A Graying World

The Dangers of Global Aging The ills of old age have always interested poets and philosophers, but until quite recently they did not interest governments. For most of human history, the elderly have comprised only a tiny share of the population. In the days of Hammurabi, Julius Caesar, or Thomas Jefferson, the odds of a random encounter with a person aged 65 or over were about one in 40. Older people mostly lived with their extended families, where they were integrated seamlessly into the economic and social Life of the community. This pattern began to change during the 19th century; starting in the developed world. The growth in the number of elderly--together with industrialization, urbanization, and the breakdown of the extended family--turned "old-age dependence" into a social problem. Governments responded by establishing old-age benefit programs that, over time, were supplanted by universal social insurance for the aged. Meanwhile, society came to regard aging as a health problem, a progressive decline in function analogous to a d ebilitating and ultimately fatal disease. It is this view that justifies the elderly's claim to a large portion of government budgets, and it explains why voters in most countries believe that all benefits to the elderly are as sacrosanct as national health insurance. Most gerontologists reject this view, however, arguing that health is an age-related norm. But, this idea no longer has much popular appeal in the now-affluent developed world. Societies in which old people seek hip replacements and organ transplants and spend freely on Viagra and human growth hormone are not societies that accept declining biological capacity as natural and inevitable. Very soon, however, most societies will have to change course. The world now stands on the threshold of a great demographic transformation with few parallels in human history. When this transition is complete, our children and grandchildren will live in societies demographically older than any we have ever known. The odds of meeting a person over age 65, once one in 40 and today one in seven, will climb to one in four in the developed countries by the year 2030. If fertility rates do not rise again, the median age in these countries will reach 51 by 2050. In Germany, the median age is projected to reach 53; in Japan, 54; and in Italy, 57. By way of comparison, the median age in Europe today is 38; and in Africa, it is 18. Demographic aging is the most economically consequential health issue the world will face over the next century. National budgets and economies will come under pressure as growing numbers of aged persons must be supported by relatively fewer younger persons. How can the developed countries prepare for this challenge? At the most fundamental level, there are only two options. Societies can reduce the future old-age dependency burden by increasing available resources--that is, by pursuing policies that increase the size and productivity of tomorrow's working-age population. Or they can rethink the private attitudes and public policies that now equate old age with a loss of health that somehow entities the elderly to government spending. The Challenge of Global Aging While the whole world is aging, some countries will grow older much sooner than others. In the developed Countries of Western Europe, North America, Japan, and Australia, the elderly already comprise 15 percent of the population; the former Soviet bloc countries of Eastern Europe are just as old. By the year 2030, the proportion of the elderly in the developed world's population will near 25 percent and in some countries will be closing in on 30 percent. In the developing world, the urgency of the aging challenge differs greatly among regions. In Africa, the Middle East, and Central Asia, aging poses few direct challenges for the foreseeable future. These countries have the world's highest fertility rate, at just over five lifetime births per woman, and the lowest life expectancy, at about 50 years for sub-Saharan Africa. …