HEALTHY AGEING WITHOUT HEALTH EQUITY? The Bioethics of Active Ageing in the UN Decade

Population ageing is increasingly framed as a fiscal and administrative burden, yet the UN Decade of Healthy Ageing sets a different normative horizon: healthy ageing aligned with the final decade of the Sustainable Development Goals. This article offers a conceptual and bioethical analysis of why “active ageing” can become rhetorically attractive while remaining materially unattainable for many older persons. It distinguishes two governance regimes: passive-assisted ageing, organised around downstream risk containment, scarcity triage, and administrative burden; and active ageing reconstructed as dignified longevity, assessed by functional ability and its social preconditions. The analysis introduces the “malaise state” to name structural welfare drift under demographic pressure and political–economic incentives, and develops the epistemic–existential paradox: societies can be knowledge-rich yet equity-poor because scientific and digital proliferation does not translate into health without upstream action on social and commercial determinants. Extending the argument globally, the paper contrasts longevity with inequality in high-income settings and premature mortality in low-income contexts, arguing that the Decade must be treated as a justice project rather than a behavioural exhortation. It concludes with a Decade-alignment checklist and policy-relevant ethical commitments.