INTERNATIONAL
WORKSHOP
IN
ASIA PACIFIC REGION
FOCUS ON HEALTH AND WELLBEING
Thiruvananthapuram,
India, June 4-6, 2012
Summary of Proceedings
BACKGROUND
The population of older people in the Asia Pacific Region is increasing
rapidly in comparison with the other segments of the population. Currently this cohort represents
approximately 11% of the total population and projected to increase to 20% by
the 2025 and more than quadruple by 2050.
Older people who live mostly in rural areas are poor, the majority are
women and most of them are widowed.
In most of the developing countries of this region there is a lack of
adequate healthcare and social security systems for persons of all ages
including older persons. Evidenced by national
plans and strategies many countries are trying to cope with the problems and
needs of older persons but the approach is being marked by “welfare” rather
than a “rights” perspective.
Gender
dimensions of ageing reflect that both men and women face discrimination due to
old age, but women experience ageing differently due to age and gender based
violence, exclusion and multiple discrimination throughout their life course. Women's longer life expectancy than men
worldwide leads to a situation where women are more likely to be widowed than
men and being widowed puts older women at high risk of being poor and to be
alone.
This unique demographic reality reveals the special
vulnerability of older women and led the Committee on the Elimination of Discrimination Against
Women, to adopt General Recommendation No. 27 on older women and
protection of their human rights (adopted in 2010). It provides protection for older women with a
binding obligation on States parties if incorporated in the concluding observations
of the Committee on the Elimination of Discrimination Against Women (CEDAW).
The necessity
for a convention on the rights of older persons was acknowledged by the United
Nations in May 2009 in the Report of the Expert Group Meeting on “Rights of
Older Persons” of the United Nations
Department of Economic and Social Affairs (UN DESA), Division of Social
Policy and Development[1].
Of late, the
concerns of old people have received new impetus from some member states and
civil society espousing their cause all over the world, including the Asia
Pacific Region. The demand to approach
the needs of older people from a “rights” perspective has gathered momentum at
national, regional and to a lesser extent international levels and resonates
with the intent of the Madrid International Plan of Action on Ageing
(MIPAA).
There have been
wide ranging discussions and debates advocating for new human right instruments
and covenants for the protection of the rights of older persons starting with
the Congo Committee on Ageing in October 2008, the Organization of American
States (OAS) 2010 and Organisation for Economic Co-operation and
Development (OECD) in Europe 2010 at the regional level, Argentina, Australia,
Canada and Malaysia at a country level and the International Federation on Ageing (IFA), HelpAge
International and AARP at the NGO level.
The Open-Ended Working Group on
Ageing was
established by the General Assembly by Resolution 65/182 on 21 December 2010. The Working Group will consider the existing international
framework of the human rights of older persons and identify possible gaps and
how best to address them, including by considering, as appropriate, the
feasibility of further instruments and measures.
The Third Session of the Open-ended Working
Group (OEWG) on strengthening the protection of older persons will be convened
from 21 to 24 August 2012 at the United
Nations North Lawn Building (NLB) in New York.
WORKSHOP
In the context of
the work of the Open-Ended Working Group on Ageing, UN DESA, the Office of the High
Commission for Human Rights (OHCHR) and the review of the implementation of MIPAA, the Centre for
Gerontological Studies (CGS) in Thiruvananthapuram, India, in collaboration
with the International Federation on Ageing (IFA) organised an International Workshop
of concerned and interested parties to discuss this issue.
The objectives of the workshop were:
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1.
|
To examine and share best practices relating to the
status of the rights
of older
persons in the context
of existing regional
and international instruments;
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|
2.
|
To examine and share best practices relating to
areas where the
rights of older
people are especially known to
be vulnerable,
e.g.
in abusive and neglectful situations, social
insurance and universal social pensions including economic
security, health security and family
security;
|
|
3.
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To determine the nature and
extent
of gaps in protecting
the rights of older
people in the
region;
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|
4.
|
To focus on
the
special conditions
of marginalized groups – widows, single women, older people
with disabilities,
those who are in the
oldest
old
age groups
and older people
who are dependent;
|
|
5.
|
To raise awareness of the national and regional
mechanisms used to implement and monitor
recommendations
of UN bodies; and,
|
|
6.
|
To network to identify
the different stakeholders who work on the protection of the rights of older
people in order to strengthen protection mechanism.
