Health and Social Care in the Community (2011) 19(1), 43–51 doi: 10.1111/j.1365-2524.2010.00947.x Healthy ageing in a salutogenic way: building the HP 2.0 framework 1,2 2 2 Jeanette Lezwijn MSc , Lenneke Vaandrager PhD , Jenneken Naaldenberg MSc , 2 3 3 Annemarie Wagemakers PhD , Maria Koelen PhD and Cees van Woerkum PhD 1GGD Gelre-IJssel (Community Health Service), AGORA Academic Collaborative Centre, Apeldoorn, The Netherlands, 2Wageningen UR, Department of Social Sciences, Health and Society Group, Wageningen, The Netherlands and 3Wageningen UR, Department of Social Sciences, Division Communication and Innovation Studies, Wageningen, The Netherlands Accepted for publication 4 June 2010 Correspondence Abstract Jeanette Lezwijn Healthy ageing is influenced by a variety of interacting GGD Gelre-IJssel determinants. Because no one agency can tackle all these AGORA Academic Collaborative Centre determinants, the promotion of healthy ageing requires an Deventerstraat 43 intersectoral approach. The aim of this article is to 7311 LV Apeldoorn describe a theoretical basis, the development and possible The Netherlands E-mail: [email protected] applications of a framework within a municipality in the Netherlands. This framework supports intersectoral collab- oration by guiding and stimulating the development, What is known about this topic implementation and evaluation of health promotion activi- ties for healthy ageing. It is based on the principles of d Healthy ageing is influenced by a variety of health promotion and on the theory of salutogenesis and interacting determinants within and outside built upon three interrelated central concepts: (1) sense of the health sector coherence, (2) resources for health, and (3) health. The d An important determinant of healthy ageing is framework visualises the interrelationships of the three the ability to maintain autonomy and indepen- concepts within health promotion and salutogenesis. This dence visualisation makes explicit the value and the contribution d Salutogenesis offers a theoretical basis for with respect to content of intersectoral collaboration and development, implementation and evaluation the participation of older people in health promotion. The of healthy ageing strategies relationships between the concepts of the framework also What this paper adds indicate the need to undertake different types of research and gather different kinds of data to develop, implement d A framework which facilitates stakeholders creating actionable knowledge for a community and evaluate healthy ageing strategies. programme Keywords: health promotion, healthy ageing, intersectoral d Provides evidence of the utility of the saluto- collaboration, salutogenesis, sense of coherence genic resources for health d A framework which facilitates adaptation of resources to promote the wellbeing of older people in their context Introduction Generally, health promotion for older people stresses the problems and limitations that occur due to ageing. As people grow older, biological changes caused by However, in today’s health promotion, ageing can also ageing influence their mental, physical and social state, be approached in a more positive way. Positive including their social networks (Nygren et al. 2005, approaches to healthy ageing are illustrated by concepts Borglin et al. 2006, Ciairano et al. 2008). These develop- such as active ageing and healthy ageing (Minkler et al. ments can have a large impact on the quality of life of 2000, Hansen-Kyle 2005). The World Health Organisation older people, which is largely determined by their ability defines active ageing as a process of optimising oppor- to maintain autonomy and independence (WHO 2002). tunities for health, participation and security to enhance ª 2010 Blackwell Publishing Ltd 43 J. Lezwijn et al. quality of life as people age (WHO, 2002). Healthy such as: (1) empowerment of individuals and the com- ageing has several definitions, from different perspec- munity, (2) participation of individuals and other tives, i.e. medical ⁄gerontological, psychological and stakeholders in the community, (3) holistic view of sociological. Hansen-Kyle (2005:52) has summarised health, (4) intersectoral collaboration between the differ- these different definitions and defines healthy ageing ent sectors influencing health, (5) equity in health, (6) as: ‘the process of slowing down, physically and cogni- sustainability of effects of health promotion actions, and tively, while resiliently adapting and compensating in (7) use of multistrategies (WHO 1986, 2005, Rootman order to optimally function and participate in all areas et al. 2001). These principles support AGORA and the of one’s life (physical, cognitive, social and spiritual)’. collaborating partners in