Respect and Social Inclusion

An inclusive society that encourages older people to participate in more of their city’s and town’s social, civic and economic life is supportive of a Healthy Active Ageing community.

Facilitating social engagement and belonging to combat loneliness and support physical activity for older people involves understanding the social, political, economic and cultural dimension of ageing, including understanding the specific context of ageing in Australia, in particular the key aspects of the heterogeneity of the older population. The older population is not a homogenous group: it is important to appreciate the different realities of ageing in Australia, including life expectancy and understandings of what it means to be old. The diversity of Australia's ageing population raises important issues which must inform any discussion of Healthy Active Ageing.

Older people from lower socio-economic status, along with older Aboriginal and Torres Strait Islander people and older female migrants, are among the poorest and most vulnerable members of our society [39] [51]. Poverty in older ages is resulting in poor health outcomes, increasing rates of homelessness and decreased life expectancy among older adults (CSI Homelessness Report).

Significant differences also exist between urban, suburban, rural, regional and remote communities [43]. Given that the vast majority of Australians live in urban centres characterised by urban sprawl, as well as the vast distances that separate regional, rural and remote centres, the challenges of social isolation and loneliness, as well as access to transport, are particularly critical issues of relevance to Healthy Active Ageing.

Cultural diversity and ageing

Australia has one of the most diverse older populations in the world, with one in three people over the age of 65 born overseas [7]. Culturally and linguistically diverse (CaLD) groups in contemporary Australia include the Southern European migrant communities, the majority of whose members began arriving in the 1950s and 1960s. These communities are ageing at a faster rate than more recently arrived groups and people born in Australia.

Different cultural groups have diverse understandings of what it means to grow old, including the relevance and value of physical activity to health and wellbeing. CALD migrants in Australia face significant health risks as they adapt to new cultures [84]. These risks are exacerbated by their limited participation in preventative behaviours, such as sports and physical activity [34] [57] [92]. 

Reflecting findings in the broader literature, the role of social engagement and belonging is especially relevant in both educating older CaLD adults about the importance of physical activity, as well as in helping them to maintain high levels of exercise. Lack of social support networks and isolation is a well-documented barrier among CaLD groups to accessing all types of services, including in areas of health and wellbeing. The importance of developing a social network both within the same culture, and with those from other cultures has been identified [14] [29] [38]. More specifically, a study examining factors affecting walking activity of older people from culturally diverse groups in Australia [18] states that the continued advocating of walking as a health-promoting activity should be central to future campaigns. To increase physical activity in this age group, the study states: "The provision of locations that are accessible, safe, aesthetically pleasing, and encourage social engagement are likely to facilitate older people's participation in walking. For maximum effectiveness, however, strategies may benefit from being tailored to meet specific gender and cultural preferences".

Relatedly, perceptions of health and safety have also been found to strongly influence physical activity levels of older people from culturally diverse communities in Australia [19]. Gender practices and cultural understandings are also important. A study of physical activity behaviours of CALD women living in Australia found that, while participants understood that being physically active was beneficial for health and wellbeing, they did not recognise it as an important daily necessity, but rather a luxury [28].

A study of levels of physical activity among ethnically diverse minority older adults in America identified that walking was the exercise of choice across all ethnic groups involved in the study [16]. Perceptions of health and personal safety were both a motivator and a barrier to physical activity, as were weather and transportation. The findings included a series of recommendations to enhance participation: fostering relationships among participants; providing culture-specific exercise; offering programs at residential sites; partnering with and offering classes prior to or after social service programs; educating families about the importance of physical activity for older adults and ways they could help; offering low- or no-cost classes; and involving older adults in program development.

Ageing and Aboriginal and Torres Strait Islander Australians

The heterogeneity of Aboriginal and Torres Strait Islander Australians is often overlooked when presenting epidemiological data, for example, on life expectancy and rates of physical activity [88]. For the Aboriginal and Torres Strait Islander population born in 2015–2017, life expectancy is estimated to be 8.6 years lower than that of the non-Indigenous population for males (71.6 years compared with 80.2) and 7.8 years for females (75.6 compared with 83.4) [9].

