
It is the Local authority landlord of Poitiers,
which currently adopta participative approach
(“IHHS”) for the creation of a reference
document with all the factors contributing to the
wellbeing in a neighbourhood.
Grand Poitiers can also rely on previous studies
focused on the analysis of elderly people
needs. In fact Grand Poitiers has established
regular cooperation with academic students who
have contributed to carry out a number of surveys
on the theme of intergenerational relationships, and
particularly on two specific topics:
-
intergenerational relationships in association
and in the development of volunteering;
-
intergenerational cohabitation
Those surveys have enabled the definition of needs
and the implementation of well focused actions:
training
sessions
oriented
to
enhance
intergenerational actions in associations and the
creation of an intergenerational cohabitation
service.
Grand Poitiers is keen to use the survey
methodology of collecting data to monitor the
activities to be transferred within the Urbact Healthy
Ageing Project.
The activities that Grand Poitiers is going to transfer
will be managed, monitored and assessed as follow:
1. City Health Profile and GIS mapping
The LSG considers the City Health Maps a practice
of particular interest for the policy making at local
level. City Health Maps represent a great
opportunity to know in a more detailed way the local
context in order to lead targeted actions. Healthy
maps could allow policy makers and stakeholders
knowing better the local context: the geographical
context in which elderly people live; the location of
existing services on the territory in different
domains: housing, social life, services, public
spaces. The linkage between these two main
informative streams can offer the City a high added
value in decision making. The implementation of the
Health City Maps is also linked to a work currently
led on the territory of Grand Poitiers: the creation of
a reference document that allows defining the
adapted environment to ageing of the elderly. Those
maps can effectively help the planning of, and the
decision on, other actions.
The following questions will be taken into account
during all the process of transfer of the practice:
What data are needed for the implementation of the
WHO indicators as well as for the maps’ building?
Are they available?
Who can provide data? (check list and review of the
data sources)
Which data are relevant to be crossed with respect
to the case of Grand Poitiers? At the moment, the
LSG has identified the following areas of collecting
data for mapping: older people distribution;
transport services; social care organisms and
associations.
33
A number of map to be built will be agreed within the
LSG according to the prior needs of the City.
The team is expecting that, starting from a better
knowledge of the territory, policy makers will be able
to provide public services which correspond
better to the life of older people in order to
promote a really Age-Friendly Healthy city.
2. Vancouver Protocol
Grand Poitiers is very interested in transferring the
methodology of the Vancouver Protocol. This
methodology would help the City to improving
knowledge on needs, problems, obstacles to daily
life of elderly people and collecting suggestions on
more effective interventions to be run at local level.
At the same time the involvement of elderly people
and other stakeholders favour active participation in
community life, sustaining both social cohesion and
trust towards institutions.
Get older people involved in the community
life make the City much more Age-friendly
and this is the added value of this good practice.
Grand Poitiers, following the Age Friendly Cities
Guide as well as the experience reported by Udine
during the Study Visit (5-7 March), Grand Poitiers
will set up the “focus groups” engaging, at the
beginning, elderly people (4 Focus Groups) and
older people houses Associations (1 focus group).
Grand Poitiers will be engaged in involving about
100 people in this activity. Another effort will be
done to identify, according to the criteria suggested
by WHO methodology (age and income), those
participants that will suite at best the characteristics
required.
The assessment of this activity will follow two
routes: on the one side, the LE and some external
experts of the staff of Udine will use the method
suggested by the WHO protocol; on the other side,
a social housing organization (member of the LSG
in Grand Poitiers) will carry out a survey in 2
neighbourhoods of Poitiers to assess the
relevance of the indicators issued by the protocol of
Vancouver for the older people and professionals
engaged in the focus groups.
3. Preventative actions - Projects to remain
mentally and physically active –
It would be useful to replicate at local level the
good practice of “Move your minds…minds on the
move” that has seen the cooperation between the
University of Udine, the University of the Third Age
and a number of professionals, associations and
so on. Grand Poitier, starting from the good
practice of Udine, is thinking about the creation of
a “Université Inter-âges” in domains like
sports. To improve the social inclusion of elderly
people, keep them active, mentally as well as
physically healthy, a partnership between the
Sports service of Grand Poitiers and some social
care organisms and associations (CCAS) could be
built.
The number of people to involve has not been yet
defined but the LSG has planned to reach at least
50 people in the first programme session.
In order to monitor and evaluate the satisfaction of
participants in this project, a satisfaction survey will
be carried out using the pre and post test
questionnaire already tested by Udine. These tools
represent a template that Grand Poitiers will be
free to adapt to the specific contents of the courses
and services offered within the project.
Innovative capacity
The Prospective and Territorial Cooperation
Department
has
already
started
the
implementation of Innovative practices in the field
of Time and intergenerational policies. The main
questions that the good practice of Udine could
help the City to cope with, concern the following
points:
-
How to reach elderly people and engage them
in giving a contribute to community life?
-
How to make elderly people knowledge and
know-how visible and available for transfer to
other generations? The idea of Grand Poitiers
is to put into action elderly people
experience as a resource for young
generations.
-
How to build a local active ageing public policy
rooted in a stable and sound cooperation with
a number of local stakeholders? The main idea
is willing to make the LSG sustainable
beyond the URBACT project.
Funding
The activities that the stakeholders of the LSG will
carried out within this project will be self-funded.
According to the provisional version of the FEDER
regional programme 2014-2020, this project could
apply for EU funds regarding the following lines of
action:
Axis 2. Specific Objectives: increase the
accessibility to services of sustainable and clean
mobility. In this sense, the “accessibility of train
34
stations by persons of reduced mobility, in a context
of an ageing population” could be supported
3. Preventative actions - Projects to remain
mentally and physically active –
Axis 3: Specific objective 2c.1: “Improve the
accessibility of services to the public by numeric
tools”. The actions financed will be on the following
domains:
- e-health (e-medicine, e-supervision, etc)
- for the ageing population and/or persons in a
situation of disability; support to digital projects
enabling to improve their life conditions at home,
development of health information systems.
