Healthy Ageing without Health Equity? Capability, Justice, and Ageing Governance in the UN Decade

The U.N. Decade of Healthy Ageing frames later life through functional ability, environments, and well-being rather than through demographic burden alone. This article argues that healthy ageing becomes ethically unstable when it is pursued without health equity. It first distinguishes the historically influential vocabulary of active ageing from the later healthy-ageing framework centred on functional ability. It then develops a bioethical account of capability-enabling ageing governance: assistance and long-term care are ethically necessary, but they become insufficient when downstream service delivery under scarcity substitutes for upstream conditions that sustain agency, mobility, care, and social participation. The article introduces the malaise state as a conceptual diagnostic category for welfare drift under demographic, fiscal, administrative, and commercial pressure. It also formulates the knowledge-to-equity conversion problem: societies may expand biomedical knowledge, digital health, and innovation while failing to secure the conditions through which those resources become equitable functional ability. The article concludes that the Decade should be evaluated as a justice project, not as a behavioural exhortation to older persons.