If you knew you could remain healthy for a few more decades by making some changes, would you do it?

That’s the question at the heart of a new report created for the National Academy of Medicine by an international commission of experts on aging.

Their report, “Global Roadmap for Healthy Longevity,” says it’s not an idle question. In the last century, the world’s over-65 population has been the fastest growing. “By 2030, for the first time in recorded history, the old will begin to outnumber the young,” the report says. And people are living longer, though the pandemic may have changed some of the lifespan estimates.

That could be great news — if older adults are not challenged by ill health, poverty and disconnection. 

Right now, longevity gains are a mixed blessing, said Linda P. Fried, commission co-chair and dean of the Columbia University Mailman School of Public Health, who also directs the Robert Butler Columbia Aging Center.

The roadmap was created, she told the Deseret News, to tell leaders, policymakers and the public what could be accomplished. But societies have to choose to change their narrative and path. While life expectancy worldwide has almost doubled, “we haven’t built a society for this new second half of life,” Fried said.

That’s the challenge. 

A vision for 2050

Commission members came from many countries, including Chile, China, Singapore, the United Kingdom and the United States, among others. They include people from business, academia and government.

The report envisions what life would be for older people across the world by 2050 if societies implemented what they have learned about improving health to make those extended years high quality. Set to release in multiple countries this summer, the report includes short-term ideas to jumpstart planning in the next five years and a vision of what aging could look like in 2050 if recommendations are followed.

The authors define healthy longevity as “the state in which years in good health approach the biological life span, with good physical, cognitive and social functioning.” But there are “major disruptors” to a healthy old age, including ageism, disease, poverty, pollution and inequity, they wrote.

“Very few countries have made significant progress to prepare financially, socially, and scientifically for longer and healthier life spans, but it does not have to be this way,” said Victor J. Dzau, president of the National Academy of Medicine, in the report foreword. “This study underscores the fact that humanity needs to fundamentally shift how we are preparing for population aging to maximize the number of years lived in good health — not simply extend the number of years lived.” 

The commission said all societies were created for a life span that’s half of that expected by 2050, which isn’t far away. Opportunities could be forfeited if countries fail to act. 

The case for change

Two global tipping points are happening — one born of failure, the other of success. Both could create a crisis, Fried told the Deseret News. 

The first, she said, is climate change and its impact. “We created that and human beings and societies need to invest in protecting our health and mitigating it,” she said.

Increased longevity is the success — but only if people can spend those extra years with productive, healthy lives. “We will only flourish because of it if we do the next step,” she said.

The report calls for action in work, volunteering, education, social infrastructure, the physical environment, public health, health systems and long-term care. There’s plenty to do across the lifespan.

Changing a single sector won’t do it, Fried said. “This is a huge, complex system problem, and we need to demonstrate initial progress in each sector to create optimism, momentum and commitment.”

She uses health as an example, noting that research says 20% of health results from medical care. At most, 10% comes from a person’s genes. The other 70% is how people live and whether society promotes health and disease prevention. That includes making a healthy physical environment where people don’t choke on pollution, for example, and on social determinants of health that favor well-being, including education and whether people have enough income to see a doctor or afford nutritious food. People also need social protection so they “are not living highly precarious lives and can raise their children in nurturing conditions. Those all create opportunity for a population to be healthy, “ Fried said. 

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Pieces of a plan

When older people flourish, society benefits, according to the report. But societies at every level worldwide need to have their own plan. While aging issues have much in common everywhere, there are cultural and other differences that have to be taken into account.

Among the needed steps, according to the report:

  • Supporting productive engagement in work, volunteering and lifelong education for older adults.
  • Reducing ageism and promoting social inclusion and financial security.
  • Improving housing, public spaces and infrastructure, as well as transportation.
  • Increasing coordination and affordability of equitable health care and investing in public health.

The report calls for more work supports in high-income countries so older adults can keep working if they want. It notes that older adults have high levels of talent and productivity that can be used to boost the economy and also create more jobs for other people.

That requires getting rid of structural barriers that make it hard to keep working beyond retirement age. The barriers range from age discrimination to higher taxes on earnings. But the report said employers have many tools to entice older workers to stay on the job, including more work flexibility and letting people transition to retirement incrementally. 

With fewer younger people, making sure that older people who want to work have the opportunity to do that is “critical for economies,” she said. But she emphasized it has to be productive work, not “make work,” because older workers are very productive, skilled and capable.

“It requires changing our policies and attitudes about older people in order to create places for them in the workplace, where their assets are being well used,” Fried said.

Populations are shrinking primarily in high-income countries that really need more workers. And older adults can help fill those jobs, which in turn creates more jobs for young people. It benefits everyone.

As countries age, too, more businesses will cater to the half of the population that’s older. And that will make new jobs for younger workers, too, according to Fried.

Several countries made changes between 2017 and 2019 that encourage older people to stay in the workforce. Canada increased earning exemptions, while Denmark offers a lump sum to people who work more than a specified number of hours after retirement age. Belgium abolished the maximum limit of pension accrual years, while Sweden created tax credits for people over age 65 who keep working, according to the report.

The government should provide health, safety, legal and income protections, including for gig workers and workers with disabilities, the report said.

Governments can eliminate mandatory age-based retirement and provide incentives for job retraining. Intergenerational national and community service encore careers would help keep old age vibrant, as would redesigning education systems to promote lifelong learning.

Efforts to reduce ageism should include intergenerational and cross-sector collaboration and public education campaigns. But age discrimination should also be illegal, the report said.

Between one-fifth and one-third of older adults in China, Europe, Latin America and the United States say they are lonely. The impact on health has been compared by researchers to smoking, alcohol misuse and obesity, so countering loneliness should itself be a public health priority, the report says.

Getting started

Within five years, every government should have a plan to ensure basic financial security for older people through retirement income systems. And governments and employers should work on strengthening financial literacy and promoting pension contributions and lifelong savings, among other steps, the report says. 

People can be healthy or not as they age in part based on their physical environment, which contributes to social engagement and cohesion, safety, physical activity and access to essential services and community institutions. Safe and affordable housing is especially vital to help people, including those with disabilities, live independently as they age. Parks and other public spaces improve cohesion and reduce isolation.

The report calls for investing in public health and access to care. But it also emphasizes health promotion and chronic disease prevention beginning in childhood. “All countries should establish five-year targets for preventive health and track their progress toward reaching those goals.“

As for delivering needed health care services, “integrated, person-centered primary care” is the best model.  The care should be affordable, accessible and culturally appropriate, the report says.

The members of the commission would like governments to align health care payments and reimbursement systems with healthy longevity outcomes. They want incentives to develop and maintain a geriatrics workforce.

Best of all, interventions that help an older population help younger ones, too. “When older people thrive, all people thrive,” the report said.

Of note is that many of the low- and middle-income countries are aging extremely fast because of societal investments, and within the span of 20-40 years, Fried said, they will grow old to the degree that the United States, Japan and Italy took 100 years to do.

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“We’re hoping that this report will enable them to leapfrog into preparing for longer lives at the center of their successful development agenda,” she said.

High hopes

Fried predicts a “huge return on investment” for individuals, families, communities and for the societies that rise to the challenge. She predicts older people will do their part.

“Older people, the evidence is clear, are not a dependent bunch who don’t want to contribute in any way. With health, people want to make a difference for the future as they get older, for their families, and for their communities,” Fried said.

Co-chairing the commission has allowed Fried to be part of a shared positive vision and it’s made her optimistic, she said. If science is heeded, health can be protected at every stage of life — and how healthy one is at any stage sets the table for one’s health at the next stage, Fried said.

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