Global Aging Report
Threats to Longevity

United States of America
Japan
FranceUnited Kingdom
Dominican Republic
India
South Africa
Argentina
The Netherlands
IsraelThe International Longevity Center Global AllianceContents

A Call to Action

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Appendix I – Tables
Table 1 Life Expectancy in 50 Locations, Both Sexes........................... 20
Table 2 Populations of Countries with At Least 10 Percent of Their
Population Age 65 and Over ..................................................... 21
Table 3 The New Longevity: Life Expectancy from Age 60 ................. 23
Table 4 Ten Nations with Largest Populations: Selected Demographic
Characteristics .......................................................................... 24
Table 5 Healthy Life Expectancy (HALE)
at Birth, Both Sexes, in Selected WHO Member States ........... 24
Appendix II – Reports from International Longevity Centers
United States of America (founding member) .............................. 26
Japan (founding member) .............................................................. 37
France (1996) ............................................................................. 45
United Kingdom (1997) ............................................................. 55
Dominican Republic (1998) ....................................................... 67
India (2004) ................................................................................ 72
South Africa (2005) .................................................................... 78
Argentina (2005) ........................................................................ 86
The Netherlands (2006) ............................................................. 97
Israel (2007) ...............................................................................104

GLOBAL AGING REPORT
Threats to Longevity
A Call to Action
2009

The International Longevity Center Global AlliancePreface

The International Longevity Center Global Alliance comprises ten centers – theUnited States of America, Japan, France, the United Kingdom, the Dominican
Republic, India, South Africa, Argentina, The Netherlands, and Israel. Together, weare engaged in an effort to understand and address the profound consequences of
population aging and advancing longevity.
This report is a collaborative effort of all ten centers, presenting a detailed portraitof the realities of population aging around the world and articulating a call to action
from an intergenerational and lifespan perspective.

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A Call to Action
Geography of Longevity
a. Population aging
One of the dramatic events of the 20th century has been the unprecedented aging of
populations around the world in both the developing and developed countries. In less than acentury and particularly in the developed world there has been an average 30-year gain of life
expectancy. Nearly 20 percent of that gain was from a base age 65, in addition to the sharp
reduction in maternal, childhood and infant mortality rates. By the year 2020 one fourth of the
population in many nations will be over 60, and by 2050, every fifth person on the planet will
be over 60. At the same time, many developing countries are experiencing a significant
downturn in their birth rates, increasing the percentage of older persons in these countries.
In contrast to the developed world, which grew rich before it grew old 1 , thedeveloping world, where 81 percent of the world’s population lives, will grow old before it
grows rich, with older persons among the poorest and most vulnerable. On average, men andwomen in the developed world live 75 years, although this could change in the event of an
epidemic or pandemic or because of poor health habits that result in obesity.* In thedeveloping world, however, life expectancy is substantially less, averaging 53 years for least
developed countries and 64 years for less developed regions,** with enormous economic,
social and personal consequences that include significant trade disadvantages. Currently, in 18
nations, (17 nations in Africa, and Afghanistan) life expectancies are less than 50 years anddisability-free life expectancies or active life expectancies are less than 46 years.
b. Shortgevity
The populations of many poor nations suffer from shortgevity, and indeed, poverty andshortgevity move in the same direction. Sierra Leone, for example, has an average life
expectancy of 40 years and a disability-free life expectancy of only 29 years. In addition,although it is unusual for a nation to reverse a longevity trend several nations of the former
Soviet Union (FSU) have indeed lost life expectancy, largely resulting from the AIDS
epidemic, and an increase in the incidence of alcoholism caused by the despair and loss of
purpose that befell these societies at the breakup of the Soviet Union. Mozambique is anothernation that has lost previously gained years of life.
Nations experiencing shortgevity have lower productivity and are at a disadvantage in* Alex Kalachi, World Health Organization** Source; UN Population Division

Global Aging Report3Male life expectancy in the Russian Federation is now 60.
It is the lowest of any nation in the developed world.
the global economy because they are limited in their ability to produce, exchange, buy and sell
products and services to the developed world.

Threats to Longevity
a. Diseases of Developed Nations
With the advent of mass vaccinations and advances in public health, developed nations
have in large mea sure overcome acute diseases. Chronic diseases, the so-called diseases ofaffluence, have replaced diseases like polio, diphtheria, and smallpox. They include obesity,
coronary heart disease, diabetes and smoking-related diseases. The World Health Organization
reports that tobacco is the leading cause of death worldwide.
David J.P. Barker theorized2 that chronic diseases in later years have their origins infetal life and early infancy. Low birth weight, which is a function of poor nutrition as well asother adverse prenatal environments, and conditions during infancy, have a direct bearing on
the development of risk factors for adulthood diseases. Childhood infections may have a longterm effect on adult mortality, and there is a strong correlation between childhood diseases andlater health problems.
In fact, many diseases generally considered “geriatric” did not suddenly emerge in old
age but have a long history. It might be more appropriate to refer to them as “disorders of
longevity”, and to intervene early in life. Osteoporosis, for example, may be seen as a pediatricdisease that originates in pubescence and adolescence, when, ideally, bone density is achievedand “banked.” In part, the disease is the cumulative outcome of a lack of anti-gravity exercise,
calcium and vitamin D. Heart disease and even type II diabetes, particularly when associatedwith obesity, may take root in infancy and later childhood culminating in death.
b. Diseases of Developing Nations
Not long ago public health experts optimistically predicted the end of infectious
diseases. But in the developing world pulmonary and diarrheal diseases (especially in children),tuberculosis (including the extremely resistant form), malaria and acquired immune deficiency

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A Call to Action

syndrome (AIDS) remain common, debilitating and deadly.
It unfortunately remains true that only 10 percent of disease-related drug research in thedeveloped world focuses upon diseases that affect 90 percent of the world population. For
example, hepatitis B vaccine was developed in 1981 but 2 decades passed before it was
introduced in the poor nations. Indeed, despite the progress that has been made in bringing
vaccine inoculations to poor and remote areas, 20% of the world’s children are not vaccinatedagainst vaccine-preventable diseases: measles, polio, tuberculosis, diphtheria, whooping cough,and tetanus.
700,000 children die of pneumococcal disease annually
in developing countries.
AIDS
More than 15 million children under the age of 18 have lost one or more parents to
AIDS, with the greatest burdens being borne by Sub-Saharan Africa and parts of Asia. In SubSaharan Africa the cumulative number of AIDS orphans is estimated to be 12.1 million.3
HelpAge International reports that in Sub-Saharan Africa 60 percent of
AIDS orphans have a grandparent as a principal guardian.
In many locations orphanages do no exist at all, and in addition to caring for their terminally ill
adult children, older persons are the best and often only realistic solution to meeting the needsof their grandchildren and other orphans in the community.
The consequences of the erroneous assumption that older persons are not sexuallyactive can have tragic consequences because they do not receive policy attention, and are nottargeted for HIV prevention messages. Older persons are also excluded from many statistics on
HIV/AIDS that typically does not include anyone over age 50, such as data from UNAIDS and
WHO 2006. Not only are older persons often sexually active, they are also at risk of infection
through their role as caregivers. In affected developing countries the impact of HIV/AIDS on
older people has been particularly severe. When adults in the prime of their lives die of AIDSassociated illness, they leave behind two vulnerable populations, their children and their aging
parents. During the time older persons care for their ill adult children, the physical demands

Global Aging Report5and emotional strain can seriously affect their health.
In the future, expanding access to antiretroviral therapy that prolong lives and delay
serious illness may alter the important role older persons play. Instead of providing care for
their grandchildren and terminally ill adult children, older persons in these countries may help
ensure compliance to medication regimens by encouraging treatment and monitoring
adherence.4
Diseases of “affluence” in poor nations
In the 21st century chronic diseases like obesity, coronary heart disease, diabetes andsmoking-related diseases — the so-called diseases of affluence (or lifestyle) that afflict thedeveloped world — have overtaken acute infectious diseases to become the predominant causesof disability and death in developing nations, placing an increased economic burden uponalready fragile economies.
In just 20 years, the number of people suffering fromdiabetes increased from 30 million to more than 177 million.
By 2030, as many as 366 million people worldwide
will be diabetics. The fastest growth will bein developing countries.5
Many chronic diseases are also related to the amount (or intensity) and the duration of
exposure to one or more pathogens, including infectious agents,6 toxins, carcinogens, andmutations. Infectious diseases and malnutrition as well as other type of medical andsocioeconomic stressors often set the stage in childhood.
Further, a World Health Organization (WHO) report states that slow growth and lackof emotional support in prenatal life and early childhood reduce physical, cognitive andemotional functioning in later years. But poor lifestyles affect rich and poor alike, andunhealthy parental behaviors, such as smoking and alcohol consumption are also implicated.
Aging itself is a risk factor for a variety of chronic diseases7 with the accumulation of
normal aging characteristics creating a threshold beyond which a person becomes increasingly
susceptible to an array of pathological outcomes. Disorders like Alzheimer’s disease, spinal

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A Call to Action

stenosis, and temporal arthritis are age-related, but a variety of diseases such as atherosclerosis
may hasten the aging process.
Tobacco is the leading cause of death globally.8
Pandemics and epidemics
The WHO defines a pandemic as the emergence of an easily spread disease that infects
humans and causes serious illness, and one that is new to the population. For example, in apandemic in 1918 an estimated 40-50 million people perished worldwide as a result of an
influenza strain known as the “Spanish Influenza”. Pandemics as well as epidemics requireinternational support, including early warning alert and response systems; international training
programs to maintain preparedness; development of standardized approaches for readiness andresponse to major epidemic-prone diseases as determined by the WHO (e.g., meningitis, yellow
fever, plague); strengthening of biosafety, biosecurity and readiness for outbreaks of dangerous
and emerging pathogens outbreaks, such as Severe Acute Respiratory Syndrome (SARS).
The avian flu presents a new threat worldwide. Scientists fear that the virus will mutate
and spread to humans. Indeed, the first case of human infection was reported in May 2008 in
Bangladesh, where a 16-month-old child who had been exposed to fowl in his home was
infected. Should avian flu spread, the nations of the world are not prepared. They lack themeans to rapidly manufacture large quantities of vaccine; they lack veterinarians andlaboratories to test for the virus; and they lack the means with which to protect poultry farmers
by providing economic incentives if they must cull their flocks to stem spreading the disease.
Feeding the world
Although there is more food in the aggregate in the world than needed, nearly one
billion are underfed and starving. Nigerian families spend 73 percent of their budgets on food,Vietnamese 65 percent, Indonesians half. In 2008 the president of the World Bank9 warned thatnations are at risk of social unrest because of the rising prices of food, and noted that over thelong term, agricultural productivity must increase in the developing world. He suggested richcountries could help finance another “green revolution” to increase farm productivity and raisecrop yields in Africa.

Global Aging Report

7The first Green Revolution was started in the 1940s when the Rockefeller Foundation
began a research project to develop a high-yield, disease resistant dwarf wheat crop to improve
agricultural yields in Mexico. Under the direction of Norman Borlaug, who won a Nobel Prizefor his work, a wheat plant was developed that yielded more grain than traditional varieties.
With the development of the Green Revolution, food productivity rose while using less land.
Subsequently, in response to concern about the potential of famine in Southeast Asia,
Asia and Latin America, the Rockefeller and Ford Foundations funded a major scientificresearch effort to improve agricultural productivity. In addition to seeds, over the years theGreen Revolution provided farm technology, better irrigation and chemical fertilizers todeveloping nations, and was highly successful at increasing crop yields, as well as augmenting
food supplies.
Global warming and the world’s foodGlobal warming and rising food prices are inextricably bound. In order to meet thegrowing fuel demand, developed nations have supported the production of biofuels, such as
corn ethanol, raising the price of corn and soybeans. The International Monetary Fundestimates that corn ethanol production in the United States accounted for at least half the rise inworld corn demand in each of the past three years, which has elevated corn prices and resulted
in an increase in the price of animal feed. In order to help millions of victims of hunger aroundthe world, the World Food Program reported that rising grain costs increased expenditures bymore than $500 million. It is ironic that although scientists hoped that biofuels would reducegreenhouse gases, at best, corn ethanol delivers only a small reduction when compared withgasoline.
Global warming and pollution affect the water supply, which in turn endangers theworld’s food supply. Water shortages, particularly in Asia, impair the production of rice. Sea
life, a major source of protein in many nations, is clearly in short supply.
• In 2007, the food import bill of developing countries rose by 25
percent, and food prices rose to levels not seen in a generation.
• Since 2006 the price of corn doubled, and wheat reached its
highest price in 28 years.

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A Call to Action• The United Nations Food and Agriculture Organization reportsthat world cereal stocks this year will be the lowest since 1982.
• Between 2006 and 2008 overseas aid by rich countries fell 8.4
percent.10

Health Creates Wealth
Both micro and macro data, including research done by economists at the University of
Chicago11, Harvard12, Yale13, UCLA14, and the University of Belfast15 offer a perspective thatlinks health and longevity. Their work suggests that most discretionary funds are accumulated
by populations 50 and above; healthy individuals have accumulated more savings andinvestments by their old age than individuals beset by illness; most private intergenerationaltransfers go from old to young, not from young to old. Their studies indicate that healthy older
persons are more apt to remain productively engaged in society in their old age throughcontinuing work or voluntary activity and that they require fewer health services. Finally, thehealthcare and pharmaceutical industries, financial services and the like all profit by therealities of people living longer, as do other industries known as “mature markets”.
Bloom and Canning’s work demonstrate that nations that have a five-year advantage inlife expectancy show significant increases in gross domestic product, for example, from 0.3%
to 0.5% GDP faster per year. Currently, conventional measures of national income and output
exclude the value of improvements in the health status of the population.
Economist William Nordhaus of Yale University developed a methodology andpreliminary estimates of how standard economic measures would change if they adequatelyreflected improvements in health status. He discusses how health income fits into existing
theories for measuring and valuing consumption and health status, and concludes that the“value of increase in longevity in the last 100 years is about as large as the value of growth in“The benefits from just lower infant mortality and better treatment ofheart attacks have been sufficiently great that they alone are about
equal to the entire cost of insurance for medical care over time.”
David Cutler and Mark McClelland17

Global Aging Report9non-health goods and services”16. Nordhaus measures “real output” of the health care industry
and estimates the dollar value of the prevention of a fatality to range between $0.6 and 13.5
million. He settles on $3 million as a reasonable figure.

Financing Longevity
Old people are among the poorest of the poor. Nonetheless, the so-called welfare
states of Europe have demonstrated that it is possible to sustain basic core public pension andhealth care systems for all their peoples including old people. The European system has beenmodestly modified but firmly secured over the last several decades despite economic, politicaland ideological pressures. The International Monetary Fund and the World Bank have assisted
the poor nations to some degree but their requirements emphasized a free market. Free-trading
globalization often resulted in the institution of severe and onerous austerity requirements forindebted nations. These have been especially punishing to marginal groups such as old people
who are most in need of social protections. The World Bank has been severely criticized for its
neglect of agriculture in Sub-Saharan Africa and for inadequately dealing with corruption. The
U.N. Convention Against Corruption makes an effort to make it harder for political leaders topark money in overseas banks.
With globalization of the economy the free movement of capital has focused uponcheap labor. Both to protect workers in developing and developed world’s foreign policy
agreements should foster a minimum and living wages, wage and employment insurance,
training and retraining benefits, safety and health as well as the right to collective bargaining.
Forced and child labor should obviously be forbidden.
In 2007, U.S. trade legislation began to move in these directions. However, we fear theextent of poverty and the lack of worker’s rights will remain problematic for sometime to comewithout truly transformative changes in the foreign policy of the developed nations. It should
be stressed that the protection of workers of the developing world also helps preserve the social
protections in the developed world since cheap labor undermines developed world economies
and their tax base that supports such protections.
Government policies that provide public pensions and health care need to besupplemented by the civil society, the for-profit sector, and by individuals themselves, who must
be cognizant of the importance of working to maintain their own financial security and health.

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A Call to Action

Health Care
As noted in the follow-up to the Madrid International Plan of Action on Ageing which
was adopted in 2002, the aging of the population entails a shift from a predominance of
infectious diseases and high maternal and child mortality to that of non-communicable diseases
at older ages, particularly chronic diseases. As a result, as the population ages there is anincreasing need to deal with diseases that are more costly to treat, degenerative and difficult tocontrol.
Health and well-being in old age varies widely among regions, and within them. In
developed countries, demographic and epidemiological transitions have taken place over alonger period of time than in developing countries. Dramatic increases in longevity occurred
after a reduction in social and economic disparities and an increase in access to health care. In
developing countries, the transitions are taking place in the context of fragile socio-economic
conditions, a high poverty rate and increasing inequalities in health coverage.

A New Paradigm
There is only a modest investment in research on aging in the world. In the UnitedStates, for example, the annual budget of the National Institute on Aging approximates $1
billion far less than 1 percent of the budget of Medicare, which is the public health financing
system for older and disabled people. Only about $200 million is spent on the basic biology of
aging. If only one percent of Medicare expenditures were set aside for research anddevelopment, this would triple the investment in biomedical, social-behavioral and especiallythe biology of aging and age-related diseases.
We know that age-related diseases are profoundly influenced by basic biologicalchanges that occur in our bodies as we grow older. For example, 80 percent of all cancer
occurs after age 60. It is important to devote resources to target specific diseases but it is also
important to complement the disease-by-disease approach by better understanding theunderlying biology that predisposes us to disease and death.

Inequalities of Longevity
Inequalities in longevity around the world are the consequences of many factors that
include social-economic and geographic disparities. Globalization continues to favor the richGlobal Aging Report11nations over the poor. Europe and the U.S., for example, sustain agricultural subsidies, to thedisadvantage of the poor countries.
.