Grand Poitiers has already identified some relevant
aspects
Success factors and lessons
learned
Differently from Edinburgh and Brighton & Hove,
Grand Poitiers is less robust with respect to the
success factors evidenced by Udine. In Grand
Poitiers we cannot count on the current political will
because elections are forthcoming and a shift in the
political governance of the City could put an
obstacle to the Healthy Ageing Project transfer; the
City is not currently involved in any international
network and it has less experience in managing
European project with respect to the other partners;
an integrated model of governance is not adopted,
and this limit represents one of the most challenging
factors put into evidence by the staff of Grand
Poitiers. The last point, the one concerning the
participative and deliberative process adopted by
Udine to involve elderly people, represents one of
the results expected by Grand Poitiers from this
transfer experience.
Anyway, there are some specific strength points that
will enable Grand Poitiers in reaching the expected
results within each line of action.
Here below some success factors on which Grand
Poitiers can count on along each line of action:
Transfer conditions
With respect to the transfer of the practice
concerning the City Health Profile and the GIS the
following steps will be run:
1.
2.
3.
4.
5.
6.
7.
8.
9.
With respect to the transfer of the Vancouver
Protocol methodology the steps to be followed are
shown below:
1.
1. City Health Profile and GIS mapping
favourable exchanges of data and information
among stakeholders. The cooperation with public
managers and the presence in the staff of
professionals with expertise on GIS will make
easier for the City partners to select information
effectively neede for creating mapping;
2. Vancouver Protocol
Grand Poitiers is strongly committed on bottom-up
processes and this could a strength point to
succeed in the transfer of the Vancouver Protocol;
adoption of the WHO methodology (Guidance
for producing local Health Profiles);
check of the feasibility of building the 22
indicators in the WHO list;
check of the feasibility to map elderly
population distribution on the territory of Gran
Poitiers;
check of data availability and review of data
sources at the local level;
involvement of the expert that the staff of
Grand Poitiers has already identified as key
actor of this transfer action. In fact, Grand
Poitiers has the know-how needed for the
realization of the GIS mapping;
consultancy with the staff of the University of
Udine to plan data organisation for building
maps;
production of both population and WHO
indicators for matching information by mapping;
Reporting
Assessment by Udine staff and Lead Expert
2.
3.
4.
5.
6.
adoption of the WHO methodology (Age
Friendly City Guide) accompanied by the Udine
Report on “The health profile of elderly people
in Udine”;
building groups engaging the LSG members in
finding out how to get elderly people involved.
Grand Poitiers has also planned to use local
media, social care workers and the “Ville
hôpital network”, a geriatric care network,
etc…;
identification of volunteers with the expertise
needed for the conduction of the focus groups;
conduction of the focus groups;
reporting activities according to the standard
fixed by WHO;
assessment of the work done on the basis of
the guidelines indicated by the Who guide.
35
According to the third line of intervention focused on
preventative actions aimed at enable elderly people
to remain mentally and physically active, the steps
that Grand Poitiers has agreed to follow are
described below:
1
2
3
4
5
6
involvement of a number of actors motivated to
accompany the implementation of the action as
teachers or trainers (students in advanced
degree in Nursery, public hospitals, sport
services, municipal centre of social actions,
local association networks, etc…);
dissemination of the initiative at local level in
order to collect elderly people interested in
attending labs/activities (older people houses,
general practitioners, chemists, etc…);
selection of topics or specific activities to
implement;
planning the programme of labs/activities;
start of the activities programme and
submission of the pre-test questionnaire to
participants;
at the end of the programme submission of the
post-test questionnaire to participants.
Grand Poitiers staff – Study Visit in Udine – 5-7
March 2014
Grand Poitiers Working group - Study Visit in Udine
– 5-7 March 2014
Grand Poitiers and the other representatives of the
Network - Study Visit in Udine – 5-7 March 2014
36
Klaipeda: embedding actions in a wide healthy ageing
strategy
The local context and the policy
challenges
The City of Klaipeda (LT) has a population of
158,541 (2013) inhabitants living in a boundary
which covers 98km2.
Fig. 1 – The map of Lithuania and the City of
Klaipeda
Collaboration among different sectors of policy is
limited and an effective understanding between
decision makers and elderly people is still lacking.
Age Friendly Cities principle are differently
interpreted among groups and sustained by a
variety of motivations.
Difficulties are also encountered in collaboration
among health, sport and NGOs engaged in active
ageing activities. Participation of elderly people in
activities is limited for different reasons.
Anyway, it seems quite easy to motivate politicians
and specialists to integrate and implement new
activities at the local level as well as to create a
common Age–Friendly City strategy and integrate
activities into a common plan of interventions in
Klaipeda.
The good practice of Udine shows that it works and
is effective. The transfer project will help to motivate:
a) politicians to implement a new active ageing
strategy;
b) specialists and professionals to work more
actively with new activities;
c) elderly people to participate in new
activities.
In Klaipeda elderly people aged 60 years and over
are 23.7% of total population. Given the
demographic trends of the City, as well as
throughout Lithuania and Europe, the number of
elderly people raise while, according to health
monitoring indicators, quality of life decline. By
studying the tools and instruments put in place by
Udine in order to cope with these trends Klaipeda
hopes being able to provide elderly population with
new and more tailor-made services.
In Klaipeda a variety of wellness activities and
programmes is designed to involve a higher
proportion of individuals belonging to this target
group. Still initiatives aiming at ensuring a healthy
life to elderly people are scattered and not
embedded in a wide strategy. For this to happen
there is a need for an in depth analysis of the target
population and the services available and their
distribution.