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The Workshop was held in Thiruvananthapuram,
capital of the Indian State of Kerala and was attended by over 120 delegates
from 10 countries – Bangladesh, Canada, China, India, Indonesia, Thailand, Sri
Lanka, Switzerland, United States and Vietnam. A number of activists from advocacy and human
rights groups also attended the workshop as observers.
Key speakers included
Mr. Anand Grover, UN Special Rapporteur on the Right to Health, Ms. Frederika
Meijer, Representative from UNFPA, Ms. Cai Cai, Social Affairs Officer,
UNESCAP, Dr. K. R. Gangadharan, President of the International Federation on
Ageing (IFA), Dr. Jane Barratt , Secretary
General of the IFA, Ms. Susan Somers, Secretary General, International Network
for the Prevention of Elder Abuse (INPEA), Ms. Ferdous Ara Begum, Former member
and Chair of Working Group, CEDAW
General Recommendation 27, Prof. James T. Sykes, Senior Advisor on Aging
Policy, University of Wisconsin, Prof. N. R. Madhava Menon, Former Vice
Chancellor, National Law Schools of Bangalore and Calcutta, Dr. Mohini Giri, Chair of Review Committee of
India’s National Policy on Older Persons 1999, Dr. S. D. Gokhale, Chair of
ILC-India and a stalwart on aging
movement in India and Dr, Vinod Kumar, Patron, Geriatric Society of India and a
pioneer in geriatrics in India.
In addition
attendees came from several State Human Rights Commissions academia and the
professional and civil society organizations working on and for older people.
The Workshop
was co-sponsored, by the Indian National Human Rights Commission, UNFPA,
HelpAge International, the Government of India National Institute of Social
Defence (NISD), Indian Council of Social Science Research (ICSSR), Indian
Council of Medical Research (ICMR) and the Government of Kerala.
Besides the Inaugural and Valedictory Sessions, there was a Special
Address by Mr. Anand Grover, UN Special Rapporteur on the Right to Health about
the protection of the rights of older persons. Workshop sessions included: Country
perspectives on the right of older people to health and wellbeing; the right to
be safe; the importance of advocacy and the role of civil society; and a final panel
discussion on the next steps toward empowering older persons at the global,
regional and state level.
All sessions were interactive resulting in ideas and suggestions from active
participants on how to ensure the rights of older persons. The delegates suggested that in the absence of
a regional convention on the rights of older persons in the South Asian Association for Regional Cooperation (SAARC) as well
as in the Asia Pacific Region, the workshop be treated as a
forum of the countries of this region to voice the needs and concerns of older
persons.
The suggestions and recommendations of the workshop are given in the
form of Outcome Statement in the next section which also throws light on the
major points discussed at this important three day event.
The Workshop was coordinated by Dr. P. K. B. Nayar, Chairman, Centre
for Gerontological Studies, with the support of Dr. Jane
Barratt , Secretary General, International Federation on Ageing
and the Summary of the Proceedings and Outcome Statement reflects the joint
cooperation.
OUTCOME STATEMENT
THE
SCENARIO
This outcome statement reflects
the concern of the delegates attending the International Human Rights Workshop in the Asia Pacific Region with a
Focus on Health and Wellbeing held in Thiruvananthapuram, India June 4 -
6, 2012. It is derived from a detailed
review of the current situation and discussion of the various issues involved
in the formulation and implementation of a protocol on the human rights of
older persons.
Whereas recognition of the
inherent dignity and of the equal and inalienable rights of all members of the
human family is the foundation of freedom, justice and peace in the world (UN,
1948), the rights of older people are ipso
facto human rights and are absolute and inviolable. This has been accepted by the United Nations
in 1948 (UN Declaration of Human Rights 1948) in a general way and more
specifically and firmly since 1982 (UN Assembly on Ageing, 1982).
In 1982 the United Nations (resolution 37/51) endorsed the Vienna International Plan of Action on Ageing. It aimed to
strengthen the capacities of governments and civil society to deal effectively
with the ageing of the populations and to address the developmental potential
and dependency needs of older persons. The Plan was to be considered in relation to
agreed standards and strategies in specific areas including human rights and
the advancement of women.
In 1991 the United Nations General Assembly adopted
the UN Principles for Older Persons (resolution 46/91). The Principles
have provided a framework on which to base national ageing strategies.
In 2002 the Madrid International Plan of Action on
Ageing (MIPAA) was endorsed by the United Nations (resolution
57/167). A central theme running through
the Plan is ‘the full realization of all human rights and fundamental freedoms
of all older persons.’
