Multisector, all-of-society transformation needed to ensure aging societies worldwide are poised to thrive by 2050

Ensuring that populations globally are actively engaged in society while living longer, healthier lives will require an all-of-society approach—from governments and the private sector to individuals and families, says a new report from the National Academy of Medicine. The report provides a roadmap with recommendations for both addressing the needs of older people in the next five years and supporting actions to improve healthy longevity by 2050 in the areas of work, volunteering, and education; social infrastructure; physical environment; and public health, health systems, and long-term care.

The Global Roadmap for Healthy Longevity says healthy longevity is the state in which years in good health approach the biological life span, with good physical, cognitive, and social functioning, and enables well-being across populations. However, major disrupters to healthy longevity include ageism, disease, poverty, pollution, and inequity. In the past century, the world's population of people over age 65 has grown more rapidly than other age groups due to longer life spans and declining birth rates. This growth is expected to continue into the future, although the recent decline in life expectancy across many countries adds uncertainty to predictions made before the COVID-19 pandemic.

"Like climate change, demographic change is unprecedented. Successful societal investments have created longer lives, which impacts the way we live, learn, work, and play and all other dimensions of the human experience," said Linda Fried, dean, Columbia University Mailman School of Public Health, and co-chair of the commission that wrote the report. "Our report conceives what societies could look like in 2050 if we applied all that we know about how we can add improved health to our longer lives so that societies can remain robust and even thrive because of, not just despite, demographic change."

Supporting productive engagement in work, volunteering, and lifelong education

Longer life spans result in the need to enable people to continue contributing to society, through various avenues such as helping younger generations, caring for grandchildren, mentoring, volunteering, or working. Providing opportunities to increase workforce participation for people over age 50 in high-income countries who have the desire or need to work is the best way to harness healthy longevity in service to those countries' economies, the report says. Moreover, healthy longevity will contribute to growth in gross domestic product, personal savings, and government coffers.

Removing structural barriers that prevent people from working as long as they want—such as age discrimination and higher taxes on wages earned after retirement age—and establishing incentives to encourage people to work have historically increased workforce participation. Employers can make employment more attractive by allowing people to transition incrementally into retirement. Governments can eliminate mandatory age-based retirement and provide incentives for job retraining.

Governments, in collaboration with the business sector, should develop new policies that ensure worker health and safety and legal and income protections (including for those working in the gig economy and during periods of disability), increase opportunities for part-time work and flexible schedules, and promote intergenerational national and community service and encore careers. In addition, governments, employers, and educational institutions should prioritize investments in redesigning education systems to support lifelong learning and training, the report says.

"By increasing healthy longevity, societies can tap into the opportunities offered by people as they live a full and robust life, being and doing what they value," said John Eu-Li Wong, Isabel Chan Professor in Medical Sciences and senior vice president of health innovation and translation at the National University of Singapore, and commission co-chair. "In 2050, the commission envisions a world in which older adults, with good health and function, engage in relationships, their communities, families, and the economy such that extraordinary amounts of social and human capital are enabled by the collective impact of this engagement."

Reducing ageism and promoting social inclusion and financial security

Structural and individual age discrimination is a barrier to healthy longevity and productive engagement in society. Governments should develop evidence-based, multipronged strategies for reducing ageism and age discrimination, including intergenerational and cross-sector collaboration, public information campaigns, and legal protections against age discrimination, the report says.

While many older people have strong social and family ties that keep them connected and engaged, at the same time an estimated 20 percent to 34 percent of older adults in China, Europe, Latin America, and the United States identify as lonely. The effects of isolation and loneliness on mortality and health rival in magnitude those of smoking, alcohol misuse, and obesity. Evidence-based programs to reduce loneliness and strengthen family, community, and social ties can be scaled and replicated.

In the area of financial security, the commission calls on all governments to develop plans for ensuring basic financial security for older people by 2027 though retirement income systems. In addition, governments and employers should develop strategies for increasing financial literacy and mechanisms for promoting pension contributions, self-funded pensions, and lifelong savings.

Improving housing, public spaces and infrastructure, and transportation

The physical environment can either enable or impede healthy longevity by affecting social engagement and cohesion, safety, physical activity, and access to essential services and community institutions, the report says. Specifically, safe and affordable housing is critical to quality of life and the ability to remain independent, especially for older people and people with disabilities. Governments and the private sector should update physical housing infrastructure to address affordability and inadequate housing stock. In addition, intentional design of public spaces, such as parks, can strengthen social cohesion, promote urban health and citizen well-being, and support the local economy.

Limitations in public transportation options can impact everything from a person's ability to stay engaged in the community to health care access. The report notes several options for improved transportation, such as universal design in cars; innovative design of railways and buses that remove barriers to accessibility; and installation of bus shelters, benches, and street lighting at stations.

Increasing coordination and affordability of equitable health care and investing in public health

Most people over age 65 do not need assistance in carrying out life's basic functions, but the majority have multiple chronic conditions due to influences on their health since childhood. The report embraces a life course approach to health, where health promotion and chronic disease prevention starts in childhood. To achieve the best possible health for all people, over the next five years governments should develop strategies for increasing investments in robust public health systems that can promote health at the population level and across the life course. All countries should establish five-year targets for preventive health and measure progress toward those targets.

Integrated, person-centered primary care is the most appropriate care delivery model to maximize health for people across the life course and is essential for older people with multiple chronic conditions, the report says. Several actions should be taken by 2027 in order to shift health care systems to focus on promoting healthy longevity, such as:

• Health systems, in concert with communities and the people they serve, should adopt affordable, accessible, culturally appropriate models (including geriatric and long-term care models) for providing person-centered, integrated care for older people facing functional limitations, multimorbidity, frailty, and complex care needs.
• Governments should develop plans for aligning health care payment and reimbursement systems with healthy longevity outcomes.
• Relevant licensing and certification bodies should ensure that all health care providers receive training in how the physiology and psychology of aging affect diagnosis and treatment of older patients.
• Governments, professional societies, and health systems should provide incentives for developing and/or maintaining a geriatrics workforce to focus on older adults with multimorbidity, geriatric syndromes, and declining physical and cognitive functioning.

"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. "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. In implementing the multisector, all-of-society approach called for in this report, we must also ensure that revolutionary advances are distributed equitably worldwide in order to achieve the critical goal of improving how we all age."

The commission noted that while the need to address healthy longevity is universal, the best path forward in different parts of the world will differ, particularly due to variation in resources and political, economic, social, and environmental forces. This variation is especially challenging in a world facing crises such as climate change, a pandemic, and threats to global political stability that will compete for the same resources needed to improve healthy longevity.