Political commitment is currently very low and there
is a huge gap between theory and practice.
An increased political attention to a Healthy Ageing
strategy could foster new innovative and more
accessible activities adapted to Klaipeda context;
improve relationships among sectors in the process
of healthy ageing decision making.
Political and strategic context
At the moment, Lithuania is implementing a state
programme, coordinated by the Lithuanian Ministry
of Social Security and Labour. In the beginning of
the 2014-2020 period, the regional development
plan provides for the inclusion of older people in
health preservation and promotion programs.
Klaipeda has established at City level a Public
Health Bureau active in senior health promotion. Its
qualified staff is currently in charge of implementing
the Healthy Ageing project activities.
The Municipality has also a Health care Department
entitled for managing the Strategic Development
Plan of Klaipeda city 2020. The plan is available at
the following link:
http://www.klaipeda.lt/eng/The-strategicplan/2496.
37
The priorities of the City Plan concerns a) a healthy,
bright and safe community; b) a sustainable urban
development; c) the improvement of the
competitiveness of the city.
The preparation of Klaipeda City Strategic
development plan 2013-2020 has taken a year and
a half. A lot of community people have participated
in its preparation. Five working groups for
preparation of the strategic plan were established in
the following fields: Social Care, Health Care and
Security Affairs; Education, Culture, Sports and
Youth Affairs; Business and Tourism; Spatial
Planning, Environment and Ecology; General
Management of Public Services. Members of the
working groups were politicians, civil servants,
representatives from budgetary institutions (schools,
social care, culture and sports institutions, hospitals
and other) representatives of universities and
colleges, trade unions, business organisations,
NGO‘s.
A strategic monitoring system of Klaipėda City
Strategic Development Plan 2013-2020 has been
foreseen. It consists of two parts: methodology
advices on data collection; a list of key performance
indicators. The review of key performance indicators
is presented to the City Council and society.
Some initiative programmes are ongoing: eg.,
physical activities (Nordic walking, gym, sport
activities), Third age university, a community health
board, etc…
Finally a Health programme for quality updating at
city level has been defined.
Implementation of the good
practice at local level
Klaipeda has a strong will in implementing most of
the good practice of Udine: the City Health Profile
and the GIS mapping system; the Vancouver
Protocol; the active ageing projects to remain
physically ad mentally active.
At this aim the City has set up the project team
made up of employees and local supportive group
(9 persons). Every person has individual role in the
project transfer process. One person is going to be
employed for a period of 14 months (financial
officer).
The staff of the city is made of Jurate
Grubliauskiene, member of the Public Health
Bureau of Klaipeda, Local coordinator of the the
Project; and Natalja Istomina, professor in the
Faculty of Health Sciences of Klaipeda University,
Member of Klaipeda city municipality Council, Chair
of Health Care Commission (fig. 2).
There are also a number of elective members
directly involved in the Project as Klaipeda
municipality is a main beneficiary from the transfer
of the good practice of Udine with the most impact
on the quality of life of elderly.
Fig. 2 – The staff of Klaipeda – Study Visit in Udine
– 5-7 March 2014
Hence, the elective members involved in the activity
of the LSG are:




the Mayor of Klaipeda city;
the Head of the Department for City
Strategy Planning and Implementation;
the Head of Health Care Department
the Director of Public Health Bureau. He
also plays a role of project coordinator at
the local level.
The stakeholders of the LSG varies with respect to
the different lines of intervention. Hence, the LSG
working on the City Health Profile and the GIS
mapping transfer, is made of:






General Practitioners
Public Health specialists
Social workers
Municipality staff
University staff
Small and medium size companies
That one working on the Vancouver Protocol
transfer, is made of:





Urban plannig specialists
Transport specialists
Public Health specialists
Municipality staff
University staff
Finally, the LSG working on the implementation of
preventative services aiming at enabling elderly
people to remain mentally and physically active in
later ages, is made of:



Public Health specialists
Municipality staff
University staff


38
Sport specialists
Sport and social institutions
Fig. 3 – Working groups and the staff of Klaipeda Study Visit in Udine – 5-7 March 2014
In fact, the production of Healthy Ageing maps is
included into national and local documents. Hence
political support to mapping idea does exist. GIS
systems have been already implemented in different
sectors of action at the local level. But, until now, the
population has never been mapped.
Fig. 5 – The Mapping System in Klaipeda
All involved participants and groups has their role
and interest and the achieving of the results
depends on their participation.
The LSGs have already started working on the three
lines of intervention and they have identified the
crucial point to address in the transfer of the good
practice of Udine. Here, below a summary of the
main results coming from the LSGs work:
1. City Health Profile and GIS mapping
It is worth noting that Klaipeda has already
developed a GIS system mapping of some existing
services and activities, such as green areas, bicycle
trucks, public toilets, physical activities (fig. 4 and 5).
The interest of the stakeholders in this line of
intervention consists of setting up new maps on the
distribution of elderly population to overlap to the
existing maps in order to provide policy makers with
useful information for decision-making. Moreover
new maps should be prepared on some specific
activities of elderly people: eg., their occupational
activities.
Last 17 March 2014 a first discussion with GIS
specialists started in Klaipeda with respect to the
effective possibility to implement population age
mapping in the City. A first contact with the expert
of Udine for the GIS, prof. Fornasin, was
established and the format for the implementation
of GIS system shared with the partners.
A first draft of a population age map is foreseen for
next September 2014. At that date a number of
population maps, not fixed yet, will be provided for
policy makers who are effectively supporting the
transfer of this good practice.
The GIS system implementation will need adequate
assessment. It is described below in next pages in
more detail.