In 2010 at the sixty-fifth session of the Third
Committee, Follow-up to the Second World Assembly on Ageing, Member States were called upon to develop a
national capacity for monitoring and enforcing the rights of older persons in
consultation with all sectors of society, including organizations of older
persons through, inter alia, national
institutions for the promotion and protection of human rights where applicable.
There
are several Articles on Older Persons in existing Treaties and Protocols which
are ratified by the majority of the member states; however in general there is
a fragmentation between the documents resulting in few applications. At the same time, the guidelines on human
rights of older persons set by the MIPAA and the several conventions,
resolution and recommendations of the other international bodies -
International Labour Organisation, the World Health Organization and other
United Nations agencies - have been found only partially operable or
enforceable.
There
is a universal lack of clarity and awareness about what older persons’ rights
are by themselves (rights holders) by the community in which they live and by
the duty bearers who have responsibility to protect these rights. What is more, many of the protocols and
instruments on the subject are soft laws and not legally binding on member
states. Resolutions are not legally
binding and implementation of Declarations lie within the purview of member
states.
There is an urgent need for a unified human rights
instrument that would protect the rights of older persons in precise and
defined terms within an explicit legal framework to support States to ensure
that the rights of older people are fully realised in the increasingly ageing
societies.
On the report of the General
Assembly’s Social, Humanitarian and Cultural Affairs Committee (also known as the Third
Committee) the Open-Ended Working Group (OEWG) on Ageing was established by the General Assembly by
Resolution 65/182 on 21 December 2010.
The OEWG is open to all States Members of
the United Nations, for the purpose of strengthening the protection of the
human rights of older persons by considering the existing international
framework of the human rights of older persons and identifying possible gaps
and how best to address them, including by considering, as appropriate, the
feasibility of further instruments and measures.
FACTS
·
In the Asia Pacific region the number of people
aged 60 years and over has surpassed 400 million (being 438 million in 2010)
and is estimated to double in 15 years and to reach above 1.2 billion by 2050.
·
Sixty per cent of the world’s older population lives in
the Asia Pacific region and by 2050 one in four people will be over the
age of 60 years.
·
The
majority of older people live in rural areas, with a high proportion being
women and widows. More than one-half of
all older people in the region are poor and many are dependent and in most
cases these are women.
·
The current
demographic transition and unprecedented migration has consequences on the living
arrangements and shape and form of the family.
In this changing scenario, older people will require additional health
security and economic, social and psychological support.
·
Illiteracy
and poverty in families means that older people must undertake work as a survival
strategy and generate income to contribute to the household income.
·
The
burden of poverty is borne by older women in the Asia Pacific region consequential
through not only the lack of financial resources, but also an outcome of gender
bias and discriminating cultural values and norms.
·
The
challenges confronted by older women are unique: living longer than men and
often responsible for the care of family and kin. Women lack access to the same rights and
services as men which warrants special focus on their specific problems and
needs.
·
In
2002 at the Second World Assembly, Governments agreed to adopt the Madrid
International Plan of Action on Ageing (MIPAA).
In the Asia Pacific region 21 countries have developed national policies
on older persons and 11 countries have established national legislation to
protect the rights of older persons.
In the two prime areas of concern and need,
viz., health and social security, there is insufficient legislation and
inadequate implementation in most of the countries of the region. The perspective and approach, by and large,
continue to be “welfare based”, rather than
“rights” oriented.
·
Gaps
between policy commitments and implementation are evident in the countries of
the region. Whereas to make sense of the
agenda both a needs-based and rights-based approach are necessary in the
context of realisable goals.
·
Normative,
implementation and information gaps impact significantly on the degree to which
coherent and concrete agreements are formed in the dialogue towards protecting
the rights of older people in the region.
·
Multiple
discrimination and marginalisation due to age, sex, health conditions, economic
conditions, ethnicity, place of living and literacy exist in the countries of
the region. Exploitation and abuse, both
physical and mental and neglect and abandonment of older people exist and pose
a threat to the health, dignity and security of the older persons in these
countries.
·
Inadequate social protection, health care, and
discrimination in all forms are three key issues confronting old people in the
Asia Pacific Region today.
RESOLUTIONS
AND CALL FOR ACTION
1. Older people have a right to freedom from discrimination
Older men and women
are often denied access to services and jobs and treated without respect
because of their age and other factors such as gender or disability. This discrimination has to be guarded against.
The
institution of family is a vital agency that links the generations
and should be strengthened and protected.
The family should be used as the prime lever
for combating discrimination and fostering equality.
