I recently spent three days at a conference on ageing in developed economies, hosted by the Ditchley Foundation at their splendid Oxfordshire pile. I was one of the rapporteurs for the event and asked to focus on the causes and impacts of population ageing.
Undaunted by the breadth of this exam question participants from Sweden, the UK, Canada, the US, Japan and the Netherlands pooled their evidence and insight to considerable effect. In this first blog, I précis our discussions on causes and trends (NB the whole conference was under the Chatham House rule).
Fertility – There was surprisingly little discussion of the impact of the post-1945 baby boomers (perhaps experts now take them for granted, or see them as only transitory phenomenon). By contrast there was intense debate on the subsequent slump in fertility observed since the 1960s across the developed world.
Fertility rates vary widely, with the USA and Scandinavia remaining fairly fertile, while Southern Europe and East Asia have seen fertility fall far below population replacement requirements. The latter will lead to population decline and for coming decades skew the age profile of the population upwards, for as long as older, more fertile generations remain alive.
Interestingly the UK, Germany and France seem to have had some success in improving fertility in recent years. There was scepticism about the effectiveness of deliberate pro-birth incentives but agreement that flexible work and supported childcare is very important (migrant mothers play a moderate role too).
However I was surprised to hear that the strongest determinant of variations in developed world fertility rates are our different attitudes to birth outside marriage. This lesson implies that conservative cultures may find it very difficult to increase fertility (it also adds a new dimension to the UK debate on using public policy to support marriage).
Longevity – the other key driver of ageing is rising life expectancy. The Ditchley participants (who included demographers and biologists) agreed that there was no sign of the linear increase in life expectancy of the last 150 years coming to a halt.
From a biological and social perspective ageing is a malleable process, even if there are ultimate constraints imposed by our genetic endowment. Most nations still have considerable room to catch up with the leader, Japan (which itself still has many preventable deaths). On an individual level until many more of us are matching the world-record 120-year lifespan, we can assume there is much potential for life expectancy improvements.
The conference participants had mixed views on the prospect of genetic technology leading to a significant acceleration in longevity increases in the more distant future. Although there have been interesting experiments to prolong the lives of cells and simple organisms there is no immediate prospect of a technology with the potential for application to humans.
On the other hand some delegates commented that we have a poor record of predicting future scientific breakthroughs. There was a common feeling that if new genetic therapies became available they would be used; what wouldn’t a billionaire somewhere pay to buy a pill to extend their own life of that or their 90-year old mother? So serious ethical debate is needed sooner rather than later.
Healthy life expectancy – the conference participants viewed helping people to stay in good health until the end of our lives (or as close as possible) as a much higher priority than extending years of life pe se. We should aim for ‘rectangulation’; in other words, to live well and die fast.
In general there was pessimism about healthy life expectancy, with a feeling that the years of disability before death were increasing (though life expectancy gains are still leading to increased years in good health too). Participants from the US were particularly gloomy; concerned that ill health was rising, especially because of obesity and diabetes.
There was some discussion about the lessons of smoking cessation policies (which have demonstrably sped up the pace of life expectancy gains). Some people felt that obesity could be tackled over a similar timeframe through the same combination of regulation, financial incentives and challenging social norms. Others worried it would be a much tougher nut to crack, both because diet and exercise are harder to influence and because people are less persuadable if the main risk is chronic illness rather than early death.
How will society change? While the demographic trends are well understood, there has is far less insight on the social trends.
First, what are the implications of most families having zero or one child, as is now the case in East Asia? What will that mean for our psychology? Will we as a society take a different view on our long-term future (we discussed whether families with children are more concerned with the welfare of future generations collectively)?
The group also discussed the implications of many more older people being single and with few family ties (especially if childless themselves). This could have very serious consequences for our happiness and socio-economic participation in very long-lived societies, as well as for public sector costs.
There was speculation about changing social norms. Will further strides in life expectancy finally end our endemic culture of ageism and the cult of youth, as we all come to terms with very long lives and see true old age starting at 80 not 60? And how will ideas of masculinity change as there are fewer young men (less aggression) and more old men (implying a less feminised old age, but perhaps a more toned-down conception of masculinity)?
Finally there was agreement that we will need to ‘age-scape’ the design and organisation of our societies, with challenges ranging from building liveable mid-density communities to designing products we can use effectively with impaired cognition and dexterity.