Perth framework for age-friendly community-based primary health care
The Madrid International Plan of Action on Ageing adopted by the Second UN World Assembly on Ageing (2002) emphasizes that health promotion activities, disease prevention throughout the life course and equal access of older persons to health care and services are the cornerstone of healthy ageing. It recommends measures to provide universal and equal access to community-based primary health care and to establish community health programmes for older persons. The Madrid Plan also calls for the elimination of discrimination in access to health care based on age or any other forms of discrimination.
The United Nations Principles for Older Persons (1991) reaffirm the principles of independence, participation, care, self-fulfillment, and dignity, whereby older persons should have access to health care and should benefit from family and community care and protection, in accordance with each society's system of cultural values.
Every human being is entitled to the enjoyment of the highest attainable standard of physical and mental health conducive to living a life in dignity. The human right to health is recognized in numerous international instruments, among them the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, the International Convention on the Elimination of All Forms of Racial Discrimination, the Convention on the Elimination of All Forms of Discrimination against Women, and the Constitution of the World Health Organization (WHO).
The process of rapid population ageing poses tremendous challenges to the provision of health care and social services and demands on such services may intensify as the number and proportions of older persons in populations continue to increase. The global disease profile is shifting from infectious to non-communicable and chronic diseases such as heart disease, stroke and cancer, many of which can be prevented or delayed through strategies which include health promotion and disease prevention. While the disease burden is rapidly shifting towards chronic conditions, health systems are still mostly geared to address acute, episodic events. But chronic diseases require ongoing monitoring in order to minimize the development of associated disabilities and negative effects on the quality of life. Chronic care is often more effectively provided in a community-based rather than an acute care or institutional setting.
While most older persons continue to enjoy relatively good health and are active contributors to their communities and families, many older persons require special attention and support in order to maintain health. Generally, older persons prefer to age in their own homes, within their communities or familiar environments. The proximity, accessibility, cost effectiveness and user-friendliness of community-based primary health care services are therefore of vital significance to the health and well-being of older persons and their families.
Community-based primary health care is generally the first point of contact with formal health services and is often complemented by social care. Health care provided at the community level should also include a range of health promotion and disease prevention activities. However, with a few exceptions, community-based primary health care services are often fragmented and are not sensitive to the needs of their older users. They may have inadequate resources and little emphasis on health promotion, prevention, systematic screening and referrals -- all of which are essential for maintaining health of ageing populations.