2.
Older
people have a right to freedom from violence
Older men and women
are often subjected to abuse including verbal, sexual, psychological and
financial exploitation. Neglect and
abandonment and even physical violence of older persons are also not uncommon.
Abuse and
exploitation is a barrier to the enjoyment of the full range of human rights of
older persons. More importantly, they
pose a threat to the dignity and self-respect of the older person. Measures must be devised to raise awareness
of abuse and neglect, identify victims and perpetrators, and develop services
to eliminate such visitations.
3.
Older
people have a right to social security
Economic empowerment is basic to the enjoyment of rights. Older men and women often do not
have financial protection such as pensions and other forms of social security. The single most pressing challenge to the
welfare of older persons is poverty – poverty is a multiplier of risk for
abuse, and often poverty and ageing go together. Without a secure minimum income many older
people and their families fall into poverty.
A non-contributory, state-funded pension for all old people irrespective
of economic status is an imperative. The
pension should be based on minimum needs and benchmarked to cost of living
index.
4.
Older
people have a right to health
Older persons have the right to the highest
attainable standard of physical and mental health care, including preventive,
protective, curative and rehabilitative and palliative care.
Older men and women
may not receive appropriate health care because of their age. Unattended chronic diseases, unaffordable
medicines and treatments and malnutrition are part of old age life in the
region. Treatment can be denied or
delayed and older people very often receive poor or insufficient health care
service.
Provision of health
care for older persons at various sites such as hospitals, nursing homes, old
age homes and other places of shelter should be within the umbrella of
legislative protection of human rights and effective legal redress mechanism
should be in place to guard against human rights violations.
There
is a need to develop a system of affordable health care underpinned by a universal
health insurance scheme for all older people irrespective of income.
Introduction of gerontology
and geriatrics in medical syllabus and support to start social gerontology
course to promote community-based care are essential. Health care providers should be trained in alternative
systems of therapy and be exposed to the subject of health related human rights
of older persons.
Dementia is found to be mainly
an old age illness and the percentage increases with age. The management of dementia must be a publicly
stated national health and social care priority and formally recognized in
funded plans for service development and public spending. Older persons suffering from any form of
dementia should receive benefits similar to those given to persons who have a
‘physical’ disability.
Assistive devices and other
support mechanisms should be provided at the state’s expense for older persons
with forms of impairment in order to optimize function and ability to
contribute to society.
5.
Older
people have a right to work
Older men and women
are being deemed ‘unemployable’ because of their age and forced to stop working
because of mandatory retirement ages.
The International
Covenant on Economic, Social and Cultural Rights (CESCR) has held this to be a
violation of a person’s right to be free from discrimination including in the workplace
and should be formally recognised as a barrier to older people’s avoiding
poverty in older age[2]. Everyone has the right to free choice of
employment. The right to work is
important not only because of the financial security but enhances the physical,
mental and social capacity and capabilities of human beings.
6.
Older
people have a right to property and inheritance rights
Violations of an
individual‘s right to equality in ownership, management and the disposition of
property exists for older people. Older
men and women, in many parts of the world suffer in matters related to
inheritance laws, both statutory and customary.
In many societies, women
of all ages are denied the right to have an equal share of the family property
or to inherit property of their deceased husbands and this issue must be
addressed as a priority.
7.
Marginalised groups need special
provisions.
The
older population is not a homogenous group; some older people require special
protection: the destitute who have neither economic nor caregiver support; single
women; widows; the oldest old especially those who are ill and with a terminal
illness; the older person who is disabled; suffering from mental illness, and,
people with dementia.
Older
people with special needs must also be able to enjoy their human rights to
self- determination, autonomy and informed consent particularly in health care
decision making and in legal proceedings regarding mental incapacity which are
often violated because of their inability or incapacity to enforce them.
8.
Care providers
In the rapidly changing family
arrangement with the pervasiveness of the nuclear family, the need for paid
caregivers will increase.
There is need to establish
standards for service care providers, including in-home, community–based and
residential settings.
Furthermore it is necessary to establish institutions to professionally
train caregivers and qualified trainers to ensure better care across the
continuum of care which includes the frail old person and those in end stages
of life.
Monitoring and enforcement mechanisms should be developed and implemented
to protect against abuse and neglect in such settings.
9. Role of civil society
Civil society has a long and important history of
advocating for the rights of older people globally and as such should be
closely and fully involved in dialogue and programmes which work to protect
their rights.
