Vânia de la Fuente-Núñez

Bio: Vânia de la Fuente-Núñez is an academic researcher from World Health Organization. The author has contributed to research in topics: Philosophy of medicine & Mental health. The author has an hindex of 5, co-authored 7 publications receiving 242 citations.

A global campaign to combat ageism.

Abstract: The World Health Organization (WHO) defines ageism as the stereotyping, prejudice and discrimination towards people on the basis of age.1 Ageism cuts across the life-course and stems from the perception that a person might be too old or too young to be or to do something. Ageism is highly prevalent;2,3 however, unlike other forms of discrimination, including sexism and racism, it is socially accepted and usually unchallenged, because of its largely implicit and subconscious nature.4,5 Children as young as 4 years are aware of their cultures’ age stereotypes.6 These stereotypes focus predominantly on the negative aspects of ageing, with older age typecast as an inevitable decline in physical and mental capacities and a period of dependency. Language and media, including films, television, popular music, print and social media, most often echo and reinforce these stereotypes, because ageist depictions tend to be the norm.7–9 As we get older, we experience ageism from others, but also from ourselves, because of the unconscious internalization of society’s negative attitudes and stereotypes towards older people. This helps to explain why older people often try to stay young, feel shame about getting older and limit what they think they can do instead of taking pride in the accomplishment of ageing. Perceived discrimination, whether based on race, gender or age, has negative health outcomes.10 Ageism has been shown to have significant impact on our participation in society, health and longevity. For example, evidence shows that those who hold negative attitudes on ageing have slower recovery from disability,11 live on average 7.5 years less than those who hold positive attitudes12 and are less likely to be socially integrated.13 Ageism also imposes barriers to the development of good policies on ageing and health as it influences the way problems are framed, the questions that are asked and the solutions that are offered. In this context, age is often understood as sufficient justification for treating people unequally and limiting their opportunities for meaningful contribution. Experience with sexism and racism has shown that changing social norms is possible and can result in more prosperous and equitable societies. Changing people’s understanding, social behaviours and political determination around age and ageing is possible and essential to foster healthy ageing, the ability for all people to live long and healthy lives and do what they have reason to value. Collective, concerted and coordinated global action is required to tackle ageism. Given the current demographic transition, with populations around the world ageing rapidly, we need to act now to generate a positive effect on individuals and society. In May 2016, the 194 WHO Member States called on the organization’s Director-General to develop, in cooperation with other partners, a global campaign to combat ageism.14 To be effective, the global campaign to combat ageism must tackle individual and social attitudes, stereotypes and behaviours towards people on the basis of their age, as well as the laws, policies and institutions that either perpetuate ageism or do little to stop it. To develop the campaign, WHO will build an evidence base on ageism and draw from evidence of what has worked for other public health campaigns, such as end violence against women15 and adopt healthier behaviours.16 Both campaigns have increased awareness, helped to rally public support and influenced change in individual behaviours and in international and national legislative and policy frameworks.17 Evidence suggests that certain conditions need to be met for a campaign to work. In addition to having clear goals and vision, a campaign needs to be evidence-based to understand the nature of the problem, who is affected and how, and which actions should be taken for which target audiences.18 The campaign’s approach should include actions that help to change attitudes and behaviours and to develop supportive policy and legal frameworks.19 A successful campaign should also be underpinned by a theory of change to anticipate possible routes towards change among target audiences, devise effective implementation strategies20 and facilitate evaluation.17 The campaign should be multisectoral and multilevel, as well as supportive of monitoring and evaluation. Finally, to ensure sustained action, the campaign should be supported through long-term funding.21 Ageism has received little attention in research and policy-making4,5 and the evidence base for global action is yet to be established. There is no global analysis on the magnitude of ageism, its determinants, consequences and what strategies and messages could work to address ageism. To develop the global campaign to combat ageism, WHO needs to find answers to six fundamental questions: (i) what is the global prevalence of ageism? (ii) what are the causes or determinants of ageism? (iii) what are the consequences of ageism at an individual and at a societal level? (iv) what strategies exist to effectively tackle ageism? (v) what are the available metrics to measure the different dimensions of ageism and its implicit and explicit expressions? (vi) What are the most effective ways of building public understanding and expanding thinking about age and ageing? To start answering these questions, in July 2017 WHO held a meeting with researchers from several universities to outline the methods for conducting a global set of systematic reviews on ageism. The evidence generated from those reviews will help to identify those strategies that are most likely to reduce ageism as well as those populations that should be targeted, either because they affect ageism or because they are affected by it. These reviews will support the development of a tool to measure ageism globally and help to identify key research A global campaign to combat ageism Alana Officer & Vânia de la Fuente-Núñez

Protected to death: systematic exclusion of pregnant women from Ebola virus disease trials.