New imaginative steps are underway to assist the developing world. Note the Nobelist

economist Mohammed Yunis who created microcredit, which helps poor women. Sovereignty
in Bosnia and Kosovo was affected by military actions, international courts and conventions.
The world is increasingly interconnected. Many multinational corporations are wealthier andmore powerful than many individual nations. It is time to find new ways to eliminate poverty
and advance the general welfare of all nations and peoples.
The prospects of personal health and economic prosperity remain constrained by tariffs
and other trade policies and inadequate donations and investments to improve the lives of thoseliving in the developing world. The U.S., for example, has not been in the lead in contributing
to the developing world compared to the Scandinavian countries and the Netherlands.
Debt relief should be extended and grants rather than loans made to developing
countries.

Human Rights
2008 marks the 60th anniversary of the Universal Declaration of Human Rights, which
has roots in the U.S. Bill of Rights and the French Declaration of the Rights of Man and the
Citizen. Notwithstanding these documents, the codification of basic human rights have notbeen widely adopted. But as we move forward in the 21st century it seems clear that politicalpressures will intensify. Concern for social, economic and cultural rights, such as worker’s
rights and trade agreements, property rights for the dispossessed who may be encouraged to lay
claims to the land they work, the rights of women and the rights of minorities which whiledestabilizing will hopefully lead to the improvement of the daily lives of people who need
economic security and jobs. Such progress is opposed to inequality in general, and toinequality in longevity.

What Can We Do? An Agenda for Action
Up to now no nation has fully embraced the challenges posed by population aging andadvancing longevity with the possible exception of Japan. Yet, we need all f ields ofscholarship, policy, the civil society and government – and individuals – to respond to the12

A Call to Action

economic, social, cultural, health and personal issues resulting from population aging.
Nations can learn so much from each other, comparing policy and cooperating inscientific and scholarly activities. Sovereignty has been valuable for the development of
individual states, and it is not easy to imagine a nation giving up individual sovereign power,
although the European community is moving slowly in that direction. Yet it is hard to imagine
the easy entry by nations into necessary treaties and agreements on a worldwide scale toresolve issues relating to climate change, energy sources, air and water quality, not to mention
such issues as human rights – without giving up a piece of sovereignty. It is essential thatnations enter into agreements, which could take the form of a sophisticated balance between
national sovereignty on the one hand and international sovereignty on the other.
It is likely that there will be further additions to longevity in the 21st century as a resultof genomics and regenerative medicine and other unanticipated innovations in health, forexample, from the pursuit of research into the basic biology of aging. Those scholars involved
with gerontology, population and longevity should extend their reach and undertakecomparative international studies.
We should continue to pursue the recommendations of the Vienna (1982) and Madrid(2002) World Assemblies on Aging.
Those in medicine, specifically geriatrics, must help lay the foundations for health andeducation in medicine throughout the world.
Those in epidemiology must share their growing knowledge.
Those in politics and policy must emphasize health in foreign policies and create
effective global strategies to address global challenges such as global warming. A carbon tax
should be widely adopted. For example, we need a global health strategy and a global water
strategy. We have much to do. These efforts must be lifespan in perspective and application.
A few specifics that have commonly been recommended:
1. Save the 20 percent of children who are unprotected through immunization against 6
vaccine preventable conditions. Realize nutritional goals for children by fortifying foodstaples like salt and sugar with important dietary minerals. These include vitamin A,
without which 250,000 – 500,000 children become blind annually, and iodine, which isimportant for normal brain development18.

Global Aging Report132. Make widely available medicated mosquito nets against malaria and rehydration kits tosave children with diarrhea.
3. Support the creation and expansion of educational systems that are culturally sensitive butat the same time promote gender equality and improve human resources in developing
nations.
4. Promote the U.N. Millennium Development Goals, which has not specifically mentioned
older persons: to eradicate extreme poverty and hunger; achieve universal primaryeducation; promote gender equality and empower women; reduce child mortality; improvematernal health; combat HIV/AIDS, malaria and other diseases; ensure environmental
sustainability; and develop a global partnership for development. The Goals were
established in 2000 and have a target date of 2015.
5. Support the movement for health and longevity equity exemplified in the work of Sir
Michael Marmot who heads the WHO Commission on the Social Determinants of Health.
Among the determinants are social-economic status (poverty) and race.
6. Create nonprofit pharmaceutical companies and fair agreements regarding intellectual
property of pharmaceutical companies. The aim is to make attractive to both the for-profit
and nonprofit pharmaceutical companies widely available effective medications against
both infectious and chronic diseases. The Institute for World Health, which was created byVictoria Hale and is supported by the Bill and Melinda Gates Foundation, is the first
nonprofit U.S. drug company designed to create drugs that can be offered cheaply indeveloping countries.
7. Create systems of delivery of preventive and therapeutic services based on research into
the means of effective implementation.
8. Catalyze a major international movement by the civil society through the strengthening of
Non-Governmental Organizations (NGOs) movement. An exemplar is the International
Campaign to Ban Landmines, a coalition of non-governmental organizations founded by
Jody Williams, who won the Nobel Peace Prize for her efforts. The coalition has worked
tirelessly to abolish the production and use of anti-personnel mines. Other examples:
HelpAge International and Doctors without Borders.
9. Support the World Health Organization Framework Convention on Tobacco Control,
which, since 2003, has been signed by 168 nations. Its aim is to enforce international

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A Call to Action

standards on tobacco price, advertising and sponsorship, labeling, illicit trade and secondhand smoke. Ultimately, its mission is to reverse World Health Organization statistics
showing that tobacco is the leading cause of death globally.
10. Establish both a Declaration and a Convention for the human rights of older persons.
11. Seek universal ratification of The International Covenant on Civil and Political Rights andthe International Covenant on Economic, Social and Cultural Rights.
12. Work to strengthen the United Nations and its agencies, including the U.N. Population
Fund, the WHO and the U.N. International Institute on Ageing in Malta.
13. Support a life-cycle approach to women’s health, including access to affordable quality
health care; information and appropriate services relating to their reproductive lives andsexually-transmitted diseases.
14. Support universal social security programs, promoted by the International Social Security
Association.
15. Support efforts to confront climate changes. Tropical diseases such as chikungunya are
spreading to temperate zones (e.g., Italy).
16. Create educational institutions to establish well-trained health care workforces of which
there are critical shortages in the world.
17. Make available a special stove for the poor. About 14 million people a year die in fires
caused by paraffin stoves and by the effects of toxins in the air.
18. Phase out agricultural subsidies in Europe and the U.S.
19. Advance science and technology to promote sustainable well-being.
20. Call upon older persons to take major roles in mobilizing societal changes. Former South
African President Nelson Mandela has assembled “Council of Elders” made up of leadingstatesmen and Nobel laureates such as former President Jimmy Carter, Bishop DesmondTutu, former U.N. Secretary General Kofi Annan, former Norwegian Prime Minister Gro
Harlem Brundtland, former Irish President Mary Robinson and the Nobelist in economics
Mohammed Yunis from Bangladesh.
We must exploit the model of Doctors without Borders by creating organizations ofeducators, scientists and scholars who cross borders to work among nations to promote
effective change.

Global Aging Report15Conclusion
In conclusion, why should the developed nations care at all? Because we face common
challenges, such as the threat of a flu epidemic, economic issues of globalization, climatechange, energy shortages and poverty, all of which profoundly affect us as well as longevity.
The ten nations whose representatives constitute the ILC Global Alliance believe thatthe challenges can be effectively met, that nations can afford old age, that old age will not bringabout economic stagnation but rather will contribute to the wealth of nations, thatintergenerational conflicts need not occur and gerontocracies will not develop. But we cannot
afford to delay.
We must grow weary of pessimism, cynicism and skepticism, and we must keep inmind that developed nations were once very poor. We must act not only for humanitarianreasons or even with the goal of international economic development but also because what
happens in the developing world can profoundly affect our health and economic security andour national security for good and bad.
Idealism is perhaps the only practical course left to us. And it has been said, “Crisis is aterrible thing to waste.”

Postscript
Hugo Grotius wrote The Law of War & Peace in 1625. His legal masterpiece laid thefoundation of international law. It is fair to say that his aspirations have not yet been reached.
So, too, the aspirations described above – the call to action – by the ILC Global Alliance – arenot likely to be immediately met. But it is important to stress now the urgent need to respondto the challenge of population aging and advancing longevity.

16

A Call to ActionEndnotes
1 Olshansky, SJ & Butler Robert N & Douglas PJ, et al. 2005. A Potential Decline in Life Expectancy

in the United States in the 21st Century. New England Journal of Medicine 352:1138-45.
2 Barker, D.J.P., ed. 1992. Fetal and Infant Origins of Adult Disease. London: British Medical Journal

Publishing Group.
3 United Nations Children’s Fund (UNICEF), UNAID, & U.S President’s Emergency Plan for AIDS

Relief (PEPFAR). 2006. Africa’s Orphaned and Vulnerable Generations: Children Affected by AIDS.
New York: UNICEF.
4 Knodel J. 2006. Parents of persons with AIDS: Unrecognized contributions and unmet needs. Global
Aging: Issues and Action. August 2006: 46-55.
5 World Health Organization. 2007. World Health Statistics, Ten statistical highlights in global publichealth. Geneva: WHO.
6 Finch, Caleb E. & Crimmins, Eileen M. 2004. Inflammatory exposure and historical changes inhuman life spans. Science 305:1736-39.
7 Butler, Robert N. & Warner, Huber & Williams, FT. 2004. The aging factor in health and disease.
Aging Clinical and Experimental Research 16:104–12.
8 World Health Organization. 2007. World Health Statistics, Ten statistical highlights in global publichealth. Geneva: WHO.
9 Hoyt, Clark. 2008. The World Food Crisis. The New York Times, April 10, Opinion Section.
10 Hoyt, Clark. 2008. The World Food Crisis. The New York Times, April 10, Opinion Section.
11 Kevin, MM &Robert TH. 2006. The Value of Health and Longevity. The Journal of Political Economy.
114(5): 871-904.
12 Bloom, David E. & Canning, David M & Michael J. 2004. The Effect of Improvements in Health andLongevity on Optimal Retirement and Saving. NBER Working Paper Series: w10919.
13 William D. Nordhaus. 1998. The Health of Nations: Irving Fisher and the Contribution of Improved
Longevity to Living Standards. Cowles Foundation Discussion Papers 1200, Cowles Foundation, Yale
University.
14 Hartog, Joo &, Oosterbeek, Hessel. 1998. Health, wealth and happiness: why pursue a higher
education? Economics of Education Review, Elsevier 17(3): 245-256.
15 Bloom, David E. & Canning, David. 2000. The health and wealth of nations. Science, 287:1207-09
16 Nordhaus, William D. 2003. The Health of Nations: The Contribution of Improved Health to Living
Standards, Working Paper 8818, National Bureau of Economic Research.
17 Cutler, David M & McClellan, Mark & Newhouse, Joseph P, 1998.What Has Increased Medical-CareSpending Bought? American Economic Review, American Economic Association. 88(2):132-36.
18 Butler , Robert N. 2008. The Longevity Revolution. New York: PublicAffairs Press.

Global Aging Report

17

Coda

As this publication goes to press, we are confronted with issues that affect the viability of theworld’s populations, irrespective of age. They include food and water shortages, soaring energy
costs, planet deterioration and global warming. It is in the interest of all nations to work
together to promote a better understanding of our common goals.
Organized humanitarian efforts are relatively new in human history. Natural and manmade
disasters especially affect older persons. It is fitting that we, the undersigned, should speak up
and call for actions that will benefit people of all ages and all generations.

Robert N. Butler, M.D.
ILC-USA

R.A.Mashelkar, Ph.D.
ILC-India

Shigeo Morioka
ILC-Japan

Monica Ferreira, D. Phil
ILC-South Africa

Françoise Forette, M.D.
ILC-France

Lia Susana Daichman, Ph.D.
ILC-Argentina

Baroness Sally Greengross
ILC-UK

Jacques Schraven
ILC-Netherlands

Rosy Pereyra, M.D.
ILC-Dominican RepublicSara Carmel, Ph.D.
ILC-Israel

18

Coda

APPENDIX I

Global Aging Report

19

APPENDIX ITABLE 1
Life Expectancy in 50 Locations, Both Sexes

COUNTRYYEARSCOUNTRY

YEARS

Japan

83

Finland79

Andorra

82

Malta

79

Australia

82

Portugal

79

Monaco82

Republic of Korea

79

San Marino

82

United Kingdom

79

Switzerland

82

Chile

78

Canada81

Costa Rica

78

France

81

Cuba

78

Iceland81

Kuwait78

Israel81

Slovenia

78

Italy

81

United Arab Emirates

78

Spain

81

United States of America

78

Sweden81

Brunei Darussalam

77

Austria80

Czech Republic

77

Cyprus

80

Qatar

77

Germany80

Croatia

76

Greece80

Panama76

Ireland80

Argentina

75

Luxembourg

80

Bahrain

75

Netherlands

80

Barbados

75

New Zealand

80

Bosnia and Herzegovina

75

Norway80

Paraguay

75

Singapore

80

Poland75

Belgium

79

Saint Lucia

75

Denmark

79

Uruguay75

Source: World Health Organization, Statistical Information System, 2006.

20

TablesTABLE 2
Population of Countries with At Least
10 Percent of Their Population Age 65 and Over
Number

Percent

Region or country
Total

65 and overItaly

57,998,353

10,893,973

18.8

Japan

127,214,499

23,720,030

18.6

Greece10,625,945

1,947,336

18.3

Germany

82,398,326

14,643,067

17.8

Spain

40,217,413

7,075,743

17.6

Sweden8,970,306

1,545,515

17.2

Belgium

10,330,824

1,777,398

17.2

Bulgaria

7,588,399

1,293,949

17.1

Portugal

10,479,955

1,749,225

16.7

France60,180,529

9,801,524

16.3

Croatia

4,497,779

723,788

16.1

Estonia

1,350,722

217,199

16.1

Austria

8,162,656

1,282,955

15.7

United Kingdom

60,094,648

9,429,087

15.7

Finland5,204,405

805,215

15.5

Latvia2,322,943

358,400

15.4

Switzerland

7,408,319

1,131,164

15.3

Ukraine48,055,439

7,212,722

15.0

Georgia

4,710,921

706,380

15.0

Denmark

5,394,138

802,456

14.9

Norway4,555,400

676,160

14.8

Hungary

10,057,745

1,492,216

14.8

Slovenia

2,011,604

298,344

14.8

Serbia and Montenegro

10,823,280

1,592,794

14.7

Lithuania

3,620,094

530,425

14.7

Global Aging Report

21

TABLE 2 (continued)

Number

Percent

Region or country
Total
Luxembourg

65 and over

456,764

65,985

14.4

Belarus10,322,151

1,478,835

14.3

Romania

22,380,273

3,169,849

14.2

Czech Republic

10,251,087

1,432,188

14.0

Netherlands

16,223,248

2,241,317

13.8

Russia144,457,596

19,203,848

13.3

Malta

395,178

51,96913.2

Uruguay

3,381,606

442,733

13.1

Canada32,207,113

4,167,291

12.9

Poland38,622,660

4,924,081

12.7

Australia

19,731,984

2,502,665

12.7

United States

290,342,554

35,878,341

12.4

Hong Kong S.A.R.

6,809,738

836,153

12.3

Puerto Rico

3,878,679

461,501

11.9

Iceland291,064

34,055

11.7

Slovakia

5,416,406

630,190

11.6

New Zealand

3,951,307

457,805

11.6

Ireland3,924,023

447,070

11.4

Cyprus771,657

85,62911.1

Macedonia

2,063,122

217,965

10.6

Argentina

38,740,807

4,042,311

10.4

Martinique

425,966

43,818

10.3

Armenia

3,001,712

306,182

10.2

Moldova

4,439,502

452,797

10.2

Bosnia and Herzegovina

3,989,018

401,929

10.1

Source: U.S. Census Bureau, International Data Base, 2004.

22

TablesTABLE 3
The New Longevity: Life Expectancy from Age 60

Male
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
15
17
18
19
20
21
22
23
24
24
26
27
28
29
30
31
32
33
34

Country
Iceland
China, Hong Kong
Switzerland
Japan
Australia
IsraelCanadaCosta Rica
SwedenNew ZealandSouth Africa
China, Macao
EcuadorMartinique
Italy
FranceNorwaySierra Leone
Guadeloupe
Cuba
GreeceChile
Austria
MexicoNetherlands
United Kingdom
BelizeMalta
PanamaUnited States of America
Belgium
Dominican Republic
United Arab Emirates
CyprusAdditional
Years
22.48
22.39
22.24
22.13
22.01
21.89
21.70
21.61
21.38
21.33
21.28
21.27
21.17
21.07
21.06
21.06
21.04
20.99
20.87
20.78
20.77
20.72
20.69
20.65
20.65
20.42
20.36
20.35
20.32
20.30
20.28
20.25
20.19
20.08

FemaleRank
Country
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
26
28
29
30
31
32
33
34

Additional
Years
Japan
27.76
China, Hong Kong, SAR 4
26.78
France26.18
Switzerland
26.12
South Africa
25.97
United States, Virgin Islands
25.67
Australia
25.65
Italy
25.49
Puerto Rico
25.40
Martinique
25.24
Canada25.20
Guadeloupe
25.08
Iceland25.05
China, Macao SAR5
24.98
Sweden24.83
Israel24.65
New Zealand
24.63
Austria
24.60
Norway24.52
Belgium
24.50
Chile
24.46
Finland
24.45
Costa Rica
24.38
Germany
24.33
Republic of Korea
24.25
United States of America
24.21
Netherlands
24.21
Luxembourg
24.03
United Kingdom
24.00
Greece23.99
Sierra Leone
23.93
United Arab Emirates
23.91
Slovakia
23.87
Malta
23.67

Source: United Nations Statistics Division, Statistics and Indicators on Women and Men, 2007.