Particular attention should be paid to geographic location (urban, regional, remote) and emphasis must be placed on locally developed strategies [76]. In general, Aboriginal and Torres Strait Islander populations are less healthy and have higher rates of chronic diseases compared to non‐Indigenous Australians. There is a higher prevalence of chronic health problems, including cardiovascular disease, circulatory diseases, diabetes and musculoskeletal conditions, as well as higher rates of psychological distress, depression and anxiety [8].

Research shows that Aboriginal and Torres Strait Islander Australians face more and unique social, cultural and financial barriers to engagement in physical activity, including lack of available, affordable and sustainable sporting facilities, and limited opportunities for engagement [46]. Research suggests grouping these barriers into three common themes: (1) cost, (2) time management and (3) environmental factors, including feeling unsafe and unwelcome to walk in neighbourhoods [88].

Like some migrant groups, Aboriginal and Torres Strait Islander Australians may not conceptualise physical activity as a distinct form of behaviour, but as activities incorporated into their overall lifestyle. Therefore, to encourage participation, physical activity programs need to be in line with this holistic vision of life and health and the important connection of land and waters with culture. Otherwise, they may be inappropriate for Indigenous people and limit their participation.

Living with Dementia

Designing dementia enabling environments will support people living with dementia to remain part of the community. Dementia is the term used to describe the symptoms of a large group of illnesses which cause a progressive decline in a person's functioning. It is a broad term used to describe a loss of memory, intellect, rationality, social skills and physical functioning. There are many types of dementia, including Alzheimer's disease and vascular dementia. Dementia can happen to anybody, but it is more common after the age of 65 [37]. The World Health Organization states that, while age is the strongest known risk factor for cognitive decline, dementia is not a natural or inevitable consequence of ageing. Several recent studies have shown a relationship between the development of cognitive impairment and dementia with lifestyle-related risk factors, such as physical inactivity [115].

Dementia in Australia is a substantial and growing public health challenge. In 2020, an estimated 459,000 Australians live with dementia., At present rates, this is expected to increase to approximately 590,000 by 2028, and to 1,076,000 by 2058 [36]. Dementia Australia reports that dementia is the greatest challenge for health and social care in Australia. It is the leading cause of death in women and the second leading cause of death of all Australians. One in ten 65-year-olds in Australia live with dementia and three in ten 85-year-olds, with rates three to five times higher in Aboriginal and Torres Strait Islander Australians. Dementia is the single greatest cause of disability in older Australians. Around 70% of people with dementia live in the community, and more than half of all people in residential aged care have dementia. Town planners and urban designers can encourage the integration of dementia enabling environments into buildings and precincts to include and enable those people living with dementia specifically.

Gender and sexual orientation

Many LGBTQI older people experience increased social isolation due to a tendency for more traditional ideals to dominate among their age group, which also characterises services targeted to this age group [40] [89] [98]. Research emphasises the important need to eliminate discrimination and recognise the higher rates of depression, isolation, cardiovascular disease, and chronic pain among this group, but also to acknowledge the potential supportive role played by LGBTQ communities [81] [109]. Policy makers should actively engage with this group to inform a more inclusive society.

A participatory approach

It is widely accepted that both the physical and social environments affect the wellbeing of older people and that good governance and comprehensive planning are critical for the development of age-friendly communities [31] [66] [71]. An essential part of good governance is embedding a socially inclusive and respectful approach to older people into policies and processes. The World Health Organization Age-friendly Cities and Communities approach [60] is a globally recognised method for developing appropriate policy and practice responses to support healthy ageing. This approach can be tailored to the needs of local communities and conditions, based on a bottom-up, participatory community consultation approach [56]. When considering the design of urban and regional environments, town planners and urban designers should identify how the built environment will support a respectful and inclusive community by actively including older people with diverse life experiences and backgrounds into the engagement processes.

Creating inclusive activities



Older people from marginal groups (Aboriginal and Torres Strait Islander Australians; CaLD; LGBTQI; and those living with dementia) face more and unique social, cultural and financial barriers to engagement in physical activity, including feeling unsafe or unwelcome in neighbourhoods [29] [46]. For these groups, fostering relationships among participants, providing culture and gender appropriate exercise, partnering with and offering classes prior to or after social service programs, offering low- or no-cost classes and involving older adults in program development are particularly important strategies to increase participation [14] [18] [38]. These strategies to improve engagement can be translated into policy adopted by government, organisations and businesses attempting to be more inclusive of older people.