the action and research to pro- To function optimally means for older people to mote healthy ageing on the individual, organisational perceive control over the decisions that affect their lives and ⁄or political level. Working in a way that is guided (Forbes 2001). This can also mean, when necessary and by the principles of health promotion also improves the in accordance with the older person, that family chance of making sustainable changes in both the physi- caregivers are also involved in these decisions cal and social environment of older people in order to (Hansen-Kyle 2005). Thus, perception of control is an promote healthy ageing and contribute to the improve- essential element of healthy ageing. ment of the quality of their life in the municipality Just like health and well-being in general, healthy (IUHPE & CCHPR 2007). ageing is influenced by different determinants (WHO Within health promotion and thus within AGORA, 1998). According to Dahlgren & Whitehead (2006), these intersectoral collaboration is one of the core principles determinants are: individual lifestyle factors, social and because it creates opportunities for linking and sharing community networks, living and working conditions, information, activities, expertise, skills and resources and general socioeconomic, cultural and environmental between the sectors. So that actioninrelationtohealth factors. These different determinants interact with each can be more effective, efficient and sustainable than other. For example, lifestyle factors are influenced by might be achieved by the health sector alone (Koelen social norms, but also by living conditions, and vice et al. 2008). Intersectoral collaboration, however, is versa. Because of the variety of these determinants and not easy. The different sectors who are involved have the interactions between them, health and healthy ageing different formal structures, and different organisational are subject to complex processes (Saan & De Haes 2005) cultures and values, which are based on professional atti- in which different sectors (Koelen & Van den Ban 2004) tudes, knowledge domains, interests, perceptions and have a responsibility. Examples of these sectors for behaviours (Naaldenberg et al. 2009b). It is therefore a healthy ageing are: health, welfare, housing, transport challenge to achieve and sustain intersectoral collabora- and infrastructure. tion. To manage intersectoral collaboration successfully, In the Netherlands, although many activities, facilities a stable team which is able to provide a broad range of or services for older people in municipalities have been services is essential (Axelsson & Bihari Axelsson 2006, developed and implemented, the reach is sometimes Koelen et al. 2008). AGORA put a lot of effort into creat- low. Consequently, outcome evaluation of these strate- ing such stable teams in the municipalities and found gies shows minor effects on the objective health of older that in practice it was rather difficult to achieve and people (GGD Gelre-IJssel 2006); but this does not neces- sustain such teams. One of the reasons was that the sarily mean that this strategy in itself cannot be effective. participating stakeholders all not only had different In a region in the eastern part of the Netherlands, to views on healthy ageing, but also had different questions promote healthy ageing, in which the development, on the development, implementation and evaluation of implementation and evaluation of a strategy take place at strategies for older people in the municipality. To be able the local level, different disciplines, including health pro- to reach consensus in the teams, common ground was motion professionals, epidemiologists, policy-makers and needed. Therefore, a policy framework was developed researchers, participate in a consortium called AGORA. to support the team working with the principles of health promotion to improve healthy ageing. This frame- work was named the HP 2.0 framework. AGORA This article describes its development and the theoret- AGORA is a collaboration between the Wageningen ical concepts on which the framework is built. First, the University and Research Centre, a regional community salutogenic perspective and the different concepts of this health service and several municipalities, and aims to theory are described. Second, the development of the develop, implement and evaluate methods and tools to HP 2.0 framework is outlined.Third,thesupportive promote healthy ageing. AGORA works in each munici- framework, the concepts of the framework and the rela- pality according to the principles of health promotion, tionships between the concepts are elaborated upon. 44 ª 2010 Blackwell Publishing Ltd HP 2.0 framework for healthy aging One example of an application