Islamset - A matter of human rights

It comes as no surprise that Dr Darnton-Hill cites socioeconomic and health status as the two most important determinants of the quality of life of older persons. This is amply documented in the literature on aging. But he also subtly shifts the public policy paradigms from "caring for the elderly" to more active health promotion and interventions to improve older persons' economic security and psychosocial well-being. For this he must be congratulated since in most countries it tends to be the stereotypes of disabled and vulnerable older persons that provide the inspiration for policies on aging. However, he stops short of saying that, with ever more people living longer, the protection and promotion of older persons' health and socioeconomic security is a matter not only of public policy but of basic human rights.

The Constitution of the World Health Organization confirms this view. It defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". It goes on to say explicitly that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being". This view of health as a basic human right is further strengthened by international human rights law which, through international conventions, specifically protects certain population groups, such as women and children, considered to be especially exposed to injustices. However, so far it has not been deemed necessary to extend such international human rights protection to older persons.

This raises several questions. For example, is there no international consensus on minimum standards of human rights protection for older people? Or are they perhaps not in need of such protection? Are they already protected by existing human rights treaty bodies ? If so, what are the international instruments which explicitly or implicitly deal with human rights issues concerning older persons, and are they adequate? And finally, is it now necessary to develop an international instrument specifically protecting the human rights of older people?

Employment

A thorough discussion of these questions would obviously exceed the scope of a brief response to Dr Darnton-Hill's article, but a number of factors he mentions deserve a brief examination in the light of their implications for human rights. For example, he mentions a study which found that continued employment into old age was generally associated with higher morale, happiness, better really be very happy to continue to work, possibly on a flexible basis, but find they are unable to do so because of discriminatory employment policies? The fact that retirement is most often based on an arbitrary age-related cut-off point from employment can in itself be considered a form of age discrimination. Yet, in the eyes of law-makers the elimination or liberalization of mandatory retirement ages often conjures up the spectre of legions of unemployed youth starting intergenerational warfare by angrily demanding to take over the jobs to which the elders tenaciously cling. The reality is in fact quite different: the majority of older persons want to and do retire at pensionable ages if their pensions are adequate to maintain their quality of life, while some may wish to continue to work, and others, particularly women, may have to work because of inadequate retirement income.

Further, age discrimination is not limited to those who wish to continue to work past mandatory retirement ages. First and foremost, it affects older workers in their fifties and sixties, who often find themselves forced out of the labour market before younger workers but with little prospect of finding re-employment in tight labour markets. Older women in particular often encounter a double jeopardy in the labour market: age and sex discrimination. In developing countries, most older people simply must work to survive and continue to do so until they are no longer able to, but they also encounter discrimination with respect to inclusion in development projects, and access to credit, training and new technologies.

The relevant legal instrument is the International Covenant on Economic, Social and Cultural Rights, Article 6 of which requires States Parties to take appropriate measures to safeguard the right of everyone to the opportunity to earn a living by work which is freely chosen and accepted. The United Nations Committee which monitors the implementation of this Covenant has repeatedly skirted the issue of whether "everyone" includes older people, and is currently unable to decide about it. Similarly, although the International Labour Organisation adopted a Recommendation on Older Workers in 1980, it has not

The fact that retirement is most often based on an arbitrary age-related cut-off point from employment can in itself be considered a form of age discrimination.

been a strong advocate for the rights of older workers in recent years. Most observers of such discussions therefore inevitably come to the conclusion that they tend to be influenced more by political and ideological considerations than by human rights principles.

Living conditions

As Dr Darnton-Hi1l points out, an important aspect of older people's quality of life and well-being is their living conditions. He observes that in Western countries, more and more older persons prefer to live independently rather than with their children. In many other countries, people still prefer to live in an extended family setting. In all countries, however, the emergence of the urban nuclear family as the more common living arrangement will entail profound changes in social structures. In 1991, the United Nations General Assembly adopted the United Nations Principles for Older Persons, which reaffirm many of the policies expressed in the Vienna International Plan of Action on Aging, adopted in 1982. These Principles are intended to serve as targets and benchmarks to evaluate current policies on aging. They are not a declaration or a convention which can be monitored or which Member States have to implement. On the issue of care, the Principles simply state that older persons should benefit from family and community care and protection in accordance with each society's system of cultural values. In order to implement this policy, we need a much clearer understanding of cultural values and expectations, demands on families for providing care, elderly people's perceptions of loneliness, and me impact these perceptions have on their quality of life and well-being.

Women's needs

In this connection, Dr Darnton-Hi1l also refers briefly to the needs and changing roles of older women. Older women are most often me ones who care for their spouses, and frequently for their parents - especially their mothers - as well. The right of these carers to respite, paid employment, self-fulfilment and economic security in later life must be acknowledged and translated into public policies. Advocates for women's rights have given relatively little attention to me rights of older women. While some small progress may be anticipated, it is unlikely that the upcoming Fourth World Conference on Women in Beijing will put a major emphasis on this important category of women.

Similarly, older women tend to live longer than men and to suffer more from chronic diseases, but me difference between men and women in questions of morbidity and aging has so far been neglected by research. Considerable progress has been made in improving reproductive and maternal health, but women's right to health must now be broadened to ensure that the health needs of women of all ages are adequately recognized.

Healthy dying?

Finally, there is the whole area of ethical and human rights with regard to illness and medical treatment at the end of life. There is no international consensus on guidelines or standards in this area, and in many countries there seems to be little national consensus either. The United Nations Principles state that "Older persons should be able to enjoy human rights and fundamental freedoms when residing in any shelter, care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right to make decisions about their care and the quality of their lives." The Declaration on the Rights and Responsibilities of Older Persons of the International Federation on Ageing, on which these Principles are based, goes one step further by declaring that "older persons have the right...to die with dignity by accepting or rejecting treatments designed solely to prolong life". When adopting the Principles, United Nations Member States could not agree with this statement. Dr Darnton-Hill, however, introduces the idea that the ultimate aim of health promotion is "healthy dying", meaning that older persons should remain independent as long as possible and have control over their lives. This concept deserves further consideration. At the same time, more serious attention needs to be given to the whole range of implications healthy aging has for human rights.