2. Vancouver Protocol
Fig. 4 – The home page of the Mapping System in
Klaipeda
Klaipeda is also interested in the transfer of the
methodology of the Vancouver Protocol for a more
precise and effective assessment of elderly people
needs in a life-course approach. The aim of the City
is to identify the crucial point to realize an AgeFriendly City. The idea is to involve both elderly
people and specialists, politicians and other
professionals on the main problems, threats, but
also solutions and suggestions to take into account
for planning a more Healthy and Age-Friendly City.
about criteria of Age
39
The WHO Age-Friendly City criteria are willing to be
integrated into the current Strategic Development
Plan of the City. This is a very important step
towards the embedding of Healthy and Age-Friendly
City criteria within a wider strategy of action. It mean
to adopt a more integrate model of governance
where interventions are not scattered or isolated but
embedded in wider Action Plan.
3. Preventative actions - Projects to remain
mentally and physically active –
Klaipeda is particularly interested in the
implementation of the Project of Walking Groups.
All these activities will required monitoring and
evaluation. Monitoring will be focused on indicators
of effectiveness in the implementation and transfer
of the good practice at the local level. Public health
specialists (workers from Klaipeda city municipality
Public Health Bureau) will be responsible for the
monitoring activity. Local Support Group members
will be mainly responsible for the evaluation
process. They will check:







The number of activities implemented;
The opinion and satisfaction of elderly
people participating in the activities
transferred;
The opinion of specialists, politicians, and
other target groups on the results reached;
The number of elderly people participating
in the activities;
Levels of increasing in quality of life among
elderly people groups;
Collaboration between sectors on the local
level;
The capacity to disseminate the results
reached at national level.
The evaluation approach is mainly based on the
following tools:



Independent summative evaluation carried
out by external experts;
Ongoing learning evaluation by external
expert (Klaipeda university, Faculty of
Health Sciences)
Self-evaluation
Stakeholders are fully involved in the evaluation
process. Randomised control group and survey on
recipients are planned also considering the
availability of additional budget from Public Health
Programme.
Innovative capacity
The City Healthy Ageing Profile (HAP) and the GIS
mapping represents the two main key points of
interest for Klaipeda in terms of innovative capacity.
The commitment of the City on such an issue is well
known, as it has already developed a mapping
system of services at local level. The innovative
aspect relies actually on the possibility of mapping
elderly people distribution on the territory of the
Municipality.
There are also other innovative activities of interest
for Klaipeda such as the adoption of the Vancouver
Protocol and the Project of Walking Groups.
All the actors involved are open and strongly
motivated to implement new capacities
Funding
At EU level, Klaipeda is looking for funds for the
implementation of selected activities. Moreover, the
successful implementation of the project and an
adequate dissemination of the results may help the
Municipality to obtain funds from the regional
authorities or from the Lithuanian Ministry of Social
Assistance and Labour. In fact, the City can count
on Regional funds, as a committee of Klaipeda
region has funds for specific lines of intervention.
At Municipality level there is a budget line dedicated
to the Local Public health programme. This could be
another source for funding. Klaipeda Municipality
will contribute at up to 20% of the costs incurred to
implement the project activities. The staff of the
Project is also looking for sponsors that could
contribute on further funding specific activities.
Success factors and lessons
learned
The success factors of Udine will be good example
for Klaipeda to implement new activities.
At the moment, differently from Brighton and
Edinburgh, in Klaipeda the political commitment is
low but the city partners involved in the project trust
in the possibility to motivate politicians in building a
Healthy and Age-Friendly City starting from the
experience of Udine.
The personal and direct involvement of the Mayor of
Udine in the development of the Project will
represent a strength point for the success of the
project because other local politicians, looking at
their peer, will be motivated to do their best for
succeeding in transfer.
40
A further success factor lacking, at the moment, in
Klaipeda concerns the integrated model of
governance. In fact, the city partners have pointed
out that collaboration among local public bodies,
NGOs and other local actors is frail.
Anyway, Klaipeda seem having experience in
managing European project and paying special
attention to communication and dissemination
strategies. This is a very crucial point that should be
considered at every step of the project.
Transfer conditions
With respect to the transfer of the practice
concerning the City Health Profile and the GIS the
following steps will be run:
1. adoption of the WHO methodology (Guidance
for producing local Health Profiles);
2. check of the feasibility of building the 22
indicators in the WHO list;
3. check of the feasibility to map elderly population
distribution on the territory of Gran Poitiers;
4. check of data availability and review of data
sources at the local level;
5. involvement of the expert that the staff of
Klaipeda has already identified as key actor of
this transfer action. In fact, Klaipeda has already
implemented the GIS with respect to a number
of social and health services in the City. What is
lacking is the matching of these information with
the elderly people distribution on the territory of
the Municipality. A first meeting has been
already done last 17 March;
6. consultancy with the staff of the University of
Udine to plan data organisation for building
maps (the Klaipeda experts are already in
contact with Prof. Fornasin of the University of
Udine);
7. production of both population and WHO
indicators for matching information by mapping
by September 2014;
8. Reporting;
9. Assessment by Udine staff and Lead Expert (in
itinere and ex post evaluation)
With respect to the transfer of the Vancouver
Protocol methodology the steps to be followed are
shown below:
1. adoption of the WHO methodology (Age
Friendly City Guide) accompanied by the Udine
Report on “The health profile of elderly people in
Udine”;
2. building groups engaging the LSG members in
finding out how to get elderly people involved;
3. identification of volunteers with the expertise
needed for the conduction of the focus groups;
4. conduction of the focus groups;
5. reporting activities according to the standard
fixed by WHO;
6. assessment of the work done on the basis of
the guidelines indicated by the Who guide but
also through the following tools:
o Independent summative evaluation
carried out by external experts;
o Ongoing learning evaluation by
external expert (Klaipeda university,
Faculty of Health Sciences)
o Self-evaluation
According to the third line of intervention focused on
preventative actions aimed at enable elderly people
to remain mentally and physically active, Klaipeda
has agreed to transfer the practice of the “Walking
Groups”, following the steps described below:
1. 24th March 2014 – a first meeting with
associations of elderly people has been
planned. In that occasion the “Walking
group” activity will be presented to those
who will attend the meeting;
2. 7th April 2014 – in occasion of the WHO
Health Day the first “Walking Group” will
start.