Global Aging Report

23

TABLE 4
Ten Nations with Largest Populations: Selected Demographic Characteristics

Total Number of
Persons%
Country(in thousands) 60 and overChina
1,328,474
11.0
India
1,151,751
8.0
USA
302,841
17.0
Indonesia
228,864
8.0
Brazil189,323
9.0
Pakistan
160,943
6.0
Bangladesh
155,991
6.0
Nigeria
144,720
5.0
Russian Federaition
143,22117.0
Japan127,953
27.0Life Expectancy at
Age 60Male
Female
N/A
N/A
16.4
18.7
20.8
24.0
N/A
N/A
19.2
22.3
18.5
18.5
N/A
N/A
N/A
N/A
13.8
19.4
22.4
27.9

Life Expectancy at
Birth
Male
Female
72.0
75.0
62.0
64.0
75.0
80.0
66.0
69.0
68.0
75.0
62.0
63.0
63.0
63.0
48.0
49.0
60.0
73.0
79.0
86.0

Source: “Life Expectancy at Age 60” figures are obstained from United Nations, Demographic Yearbook 2006,Table 22 last updated as of 21 July 2008.
All other figures are from World Health Organization Health Indicators last updated as of May 2008.

TABLE 5
Healthy Life Expectancy (HALE) at Birth, Both Sexes, in Selected WHO Member States

COUNTRY
Japan
Australia
Iceland
Italy
MonacoSwedenSwitzerland
AndorraCanadaFranceGermany
Luxembourg
Austria
Belgium
GreeceIsrael
Malta

YEARS
75
73
73
73
73
73
73
72
72
72
72
72
71
71
71
71
71

COUNTRY
Netherlands
United Kingdom
Denmark
Singapore
Slovenia
United States
Argentina
China
India
South Africa
RwandaAfghanistan
Malawi
Swaziland
Zimbabwe
AngolaSierra Leone

YEARS
71
71
70
70
69
69
65
64
53
44
38
36
35
34
34
33
29

Source: World Health Organization, World Health Statistics, 2008.

See also The World Health Report 2008, Annex Table 4. Further development in collaboration
with Member States is under way for improved data collection and estimation methods.
Figures not endorsed by Member State as official statistics.

24

TablesAPPENDIX II
Reports fromInternational Longevity Centers

United States of America
Japan
FranceUnited Kingdom

Robert N. Butler, M.D.
President and CEO

Dominican Republic• Professor of geriatrics at the Brookdale Department ofGeriatrics and Adult Development at the Mount Sinai
Medical Center• Founding Director of National Institute on Aging

IsraelThe Netherlands

Argentina

South Africa

India

United States of America

United States of America
Japan

Report from ILC-Centers

ILC-United States
Section 1: Profile of ILC-United States
FranceUnited Kingdom• Contact Information:
International Longevity Center-United States (ILC-USA)
60 East 86th Street
New York, NY 10016
USA
Tel: 212-288-1468
Fax: 212-288-5450
http://www.ilcusa.org

Israel27

The Netherlands

Global Aging Report

Argentina

He was Chair of the advisory committee for the White House Conference on Aging in 1995.
Dr. Butler was a principal investigator of one of the first interdisciplinary, comprehensive,
longitudinal studies of healthy community-residing older persons, conducted at the National
Institute of Mental Health (1955-1966), which resulted in the landmark books Human Aging I
and II. It was found that much attributed to old age is in fact a function of disease, social-

South Africa

In 1976 Dr. Butler won the Pulitzer Prize for his book Why Survive? Being Old in America,
which has been translated into Japanese and published in Japan in 1992. He is co-author (withDr. Myrna I. Lewis) of the books Aging and Mental Health and Love and Sex After 60. The
newest and 4th edition of The New Love and Sex After 60 appeared in 2002. He completed a
new book The Longevity Revolution: The benefits and challenges of living a long life and is
working on another, Life Review.

India

From 1975 to 1982 he was the first and founding director of the National Institute on Aging of
the National Institutes of Health. In 1982 he founded the first department of geriatrics in a U.S.
medical school. He held the Brookdale Professorship of Geriatrics. In 1990, with Shigeo
Morioka he co-founded the International Longevity Center (ILC) a policy research andeducation center, which studies the impact of longevity upon society and its institutions. There
are now Centers in France, the United Kingdom, the Dominican Republic, India, South Africa,
Argentina and the Netherlands as well as Japan and the United States.

Dominican Republic• President:
Robert N. Butler, M.D., is President and Chief Executive Officer and Co-Chair of the Alliancefor Health and the Future of the International Longevity Center-USA, and professor of
geriatrics at the Brookdale Department of Geriatrics and Adult Development at the Mount
Sinai Medical Center in New York City.

economic adversity and even personality. This research helped establish the fact that senility is
not inevitable with aging, but is, instead, a consequence of disease. The NIMH researchcontributed to a different vision of old age. It set the stage for the later concepts of “productive
aging” and “successful aging.”
In 2003 he received the Heinz Award for the Human Condition.
• Mission Statement:
Devoted to science-based policy development on the aging of populations, our vision is to help
individuals, government, and business navigate the age boom in positive and constructive ways,
and to highlight older people’s productivity and contributions to society.
• Year Organized:• 1990 — Founding Member• Major Affiliations:• An independent affiliate of Mount Sinai School of Medicine• Sources of Funding:• Private Foundations, Corporate Contributions and Individual Donations.
• Major Activities/Programs:
Ageism in America Project — The ILC-USA conducted a comprehensive analysis of age
discrimination across multiple sectors in the U.S. to further identify and analyze various forms
ageism and stereotyping, to push the issue into public discourse and to encourage public andprivate institutions to remedy ageist attitudes, policies and practices. Among the domains
studied were the denial of appropriate medical care and services, discrimination in theworkforce, degrading stereotypes in the media, and physical and financial abuse. The resulting
report, Ageism in America, which included “report cards” of the nation’s performance in thesevarious domains was presented at the White House Conference on Aging. Since then the ILC
has received funding to continue the project, enabling us to continue work, which includes
advocacy in Washington, D.C. on behalf of a variety of initiatives that promote equity for older
Americans and enhanced media outreach.
In fall 2007 the ILC-USA unveiled the Ageism in America blog on our website. It is the firstcomprehensive online community dedicated to age discrimination in the United States, opening
new channels for documentation, and knowledge-sharing and encouraging interaction among
key stakeholders in the fight against ageism. The blog offers a stream of topical, linked content
on issues of age discrimination, with up-to-date editorial content, links to other organizations
fighting ageism, and reader comments.

28

ILC-USAUnited States of America
India
South Africa
Argentina
The Netherlands
Israel29

Dominican Republic

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United Kingdom

The Sleep & Healthy Aging Project — The ILC-USA is working with medical professionals
and researchers to counter the fallacy that poor sleep is an inevitable, natural by-product ofaging. Built on earlier work done by the ILC-USA on sleep and older adults, we convened aFranceThe Caregiving Project for Older Americans — The Caregiving Project for Older
Americans is an action-oriented collaboration that aims to improve the nation’s caregiving
workforce through training, the establishment of standards, and the creation of a career ladder.
A joint three year project of the ILC-USA and the Schmieding Center for Senior Health &Education (SCSJE), located in the state of Arkansas, this project builds on our collaboration on
the Arkansas Aging Project, which provided a detailed template for how a state with a highpercentage of older people handles its aging services, specifically the growing crisis in demandfor home health care workers. The aim of The Caregiving Project for Older Americans is tocreate greater awareness of the caregiving crisis, to develop a national systemic approach torecruiting, training and retaining paid professional caregivers, and to enhance the key role ofthe new generation of caregivers. The project’s ultimate goal is the creation of an accreditation
process to train caregivers, the development of a certification/licensing process and continuing
education requirements to maintain certification.
In July 2007, The Caregiving Project and the MetLife Foundation awarded twelve U.S.
community colleges grants to develop home-based caregiver training courses. Each selected
community college will be awarded up to $25,000. The grants provide funding to community
colleges to either establish new home-based caregiver training programs or enhance programs
that already exist for professional and family caregivers.
A national survey of paid professional caregivers was conducted to determine how to improve
the quality of caregiving in the United States. Following this, leaders and experts convened to
discuss the state of the paid caregiving workforce and family caregivers, resulting inrecommendations for a national curriculum, certification program and career ladder.
A comprehensive report produced by The Caregiving Project, entitled Caregiving in America
documents the growing caregiving crisis in the U.S. — the fact that, increasingly, there are too
few caregivers, both paid and unpaid, and too many people needing care. Among the major
topics covered are who provides care, and where; the burden on family caregivers; the severe
shortage of paid caregivers; and the barriers to affordable, quality care.
The Caregiving Project is supported by the Schmieding Foundation, MetLife Foundation,Amgen Foundation, Pfizer Inc. and UniHealth Foundation.

Japan

Other reports devoted to exposing ageism in our society have been completed, including Mythsof the High Medical Cost of Old Age and Dying; Improving Drug Safety; Fallacy of the Lump
of Labor. Finally, a comprehensive research project, Understanding the Older Worker: A Studyof Job Skills and Constrained Opportunities for Older Americans is underway. This reportanalyzes the extent to which reductions in required job skills among older workers in the
United States are indicative of constrained job opportunities.

conference, with the primary goal of laying the groundwork for the formation of a broad-based
coalition of respected organizations to take the lead in the creation and wide dissemination ofprinciples and practical guidelines for the evaluation and treatment of sleep disorders in older
people. A comprehensive report, Sleep and Healthy Aging organized and summarized thepresentations and discussions that took place during the conference. Additionally, two issue
briefs were written to address different audiences: The Role of Sleep in Healthy Aging was
directed toward policy and decision makers, and Sleep: The New Vital Sign was written forpracticing clinicians. Also, a supplement to the journal Geriatrics, authored by Phyllis Zee,
MD and Harrison Bloom, MD, and entitled “Understanding and Resolving Insomnia in the
Elderly”, was circulated to journal subscribers. An article on sleep problems in older
individuals has been submitted to a peer-reviewed journal, and Eons website featured “What’s
Keeping You Awake at Night? Symptoms and Consequences of Chronic Insomnia”. A numberof media interviews resulted from both the Gallup Poll’s Sleep and Healthy Aging Survey
findings and the conference proceedings.
The project was supported by an unrestricted educational grant from Takeda Pharmaceuticals,
North America, Inc.
World Cities Project — As urbanization and population aging increase throughout the world,
we need models of how to accommodate these population shifts, as well as analyses of bestpractices. World Cities Project Co-Directors Victor Rodwin, Ph.D. and Michael Gusmano,
Ph.D., work jointly with New York University’s Robert F. Wagner School of Public Service andColumbia University’s Mailman School of Public Health to:* establish a critical understanding of how world cities, and subsequently megacities indeveloping nations, can prepare for a world in which 20 percent of the population will
be over 65 years old* identify specific program interventions and policies that may be replicated* collaborate in the design of innovative programs that respond to the challenges posedby increasing human longevity and population aging
On the basis of quantitative data collection and case studies, working group meetings areorganized on specific themes, with the participation of city officials, policy analysts, and healthand social service professionals. In the final stage of the project, designated areas of each city
will serve as a laboratory in which to evaluate the effectiveness of alternative interventions.
The Clinical Education Consultation Service — In conjunction with faculty of Mt. Sinai
Department of Geriatrics and other leading geriatrics and gerontology centers, ILC-USA offers
collaborative assistance to governments, non-governmental organizations, academic
institutions, community hospitals and clinics, and community agencies in establishing new

30

ILC-USAUnited States of America
Japan
FranceUnited Kingdom
Dominican Republicclinical, educational, and policy approaches to their demographic trends and health care needsfor older adults. Consultations may include:• assessment of community or institutional clinical resources for care of the older
population, and consultation regarding a spectrum of care, including in-hospital care,
outpatient care, home care, institutional and non-institutional long term care
• consultations regarding the incorporation of geriatric medicine and gerontology
curriculum into the training of medical students, residents in internal medicine andfamily medicine, nursing students, and faculty and fellows in the medical and surgicalsubspecialties• interactive symposia on geriatric clinical syndromes• application of principles of evidence-based medicine to curriculum development anddelivery of clinical care• planning and implementing a geriatric fellowship training program• topics in geriatric nursing• topics in geriatric psychiatry• consultation with national or international organizations, businesses, or corporations
wishing to implement and support programs for their older employees and/or retirees.
Such programs would likely focus upon appropriate physical activity, nutrition,screening and preventive health measures, and advance directives• formal presentations to clinical faculty, residents in training, medical and other healthprofessional students

India

Section 2: Profile of Ageing in the Region

Israel31

The Netherlands

Global Aging Report

Argentina

Researchers said several factors have contributed to the United States falling behind otherindustrialized nations, including:• high obesity rates

South Africa

1. Brief Review of Aging Demographics- Currently in the U.S.12.7% of the population is age 65+, U.S. life expectancy is now
77.
- After a slight drip in the 1980s U.S. fertility has been near replacement for 15 years.
- A baby born in the United States in 2004 will live an average of 77.9 years. That life
expectancy ranks 42nd, down from 11th two decades earlier.
- Black Americans have an average life expectancy of 73.3 years, five years shorter thanwhite Americans.
- Black American males have a life expectancy of 69.8 years.
- A relatively high percentage of babies born in the U.S. die before their first birthday,
compared with other industrialized nations.
- The U.S. rate was 6.8 deaths for every 1,000 live births. It was 13.7 for Black Americans.

• racial disparities• a relatively high percentage of infant mortality
2. Summary of the Main Trends/Issues of Ageing in the Nation
A. Health/Medical Care
• Forty five million Americans lack health insurance.
• Adults in the United States have one of the highest obesity rates in the world. Nearly athird of U.S. adults 20 years and older are obese, according to the National Center for
Health Statistics.
The current health care system in the United States provides limited medical care for theindigent through a program administered by individual states (Medicaid) and for the aged
through a federal program (Medicare). The Medicare program, created in 1965, focuses onpatients being treated only when sick, with little or no emphasis on prevention andcoordination. The following data provides a thumbnail sketch of healthcare in the U.S.:• Regardless of age and work status, unmarried respondents are more likely to be uninsured.
• Compared to privately insured individuals continuously uninsured individuals were63% more likely to experience a deterioration of overall health and further 23% more
likely to new difficulties with an activity of daily living involving mobility.
• The lowest income and education group reported the most cases of diabetes,
hypertension, heart disease, heart attack, stroke, chronic lung disease.
• Highest income/education had lowest reported aliments. The only disease for which theinverse is not true is cancer.
• Health insurance costs discourage retirement, but only modestly.
B. Caregiving
The United States is in the midst of a significant and growing caregiving crisis. About 1.4
million older Americans live in nursing homes, nearly 6 million receive care at home, andsignificant numbers go completely without the help they need. And the growing disparity
between the demand and supply of caregiving services will only worsen with the aging of baby
boomers in this country.
Studies have found that women who provide an average of 2 or more hours per week ofparental help worked 43% fewer hours than women overall. Women age 53 to 63 who helped
their parents with personal care reduced their hours of paid work by about 70%.
Analyses suggests that devoting time to informal care of older parents may be incompatible
with having a full-time job in middle age.

32

ILC-USAUnited States of America
Argentina
The Netherlands
Israel33

South Africa

Global Aging Report

India

Workers with defined benefit plans (usually including retirement incentives, lifelong benefits
and reduced pension investment risks) retire on average 1.3 years earlier than those withdefined contribution plans such as 401k (s). Continued workforce participation: By age 65 bothmale and female labor force participation decreases to close to half of people in their 50s.
However, an increasing proportion of people in their mid-50s state that they expect to beworking fulltime after reaching age 65. In 2000-2002 people cited a variety of reasons for
retirement: One third cited more family time. One quarter stated they wanted to do other things.
In the 55-59 age range, 35% cited poor health. Cigarette smoking and sedentary lifestyle had alarge impact on both the incidence of workforce disability and death in men and women who
left the work force before the early retirement age of 62. Arthritis and hypertension were themost commonly reported afflictions in those ages 55 and older who were employed.

Dominican Republic

The defined contribution plan (DC), which is becoming the predominant plan in the US,
operates very differently. Under a DC plan the employee, often aided by the employer, setsaside a specific amount of money at regular intervals. At retirement, the employee has anaccount balance which is completely dependent on how much has been put into the fund andhow these contributions have grown over time as they have been invested. Thus, in a DC plan,
the employee is at risk if invested funds do badly. The account balance can be taken as a lumpsum or used to receive a pension.

United Kingdom

The defined benefit plan (DB) was, for many years, the main type of plan that large employers
offered, wherein the employer def ines and guarantees a specif ic pension amount to theemployee. The benefit is determined according to a formula or computation based on theemployee’s salary and years of service. Under the DB plan the employee is entitled to thepromised specific benefit. Employers with DB plans are required to set money aside to pay
promised benefits and to pay into an insurance fund to cover benefits if the employer is unable
to fulfill that commitment.

FranceRetirement income in the U.S. rests on three sources of income: pension, social security andpersonal savings. Pensions that were traditionally def ined benef its, have been largely
supplanted by defined contribution plans that makes employees responsible for creating andmanaging their retirement funds.