Governments, NGOs and civil society can contribute positively to
improve the life of older people using international human rights norms such as
the CEDAW Convention and General Recommendation 27 and the World Health
Organization (WHO) Determinants of Healthy Ageing to promote behavioural and
lifestyle changes to delay onset of health problems.
10. Infrastructures
Appropriate structures
to provide services necessary to protect the rights of older people are to be
necessarily established and supported by States. Monitoring and evaluation of the formative
structure and implementation must be an
essential element of the planning.
States should make provision, including statutory mechanisms, to mobilise
adequate funds to meet the basic need programmes in ageing. Mechanisms such as a National
Commission for Older Persons are called for to connect various sectors for comprehensive solutions and for enforcement
of the rights of older people.
11. A State (National) Institute on Ageing
A State (National) Institute
on Ageing is a multi-disciplinary agency providing multi-level services. Since scientific data on ageing, especially
sex-disaggregated data, is not available to plan and implement appropriate
programs for older people in many of the countries of the region, institutes on
ageing are an essential element and partial solution.
The Institutes should focus on
collecting and processing the data on older people as a priority for use of the decision makers and researchers.
Promotion of the science of
gerontology and geriatrics should also be a priority area of the Institute on
Ageing which could assist state governments in planning, implementation and
monitoring of need- and rights-based programs for older persons.
12. State commitment
Member States shall take
initiative to be an active contributor to the discussions of the United Nations
in regard to the creation of a new human rights instrument.
This comes not only out of their
moral and legal obligations to their senior citizens but also because they are
signatories to the UN Charter. The UN
Charter commits to respect and fulfill the obligations relating to the
fundamental human rights, dignity and worth of human persons as well as the
recognition of the standard settings under numerous human rights instruments
and work of various UN and bodies and agencies as well as regional human rights
protection bodies towards protecting, promoting and monitoring rights of all
including the older persons.
Civil society, Member States,
academia and other stakeholders have a moral and social responsibility to the
older people of today and in the future to monitor the progress of discussions
at the United Nations in regard to a convention and be accountable to senior
citizens whose plight rests in their hands.
Notwithstanding the work of
the Open-ended Working Group all stakeholders must continue to demonstrate
unbridled commitment and dedication to the task of the day-to-day protection of
the rights of older people through the current albeit inadequate mechanisms at
a state, national, regional and international level.
13. A Convention
on the human rights of older persons
New
human rights instruments are necessary to not only clarify the state’s
responsibilities towards older women and men and improve accountability by
concerned agencies, but also to provide a framework for policy and decision making.
A
Convention on the Human Rights of Older Persons is a collective responsibility
to which the United Nations and Member States should view as an urgent and top
priority.
14. Responsibility of the United Nations
The United Nations DESA and the Office of the High
Commissioner on Human Rights (OHCHR) have a responsibility to informing the debate from a
substantive human rights perspective by addressing urgent and relevant gaps in
the respect, protection and fulfillment of human rights of older persons.
The United Nations and Member
States shall consider the appointment of a Special Rapporteur on the Protection
of the Human Rights of Older People under the auspices of the United Nations
Human Rights Council.
The United Nations may provide
advisory services to the States in fulfilling their obligations in this field and
to have a monitoring mechanism to oversee the progress in implementation of the
programme.
15. Regional Human Rights Institutions
Regional Human Rights Institutions shall
have a special unit to monitor the progress of work relating to the
implementation of the convention on the rights of older people in their region
and / or develop a specific mechanism that measures the degree to which the
rights of older people are protected.
The development of instruments at the Asia
Pacific as well as SAARC region is of special interest in view of the diversity
of socio economic conditions and paradigm shifts in the consequences of
demographic change.
The Institutions may take up the issue as a
priority item in their periodical meetings and may use their influence to
convince delegates from non-complying states to be active contributors in the
discussion about a new UN convention. Since
neither the United Nations nor the Regional Human Rights Institutions have any
statutory powers over Member States, these units will play a defining catalytic
role in accelerating action by Member States.
__________________________
UN: Bonn
“A convention on the rights of older persons
would add additional weight in furthering, deepening and more precisely
defining the rights of older persons. A convention would create obligatory and
binding international law. Similar to the adoption of various other human rights
instruments, member states would undertake a threefold commitment when adopting
such a convention: to respect, to protect and to fulfill the rights enshrined
in the relevant text” (p. 18).
[2] (See
General Comment No 20, “Non-Discrimination in Economic, Social, Cultural
Rights.” cit, Para 29)
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