By September a first monitoring of the ongoing
process will be carried out.
Methodology for transferring activities at local level
41 Methods and techniques for
The “Vancouver Protocol”
transfer
a)
have
been
provided
with
the
Guidelines
of the WHO explaining the
steps to follow to build the 22 indicators needed
to define the City Health Profiles. The
Guidelines have been described in detail during
the first “Study Visit” in Udine (5-7 March). In
order to get results with respect to this activity
the direct engagement of the Statistical Offices
operating at local level is recommended. The
partners have already invited the local
Statistical Offices to joining the Local Support
Groups to enhance a more effective
cooperation. Two out of four cities have already
developed at local level experiences in
mapping services and also population (Brigthon
& Hove and Klaipeda);
b)
c)
b)
will be offered through: visits (two visits of
prof. Fornasin have already been planned in
Klaipeda and Grand Poitiers; Fiorenza Deriu
has just come back from a visit to Brighton (8-9
April) to present the Urbact project to the
Steering group meeting on Healthy Ageing and
to keep in touch with the director of Health
Department to reinforce the support to the
Local
Support
conferences
Group);
c)
with
Partners have been provided with a
the
check
the participants into the focus groups; for
drafting the tracks to conduct the focus groups.
Brighton has already started this activity: during
the visit the Lead expert has discussed with the
Steering group the track prepared for the focus
group on “Housing”, the first issue that will be
addressed by the City.
In order to favour the engagement of people in
this
activity,
communication
events
d)
have been recommended. During
the first Transnational Exchange Thematic
Meeting that will be held in Klaipeda from 16th
to 18th of June, partners will be invited to
discuss and plan a communication event. The
communication events will be organized by
each city at the local level; they may have
different forms: seminars, workshops, miniconferences and they will be focused on the
experience of exchange with the other cities on
the Healthy Ageing issue;
Partners will be provided with the assistance of
expertise from the Udine staff responsible for
the Vancouver Protocol implementation. The
assistance will be offered through:
visits
and/or video conferences with dott.
Gianna
Zamaro
and
Stefania
Pascut
responsible at local level for the management
of the activities related to the focus group
conduction;
video
with the lead expert to
monitor the ongoing process and overcome
difficulties.
provided
list including the criteria to follow for recruiting
Partners will be provided with a check list
including all the activities required to build the
City Health Maps. The check list will include the
types of data to collect in order to build the
population indicators as well as for mapping the
services on the territory;
Partners will be provided with the assistance of
expertise from the Udine staff responsible for
GIS system implementation. The assistance
been
of the WHO, explaining the
steps to follow to build and carry out the focus
groups needed to engage elderly people and
social actors in the identification of priorities of
intervention with regard to the following 8
thematic areas: housing, social participation,
respect and social inclusion, civic participation
and
employment,
communication
and
information, community support and health
services, outdoor spaces and buildings,
transportation. The Guidelines have been
described in detail during the first “Study Visit”
in Udine (5-7 March).
City Health Profiles and City
Health Maps (GIS)
Partners
have
Guidelines
In order to favour and sustain the best transfer of
the activities part of this pilot transfer network, the
partners will be provided with, and will adopt the
following methodologies within each work package:
a)
Partners
e)
Videoconferences
with the lead
expert to monitor the ongoing process and
overcome difficulties. Two videoconferences
will be agreed in advance with the LE
according to each partner needs. As an
example: starting from the checklist provided
by the LE, each city will identify the most critical
steps, on which a discussion with the LE is
considered useful. Moreover, further contacts
and videoconferences may be agreed with the
Lead Expert to discuss about problems coming
up during the project.
42
Micro-projects to remain older
people mentally and physically
active
a)
Partners have been provided with
specific
Guidelines, described and discussed
during the first Study Visit in Udine (5-7 March).
In that occasion partners have identified the
aspects of major interest to consider at local
level for transfer. It must be considered that
cities such as Edinburgh and Brighton have
already implemented a wide number of
services at local level which are very similar to
those working in Udine. Anyway, they are
interested in identifying innovative ideas for a
wider engagement of older people. As an
example, during the recent
visit of the
Lead Expert
b)
to Brighton, the Steering
group has put on the floor many questions
about the implementation in Udine of the
“Urban gardens” because this initiative is not so
effective in their city if compared to the results
got in Udine. The common discussion enabled
the participants to identify a few new ideas to
experiment at local level for improving this
activity (reducing the area of each plot,
eliminate the boundaries, favour the contact
among tenants of the allotments, the adoption
of an intergenerational approach based on the
involvement of schools in caring plots).
Partners
have
been
provided
with
evaluation and observational
tools already tested on the projects
c)
implemented in Udine (e.g. “Move your minds--minds on the move”). A wider use of these
tools can increase the confidence and
feasibility of these tools in monitoring the
activities transferred.
Partner will be provided with the assistance of
expertise from the Udine staff responsible for
the
Micro-projects
implementation.
The
assistance will be offered through:
conferences
video
with dott. Laura Pagani
(University of Udine), Donatella Basso and
Antonietta Zanini (Faculty of Nursing Studies),
Stefania Pascut responsible at local level for
the management of the activities related to the
micro-projects development;
d)
Videoconferences
with the Lead
Expert to monitor the ongoing process and
overcome difficulties. Two videoconferences
will be agreed in advance with the LE
according to each partner needs. Moreover,
further contacts and videoconferences may
be agreed with the Lead Expert to discuss
about problems coming up during the
project.