Japan

C. Pension/Economic Security
In 2002, 30 percent of individuals who remained economically active after age 70 held
professional and managerial jobs. The share of workers in clerical and sales positions was only
slightly less, accounting for about 27 percent of all jobs over age 70. Among workers over age
50, older people appear to have more flexible work arrangements than do younger people. An
increasing percentage is self-employed.

Social Security, on the other hand, is a government run pension program that protects all older
Americans by providing a guaranteed subsistence safety net.
D. Status of Older Women
Women in the United States make up a full 70 percent of all older people who are poor. The
poverty rate increases substantially with duration of widowhood, rising 22% for 20 year of
widowhood. Women are far more likely than men to outlive their retirement incomes because
of several factor:• women are more likely than men to leave their career to work in unpaid caregiving roles• women still earn significantly less than men, leading to less retirement savings• women live longer than men• many pensions decrease in value or are eliminated entirely when the husband dies
• a divorced woman must have been married at least 10 years to be eligible for her
former husband’s social security benefits
Section 3: Current and Future Needs for Research/Training/Policy Change in the Region
Every day, 12,000 baby boomers in America turn 62. A new generation of older Americans isforming. With each year we gain in life, the United States falls further behind in preparation.
Corporations are watching their workforce age. Policymakers are struggling to keep financial
and health support systems in place. Scientists are rushing to find treatments for age-related
illnesses. The key issues for the United States to address are as follows:
1- Age Discrimination: Ageism is one of the most pervasive prejudices across human society,especially in the United States. Although ageism is less acknowledged than racism or sexism, it
is a harmful prejudice that results in widespread mistreatment, ranging from stereotypic anddegrading media images to physical and financial abuse, unequal treatment in the workforce,and denial of appropriate medical care and services.
2- Redesigning Healthcare: The essential structure for health care for older adults in the UnitedStates has not changed for 40 years. It remains a reactive medical insurance system rather thana proactive health system, with an emphasis on acute in- and outpatient care. In 1965 the fields
of geriatrics and gerontology were not well established in the United States. Consequently,
neither experts in the care of older persons nor older persons themselves were included at the
Medicare planning table to make a case for the specific needs of older patients, which include
the complexity of issues associated with their health and the extra time a physician needs totake care of such complex patients.
3- Geriatric Training: Medical students in the United States are not prepared for the older
patients who will dominate waiting rooms and hospitals during the next decade. Only 11 of the34

ILC-USAUnited States of America
United Kingdom

5- Longevity Research: Rates of disability and the cost of health care among older people could
be avoided if the United States invested in research that looks at the basic biology of aging. The
National Institute of Health is funded at $28 billion in 2006 but less then 0.1% of that amountwent to the understanding of the biology of aging and how it predisposes people to a suite of
costly diseases and disorders.

France4- Caregiving: The United States is in the midst of a significant and growing caregiving crisis.
About 1.4 million older Americans live in nursing homes, nearly 6 million receive are at home,and significant numbers go completely without the help they need. There is a shortage of welltrained professional caregivers and a lack of structured support for family caregivers.

Japannation’s 125 medical schools require courses in geriatrics, and only 5 have established geriatrics
departments.

Section 4: Proposal of an Agenda to Help Resolve the Concerns Outlined in Section 3

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Argentina

3- Geriatric Training: In order to improve the health and well-being of older adults in the UnitedStates, we must develop a cadre of 1,440 or more academic geriatricians, enabling each of the
144 medical schools in this country to at least have ten academic geriatricians on its faculty.
There must be continued support for Geriatric Career Awards through the federal government inaddition to private support to ensure the a foundation of knowledge and leadership sufficient toimprove our health care system’s capacity to care for our aging population.

South Africa

2- Redesigning Healthcare: The United States must work to develop health care that is
proactive, rather than reactive. As our population ages, our system needs to focus on healthpromotion, disease prevention and the treatment of chronic disease. The Medicare program
created in 1965 focused on patients being treated only when sick with little or no emphasis on
prevention and coordination. We must integrate what we now know about health care for older
persons into a new system with an emphasis on keeping people healthy and productive as theygrow old.

India

1- Age Discrimination: The effort to transform the culture and the experience of aging in
America is quintessential and urgent. Legislative initiatives must be proposed at the local, stateand federal level to provide legal protection against age discrimination, incorporating age in the
Title VII of the Civil Rights Act which already protects Americans against sex and racial
discrimination.

Dominican Republic

The International Longevity Center-USA is committed to solving some of the most important
issues facing the aging population of the United States. Our recommendations and agenda for
future action include:4- Caregiving: To combat the growing disparity between the demand and supply of caregiving
services the public and private sectors must join together to solve the growing caregiving crisisin the United States. Our recommendations include developing a curricula for paid and family
caregivers with special modules on dementia, congestive heart failure, and other conditions;working to create an accreditation and national certification program for paid professional
caregivers; establishing a success career ladder initiative to help recruit and retain caregivers;and create a national association for professional caregivers.
5- Longevity Research: The United States must adopt a new research paradigm and provide
major new infusions of money to be devoted to the basic biology of aging and longevity tocomplement funds allocated to specific diseases. Congress should invest $3 billion annual tothis effort, or about 1% of the current Medicare budget of $309 billion. Federal government
also needs to provide the organization and intellectual infrastructure to make this work.

36

ILC-USAUnited States of America
Japan
FranceUnited Kingdom

Shigeo Morioka
President(current Astellas Pharma Inc.)• Former Chairman of the Fair Trade Council of the
Ethical Pharmaceutical Drugs Manufacturing Industry

India

Japan

Dominican Republic• Former CEO of Yamanouchi Pharmaceutical Co., Ltd.

South Africa
Argentina
The Netherlands
IsraelReport from ILC-Centers

ILC-Japan
Section 1: Profile of ILC-Japan• Contact Information:
International Longevity Center-Japan (ILC-JPN)
Toranomon 33 Mori Building 8th Floor, 3-8-21, Toranomon,
Minato-ku, Tokyo 105-8446, Japan
Tel: 81-3-5470-6767
Fax: 81-3-5470-6768
ilcjapan@mba.sphere.ne.jp
http://www.ilcjapan.org• President:
Shigeo Morioka is president of the International Longevity Center-Japan. He was president andCEO as well as chairman of the board of Yamanouchi Pharmaceutical Co., Ltd. (current
Astellas Pharma Inc.) for about twenty years until he assumed the present position in 1999. Mr.
Morioka has served in a number of key positions in the pharmaceutical industry in Japan andabroad, including as chairman of the Fair Trade Council of the Ethical Pharmaceutical Drugs
Manufacturing Industry and executive vice-chairman of the International Federation of
Pharmaceutical Manufacturers Associations. In 1999, he was awarded Japan’s Order of the
Rising Sun, Gold and Silver Star.
• Mission Statement:
Since its founding in 1990, the ILC-Japan has conducted international, interdisciplinary
surveys, research and education on various issues related to the aging society with declining
birthrate. Japan leads the world with the rapid pace of the aging of its population, and the ILCJapan recognizes its important responsibility to share the results of its surveys and researchwith wider society and to actively make proposals based on the concept of “productive aging,”
which the ILC Global Alliance has consistently advocated.
In addition to conducting surveys and research in various fields, the ILC-Japan plays a role innational policymaking projects, including participating in the Japan-U.S. Joint Commission on
Aging. The ILC-Japan also implements education programs that provide accurate information
to the media regarding the aging society with declining birthrate. These programs haveproduced meaningful results. Moreover, the ILC-Japan disseminates scientific information
nationally and internationally on various topics through its journals and website, with the aimof creating a new value system for the epoch-making longevity revolution.

38

ILC-Japan

United States of America
France• Year Organized:• 1990 — Founding Member

Japan

Aiming to make Japan into a society where the longevity of individuals is a great asset tosociety, the ILC-Japan will continue to address issues in the future drawing on its cooperative
relationship with the ILC Global Alliance.

• Major Affiliations:• Ministry of Health, Labour and Welfare• International Network for the Prevention of Elder Abuse

Dominican Republic• Major Activities/Programs:• PR and educational activities through the journals and website• Five-Year Longitudinal Study on People Age 75+• “A Profile of Older Japanese” Project

United Kingdom• Sources of Funding:• Subsidies from the Ministry of Health, Labour and Welfare and some privatecompanies and organizations• Annual membership fee paid by supporting members (approximately 40 major
Japanese companies)

India

Section 2: Profile of Ageing in the Region

South Africa
Argentina

1. Brief Review of Aging Demographics
As of April 2008, Japan had a population of 127.69 million, of which 27.78 million werepersons age 65 and over (11.89 million men and 15.98 million women) for an aging rate of
21.8 percent. In 1985, the aging rate was 10.3 percent, indicating that the aging rate has
climbed rapidly in that twenty-years’ period. The aging rate is estimated to reach 31.8 percent
in 2030 and 39.6 percent in 2050. What should be noted in particular is that the old-old (thoseage 75 and over ) segment is expected to make up 19.7 percent of the total population in 2030
and 24.9 percent in 2050. At the same time, Japan’s birthrate is still low with 1.34 in 2007.
Japan has the highest aging rate in the world today and this will continue in the near future.
2. Summary of the Main Trends/Issues of Ageing in the Nation

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A. Health/Medical Care
Japan’s life expectancy at birth was 79.18 years for men and 85.99 years for women in 2007.
The healthy life expectancy was 72 for men and 78 for women, the longest in the world. Japan
has a universal healthcare system. Patients can select their provider of healthcare services, andthey pay a 10 percent to 30 percent co-payment in principle. Japan’s healthcare system
functions effectively today, although it faces various challenges which it must overcome.
B. Long-Term Care Insurance System
The long-term care insurance system, initiated in April 2000, aims to have all members ofsociety join together to support older persons who need long-term care (in principle, those age
65 and over) through the end of their lives. Services include in-home services, institutional
services, and preventive care. The level of services provided for an individual is determinedbased on his or her long-term care needs; and he or she can select home-help services, homevisit nursing, or day services depending on the level of services needed. The co-payment is 10
percent.
At the time of the 2005 revision to the long-term care insurance system, preventive careservices were incorporated, and efforts aimed at preventing the need for long-term care were
strengthened.
C. Pension/Economic Security
Japan’s universal pension scheme is essentially a two-tiered system. It is composed mainly of(1) the national pension system for all people and (2) the employees’ pension for salaried
workers. The income replacement ratio for a model Japanese household in which the head ofhousehold is employed for forty years is about 59 percent today, and policymakers hope tostabilize that figure at about 50 percent in 2023. The annual per capita income of older-personhouseholds is about 1,900 million yen. Pension income makes up 70.2 percent of the income ofolder-person households.
D. Employment and Retirement
The Labour force rate of older persons is high in Japan, standing at 68.4 percent for those aged
55 to 64. To further expand employment opportunities for older persons, the revised Law
Concerning the Stabilization of Employment of Older Persons came into force in fiscal 2006.
Under the revised law, companies that presently impose mandatory retirement on theiremployees are obligated to (1) raise the retirement age from the currently common 60,(2) introduce a viable plan to continue the employment of post-retirement age workers, or(3) abolish the retirement practice.
In a Cabinet Office survey on older persons’ participation in the community, those respondingthat they had participated in a group activity in the community at least once in the preceding 12months increased from 43.7 percent in 1998 to 54.8 percent in 2003. There are high hopes thatbaby boomers will get involved in volunteer activities after they retire, and some say that a new
culture will be created. However, it is not yet clear what kind of activities the baby-boomer
generation will choose to get involved in.

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It is forecast, however, that Japan’s aging rate will exceed 30 percent and the old-old will makeup 20 percent or more of the total population within the next 30 years. If we think about thisJapanese society of the future, dramatic reforms of the overall social system and of people’svalue system are called for. The key issues for Japan to address are as follows:

South Africa

It can be said that Japan today has an industrious, highly-educated populous, prosperous
economy, a low level of crime, and a well-developed social security system. So far, the reformof the social welfare programs and the change in people’s attitude about aging have kept up
with demographic changes — namely, the launch of the long-term care insurance system(2000), the reform of the healthcare system (2004), the reform of the pension system (2004),
and the measures to raise the retirement age (2005), which have been supported by people’s
strong desire to work.

India

Section 3: Current and Future Needs for Research/Training/Policy Change in the Region

Dominican Republic

Prior to the Elder Abuse Prevention Law, Japan promulgated the Law Concerning thePrevention of Child Abuse (Child Abuse Prevention Law) and the Law for the Prevention of
Spousal Violence and the Protection of Victims (Domestic Violence Prevention Law) in 2000
and 2001, respectively. Not many countries have enacted laws in all three of these areas, and interms of legislation Japan is considered an advanced nation in the area of abuse prevention.

United Kingdom

F. Abuse Prevention Laws
In Japan, the Elder Abuse Prevention and Caregiver Support Law (Elder Abuse PreventionLaw) was promulgated in 2005. The only countries that have promulgated elder abuse
prevention laws on a national level are the U.S., South Korea, and Japan; and Japan is the firstin the world to incorporate support programs for caregivers (mainly family members providingcare) in a law that both protects human rights and provides for welfare services.

France

The total number of people certified by municipal offices as needing services in the long-termcare insurance system was 4,637,100, of which 3,239,100 were women and 1,398,000 were
men.

Japan

E. Status of Older Women
Older women living alone made up 19.0 percent of all older persons in 2005 (older men living
alone: 9.7 percent), representing a significant increase from 12.9 percent (men living alone: 4.6
percent) in 1985. The annual per capita income of older-person households (including pension
income) is about 1,900 million yen. The income of older women living alone, however, is 1,679
million yen (older men living alone: 2,266 million yen). One reason for this is that there were
few employment opportunities for the current generation of older women when they were in theworking age.

A. Is Economic Growth Possible in a Society with a Declining Working-Age Population?
Japan’s real GDP in 2007 was up 1.6 percent from the previous year. Today, the economic
recovery is expected to continue. However, a major risk factor is the decrease in the working-age
population accompanying population aging. The Japan Institute for Labour Policy and Training
estimates that the workforce, which numbered 66.6 million in 2006, will fall to 62.2 million in2017 and further to 55.8 million in 2030, assuming that labor force participation rates remainunchanged by gender and age from those of 2006. In other words, a decrease of about 10 million
workers is forecast. If the economy were to slow down, the employment, savings rate, andinvestment activities of older persons are forecast to decrease, as is government expenditure forsocial security. This would have a dramatic impact on the lives of older persons.
B. Can Japan’s Social Security System Handle an Era Where the Old-Old Make up Morethan 20 Percent of the Population?
The ratio of the social security burden to national income was 15.0 percent in 2008,
representing a dramatic increase from the 1980 f igure of 9.1 percent. The aging rate is
expected to increase further in the future, and the number of the old-old in particular ispredicted to rise. This will pose a great challenge to the pension system, which supports thelifestyles of older persons, as well as to the health insurance and long-term care insurance
systems. Needless to say, the number of people needing medical treatment or long-term careincreases as people enter the old-old age group. Moreover, the rise in the number of the old-old
is forecast to link directly to an increase in the dementia rate, and data indicates that the
number of people with dementia will climb from today’s 1.7 million to over 3 million in 2025.
It is urgent for Japan to train physicians, nurses, and care-giving professionals with in-depth
professional knowledge of dementia.

Number of Older Persons Certificated for Long-Term Care Services(1,000 people)
Young-old (age 65–74)

Old-old (age 75 and over)649 (4.4%)

3,797 (29.3%)

Sources: Ministry of Health, Labour and Welfare, Monthly Report on the Actual Condition Survey Concerning Long-term Care Benefits, March 2008
and Ministry of Internal Affairs and Communications, Population Estimates, estimates as of March 1, 2008.

C. Can Japan Attain a Balanced Population Structure in the Future?
Japan’s birthrate was 1.76 in 1985, 1.42 in 1995, and 1.26 in 2005. Although the birthrate
recovered slightly to 1.34 in 2007, the number of marriages is on the decline, so it is notexpected that this upturn represents a lasting recovery. With the declining birthrate, the aging ofsociety as well as a decrease in the population are anticipated. Japan’s population in 2006 was
127.77 million. Based on medium variant projections, the birthrate will be 1.24 in 2030, 1.26 in
2055, and the population would be 89.93 million in 2055. These changes represent a major

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Regarding older persons who require long-term care, including those with dementia, we needto improve the quality of care and to support caregivers. Japan’s long-term care insurance
system aims to make long-term care not just a family issue. A national awareness-raising
campaign is underway to promote community measures to support people with dementia andtheir families. This is part of a movement to encourage people to view long-term care as
something that all members of society join together in providing.

South Africa

Other key tasks for the ILC-Japan are to conduct activities to promote the independence ofolder persons, improve their QOL, and foster a new 21st century image of older persons as
independent. The ILC-Japan should publicize the findings of its longitudinal study currently
underway regarding the daily lives of people age 75 and over. After the completion of this fiveyear longitudinal study, we intend to broadly publicize the new independent lifestyles of older
persons revealed in the study.

India

From the perspective of preventive medicine, Japan is now promoting the Health Frontier
Strategy as a broad national health promotion campaign. Additionally it is crucial that Japan
extend the healthy life expectancy by striving to change people’s attitude. By increasing thenumber of healthy and active older persons, we will be able to provide more generous assistanceto older persons who need healthcare, long-term care, or welfare services. We should allocate
resources effectively by refraining from classifying all older persons categorically as vulnerable.

Dominican Republic

At the same time, a change in the “grand design” is called for to transform the social structure
according to the change in definition of older person. Various issues must be explored to
identify ways to facilitate older persons’ contribution, such as how they can continue toperform highly productive labor, how we can create flexible work formats for them, and how
we can help them develop work skills and pass them down to the next generation. This is theessence of the quest for productive aging which we believe important enough for the ILCGlobal Alliance to address together.