Abstract: For 30 years, women have sought equal opportunity to be included in trials so that drugs are equitably studied in women as well as men; regulatory guidelines have changed accordingly. Pregnant women, however, continue to be excluded from trials for non-obstetric conditions, though they have been included for trials of life-threatening diseases because prospects for maternal survival outweighed potential fetal risks. Ebola virus disease is a life-threatening infection without approved treatments or vaccines. Previous Ebola virus (EBOV) outbreak data showed 89–93% maternal and 100% fetal/neonatal mortality. Early in the 2013–2016 EBOV epidemic, an expert panel pointed to these high mortality rates and the need to prioritize and preferentially allocate unregistered interventions in favor of pregnant women (and children). Despite these recommendations and multiple ethics committee requests for their inclusion on grounds of justice, equity, and medical need, pregnant women were excluded from all drug and vaccine trials in the affected countries, either without justification or on grounds of potential fetal harm. An opportunity to offer pregnant women the same access to potentially life-saving interventions as others, and to obtain data to inform their future use, was lost. Once again, pregnant women were denied autonomy and their right to decide. We recommend that, without clear justification for exclusion, pregnant women are included in clinical trials for EBOV and other life-threatening conditions, with lay language on risks and benefits in information documents, so that pregnant women can make their own decision to participate. Their automatic exclusion from trials for other conditions should be questioned.

Ageism, Healthy Life Expectancy and Population Ageing: How Are They Related?

Abstract: Evidence shows that ageism negatively impacts the health of older adults. However, estimates of its prevalence are lacking. This study aimed to estimate the global prevalence of ageism towards older adults and to explore possible explanatory factors. Data were included from 57 countries that took part in Wave 6 of the World Values Survey. Multilevel Latent Class Analysis was performed to identify distinct classes of individuals and countries. Individuals were classified as having high, moderate or low ageist attitudes; and countries as being highly, moderately or minimally ageist, by aggregating individual responses. Individual-level (age, sex, education and wealth) and contextual-level factors (healthy life expectancy, population health status and proportion of the population aged over 60 years) were examined as potential explanatory factors in multinomial logistic regression. From the 83,034 participants included, 44%, 32% and 24% were classified as having low, moderate and high ageist attitudes, respectively. From the 57 countries, 34 were classified as moderately or highly ageist. The likelihood of an individual or a country being ageist was significantly reduced by increases in healthy life expectancy and the proportion of older people within a country. Certain personal characteristics-younger age, being male and having lower education-were significantly associated with an increased probability of an individual having high ageist attitudes. At least one in every two people included in this study had moderate or high ageist attitudes. Despite the issue's magnitude and negative health impacts, ageism remains a neglected global health issue.

Ethics review of studies during public health emergencies - the experience of the WHO ethics review committee during the Ebola virus disease epidemic

Abstract: Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee (WHO-ERC) was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies including interventional (drug, vaccine) and observational studies. WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues (benefit-risk assessment, study design, exclusion of pregnant women and children from interventional studies, data and sample sharing, collaborative partnerships including international and local researchers and communities, community engagement and participant information) are presented. To accelerate study approval in future public health emergencies, we recommend: (1) internally consistent and complete submissions with information documents in language participants are likely to understand, (2) close collaboration between local and international researchers from research inception, (3) generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, (4) formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, (5) formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to strengthen reviews through the different perspectives provided without the ‘opportunity costs’ for time to final approval of multiple, independent reviews, (6) direct information exchange between the chairs of advisory, safety review and ethics committees, (7) more Ethics Committee support for investigators than is standard and (8) a global consultation on criteria for inclusion of pregnant women and children in interventional studies for conditions which put them at particularly high risk of mortality or other irreversible adverse outcomes under standard-of-care.

Aging in Times of the COVID-19 Pandemic: Avoiding Ageism and Fostering Intergenerational Solidarity.