These are the methodologies that will be adopted at
a very operative level to get results in a more
effective way.
Anyway, the following methodologies for transfer will
be adopted in a mainstreamed approach to favour
the exchange of experiences among partners and
the transfer of ideas from the giving city to the
partner and viceversa.
1. A Study Visit in the Giving
City
All receiving cities have attended a full 3 days Study
Visit in Udine (5-7 March). Udine has presented in
details the good practice, the activities that have
been successfully implemented as well as the
organization structure and the specific bodies that
are responsible for its implementation. Local
experts, such as prof. Fornasin, Laura Pagani,
Gianna Zamaro, Stefania Pascut, Donatella Basso
and Antonietta Zanini, have been introduced to
partners in order to favour their future exchange and
relationships. In that occasion experts have
provided partners with their insight on the success
of the good practice.
Two working groups have given
partners the opportunity to reflect on the activities to
focus on for transfer. The discussion in plenary with
the lead expert has provided useful suggestions to
plan the future work.
2. Local
Support
Meetings
Group
All receiving cities have already set up a Local
Support Group of stakeholders that are working with
the Municipality in the validation and the adaptation
process of the good practice at local level. The
LSGs will play an active role in the organization of
the Peer-Review visits as well as in keeping the
transfer log of the project for their city. At the starting
43
point of the project, all the receiving cities had
already a LSG working at municipal level. Anyway,
during the kick-off meeting in Paris, the partners
were invited to make up a more in depth analysis of
the actors to involve in the project (primary and
secondary stakeholders), in order to increase the
probability of success of the transfer network. At the
moment, all the receiving cities have integrated their
LSGs with new participants. The LSGs have already
started their work and they are meeting once a
month on average.
3. Lead Expert visit to the LSGs
The Lead expert will visit the LSGs in order to
present to the stakeholders engaged at the local
level of the Urbact Programme, the “Healthy Ageing”
Project and to discuss with them how to overcome
obstacles to transfer or giving insights on specific
activities to implement. The visits are also aimed at
sensitizing politicians and public manager to support
the experience of transfer of this network.
The Lead Expert has already visited Brighton &
Hove (8-9 April). On that occasion she has attended
the meeting of the Steering Group on “Age Friendly
City” (Room 431 King’s House) managed by Annie
Alexander presenting the Urbact Programme (in
general) and showing in details the activities the
good practice of Udine is made of. The presentation
has given the floor to a wide and useful discussion.
Then, according to the implementation of the
Vancouver Protocol the LSG has discussed the step
forward to the City assessment on transportation
and housing as well as on Dementia needs. Other
toìime slots have been dedicated to discuss the Big
Lottery Bid, an opportunity for financing some
activities of the Urbact Project. A meeting with Dr
Tom Scanlon, the Director of Public Health has
followed, in order to motivate him to support
stronger the work of the group on this project.
4. Peer-Review visits in the
receiving
cities
within
Transnational
Thematic
Meetings
The receiving cities will organize a 2 and half a day
peer review visit in their city. Brighton & Hove and
Edinburgh will jointly organize their peer-review visit.
Edinburgh will host the event. The aim of these
visits will concern the presentation of the level of
transfer of the good practice in each city; the
discussion about the constraints and obstacles
encountered; the exchange of comments and
advices from the other project partners, including
the “giving city” and from other thematic expert,
invited ad hoc.
The first Peer-review meeting will be held in
Klaipeda in June (17-19) and it will focus on
preventative services; the second will be held in
October in Edinburgh and it will focus on citizens
engagement and prevention services for active
ageing; the third meeting will be host by Grand
Poitiers in January 2015 and it will focus on
intergenerational approach policies for active
ageing.
The choice of an issue to develop during the visit is
aimed at developing specific aspects of the topic
and providing concrete methodological tools for
better transfer and implementation of the good
practice. These meetings will bring together
“receiving cities” with the “giving city”, with the
participation of experts that were involved in the
implementation of the practice. These meetings will
give the partners the opportunity to meet the local
experts assisting them in the operative aspects of
the transfer of the activities.
During the Peer-review a time slot will be reserved
to the following monitoring activities:
a) Submission of a monitoring grid to
partners. The grid will include a number of
qualitative and quantitative indicators (see next
paragraph) on the results reached at that moment
according to each work package;
b) Swot analysis followed by a plenary
discussion on solutions aimed at problem solving.
5. The Project Diary: the story
of a transfer experience
Starting from the beginning of February the Lead
Expert has provided the partners with a template of
a Project Diary to be used to track all the activities
implemented to transfer the good practice of Udine
at local level. Every three months the partners have
to send the Diary to the LE who will draft a
Newsletter where the steps of each city will be
summarized, outlining the results already got, the
obstacles encountered, the solutions adopted to
overcome difficulties, and so on…
The project Diary, at the end of the project will be
used to summarize the main results reached and to
draft a sort of Guideline for Good Transfer, with
suggestions and lessons learned.
6. Site visits
44
In occasion of each peer-review visit the “receiving
city” hosting the meeting will plan the visit to
services, centres, as well as to associations or the
participation into activities offering the other city
partners the opportunity to know better how
managing “Healthy Ageing” initiatives.
7. Project Workshops
Each City partner is invited to organize at least one
workshop at Municipal level to reflect on the best
ways to transfer at local level the good practice of
Udine. The Project workshops could be the
occasion to invite the experts of the staff of Udine or
the Lead expert to discuss more in depth the
activities to develop for good transferring of the
experience of Udine.