United Kingdom

As an answer to the issues mentioned in the preceding section, we would suggest the definitionof older person to be changed: for example, the age limit to working/employment should beraised from the current 65 to 70. Aging societies face the crucial task of encouraging themembers of the traditionally called “retired” generation continue to contribute to theircommunity and society.

FranceSection 4: Proposal of an Agenda to Help Resolve the Concerns Outlined in Section 3Japandemographic transformation of Japan. Using an “optimistic” birthrate estimate of 1.53, 1.55 forthose two years, respectively, the population in 2055 would be 97.77 million. Effective national
policies and national dialogue are needed to deal with the challenge of population decrease.

In addition to enhancing the understanding of Japan’s system, we need to evaluate it critically.
Furthermore, it is important that we widely disseminate our findings both nationally andinternationally. As Japan will be the first in the world to experience a super-aged society, theILC-Japan is committed to actively cooperate with government and private corporations topromote the improvement of the QOL of older persons.

Reference List
• Cabinet Office, Survey on Participation Attitude of the Elderly in Local Communities 2004
• Ministry of Health, Labour and Welfare, Vital Statistics, 2007 Abridged Life Table 2007 The Reportof the State of the Long-term Care Insurance Project 2007
• Ministry of Internal Affairs and Communications, Population Projections for Japan, Apr.2008
Population Census of Japan 2005
• National Institute of Population and Social Security Research, Projected Population of Japan, Dec.
2006 Social Security in Japan 2007
• OECD, Health Data 2007 Employment Outlook 2007
• The Japan Institute for Labour Policy and Training, Workforce Supply and Demand 2007
• WHO, World Health Statistics 2007

44

ILC-Japan

United States of America
Japan
FranceUnited Kingdom

Françoise Forette, M.D.
CEO

• Former Special adviser on aging of the Minister of
Health, Social Security, Elderly, Family and Disabled
persons

India

FranceDominican Republic• President of the Board of Directors of the Hospital Broca

South Africa
Argentina
The Netherlands
IsraelReport from ILC-Centers

ILC-France
Section 1: Profile of ILC-France• Contact Information:
International Longevity Centre-France (ILC-France)
49 rue Mirabeau
75016 Paris
Tel : + 33 (0)1 55 74 67 09
www.ilcfrance.org• President:
Professor Françoise Forette MD is CEO of ILC-France. She is Professor of Internal Medicine
and Geriatrics, University Paris V, CHU Cochin-Necker, since 1994. Director of the French
National Foundation of Gerontology since 1982. President of the Board of Directors of the
Hospital Broca since 2002, Past president of the French society of Geriatry and Gerontology,
Member of the board of the Croix-Rouge.
• Mission Statement:• To catalyze the development of all innovating and constructive solutions to accompany
the challenge of the demographic revolution• To promote information in order to modify the political decisions for an active
longevity in good health• To develop an interface with researchers and decision makers on ageing• Year Organized:• 1996• Major Affiliations:• None• Sources of Funding:• Grants from Public Health Ministry and private companies• Membership fees
• Earnings from consultant activities• Major Activities/Programs:• Dissemination of Guidelines (vision, cognitive health, hearing, Advice for Parents,
balance) to the general public

46

ILC-FranceUnited States of America
United Kingdom
Dominican Republic

1. Brief Review of Aging Demographics
In 2007, the total population of France was estimated at 63.4 million. As in other nations, theFrench population continues to age (Figure 1), and the proportion of the youngest age groups isdiminishing despite the fact that births rose sharply to 2 children per woman in 2006, reaching
their highest level since 1981.

FranceSection 2: Profile of Ageing in the Region

Japan• Research studies on health and activity life expectancy indicators (HWLE)• Conferences on health prevention as a major factor of productive longevity withnumerous institutions (OECD, Les Echos, Women’s forum, FNSEA, FNAR, privatecompanies and institutions, etc.)• Pilot study “Company in good Health” on going• International conference with UNESCO in 2005- Paris: in press FIAPA• 12th, 13th, 14th Parliamentary meetings on Longevity — Paris in 2005/2006/2007• Regular meetings of the Parliamentary working group on Longevity

35
India

30
25
20
15
10

South Africa% of less than 20 yrs old

5% of more than 60 yrs old
p
05
20

00
20

80
19

60
19

46
19

20
19

19

01

0

Argentina

Figure 1: Evolution of the structure by age of the French population since the beginning of the
XX th century.1

2. Summary of the Main Trends/Issues of Ageing in the Nation

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The Netherlands

A. Health/Medical Care
In 2005, 20.9% of the population (14 millions persons) is aged sixty and over (Table 1), andthere will be a continuous increase in the populations over sixty until 20501.

Year

2005

2010

2020

2030

2040

2050

> 60 yrs (%)

20.9

23.1

27.3

31.1

33.5

35.0

> 75 yrs (%)

8.1

9.0

9.6

13.1

16.1

18.1

> 85 yrs (%)

1.8

2.5

3.4

3.8

6.1

7.5

>100 yrs(%)

0.02

0.03

0.04

0.09

0.14

0.26

centenarians(x1,000):

15

21

24

60

87

165

Table 1: Evolution of the percentage of the French population aged 60 and over from 1950 to2050 (central scenario) – Adapted from1

Life expectancy (Table 2) remains on a steady uptrend, exceeding 77 years for men andreaching 83.3 years for women2

Men

Women

Years
At birth

At 60 years

At birth

At 60 years

1994

73.6

19.7

81.3

25.0

2000

75.3

20.4

82.1

25.6

2006(p)

77.1

21.7

83.3

26.6

Table 2: Life expectancy at birth and at sixty years old.2 Insee Première N° 1118- January
2007

The female advantage over males in life expectancy remains nearly universal at each age andperiod, and the same trend is observed in France. But there seems to be a slight stagnation in
the increase of life expectancy for women, probably because of the increase in lung cancers infemale smokers. Nevertheless, the demographic pyramid3 clearly shows the predominance of
women in the older population. (Figure 2)

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ILC-FranceUnited States of America
Japan

400

300

200

0

1906
1911
1916
1921
1926
1931
1936
1941
1946
1951
1956
1961
1966
1971
1976
1981
1986
1991
1996
2001
2006

FemmesFemales

0

100

200

300

400

500
Dominican Republic

Frabce métropolitaine ■
DOM ■

100

100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0

United Kingdom

500

HommesMales

France

1906
1911
1916
1921
1926
1931
1936
1941
1946
1951
1956
1961
1966
1971
1976
1981
1986
1991
1996
2001
2006

Effectif en milliers
Number (thousand)Figure 2: The French population pyramid at January 1, 2007 - Insee-Edition 2007-France infigures-

Women

North of France

73.6 yrs

81.8 yrs

Paris and around78.4 yrs

84.5 yrs

Argentina

Men

South Africa

RegionTable 3: Mean life expectancy at birth in France, comparison of two regions (Insee 2004)

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B. Long-Term Care Insurance System
The absolute number of frail elderly needing assistance or long-term care, either at home or in
an institution is close to one million individuals — but it must be emphasized that thepercentage is low: only 6.63 percent of the population over sixty — suffer from loss ofautonomy because of disabling diseases. The rate of loss of autonomy is higher in women than

Global Aging ReportIndia

All people do not equally enjoy an excellent health status reflected by their life expectancy: forexample, in France, the place where one lives may also have an influence. Life expectancy atbirth is five years lower for men in the north of France than in the Paris region. The differenceis only 2.7 years in women (Table 3)

in men at very advanced ages. (Table 4)

Age

Men

Women

Total

60-69

2.19

1.95

2.06

70-79

4.99

4.35

4.65

80-89

13.40

19.85

17.69

90+

29.31

46.45

42.55

Total

5.00

7.80

6.63

Table 4: 6.63% of people with Loss of Autonomy among the Senior Population Aged Sixty
and Over in France-(Insee –HID study -GIR 1-4) Etudes et résultats N° 94-décembre 2000

The age-related increase in the prevalence of Alzheimer’s disease and related disorders,
represent 70% of the causes of institutionalisation and 72% of the requests of the APA
allowance. Existing structures for elderly over 75 years old are in Table 5.

Type of structures

years
1984

1991

2003

Number of 75+ (in millions)

3.1

3.9

4.8

Home helps (x1,000)

510

507

278

Home care nursing services(x1,000)

24

42

71

450

498

589

47.7

110.8

284

54

69

79

504

567

669

Number of beds in housing andliving facilities (x1,000)(of which nursing home x1,000)
Number of beds in long term careinstitutions (x1,000)
Total : 75+ in public and private
structures (x1,000)

Table 5: Evolution of home services and public/private housing facilities for 75+. BEH-N° 56/2006

After the heat wave in the summer 2003, the French government strengthened existing policies
and introduced new plans:

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India

C. Employment and Retirement (Profile of Retirees)
While the lawful age of the retirement in France is fixed at 60 years, French stop working at 58
years as a mean. The recommendations of the European Council in Stockholm in 2001
established an objective of employment rate of 50% for the 55-64 age group by the year 2010.
In 2005, the employment rate for this age group in France is 37.9 % despite a recent trend

Dominican Republic

As a whole, these new laws and plans should greatly improve the condition of the frail anddependent elderly in France.

United Kingdom• A Geriatric University Plan was implemented in 2005 in order to double the number ofProfessors of Geriatrics from now to 2010. In addition, geriatric acute care units arebeing set up in all hospitals with emergency wards and the number of rehabilitation
beds is increasing.
• Shifting the balance toward home-based care and home services aimed at giving a
choice to the older persons (Scénario du libre choix). The creation of a new checksystem «chèque emploi service universel» (CESU) co-financed by employers andcommunities will also facilitate the payment of the social workers and a variety ofhome helps by the community.
• An Alzheimer Plan was implemented which aimed at raising the rate of early diagnosis(presently at 50%) by increasing the number of Memory Clinics (263 up to 300) andthe number of Resources and Research Memory Centres (24 up to 30). The second
objective is to train GPs, professionals, patients and caregivers, and to support families
and informal carers. A new Alzheimer’s Plan was recently implemented by the
President Sarkosy in order to strongly promote research and high quality cares for
Alzheimer patients. This plan was published in November 2007.

FranceTotal expenditures on Long Term Care represent a little more than 1% of GDP (15 billiard C ).

Japan

• The law “Vieillissement et Solidarité” in 2004 was completed by the law “SolidaritéGrand Âge” in 2006. One of the most important outcomes was the creation de novo ofa new branch of the Social Security System (the Health system covers all persons
living in France) called “Caisse Nationale de Solidarité pour l’Autonomie”, CNSA. It
covers the risk of dependency and offers part of the financing of long-term care either
at home or in institution. This new agency is financed by the Health System for
medical costs and by a new system for the remaining costs: 9 billion C for the 20042008 period, funded from the product of an extra work day called “Solidarity Day” forall employees and a 0.3% tax for the employers. It covers: The costs of dependency
care either at home or in institutions through a specif ic allowance called APA(personalized allowance for autonomy). In 2007, 1,078,000 persons beneficed of thisallowance, 61% were living at home and 39% were institutionalized.4

upward and it still remains far behind the European average of 44.1% (EU 15). After age 60,
the French situation is even more critical with 7% of men and 4% of women in the economic
circuit as compared to Sweden (respectively 23% and 14%).
Reforms are under way to improve the incentives and opportunities for older people to play apart in the labour market for longer, and to tackle the various disincentives and barriers to
employment facing older workers. This requires collaboration between the public authorities,
employers and unions in the following areas:• Reform retirement and social welfare systems to strengthen work incentives(progressive retirement, new contracts, simultaneous working/retiring). The French
pension system is based on the pay-as-you-go principle and its financing is mainly
ensured by contributions from workers and employers. A “capitalisation” scheme will
be proposed to individuals in complement of this “repartition” system.
• Encouragement to change the attitudes of employers and workers.
• Adaptation of employment protection rules to promote safe working conditions andemployment of older workers.
• Promotion of training for upgrading skills and acquiring new ones.
• Improvement of the access to high-quality employment services for older job seeker.
Recently, an ILC France research project put forward an innovative Healthy Working life
expectancy indicator (HWLE)5 at age 50 in Europe, which offers a model of successful
ageing combining two essential dimensions: the absence of disease and the employment ofseniors. In average in Europe, among the 20 years available between 50 and 70 years old, men
spend 14.1 years in good health, of which about one half at work, and women 13.5 years ingood health, of which about one third at work. Therefore, it should be in theory possible toincrease healthy working life expectancy between 50 and 70 years old, especially for women,
by reallocating years in good health from retirement to work.
Section 3: Current and Future Needs for Research/Training/Policy Change in the Region
Despite the important political measures that were undertaken during the last 5 years, further
research and policies are necessary to turn France’s demographic challenge into an opportunity.
Professor Françoise Forette highlights that “Active and healthy ageing is a unique opportunity
for France and Europe to create wealth. Our leaders and the French President should create
the right health and labor environment to ensure that we do not fail meet this challenge”.
The ILC-France recent manifesto proposes the promotion of policies and initiatives to improve
both healthy and active ageing.
Key points of the manifesto include:

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Numerous experimentations on intergenerational integration have to be implemented to fightthe discrimination against the elderly. Preventing maltreatment of elderly and improving end oflife care are also major objectives.

Argentina

Another major objective for the French society should be to change the image of aging in orderto accept longevity as an opportunity and not a handicap. Then, it is mandatory that the
government implements a communication plan towards the French public at large. This plan
has to lasts for several years, in order to obtain deep change in citizens’ minds and in public’s
perceptions.

South Africa

It is also important to provide more flexibility for older workers. Working environments should
be adapted to accommodate physical and health conditions, and the retirement age should bebased on a number of years of contributions to the pension scheme and not on a defined age
limit. Tax incentives for those people who want to work longer have to be implemented.

India

Active Ageing
It is important that the lifecycle approach to work be strengthened, including more incentives
for prolonged active ageing. There is a strong need to better appreciate and recognize the valueof experienced workers. Therefore, the government should provide mechanisms to financially
support training schedules for older workers, and encourage lifelong learning to maintain theircompetitiveness and employability.

Dominican Republic

Promoting ICT and gerontechnology is also an important challenge for the next decades.

United Kingdom

Involving the healthcare community is another key element. Therefore, ILC France
recommends that lectures on ageing and geriatrics become mandatory not only for medical
students, but for all health care professionals.

FrancePrevention should also be at the core of any public health policy. In particular, publicauthorities should develop the contact points between consumers and doctors. Strengthening
the role of occupational medicine and the relationships with schools, universities or companies
would help spread key prevention messages and best practices.

Japan

Healthy Ageing
Promoting health, prevention and lifestyle education through the life course is a priority andshould start at an early age. Therefore, specific school programmes should promote concrete
safe daily behaviors which can contribute to maximize children’s health, e.g. global lifestylewith more physical exercise, careful dietary supervision, protection of vision, healthy heart,skin and brain.

Section 4: Proposal of an Agenda to Help Resolve the Concerns Outlined in Section 3
The agenda for the next 2 years is as follows:• Complete the pilot study “Companies in good health” aimed at evaluating theeff icacy of a prevention program in the work place which is a prime location to
improve the health literacy of employees. If the efficacy of such prevention approaches
is proven, the methodology of the study will be proposed to other companies andorganizations and to English speaking countries. The results of the study will be
published in a peer-reviewed journal and largely communicated to policy makers when
considering possible employment reforms.
• Strengthen a communication plan to promote the important results of HWLE withpress conference and specific EU colloquia on indicators of healthy and active life
expectancy. Expand if possible the methodology to North America and Japanesecountries.
• Follow up of the studies with ILC-US e.g.: Expand and develop the “World City
Project” in suburb with comparison of Great Paris and New York.
• Set up workshops and experimentations on gerontechnology with ICT companies.
• Take an active part inside the French Parliamentary working group on Longevity.

Reference List
1

Gaymu J., Aspects démographique du vieillissement. BEH 2006; 5-6/2006(2006):38-39.
Richet-Mastain L. Bilan, Démographique 2006 :un excédent naturel record, Insee Première
2007; 1118(Janvier 2007).
3 Bras M-A, Pégaz-Blanc O, Martial F, Di Franco M, Khouri J., France in figures. Insee,
editor.6-7.2007, Ref Type: Serial (Book,Monograph)
4 Espagnol P., L'allocation personnalisée d'autonomie au 31 décembre 2007; Etudes etRésultats 2008.
5 Lievre A, Jusot F, Barnay T, Sermet C, Brouard N, Robine JM et al., Healthy working life
expectancies at age 50 in Europe: a new indicator., J Nutr Health Aging 2007; 11(6):508514.
2

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Japan

FranceUnited Kingdom

Chief Executive• A crossbench (independent) member ofthe House of Lords

India

United Kingdom

Dominican Republic

Sally Greengross OBE

South Africa

Argentina

The Netherlands

IsraelReport from ILC-Centers

ILC-United Kingdom
Section 1: Profile of ILC-United Kingdom• Contact Information:
International Longevity Centre-United Kingdom (ILC-UK)
11 Tufton Street
London, UK, SW1P 3QB
Tel: + 44 (0) 20 7340 0440
rhiannonfreeland@ilcuk.org.uk
www.ilcuk.org.uk• President:
Baroness Sally Greengross is Chief Executive of the ILC-UK.
She is a crossbench (independent) member of the House of Lords and a Commissioner on the
Equality & Human Rights Commission.
• Mission Statement:
The ILC-UK is an independent think-tank influencing policy on societal ageing and population
change. The ILC-UK develops ideas, undertakes research and creates a forum for debate andaction.
• Year Organized:• 1997• Major Affiliations:• None• Sources of Funding:
Income from grants and donations in 2006 was signif icantly higher at £472,125 (2005,£290,873) with the addition of a number of new research projects funded by suchorganisations as the Nuff ield Foundation (Living & Caring? An Investigation of theExperiences of Older Carers), BUPA (Food Preferences in Care Homes), PRU and Partnership
Assurance (Jointly - Asset Accumulation Across the Life Course) and Pf izer (The
Effectiveness of Public Health Interventions, Intergenerational Approach to Dementia andAgeing & Gay). The Alliance for Health and the Future programme has continued.
We have received some core funding from Norwich Union, Age Concern and new corporate
partners of the ILC-UK. Legal and General sponsored our new website design and

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maintenance plus ILC-UK promotional material.