Abstract: 1School of Social Work, Bar Ilan University, Ramat Gan, Israel. 2Department of Psychology, University of Toronto, Ontario, Canada. 3Department of Human Development and Family Studies, Colorado State University, Fort Collins. 4Social and Behavioral Sciences Department, Yale School of Public Health, New Haven, Connecticut. 5Department of Psychology, North Carolina State University, Raleigh. 6Department of Psychology, Friedrich-Schiller-University Jena, Germany. 7German Centre of Gerontology, Berlin, Germany. 8Network of Aging Research, Heidelberg University, Germany.

Interventions to Reduce Ageism Against Older Adults: A Systematic Review and Meta-Analysis

Abstract: Background. Research has found a strong link between ageism, in the form of negative stereotypes, prejudice, and discrimination toward older people, and risks to their physical and mental health. L...

There is nothing new under the sun: ageism and intergenerational tension in the age of the COVID-19 outbreak.

Abstract: At the time of this writing, 203 countries and territories have been affected by the COVID-19 outbreak (Worldometer, 2020a). Older adults, in particular, are negatively impacted by this pandemic (Lipsitch et al., 2020). Current estimates suggest that the COVID-19 mortality rate stands at 15% for those over the age of 80, but 0 for those under the age of 10 (Worldometer, 2020b). Hence, there is no doubt that age poses a major risk for COVID-19 mortality. At the same time, there are incidental reports of centenarians, who recovered from COVID-19, and of younger adults, who have not (Coffey and Oransky, 2020; Lanese and Writer, 2020). Moreover, the prevalence of younger people infected by the virus is higher than that of older adults (Surveillances, 2020). Hence, age alone is likely an insufficient criterion for predicting the direct medical impact of the outbreak. In this commentary, I argue that the portrayal of all older adults as a homogenous, vulnerable group, rather than the use of a more refined discourse, which stresses the heterogeneity inherited in old age and the potential impact of the pandemic on society at large, has resulted in increased ageism and intergenerational tension, worldwide. Ageism is defined as stereotypes, prejudice, and discrimination toward people because of their age (Ayalon and Tesch-Römer, 2018; Officer and de la FuenteNúñez, 2018). Although ageism can be both positive and negative (Ayalon and Tesch-Römer, 2018), in the context of the COVID-19 outbreak, we have seen an out surge of negative manifestations of ageism. Intergenerational tension, characterized as conflict between people of different generations, also has been intensified as a result of the outbreak and has fuelled the response to the pandemic. It is argued here that the psychosocial implications of the COVID-19 pandemic exacerbate and oftentimes supersede its direct medical impact, which to date, has received a substantial amount of research attention (World Health Organization, 2020). From the get-go, the COVID-19 outbreak has been portrayed as “the problem of older adults” and a clear age division, separating young from old has been promoted (Zhou et al., 2020). In China, where the COVID-19 outbreak had started, the tension between the generations has been manifested in anger toward older adults because of the refusal of some older adults to wear face masks (Eckersley, 2020). This is consistent with the prediction that at times of scarce resources, symbolic threats, manifested in disputes over values and beliefs, intensify (Stephan and Stephan, 2017). Overtime, the public focus has shifted to financial donations made by poor older adults, who sacrificed their living in an effort to support the fight against the pandemic. Both in the case of face masks and in the case of financial donations, older adults were portrayed as a separate, homogenous group in society, defined by its chronological age. In the former example, older adults were seen as a threat to society, as they “selfishly” refused to conform to current societal practices. In the latter example, on the other hand, older adults were presented as a selfless, yet vulnerable group, which is willing to risk its own being in order to help society at large. In other countries, the division between young and old resulted in somewhat different manifestations, depending on the sociocultural background of the country and its ability to address the pandemic. In Israel, the Ministry of Defense had issued a statement that “the single most important insight : : : is to separate old people from young people. The single most lethal combination cocktail is when grandma meets her grandchild and hugs him” (Gross and TOI Staff, 2020). This statement explicitly argues for an age division between the generations and portrays intergenerational contact as THE problem. Following the same logic, in the UK, the first response to the outbreak was “business as usual.” In fact, the Prime Minister, Boris Johnson, had suggested that older adults over the age of 70 should self-isolate for a period of 4 months, while all other age groups continue as usual (Sparrow, 2020). A similar approach has been advocated in other countries, which had stressed the importance of socially isolating older adults, rather than the entire population (Armitage and Nellums, 2020). This approach was attributed to the fact that older adults already have their pensions and thus are not likely to be impacted financially by social isolation. International Psychogeriatrics: page 1 of 4© International Psychogeriatric Association 2020. This is anOpen Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. doi:10.1017/S1041610220000575