Finally, all these activities will be supported by mail
communications, phone calls, and specific internet
tools as Trello, Yummer or Dropbox, aiming at
facilitating the establishment of a continuous
dialogue among partners.
As an example, a dropbox dedicated to the project
has already been created as well as a site for to the
collection and sharing of photos, videos and so on…
Project and activities assessment
45
According to the main lines of transfer described
above the following indicators have been identified
to assess the achievement of the results expected:
I)
Number of focus groups carried out – and on
which issue
J)
Number of issues addressed – Type of issues
addressed
K)
Number of project funded on the basis of the
results got with transfer
L)
Amount of extra-funding
transferring activities
AT PROJECT LEVEL
City Health Profiles and City Health
Maps (GIS)
A)
B)
-
Number of cities implementing City Health
Profile indicators
Da 1 a 10
Da 11 a 15
Da 16 a 22
Number of cities implementing integrated GIS
Health Maps with local services
Up to 3 maps
4 maps
5 maps
6 and more maps
C)
Number of cities publishing Health Maps on
websites already existing
D)
Satisfaction
of
politician/public
managers/Managing authorities with the
adoption of the City Maps – Did they use the
Health Maps in decision making? Were the
maps useful to identify possible solutions to
resources allocation?
E)
Satisfaction of stakeholders with the adoption
of Health Maps – Were the maps useful to
identify possible solutions to older people
needs? Were the maps useful to reach older
people at risk of exclusion?
Satisfaction levels in D and E will be captured
through qualitative interviews to key actors
according to a track of interview that will be provided
by the LE.
The “Vancouver Protocol”
F)
Number of cities adopting the Vancouver
Protocol
G)
Number of associations involved in focus
groups
H)
Number of older people involved in focus
groups
allocated
for
Micro-projects to remain older people
mentally and physically active
M) Number of cities implementing micro-projects
N)
Number of cities that have used the experience
of Udine to improve similar services already
existing at local level
O)
Description of innovative solutions adopted to
improve similar services already existing at
local level
P)
With respect to the micro-project: “Move your
minds…minds on the move”, report:
-
The level of the good practice transferred
Amount of funding allocated
Communication tools used
Q)
With respect to the micro-project: “Urban
Gardens”, report:
-
The level of the of the good practice transferred
Amount of funding allocated
Communication tools used
R)
With respect to the micro-project: “Walking
groups”, report:
-
The level of the of the good practice transferred
Amount of funding allocated
Communication tools used
Considering the short life of the project, it will not
possible to evaluate the impact of the initiatives
transferred, but it will be possible:
a) To describe changes in decision making in
light of the new tools available to public
managers (health maps);
b) To describe the changes in older people
“sentiment” with respect to the city
administration, in light of the engagement in
the focus groups for rising problems and
identifying priorities in interventions;
c) To describe the innovations introduced
thanks to the transfer experience;
d) To list 3 lessons learned at project level
46
Micro-projects to remain older people
mentally and physically active
K)
With respect to the micro-project: “Move your
minds…minds on the move”, report:
-
Number
of
students
involved
in
intergenerational projects
Number of seminars organized
Number of older people attending on average
the seminars
Number of associations involved in the
management of this activity
% of good practice transferred
Amount of funding allocated
-
AT PARTNER LEVEL
-
City Health Profiles and City Health
Maps (GIS)
Pre and post-test questionnaire
A)
Number City
implemented
will be feasible for evaluate this specific microproject.
B)
Number of population
implemented
C)
Number of GIS integrated maps (population
and services) - minimum 3 maps
Health
Profile
GIS
indicators
Health
Maps
D)
Satisfaction with expertise exchange
E)
Satisfaction with other city representatives
exchange
F)
Satisfaction with communication and sharing
information system among partners
During each Transnational Exhange Meeting a self
evaluation questionnaire will be submitted to
partners by the LE in order to monitor the ongoing
transfer process and to register the feasibility of the
tools used for supporting partners in their activities.
The “Vancouver Protocol”
G)
Number of associations involved in focus
groups
H)
Number of older people involved in focus
groups
I)
Number of focus groups carried out – and on
which issue
J)
Number of issues addressed – Type of issues
addressed
An Observational grid is available as
well at the same goal (to study members
relationships dynamics within the groups attending
the seminars)
L)
With respect to the micro-project: “Urban
Gardens”, report:
-
Number of plots created
Number of people involved
Adoption of innovative solutions applied to
existing services – Description of innovative
solutions adopted to improve similar services
already existing at local level
% of good practice transferred
Amount of funding allocated
-
M) With respect to the micro-project: “Walking
groups”, report:
-
-
Number of people attending the initiative
Adoption of innovative solutions applied to
existing services – Description of innovative
solutions adopted to improve similar services
already existing at local level
The level of the good practice transferred
Amount of funding allocated
Monitoring process and final
evaluation
Qualitative and quantitative data
needed for building the indicators listed above will
be collected both in occasion of the three Peer-
Review visits/TEM in order to monitor the process of
transfer ongoing at the local level and one month
before the final conference.
47
The following tools will be used to collect data:
a)
Monitoring grid. This grid, edited by
the LE of the project, will be submitted to
partners in occasion of the three peerreview visits and it will be the occasion for
the LE to know more in detail the results got
at that moment by each city. The grid will be
made of two sections, each one divided in
two parts: one on quantitative information
and the other dedicated to get qualitative
information. The grid will be also used at the
end of the project to evaluate the overall
results achieved by partners;
b)
Swot Analysis Table. This table
will be used during the three peer-review
visits in working group sessions, where
cities will work on their own analysing
problems and constraints that could hinder
a successful transfer of the good practice of
Udine. They will be also invited to identify
possible solutions. This exercise will
represent a crucial part of the monitoring
process of the transfer activity. It will enable
partners to increase their awareness about
the effective possibility to achieve
successful results in transfer.