More recent publications include ‘Asset Accumulation’, ‘Age of Inheritance’, ‘National CareFund’, ‘Living & Caring’, ‘Obesity in the UK’, and ‘Successful Ageing & Social Interaction’.

Argentina

Recent events have included ‘Living and Caring? An Investigation of the Experience of Older
Carers’, ‘The New Age of Inheritance and Public Policy’, ‘Funding Long-term Care — Finding
a Fair Solution across the Generations’ and ‘Risk Perceptions and Policy Responses’.
Future events include ‘The State of Intergenerational Relations Today’ and ‘Choosing
Population Projections for Public Policy’.

South Africa

Events have included ‘Promoting inertia, how should government sell personal accounts andwhat should their message be?’; ‘House blockers? Older people & the housing stock in an eraof under occupancy’ and ‘The Great Wealth Transfer? asset accumulation, inequality and thegenerations’. The global conference and parliamentary debate and events on ‘Human Rights
and Older People’, was held in October in London to coincide with the ILCs last annual
meeting.

India

We have initiated some think pieces & policy briefs on our new website, eg. ‘Retirement
Capital & Online Social Networking’ by James Lloyd; ‘Older people’s housing and under
occupancy’ by Ed Harding and ‘Unlocking the Community’ by Simon Goodenough, Director of‘Upstream’ Healthy Living Centre.

Dominican Republic

Past publications include ‘Navigating Health, the role of health literacy’, ‘State of Ageing &Health in Europe’ (funded by Merck) and ‘Dementia in my family’ (funded by Pfizer).

United Kingdom

Arising from our ‘Building our Futures’ project there has been a great deal of work on ‘Older
People’s Housing and Regional/National Strategies’, including local consultancy work with the
Department of Health, Housing and Learning Improvement Network, as well as a Department
of Health publication using data in housing planning entitled ‘Sustainable planning for housing
in an ageing population’ and a ‘Lifetime Neighbourhoods’ discussion paper.

France• Major Activities/Programs:
Research links continue with European Nutrition for Health Alliance (malnutrition), Bristol
Myer Squibb (mental health and hepatitis B projects) and the Alliance for Health and the
Future. As well as research mentioned above, the ILC-UK has been working with Help theAged on ‘The Voice of Older People in Society’ which has now been published.

The Netherlands

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1. Brief Review of Aging Demographics
UK population grows to 60.6 million
age
90
80
70
60
50
males

females
40
30
20
10
0

500

250

250

population (Thousands)

population (Thousands)

500

Population: by gender and age, mid-2006

In mid-2006 the resident population of the UK was 60, 587, 000 of which 50, 763, 000 lived inEngland. The average age was 39.0 years, an increase on 1971 when it was 34.1 years. In mid2006 approximately one in five people in the UK were aged under 16 and one in six people
were aged 65 or over. (Ref: ONS. Population Estimates).
In the UK the ratio of people over 65 has risen from 1 in 20 a century ago to around 1 in 6
today, and will be around 1 in 4 by 2051 when the average man of 65 is likely to have around22 years of life ahead of him, compared with only 12 years in 1950, and 19 today. By the midcentury, the average woman of 65 will expect to reach almost 90. Secondly, with long-term
improvements in health, more of us — 8 in 10 men and 9 in 10 women are surviving middle
life to reach 65. (GAD).
At the same time there is a long-term trend for families to have fewer children or no children at
all so that people over 50, over 65 and (especially) over 85 are set to increase rapidly and they
will form a larger proportion of the total population. By 2051, people over 65 are likely torepresent over a quarter of the population. Over-85s now form just 2 percent of the total
population and 12 percent of the population over 65. By mid-century, they will account for58

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Japannearly 4 in 10 of the over-65s, and 6 percent of the total population. By 2007 the number ofpeople over 65 will exceed the number of children under 16.

2. Summary of the Main Trends/Issues of Ageing in the Nation
FranceA. Health/Medical Care
The NHS is still the overwhelming provider of health care.

The establishment of the National Services Framework has meant a fundamental change inthinking about health and social care services, a cultural shift, resulting in services being
designed and delivered around the needs of children and families.

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The issue of Mental Health gives a continuing dilemma over rights of individuals versus therights of society and need for coordinated services. However, the Government is to produce thefirst ever national dementia strategy in response to one of the great challenges now facing
society. Workstreams will cover improved awareness, early diagnosis and intervention andimproving the quality of care for dementia.

Argentina

Cancer survival rates are up, but the UK is still behind similar nations. Crucial is the need tosee dignity with older issues especially in palliative and preventative care.

South Africa

There has still been a belief in an all-embracing NHS, and that medical advances will reverse
the impact of their lifestyle choices. However, now there is an increasing awareness of rationing
as fact of life in NHS — eg. the role of National Institute for Health and Clinical Excellence(NICE) is impacting on the NHS by giving contentious judgements on dementia drugs, etc. We
are in fact moving inexorably towards a social insurance/shared costs model.

India

However there is fragmentation of responsibility for health behaviour change amongst different
Government departments. It is recognised there needs to be much more integration of services,
especially health and social care and better training for carers and care assistants for older
people.

Dominican Republic

Also there has been a major policy shift towards prevention and early intervention such as
campaigns on ‘behaviour-related’ disease. For example, a brief smoking cessation intervention
costs £500 compared to £30, 000 — £40, 000 for treating patients with advanced cancer.

United Kingdom

Expenditure doubled in 10 years to nearly £90bn — with significant increases in primary care,
new GP contracts etc.

B. Long-Term Care Insurance System
There is increasing awareness of the unaffordability of the current system: LGA/ADSS report
March 2006 identified a shortfall of £1.76bn. in care spending.
The Wanless Report and Joseph Rowntree Foundation research have been encouraging thepartnership model of shared funding: The Government is yet to legislate but a bill is expectedautumn 2007 to bring forward co-regulation for health and social care sectors. There isrecognition of an artificial distinction between health care and social care.
A Dignity in Care Campaign was launched in 2006 aiming to eliminate tolerance of indignity inhealth and social care services through raising awareness and inspiring people to take action. To
date the campaign has focused on older people to ensure that high quality health and social careservices should be delivered in a person-centred way that respects the dignity of the individual
receiving them. Unfortunately, older people are not always treated with the respect they deserve.
Also there has been increased debate over end of life issues — moving from medico-legal
dilemma into the arena of patients’ and human rights.
Recently a report by the Joint Committee on Human Rights showed poor standards in carehomes — 21% of care facilities were failing to meet minimum standards on dignity andprivacy. There is a continuing legal wrangle over the exclusion of private care home residents
from protection of the Human Rights Act.
C. Pension/Economic Security
The State Pension reforms in the recent UK White Paper are intended to make the State Pension
fairer and more widely available and to provide a solid foundation on which people can save.
The Pensions Act 2007 will greatly improve the situation for many women. Both men andwomen will gain from the reforms, but a number of the measures — focusing on fairness andimproving coverage — will particularly improve the pension outcomes of women. For the firsttime, caring will be valued equally with work so people taking time out of the labour market toundertake caring responsibilities will not be disadvantaged in terms of their state pension
entitlement.
This increased income is income which women can receive independently — they do not need
to be reliant on a partner to receive these amounts.
Auto-enrolment into personal pension accounts has potential advantages which should lead toan increase in the number of people saving for their retirement. But there are concerns aroundthis — eg. failing to address under-saving by the low paid, self-employed, contract workers.

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Dominican Republic

D. Employment and Retirement
The distinction between two states is much less obvious than even a decade ago. There has
been a slow policy adaptation to the idea of flexible work generally and continued working
beyond ‘normal’ retirement age: A Work and Families Act gives workers the right to request
flexible working hours but not the right to receive them...if we are serious about recognisingcomplex inter-generational care issues, and the contribution of older workers, there must be an
improvement on this. 56 percent of working-age people in Great Britain expected theirretirement to last at least 20 years. Only 7 percent thought they would be in retirement for lessthan ten years.

United Kingdom

Between 2004 and 2006, total membership of occupational pension schemes fell. Althoughover the last eight years pensioners’ incomes in Great Britain have risen faster than average
earnings, the levels of income that older people receive falls with age so that older pensioners
have less wealth than those around State Pension Age.

FranceThe Welfare Reform Act intends to reduce dependency on the Incapacity Benef it, acontributory but expensive benefit. Half the claimants are aged over 50. The Government do
not seem to have the right balance between coercion and incentive.

Japan

However, the Government’s proposals to increase the state pension age to 68 by 2050, will
improve the overall sustainability of the system.

India

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However an earlier report, April 2007 ‘State of the Modern Family — the ageing populationand the demands on parents and carers’ highlighted care responsibilities stating:Argentina

E. Status of Older Women
The final report of the Equal Opportunities Commission (August 2007) showed worrying
gender gaps across all areas of life and at the current rate of progress, change will be painfully
slow. For example, it will take almost 200 years to have equal representation of women inparliament. This is disappointing given the priorities of the present Government over 10 years,
particularly in implementing EU social chapter directives.

South Africa

The Retail sector has led on employing the over 50s around the time that Age Discrimination
legislation came into force in October 2006 to give new employment rights to everyone in workor looking for work. This Age Discrimination legislation will also do away with compulsory
retirement below age 65. Three priorities for government action are to achieve higher
employment rates and greater flexibility for over-50s combining work with other commitments;
to enable older people to play a full and active roll in society and to allow us all to keep
independence and control over our lives as we grow older.

“Support for modern families does not just mean childcare. Millions of people care for older
relatives or friends and 1 in 4 carers also have dependent children to look after. The increasing
expectation of disabled and older people to be able to live independently can only be achievedby effective social support services. At the moment much of this support is provided by unpaid
carers, many of whom face real diff iculties in f inding work that f its with their caring
responsibilities.”
The new UK Government in July 2007 has announced 3 priorities:
1. Supporting the care of older and vulnerable relatives by families, particularly as theybring up children;
2. Tackling violence against women and improving the way society deals with women
who commit crimes;
3. Empowering black and ethnic minority women to build cohesion within and between
communities.
Women continue to form the bulk of the professional care workforce, i.e. informal carers andchild carers. However, a visible polarisation in wealth in UK impacts disproportionately on
women; for example, there is a geographical north-south divide with more poorer women innorth.
F. Issues unique to the United Kingdom
There are tensions arising from the clash between economic policies that promote flexible
workforce, de-regulation and competitiveness in global economy, and the need to adapt ourlabour market, in particular, to the realities of demographic change and longevity.
For instance, the UK opted out of the EU Social Chapter during much of the period of
economical and industrial change in the 80s and 90s, so we are now ‘bolting on’ these
directives (designed to safeguard workers’ rights, work/life balance, etc) on an economy andsociety not adapted for them.
Another major issue is weaning the British away from attachment to traditional welfare statemodel towards social insurance and partnership models.
One of the most pressing needs throughout the UK is to achieve the better integration of healthand social care to allow older people to be cared for within their communities.

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Dominican Republic
India

The Government is to produce the first ever national dementia strategy in response to thegrowing toll of dementia in the older population. This strategy will focus on early diagnosis
and intervention; improving the quality of care for dementia and professional training needs.

United Kingdom

Mental ill-health
Mental ill-health is also a significant concern for older people. Depression in later life affects
10-15% of persons over 65. Yet many older people attribute depressive symptoms to physicalcauses, effectively contributing to under-diagnosis and under-treatment — and physician
attitudes often match those of their older patients.

FranceHealth and Social Care
It is estimated that 1.2 million older people in England use social care services (Commission
for Social Care Inspection 2005b). Yet the full costs of social care are poorly understood.
Funding derives from a multitude of sources. Social care is means-tested, thus state funding is
restricted to those with relatively low financial means. This often comes as a surprise to older
people who have assumed that social care for a frail older person with dementia or severe
arthritis will be provided by the state in the same manner as NHS funded health care. Policy
efforts are focused on finding alternatives to means-testing which may give individuals greater
flexibility to fund their care. For example, pilot schemes are underway in Scotland looking at
direct personal payments for all social care.

Japan

Section 3: Current and Future Needs for Research/Training/Policy Change in the Region

Finally, health promotion efforts are too often targeted solely at younger populations and needto take into account the full age spectrum.

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Argentina

The Government has recognised the centrality of housing to the ‘active ageing’ agenda, andhousing is mentioned in a raft of cross-sectoral guidance issued by the Department of Health,South Africa

Housing
Housing is central to efforts to ensure our healthcare, social care, community services and built
environment are equipped cope with the demands of population ageing. Older people spend
more time at home than other generations, around 70-90%. Yet the UK has a very large stockof older, ageing homes. One survey estimated that around 1 million older people live inproperties over 90 years old. Decent, appropriate housing has the potential to make government
goals of active ageing and wellbeing in later life real, but conversely poor housing will do the
opposite, exacerbating chronic conditions and disability. For example, falls amongst older
people are a major cause of loss of independence and entrance into sheltered housing, costing
the NHS around £1bn per year. Home environments have been proven to influence thelikelihood of falls, hence preventative spending offers significant and cost-effective outcomes.

Department of Work and Pensions and Communities and Local Government. Regions and local
authorities have been instructed to plan new strategies linking housing, communities, healthand care yet in most cases have been slow to include older people and population change as key
drivers of local economics and housing markets. For example, few senior social services
managers and even fewer NHS senior managers are engaged in policy or strategy on adaptation
and DFG issues, despite their major implications for healthcare spending. (CLG 2005 DFG).
Yet key opportunities to shape the future of our housing, such as regeneration areas and new
housing investment, are still going ahead with little assessment of the needs of older people,
who represent important market drivers who will only grow over the next few decades. Housing
planning is still dominated by issues of affordability and allocation by locality.
Carers and FinanceOlder Carers
Given the growing demand for care that will result from an ageing population, and the fact thatthe majority of care will continue to be provided by friends/family, most likely by older people
themselves, there is an urgent need for research into the effects that providing care has on the
lives of older people, the effect on their pension accumulation, their participation in the labour
market, and their entitlement to receive help and financial support.
Funding Retirement
Rising asset prices, particularly in housing, across much of the Western world, has seen theasset wealth of older cohorts rise dramatically, at the expense of younger cohorts who havebeen saddled with large mortgages. This creates important questions around intergenerational
equity, solidarity and justice. It is causing many policymakers to review again how society
proposes to pay for its ageing population, particularly as policymakers consider the retirementsaving activities of younger cohorts. Research and action is needed to explore how housing
wealth can be better used to fund retirement.
Section 4: Agenda to Help Resolve the Concerns Outlined in Section 3
Integration of health and social care
With increased decentralization of health and social services, we risk seeing significant
shortages in skilled staff in the community. Governments must invest further in community
services and work closely with the voluntary and private sectors, who are playing a growingrole in filling the service gap across many communities.
Investment in skilled personnel who can work across the health and social care settings isparticularly important.

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South Africa
Argentina

It also involves a strategic realignment of policy towards consideration of existing homes andcommunities as much as the planning of new ones does.

India

Housing
Key planning documents, such as regional strategies, need to accept that the wellbeing of older
populations are as much an economic issue as the wellbeing of younger ones. This involves a
recognition of the social, civic and economic capital that older populations represent alongside
an appreciation of the potential savings offered by preventative investment in housing
adaptations and maintenance.

Dominican Republic

Better Research
An overarching need is also required for better indicators to allow us to measure not only healthstatus but quality of life and functional abilities of individuals as they age. Too often, data on
older people are lumped together in a single group — ‘aged 65 and over’. There is a need fordata to be available by age group, to allow for a better understanding of risk factors and healthoutcomes across all segments of the older population.

United Kingdom

Health Promotion
Actions targeted at modifying lifestyle behaviours, for example stress, obesity and tobacco use,should be developed over the entire life course. If implemented from midlife onwards, theseactions may prevent and postpone the onset of cardiovascular disease, stroke and dementia inlater life.

FranceMental health
There is a need for better data on the costs of care at home for people with dementia and detailsof the services which people with dementia receive, all of which is vital for proper planning forthe expected rise in the number of dementia sufferers.

Japan

Moreover, greater resources (used effectively and equitably) are needed, particularly for social
care. Policy-makers must recognize that there will be an increase in social care costs andaccordingly they should plan and prepare for the financial consequences. The critical role
played by Informal caretakers must be factored into any planning of care capacity in thecommunity.

Best practice and examples of innovation do exist in some areas, but need to be collected
together and more effectively communicated to planners.

