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Community Social Infrastructure

Community social infrastructure is the most fundamental and also the most complex component of a society’s support system for the older population, enabling access to necessary resources and providing opportunities for healthy, active aging in place. It can be understood as the connective tissue of a society, broken into three key elements: accessibility, engagement, and assistance. Perhaps unsurprisingly, given the scope and complexity of the challenge, there is tremendous variation in countries’ progress – including within regions and across income levels – in the development of a robust community social infrastructure, with no country leading across the board. However, all are facing fiscal pressures that make government leadership, long-term strategic planning, innovative approaches, and stakeholder partnerships imperative.

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Aging in Place

Around the world, older people overwhelmingly prefer aging in place – more than 95 percent of older adults in all ARC economies are living at home and in communities, with this rate reaching close to 100 percent in middle-income countries. It is imperative that countries with a rapidly aging population strengthen community social infrastructure to support active, healthy aging in place, particularly middle-income countries as they are undergoing an unprecedented convergence of rapid urbanization, population aging, and changing family structure. Globally, there is growing movement among governments to promote and facilitate aging in place, as demonstrated by efforts to build age-friendly cities and communities. However, fiscal considerations and decision-making that prioritizes short-term savings over long-term benefits are constraining much needed investments.

Loosely defined, an age-friendly community is one in which older people are valued, engaged, and supported by physical and social environments that accommodate their interests and needs. Today, more than 530 cities and communities from 37 countries are participating in the WHO’s Global Network of Age-Friendly Cities and Communities, with the number having doubled in just the past two years.

Distinct Paradigms of Aging and Urbanization, by Income Level
Share of Urban Population vs. Share of Population Age 65 or Older (Baseline = Year 1950)

High-Income Countries

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Middle-Income Countries

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Low-Income Countries

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(Sources: United Nations, Department of Economic and Social Affairs, Population Division; FP Analytics)

Accessibility

Accessibility is fundamental to older adults’ ability to be actively engaged in their communities and to live independently. Limited access to transportation, buildings, and housing has been a stumbling block across countries, independent of level of economic development. The greatest advancements reducing barriers to accessibility are found in countries and communities that have comprehensive regulation and active enforcement, consider the needs of older adults in broader planning processes, and employ innovative solutions to leapfrog the expansion of traditional infrastructure.

According to Gallup surveys of people age 50 or older in 154 countries, an average of just 36 percent of respondents among low-income countries expressed satisfaction with the accessibility and quality of local public transportation systems, and the percentage rose to only 56 percent and 61 percent among middle-income and high-income countries, respectively.

In a 2015-2016 survey of 26 EU countries and including nearly 1,200 individuals (more than one-third age 50 or older), the “lack of access to the built environment” ranked as the third most significant challenge for persons with disabilities, following lack of equal opportunity in the labor market and lack of access to transportation.

Engagement

Social engagement is vital to older adults’ health and happiness, and governments and communities around the world are developing new approaches to meeting this need in a fiscally constrained era. In light of fiscal constraints, efforts to promote engagement are evolving to maximize cost-efficiency; successful models are notable for taking holistic approaches and incorporating older adults into comprehensive societal solutions. These approaches include providing facilities or creating opportunities for intra- and inter-generational interaction, and encouraging and facilitating volunteerism.

According to a meta-analysis of 148 studies of social relationships and mortality, people with strong social connections have a 50 percent increased likelihood of survival after an average follow-up period of 7.5 years, regardless of initial health status.

As social engagement prevents isolation, it helps to lower healthcare expenditure – a lack of social contacts among older adults is associated with an estimated USD 6.7 billion in additional federal healthcare spending each year in the U.S.

Assistance

Whereas social engagement enhances older adults’ well-being, assistance ensures their adequate standard of living. Although engagement and assistance often leverage the same resources, assistance – focused on providing services to support aging in place – is at much greater risk from fiscal pressures. Best practices are emerging from programs aimed at leveraging existing resources, such as postal networks, and mobilizing stakeholders in the community, including residents and front-line service providers. The most significant progress has been observed in middle-income countries that are endeavoring to develop a social infrastructure for a rapidly growing older population.

The Supportive Community Program in Israel

Successful programs enabling older adults to live comfortably in communities integrate assistance and engagement, and Israel’s long-standing Supportive Community program is a particularly effective model. Initiated in 1989 by JDC-Eshel, a leading Israeli NGO, the program provides a comprehensive package of services to older adults based on a monthly membership fee. Services include household repairs, an emergency call system, home-visit medical services, and weekly social activities. The program has achieved high levels of satisfaction – only 4 percent of respondents in a 2010 survey expressed dissatisfaction. To date, the program has grown to some 250 Supportive Communities nationwide and more than 52,000 participants (around 40,000 households), equivalent to roughly 6 percent of older Israelis who live in their community. Building on the existing infrastructure of the Supportive Community, JDC-Eshel is in the process of developing a new program called “Community for Generations,” which will give greater attention to better-matching services for older adults’ needs by engaging them as partners in the process of identifying the services appropriate for them as well as conducting assessments on their personal and families’ needs.

The Full Community Social Infrastructure Report

Download the full report in PDF format by clicking the button below.

DOWNLOAD THE FULL COMMUNITY SOCIAL INFRASTRUCTURE REPORT