Moreover, the discussion and the reciprocal
exchange of experiences with other
partners will sustain the motivation in
problem solving, also identifying innovative
ideas and solutions.
Considering the short life of the project, it will not be
possible to evaluate the impact of the initiatives
transferred, but it will be possible:
a) To describe changes in decision making in
light of the new tools available to public
managers (health maps);
b) To describe the changes in older people
“sentiment” with respect to the city
administration, in light of the engagement in
the focus groups for rising problems and
identifying priorities in interventions;
c) To describe the innovations introduced
thanks to the transfer experience;
d) To list 3 lessons learned at partner level
References
48
Brighton & Hove JSNA (2913), Ageing Well, available at www.bhlis.org/jsna2013
Brighton University (2012), Well-being in old age: findings from participatory research”, Brighton & Hove Age
UK/University of Brighton
Brighton & Hove (2010), Annual Report on Public Health, Director of Public Health
Caselli, Graziella and Viviana Egidi. 2011. “Una via più lunga e più sana,” in Antonio Golini and Alessandro
Rosina (eds) Il secolo degli anziani. Come cambierà l’Italia. Il Mulino, Prismi, Bologna, pp. 29-45.
Crimmins, Eileen M., Samuel H. Preston, and Barney Cohen. 2011. Explaining Divergent Levels of Longevity
in High-Income Countries. Washington, D.C., The National Academic Press.
Christensen, Koare, Gabriele Doblhammer, Ronald R. Rau, and James W. Vaupel. 2009. “Ageing
populations: the challenges ahead.” Lancet 374, 9696, 1196-1208. PubMed ID: 19801098.
Deriu, Fiorenza. 2011. “The emerging social and economic impact of population ageing in Europe: a focus
on the SEE countries.” Opening lecture to the South Esatern Europe Home-care conference on
Promoting active ageing, social inclusion and raising awareness for the necessity of home-care
services. Montenegro and Austrian Red Cross. Sutomore (Montenegro).
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Europe. L’Avenir des Conditions de Vie des Européens Agés. Les Cahiers de l’INED, Paris, INED.
Hemerijck A. (2013), Retrenchment Policies and the deficit of Social Europe, Sociologica
Live Well in Later Life, Edinburgh’s Joint Commission Plan for Older People 2012-2022
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and Eileen M. Crimmins (eds), International Handbook of Adult Mortality, Springer, pp. 49-81.
Meslé, France and Jacques Vallin. 2011. “Historical Trends in Mortality,” in Richards G. Rogers, and Eileen
M. Crimmins (eds), International Handbook of Adult Mortality, Springer, pp.9-47.
National Research Council. 2001. Preparing for an Ageing World. The case for cross-national research.
Washington D.C., National Academy Press.
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PubMed ID: 12004104. [ HTML | PDF ]
Plouffe L., Kalache A. (2010), Towards global Age-Friendly Cities. Determining Urban Features tha Promote
Active Ageing in: Journal of Urban Health, 87(5): 733-739
Windle K., Francis J., Coomber C. (2011), Preventing loneliness and social isolation: interventions and
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mortality at advanced ages.” Population and Development Review 34: 747-768.
Reshaping Care for Older People (2010-2021 Strategy) – Edinburgh
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Strategic Plan for Klaipeda City 2020, available at www.klaipeda.lt/eng/The-strategic-plan/2496
49
Further information on data sources
This baseline study relies on data and information collected during two Study Visits in Udine:
a. Study Visit in Udine 26-28 February 2014 (with the participation on 27 February of Eddy Adams,
Thematic Pole Manager of the Programme)
b. Study Visit with Partner Cities 5-7 March 2014
The speakers of these two meetings are listed below:
Speakers
Furio Honsell
Geoff Green
(Expert from WHO)
Gianna Zamaro
Laura Pagani
(Professor of the University of Udine –
Statistician)
Alessio Fornasin
(Professor of the University of Udine –
Demographer)
Stefania Pascut Miriam Totis
Andrea Romanini
Bruno Grizzaffi
Ennio Furlan
(Representatives of the Municipality in
charge for implementing Urban Gardens
in Udine)
Furio Honsell
Guido De Michielis
Saverio Ambesi
Antonietta Zanini
Students
Mary Ann McCoy
Anna Sostero
Walking Group members
Paolo Munini
Donatella Basso
Topics
General overview on the policy strategy of the
Municipality of Udine
WHO Healthy Ageing Sub-Network activity
Healthy Ageing Profile e introduzione DECiPHEr
Project “DECiPHEr” - training evaluation tool
GIS mapping and Health maps
Presentation of the Vancouver Protocol
Visit to the City Gardens – via Pellis
Presentation of the experiences aimed at
promoting opportunities for older people to remain
physically, mentally and socially active
Association Alzheimer Udine onlus
Involvement of the University in “Move your
minds…minds on the move” (intergenerational
approach)
Interviews to the organisers, students, participants
by the Lead Expert
Video CamminaMenti
Meeting with a “Walking Group”,
Buffet with typical organic products,
Interviews to the organisers and participants
Visit to the “Ludoteca”
Move your minds…minds on the move
Most of the lectures and interviews have been recorded
A photo gallery of the Visits was got
URBACT is a European exchange and learning
programme
promoting
sustainable
urban
development.
It enables cities to work together to develop
solutions to major urban challenges, reaffirming the
key role they play in facing increasingly complex
societal challenges. It helps them to develop
pragmatic solutions that are new and sustainable,
and
that
integrate
economic,
social
and
environmental dimensions. It enables cities to share
good practices and lessons learned with all
professionals involved in urban policy throughout
Europe. URBACT is 181 cities, 29 countries, and
5,000 active participants
www.urbact.eu/project