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Bricks and mortar are only part of the solution. Planning should encompass a vision ofcommunities that encourage an active and engaged later life for all. This implies theinvolvement of housing, health and social care in planning. Cross-sectoral planning offers

many benefits, including sharing of information to target services more effectively, andeventually, mutual recognition of the inter-dependency of funding streams and joint planning;for example, Primary Care Trusts cooperating in the strategic management and roll out ofadaptations and maintenance schemes designed to reduce older people’s accidents in the home.
Local authorities also need increased funding to ensure that the training and retention of skilled
staff allows the creation of enhanced expertise in any given area. This will ensure better
regional strategies by feeding an improved local evidence base upwards. Finally, ministerial
commitment is needed to ensure real attitudinal change from the top down.
Older Carers
More research is needed about the effects of providing care on older people. It is necessary toconsider new and innovative ways of thinking about how older people can be supported in theircaring roles, particularly when they have to balance the work and responsibilities involved in
paid and unpaid care.
Retirement Savings
More research is required into how the different financial responsibilities on younger cohorts
affects their retirement saving activities. At the same time, more research must be carried out
on how older people can be enabled to use their housing wealth to fund their retirement, andcontribute to the costs of their long-term care.

Sources: Mid-year population estimates: Office for National Statistics, General Register Officefor Scotland, Northern Ireland Statistics and Research Agency; National Government statistics
UK; Government Actuary Department; Pensions Policy Institute; Department for Work andPensions.

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Japan
FranceUnited Kingdom

Dr. Rosy Pereyra, M.D.
President• Former General Director of State Services tothe Elderly of the Ministry of Health andSocial AssistanceIndia

Dominican Republic

Dominican Republic• Organizer of Grand Parents InstituteSouth Africa
Argentina
The Netherlands
IsraelReport from ILC-Centers

ILC-Dominican Republic
Section 1: Profile of the ILC-Dominican Republic• Contact Information:
International Longevity Center- Dominican Republic (ILC-DR)
Hermanos Deligne No. 202. Gazcue.
Santo Domingo, Dominican Republic
Tel: (809) 689-6267; (809) 682-8215
rosy.pereyra@gmail.com• President:
Rosy Pereyra MD is an English trained geriatrician who has been one of the pioneers ofgeriatrics in the Dominican Republic. She was, for a period of 10 years, General Director ofState Services to the Elderly of the Ministry of Health and Social Assistance position to which
she resigned in 1996 to organize the Grand Parents Institute, umbrella organization to ILC-DR
and well recognized in the country for its contribution to the wellbeing of the elderly in the DR.
She has been a consultant in the field of ageing to the Pan-American Health Organization,member of the UN Group of Experts in the revision of the Plan of Action for the World
Assembly of 2002 and past President of the Dominican Society of Geriatrics and Gerontology.
She is also the creator of the Code of Rights for the Older Dominican converted into law in
September 1998 and has written numerous research papers and publications.
• Mission Statement:
Our mission is to promote healthy, productive ageing and at the same time help our societies toaddress the issue of ageing in a more positive way, visualizing the older population as an asset
rather than a burden, recognizing their contributions and incorporating them into thedevelopment plans of every country.
• Year Organized:• 1998• Major Affiliations:
ILC-DR is aff iliated to PAHO, Help Age International, Inter-American Network of
Associations for Older Adults (RIAAAM), Autonomous University of Santo Domingo, theDominican Alzheimer Society, INPEA and ILC Alliance.
• Sources of Funding:
Our resources come from the Grand Parents Institute, the United Nations Population Fund and

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Japan

Sanophi Pharmaceutical which sponsors most of our teaching activities.

Dominican Republic
India
South Africa

1. Brief Review of Aging Demographics
Our region is at the moment in a demographic transition which means that our society is
gradually moving from a situation of high rates of fertility and mortality to one of low rates.
The older population is as heterogeneous as the younger population in most demographics andsocioeconomic aspects. There is however a gender difference. Male mortality is higher than
women and by ages 60 to 64 there are only 89 men per 100 women in the Americas and thisratio declines steadily to a level of 53 at ages 80 and above.
This translates into a great difference in marital status. As a whole, most older men are married
but because women live longer and remarry less frequently, the majority of older women in theAmericas are widow.
Our older population in general has been growing rapidly in the last decades and it is estimatedthat by 2010 its growth rate will be 10 times as high as that of the total population.
The oldest old group (age 75 and over) is projected to grow significantly in the coming
decades, more than doubling between 1990 and 2020. There is a particularity in the region and
it is that while this group constitutes only 1 to 2 per cent of the total population Latin-Americancountries, many Caribbean nations have proportions of 3 to 4 per cent.

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Section 2: Profile of the Aging in the Region

France• List of Recent Major Activities/Programs:
Conferences:• The Importance of Physical Exercise in Mental and Physical Wellbeing of Older
Adults and presentation of the Digi-walker.
• The Importance of Risk Factors in the Prevention of Cardiovascular Disease.
• The Use of Atypical Major Tranquilizers in the Management of Agitation in Alzheimer• Osteoporosis. The Silent Epidemic.

2. Summary of the Main Trends/Issues of Aging in the Nation
At the moment our population is still relatively young. Projections, however, show that while inthe year 2000, 33.5% of Dominicans were less than 15 years old and those over 60 were lessthan 7%, the 2002 National Census show that older population rose to 8% while those under 15
showed practically no change. In the next decades older population will continue to increase ata greater speed than the other groups and it is estimated that for the year 2025 it will reach 12%
and this percentage will duplicate for 2050.

Argentina

We really do not know how our population reaches old age in the way it is doing because wehave poor access to health care, no social security, there are areas where access to sanitation
and water is still deficient.

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A. Health/Medical CareOur health system do not secure quality health care for the majority of Dominicans, it isdivided into public, private. The police and armed forces have their own health care system. If
you have a good employment or could pay private care, you do not have great problems but thisdoes not apply to the great majority. If you are an employee on minimum wage or are
unemployed or elderly without a pension, you will probably have to go to the public health caresystem which is very deficient.
This system is however in transition now because in the year 2001 the law that creates oursocial security system was passed and should therefore create a revolution in the way healthcare and pensions are given. All these years since 2001 have passed making all the necessary
arrangements for its implementation. The contributory regime which according to the law
should cover pension and health care to private employees has just started last f irst of
September. The other regimes contemplated in the law which are the contributory/subsidized(covering independent professionals and small business owners that do not have a stable
income) and the non-contributory regime that covers the elderly, disabled and the indigent,
have no defined date for its implementation because it stated in the law that it implementation
has to be gradual and will depend on the economical capacity of the central government.
Finally, a mayor issue that is affecting our country as a whole is the extraordinary amount ofillegal immigrants coming from our neighbor Haiti, bringing with them all sorts of diseases
including malaria and VIH.
B. Long-Term Care Insurance System
We most say that that 51% of older people live in extended families, only 14% live on theirown so long term care is not so far an important issue. There are however 4 long term care
residencies run by the Ministry of Health and Social Assistance, 22 that are community based
homes partially subsidized by the government and usually run by religious organizations and
20 private. There are also 18 day care centers that belong to the government. We must admit,
the demand for long term care places is rapidly increasing due primarily to the incursion of
women into formal education and consequently into the labor force.
C. Employment and Retirement (Profile of Retirees)
Age of retirement according to our law is 30 years of service or 60 years of age (whichever islonger) and it is the same for men and women. It is only mandatory in the private sector. People
in the public sector in general work much longer.
For informal workers, since old age pension is not automatic, they will continue to work
practically till they drop. This is reflected in statistical data taken from the 2002 National
census. This data shows that for that year, 47% of older Dominicans were economically active
and in men this percentage rose to 65%. This indicates that for a large percentage of our older
population the only way to survive is to remain in the labor force.

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Section 4: Proposal for Action to Help Resolve the Concerns Outlined in Section 3

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Recognizing and understanding our problems and needs ILC-DR considers we have to concentrate
in increasing advocacy with the government not only to point out our compromise with theinternational community but also to try to have the older population included in the national
agenda. If we can permeate the government and get a positive response, we will be able to get
funding for research, an increment in the amount of places for training and hopefully a change of
attitude going from the idea of simple assistencialism to one of inclusion and opportunities.

Global Aging ReportIndia

In the Dominican Republic, we have 17 geriatricians all of which have been trained abroad. We
started our own training program just last year with the accreditation of the Autonomous
University of Santo Domingo. The trainees will have to do 2 years internal medicine and 2
years of geriatrics. So far, we have 8 doctors in training and we have noticed an increasing needfor places in public hospitals since according to our studies, 35% of hospital beds are occupied
by people over 65 years of age. Research is necessary especially in the areas of quality of life
and of services offered to the elderly. The need for a change in the general attitude of thedifferent governments in our region has been outlined in different scenarios especially after the
2nd World Assembly. The next regional meeting to review what actions have been taken tocomply with that plan, will take place in Brazil next November and we expect to be there aspart of our official delegation.

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Section 3: Current and Future Needs for Research/Training/Policy Change in the Region

United Kingdom

D. Status of Older Women
Women are at greater disadvantage. Illiteracy is higher in women than in men (30% in men,
35% in women and this percentage increases in those over the age of 75) as it is unemployment
so they have to depend exclusively on the help coming from their family. This is rapidlychanging; we are seeing a feminization of higher education that will result in a total change of
our statistical data in a few years.

FranceOther facts included in our 2002 census show that only 12% of older people in urban areas
have a pension and this goes down to 3.4% in rural areas. There is also a great percentage thathas no income at all and those that do have a pension because they have contributed to apension fund, those pensions are inadequate because they have never been indexed according to
inflation so they are on average well below minimum wage.

Japan

Even though that is the case, there is unfortunately old age discrimination and this is easily
noticed in our daily newspapers when a job is advertised and putting as the top age forrecruitment, 35 years. The outcry has been so great that a resolution was passed by thegovernment increasing the age announced to 45. As you can see there is still a lot to be done.

United States of America
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R.A.Mashelkar, Ph.D.
President• Chemical engineering scientist• Bhatnagar Fellow at National Chemical Laboratry

Dominican Republic• President of Global Research Alliance• Former Director General Council of Scientific andIndustrial Research

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ILC-India
Section 1: Profile of ILC-India
FranceUnited Kingdom• Contact Information:
International Longevity Centre-India (ILC-I)
c/o CASP-Bhavan,
Survey No. 132/2
Plot No. 3, Pashan-Baner Link Road
Pune, 411021.
Tel: 91+ 020 +25862849; 91+ 20 + 65279518.
Fax: 91 + 020+ 25862836/25862849
longevitic@gmail.com
www.ilcindia.org

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Argentina• Mission Statement:
The mission of the ILC-I is to function as a not-for-prof it organization in the areas of
Education, Training, Research, Media, Documentation and Advocacy and also undertaking
Pilot Projects for Population Ageing.

South Africa

Dr. Mashelkar served as the Director of National Chemical Laboratory (NCL) and the Director
General of Council of Scientific and Industrial Research (CSIR). Since his retirement from
CSIR, Dr. Mashelkar is a Bhatnagar Fellow at NCL. He is also the Chairman of Reliance
Innovation Leadership Council and President of Global Research Alliance. He serves on the
Board of Directors of, ICICI Knowledge Park, Reliance Industries Ltd., Hindustan Unilever,Tata Motors Ltd., Thermax Ltd., Piramal Life Sciences Ltd., KPIT Cummins Infosystems Ltd.,GeneMedix Life Sciences Ltd., and Indigene Pharmaceuticals Plc., and Gharda Chemicals Ltd.

India

He has been elected Fellow of all the learned academies of Science and Engineering in India.
He was elected to the following societies: Fellow of the Royal Society, London, Foreign
Associate of the National Academy of Sciences, USA; Foreign Fellow of US National
Academy of Engineering, Fellow of Royal Academy of Engineering, and UK and Foreign
Fellow of Australian Technological Science & engineering academy. The President of India
honoured him with Padma Bhushan in 2000 for his contribution to nation building.

Dominican Republic• President:
Dr. R.A. Mashelkar is a globally recognized chemical engineering scientist of distinction, adistinguished science manager and an articulate and passionate spokesman for Indian scienceand technology, both, in academia and industry.

To work towards and support Healthy, Productive, Participatory and Qualitative Ageing!
• Year Organized:• 2004• Major Affiliations:• Athashri Foundation, YASHADA, UN INIA.
• Sources of Funding:Government of India, CASP, Bharatiya Vidyapeeth, Athashri Foundation.
• Major Activities/Programs:
a. Workshop on “Volunteers Bureau”.
b. Workshop on “Recreation for the Care of the Elderly.”c. Workshop on “Enabling Devices for the Elderly.”
d. Workshop of Leaders of Senior Citizens, ILC-I and the Pune Police Commissionerate.
e. Workshop on “Training and Orientation of Members of the Volunteers Bureau and the
Police Officials of the HelpLine.”f. Research on “Crimes against the Older Persons in Pune, Delhi and Mumbai.”g. Research on the “Demographic Profile of the Elderly in India.”h. Training Course in “Geriatric Health Care.”
Section 2: Profile of Ageing in the Region
1. Brief Review of Aging Demographics
As per the latest census of India of 2001, there were 76.6 million persons of age 60 years andabove. This is about 7.4% of the total population.
The percentage of the elderly in the age group 60 to 64 is 2.7 of the total population. The
percentage of the elderly in the rest of the age groups is as follows: 65-69 years is 1.9%; 70-74
years is 1.4%; 75-79 years is 0.6%; 80+ is 0.8%.
The proportion of females over 60 years is 7.8% and that of males is 7.1% of the total elderly
population.
2. Summary of the Main Trends/Issues of Ageing in the Nation
A. Health/Medical Care
The Primary Health Centres set up in India are not as yet fully equipped with the necessary
infrastructure and personnel trained to attend to the geriatric needs of the elderly.

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Another emerging concept is the voluntary services to be rendered by senior citizens to society
which is also catching on in India.

Argentina

Obstacles for older workers to continue their employment (e.g. discrimination) — In India, reemployment of the retired personnel is a new initiative, yet to pick up and hence, readyacceptance of such individuals would take some time.

South Africa

Measures taken by the public and private sectors to encourage workers to work longer (eg- retraining programmes, part-time positions) — In India, except for some extraordinarily
exceptional individuals, the retired individuals are not given an extension of service in thegovernment. But in the voluntary organizations and in private organizations, quite a number ofretired individuals with expertise and experience are employed either on a full-time orConsultant basis. There are other organizations which recruit such experienced retired
personnel. But no such re-training programmes take place for the retired individuals.

India

In the last five years, a new concept of Voluntary Retirement Service has emerged in the
Government services. Here the individual is given the option of taking voluntary retirement
after having reached an age of either 45 years or 50 years (differs from institution to institution)
or after having rendered a certain period of years of service. This is better known in India as
VRS and here the individual gets all the benefits of retirement.

Dominican Republic

The retirement age for the private institutions and the NGOs or voluntary organizations too
differ — either 58 years, 60 years or 65 years.

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D. Employment and Retirement
Common Retirement ages for men and women — As far as retirement age is concerned, it is thesame for both, men and women. But the retirement age limit is not uniform in India. For someof the Central Government employees, it is 60 years, whereas for some of the Central
Government employees, like the Judges of the Courts, it is 65 years.
The retirement age of the state government employees is 58 years.

FranceC. Pension/Economic Security
At present there is no social security system in India. Pensions are only given to the retired
Government employees.

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B. Long-Term Care Insurance System
ILC-I, in collaboration with the Athashri Foundation will soon be initiating a Continuing Care
Unit for the fragile elderly in need of geriatric care. This is a pioneering initiative in India.

E. Status of Older Women
Feminization of Ageing is apparent even in India. The sex ratio for the population of age 60+ isfavorable to females (1029 females per 1000 males) indicating numerical preponderance offemales in the group of elderly persons. Moreover it is important to note that this numericalexcess of females is observed only in the elderly population. The sex ratio of the total
population of India in 2001 was 933 females per 1000 males.
F. Spirituality and Family Bonding
Right from ancient times, India has always looked at Spirituality as a coping mechanism forageing. Spirituality essentially is not running away from the responsibilities of life, rather it isdoing your duty without expecting the fruits of your labour. The concept of Volunteerism of thesenior citizens is an extension of this philosophy, whereby the senior citizens render voluntary
service to society.
India has traditionally been a culture where the family ties are very strong and where the joint
family system has been one of the most revered value systems practiced in the country. A few
decades ago, the joint family had about four to five generations of an extended family residing
harmoniously under one big roof. Today too, despite the industrialization and urbanization
eroding the joint family system in the metros and cities, the family as an unit and seniorcitizens as an integral part of this unit is still largely prevalent all over India.
Section 3: Current and Future Needs for Research/Training/Policy Change in the Region
In India, as the Population Ageing grows, the problems of the elders also grow in proportion to
it. India is not yet effectively equipped to adequately address the issues and concerns of theelderly especially with regard to the medical and health problems of the seniors.
Training: Trained geriatricians and gerontologists are a comparatively new concept in India.
As mentioned earlier, industrialization has to a certain extent, especially in the metros andcities, led to the disintegration of the joint family system. Moreover, the younger generation is
also migrating outside the country for better prospects, thus leaving behind the elderly parents
to fend for themselves. This has given rise to a lonely generation of senior citizens in need ofemotional and physical care.
Thus the urgent need of the hour is a cadre of trained geriatric caregivers who would be able toprovide the necessary care and support required by the senior citizens.
Research: In India, research in geriatrics and gerontology is a field that requires urgent
attention from the government and the concerned organizations. Research in the field of ageingis still in its infancy in India. ILC-I has forayed into this field with several research studies

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FrancePolicy: Policies specif ically for the elderly became an issue of concern for the Indian
government only in the late nineties. The National Policy for Older Persons (NPOP) was
formulated in 1999. The Maintenance and Welfare of Parents and Senior Citizens Bill, 2007
has been tabled in Parliament in March 2007.

Japan

like — “Human Rights of the Elderly”, “Crime against the Elderly in major cities of India”,“Demographic Profile of the Elderly.”

Section 4: Proposal of an Agenda to Help Resolve the Concerns Outlined in Section 3
United Kingdom
Dominican Republic
India
South Africa
Argentina

1. One of the most important fields of action for the future is the training of geriatriccaregivers, geriatricians and gerontologists to meet the growing segment of Population
Ageing in India. For this adequate and appropriate training courses and orientation
programmes need to be designed and developed. ILC-I has designed a course in“Geriatric Caregiving” (undergraduate level) and is developing a course in “Social
Gerontology” at the Post-graduate level. In the offing is an orientation course for
medical doctors to be trained in geriatric needs.
2. The rural elderly in India are an unorganized segment of the elderly population. If old
age is compounded with poverty, as it very often is in the rural sectors, then thisbecomes a very cruel combination. Thus providing f inancial assistance throughpensions or some kind of social security net is essential while addressing the concernsof this segment. Another important factor to be considered is the feminization ofageing in the rural areas with the percentage of widowed and destitute elderly womenbeing quite high in comparison with the urban elderly. Thus the issue of dependentelderly destitute widows is also an important matter for consideration.
3. Advocacy and awareness in society on the issue of Population Ageing is imperative if
we have to tackle this issue in its right perspective. For this, the government, NGOs andthe society at large, including the grassroot rural areas need to focused upon
programmes and projects aimed at creating awareness on Population Ageing. ILC-I isworking on this through its seminars, workshops, research studies and publications.
4. With regard to the NPOP of India, the policy needs to be made more effective as itclearly lacks certain vital factors which would make it more effective. The NPOP has
no special department in the government or ministry responsible for its
implementation, no specific budget has been allotted to it and moreover, there are no
penalties prescribed if the provisions of the policy are not implemented. These issues
need to be addressed effectively for a better implementation of the NPOP.

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Monica Ferreira, DPhil.
President• Board of the International Institute on Ageing (UN-Malta) (INIA)• Board of the World Demographic Association (WDA)

Dominican Republic• Steering Group of the African Research on Ageing Network (AFRAN)• Former Director of The Albertina and Walter Sisulu Institute ofAgeing in Africa at the University of Cape Town

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ILC-South Africa
Section 1: Profile of ILC-South Africa
FranceUnited Kingdom• Contact Information:
International Longevity Centre-South Africa (ILC-SA)
University of Cape Town
Faculty of Health Sciences
Observatory 7925
South Africa
Tel: +27 21 406 6211
Fax: +27 21 406 6846
ilc-centre@uct.ac.za
http://www.ilcsa.uct.ac.za

IndiaSouth Africa
Argentina• Mission Statement:
The mission of ILC-SA is to understand processes and implications of individual andpopulation ageing in South Africa and Sub-Saharan Africa (SSA), and to help the societies
adjust to an expanding older population and enhance the quality of life of older persons. ILCSA carries out its mission through research, training, and dissemination of knowledge fordecision support. It views population ageing and longevity positively, and aims to facilitate theoptimisation of individuals’ capacity for active, healthy and productive ageing.

Dominican Republic• President:
The current President of ILC-SA is Monica Ferreira, DPhil. Her disciplinary training was inSociology and her career in Gerontology spans more than three decades. She retired as the
director of The Albertina and Walter Sisulu Institute of Ageing in Africa at the University ofCape Town at the end of 2006, but continues to head ILC-SA, affiliated to the Institute. She has
published widely on research and policy on ageing in Sub-Saharan Africa. She is a member ofthe Board of the International Institute on Ageing (UN-Malta) (INIA); of the Advisory Boardof the World Demographic Association (WDA); and of the Steering Group of the African
Research on Ageing Network (AFRAN).

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The Netherlands• Major Affiliations:
Strong partnerships exist between ILC-SA and the South African Gerontological Association,
the South African Geriatrics Society, the Department of Geriatric Medicine at the University ofKwaZulu-Natal, the South African Older Persons’ Forum, Alzheimer’s South Africa, Action on
Elder Abuse South Africa, Grandmothers Against Poverty and AIDS, and the African Researchon Ageing Network.
• Sources of Funding:Funds are allocated to ILC-SA from funding generated externally to support the Institute’s
research and capacity development programs. Solicitation of dedicated, substantial and stable
external funds to support ILC-SA is ongoing.
• Major Activities/Programs:• ‘Study to Understand and Foster the Functioning and Involvement of Contributive
Elders’ (SUFFICE), in collaboration with the Stroud Center for Study of Quality ofLife at Columbia University and ILC-USA in New York City.
• Regional and national coordination and expansion of the International Network for thePrevention of Elder Abuse (INPEA).
• Participation in national and regional policy development and formulation activities, inparticular the Older Persons Act No. 13 of 2006.
• Presentation of papers in several international and national congresses, expert groupmeetings, workshops and policy fora, in which ILC-SA activities were publicized and
ILC goals promoted.
• Numerous public presentations and media interviews, aimed at popularization ofknowledge on longevity and promotion of ILC and ILC-SA goals in South Africa.

Section 2: Profile of Ageing in the Region
1. Brief Review of Ageing Demographics
ILC-SA activities focus on population ageing and longevity in South Africa, but take cognizanceof related trends and situations elsewhere in Sub-Saharan Africa, with an aim to achieve a subregional understanding and to transfer technology and expertise in the sub-region. Sub-SaharanAfrica is the world’s poorest and least developed sub-region; all but two of 30 countries with lowhuman development world-wide are in SSA (UNPD, 2006). Numerous social ills beset the subcontinent, challenge nations, and retard or reverse development, which include rural stagnation,
the proliferation of urban slums, the HIV/AIDS crisis and armed conflict. Fertility and mortality
rates remain high: 65 per cent of the population is younger than 25 years and only 5 per cent is
60 years or older (projected to rise to 8 per cent by 2050). The absolute number of older persons
is however set to rise dramatically: from 36.6 million in 2005 to 140 million by 2050. Life
expectancy at age 60, currently 16 years, does not differ markedly from other world regions.
South Africa’s population aged 60 years and over constitutes 7.2 per cent of the total population,
projected to rise to 13.1 per cent by 2050. Life expectancy at age 60 in South Africa will

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increase from 16.5 years at present to 19.5 years by 2050 (UN/DESA, 2007).

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South Africa

Such is a thumb-nail sketch of the status and situations of older persons in the sub-region. The
situation of older person in South Africa is similar to that in other SSA countries, except that
South African elders who are poor enjoy virtually universal and relatively generous benefits ofregular social pension income.

India

A major crisis in the sub-region that impacts older persons severely are effects of the
HIV/AIDS epidemics. Poor and affected older persons face a loss of support and care from kin
in old age when their adult children succumb to the disease. In addition, they must assume
responsibility for raising grandchildren orphaned as a result of the disease. Older women, inparticular, bear a heavy material, physical and emotional care burden, and in most cases receive
no formal support. Older persons themselves are increasingly susceptible to infection with the
HIV virus, which is typically neither suspected nor diagnosed, and goes untreated.

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A. Health/Medical Care
Governments of SSA countries must still combat infectious diseases (especially malaria,
tuberculosis, waterborne disease and HIV/AIDS) and very few resources are available tomanage a growing burden of chronic disease. Health care for older persons is unsatisfactory
widely, especially through poor access, or barriers to services and marginalization of older
clients in health care delivery. Given widespread poverty, virtually all older Africans are reliant
on public health services for treatment; very few are able to access private health care. The
concept of long-term care is virtually non-existent in SSA. Frail and sick older persons are
typically cared for by family members in domestic settings without help from formal agencies.
Very few residential care facilities exist for older persons; institutionalization of elders tends tobe unacceptable culturally, moreover; mainly socially indigent frail elders accept placement insuch a facility.

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2. Summary of the Main Trends/Issues of Ageing in the Nation

FranceHence, SSA countries have youthful populations, although a longevity trend is under way; theconcerns of the governments are however primarily those of the young. Nevertheless,consequences of key issues and trends in the sub-region impact the welfare and well-being ofolder persons. The issues and trends include chronic poverty, weak infrastructure, high youth
unemployment, rural to urban migration of young adults, changing family structures and kin
support systems, inadequate social protection, persisting infectious diseases — especially
HIV/AIDS, poor access to health care, gender inequality, and human rights violations. Specificissues and trends, and their consequences or impact are considered briefly.

B. Pension/Economic Security
Only six SSA countries (Botswana, Lesotho, Mauritius, Namibia, Senegal, and South Africa)
currently operate a social pension program; elders in the other countries are reliant on family
for income support or continue to earn a livelihood. South Africa’s non-contributory (butmeans tested) social pension program, along with that of Brazil, is the most expansive in thedeveloping world (Barrientos, Ferreira et al., 2003). Studies show that beneficiaries (womenage 60 and over, men age 65 and over, who are eligible based on a means test of income andassets) share pension income with family and household members — and contribute todevelopment in this way. Beneficiaries are entitled to free treatment at public health carefacilities and placement in a state subsidized residential care facility, where needed and if a
facility is available. However, a downside of the pension program is that beneficiaries are
required to be economically inactive, which effectively removes older workers from the labour
force, limits their capacity for productive ageing, and increases an economic burden on thestate.
C. Status of Older Women
African society is patriarchal and characterized by deep gender divides. Older women, inparticular, are discriminated against and disadvantaged in numerous social, economic andpolitical arenas. In South Africa, customary law is practiced alongside Western law, especiallyin rural areas which fall under the authority of tribal chiefs. In such cases women may notinherit their deceased husband’s property (only males have rights to inheritance). Older widowsin these areas are particularly vulnerable to exclusion, exploitation, abuse and destitution.
Nonetheless, South Africa’s Constitution prohibits discrimination on several grounds,
especially gender and race, and the government conducts aggressive campaigns to ensure thatwomen’s rights are honoured equally. The government is less clear however on the eradicationof age discrimination; for example, mandatory age based retirement rules continue to be
enforced in most institutions. Older persons tend neither to enjoy equal application of policy
and the law in practise, as do persons in other age groups.
Section 3: Current and Future Needs for Research/Training/Policy Change in the Region
Research, training and policy needs in the field of ageing in South Africa (and the sub-region)
are multiple. ILC-SA has identified specific needs upon which it focuses, some of which aredescribed below.
Research
Only scant research on ageing and older persons is under way in the sub-region. The Instituteof Ageing in Africa and ILC-SA are the only dedicated agencies in South Africa that conduct
research in this field. Among priority research needs identified in recent international andnational research agendas for the sub-region (e.g. the AFRAN agenda (2005), the updated

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PolicyPolicy on ageing in South Africa and the sub-region is relatively under developed; what policies
exist are fragmented and uneven, and tend to have a sectoral bias. Given SSA governments’focus on youth development, poverty reduction, job creation and infectious disease eradication,
the formation of policy to benefit older persons is not a priority. In South Africa, a major schism
exists between policies and programs for older persons provided separately by the ministries ofhealth and social development (welfare), whose strategies and programs are uncoordinated. The
Social Development Ministry assumes primary responsibility for older persons, but interprets its
mandate narrowly; it focuses on the provision of old age grants, subsidization of certain facilities
and services, and the prevention of elder abuse. The Health Ministry has no specific policies onolder persons, but operates a Geriatrics sub-directorate, which mainly develops geriatric care
protocols. No other ministries have policies to benefit older persons specifically. Nonetheless,
new landmark legislation in the form of the Older Persons Act No. 13 of 2006 is aimed at

FranceTraining
Enhanced training programs in Gerontology and Geriatrics are needed nationally and subregionally. At present, training in multidisciplinary Gerontology is not offered as a degree
course at any sub-regional institution; graduate students may work in Gerontology but are
required to graduate in their mother discipline. ILC-SA is working with national and subregional stakeholders to develop and formalize multi-disciplinary training in this field. Training
in Geriatric Medicine is under developed in the sub-region in general. Thus far, healthprofessionals and teaching institutions have tended to view Geriatrics as a Cinderella subspeciality; consequently, it is hardly included in medical training curricula and attracts little
interest as an area of specialization. Training of health professionals allied to medicine inageing and the care of older persons equally needs a stronger focus. Similarly, training isneeded for a range of workers in the non-formal sector (NGOs). Once again, ILC-SA is
working with national and sub-regional stakeholders to expand and improve training in
Geriatric Medicine and geriatric care broadly.

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UN/IAGG agenda (2007), and the US National Academies of Science (NAS) agenda (2007)),
which guide ILC-SA’s research program, are studies on health conditions, health care, social
protection, and poverty reduction, specifically longitudinal studies. To these ends, ILC-SA iscurrently 1) participating in a five-year follow-up of the bi-national (South Africa and Brazil)
Non-Contributory Pensions and Poverty Study (NCPPS) conducted in 2002/03, and 2)
continuing subsequent phases of the collaborative SUFFICE project, which include a) a healthintervention at two key geriatrics sites; b) a generalisation survey in three provinces; and c)comparative data analysis with a New York collaborator and database. Other researchintervention projects under way deal with a) falls and their management; b) community stroke
rehabilitation practises; c) the diagnosis and management of dementia in specific cultural
settings; and d) the quality of geriatric care in different public health care settings.

protecting their rights, regulating facilities and services, and empowering older persons to live alife in dignity and security. ILC-SA participated in the drafting of the legislation as well as theestablishment of the South African Older Persons’ Forum; the forum assumes a policy
implementation watchdog role. ILC-SA engages moreover with stakeholders, through advocacy
and knowledge production and dissemination, to develop and reform policy. Special efforts it
will make forthwith include 1) advocacy for the formulation and adoption of a national plan ofaction on ageing, and 2) participation in review and appraisal activities of progress made in theimplementation of recommendations in the UN’s Madrid Plan and the African Union’s Plan of
Action on Ageing. Key areas in need of policy reform in South Africa include a) improved
health care provision and delivery; b) expanded community based care and support services; c)
eradication of all forms of age discrimination; and d) empowerment of older persons to know
and exercise their rights and to participate fully in social, economic and political processes,
especially those that affect them.

Section 4: Proposal of an Agenda to Help Resolve the Concerns Outlined in Section 3
ILC-SA has set a forthcoming three year agenda for action, key items of which are:
• A strong, focused research program, which includes a) a longitudinal follow-up of the
NCPPS project on the impact of social pension income on household poverty
alleviation; b) a continuation of the SUFFICE project on sustaining the functioning ofcontributive elders; c) an investigation and intervention to improve the quality of careof older health care clients — specifically interdisciplinary management of falls; andd) possibly a multi-country ILC Alliance study (specifically, with ILC partners indeveloping countries), pending identification of a research topic.
• Strengthened education and training programs in Africa-relevant Gerontology andGeriatric Medicine.
• Even stronger participation in national and sub-regional policy development andevaluation activities.
• Engagement in a range of initiatives and activities to empower and capacitate older
persons, within partnerships, through advocacy, program and project design andimplementation, and replication of best practises appropriate in the sub-region.
• Continuing organizational development of ILC-SA, and core and new ILC-SA
programs and activities.
• Stronger positioning of ILC-SA as an organization, and promotion of ILC principles,values and goals in SSA.
• Successful solicitation of medium to long term financial support, in an environment ofscarce resources and competing demands and priorities, to ensure the sustainability of
ILC-SA and its programs.

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Specific short-term agenda items include:

France• A two-week in situ international training course in Social Gerontology (that is relevantin the sub-region), in which ILC-SA staff members will give modules, in Pretoria in
January 2008, in partnership with the International Institute on Ageing (UN-Malta)(INIA) and the University of the North-West.
• A workshop to review and expand Geriatric Medicine policy, education and practise in
the sub-region, probably in Ibadan, Nigeria in 2008, in partnership with the African
Research on Ageing Network (AFRAN) and the International Association ofGerontology and Geriatrics (IAGG).

United Kingdom
Dominican Republic
India
South Africa
Argentina
The Netherlands

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FranceUnited Kingdom

Lia Susana Daichman, M.D.
President

Dominican Republic• Chair of Latin American Committee for thePreventions of Elder Abuse• President of INPEA

IsraelThe Netherlands

Argentina

South Africa

India

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United States of America
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Report from ILC-Centers

ILC-Argentina
Section 1: Profile of ILC-Argentina
FranceUnited Kingdom• Contact Information:
International Longevity Center-Argentina (ILC-ARG)
Arenales 1391 -8th Floor B(1061) Buenos Aires, Argentina
Tel: 54-11-4811-9590
liadaichman@fibertel.com.ar• President:
Dr. Lia Susana Daichman:
Academic Qualifications:

Dominican Republic
India

Medical Degree, MD, Faculty of Medicine, Cordoba National University, Argentina, 1970.
Postgraduate Training in Geriatrics and Psycho geriatrics in the United Kingdom (1972-1977).
Specialist Degree on Gerontology and Geriatrics, Buenos Aires National University, 1980.
Re-certified her Specialist Degree in Gerontology and Geriatrics at the Argentinean Medical
Association and at the National Academy of Medicine, Buenos Aires, Argentina (1996 and 2001).
Associated Professor on Psychology on Ageing, Faculty of Psychology, Belgrano University,
Buenos Aires (1991-1998).
Specialist Postgraduate Course’s Scientific Coordinator on Geriatric Medicine National
University of Buenos Aires (1995-2003).
Professional:

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Argentina• Mission Statement:• To help society address the issues of their aging population in a positive andconstructive way.

South Africa• Consultant in Gerontology and Geriatrics at the Instituto Argentino de Diagnóstico y
Tratamiento, Buenos Aires, since 1988.
• Reelected President to the Buenos Aires Gerontological Society (AGEBA), in officetill July 1994.
• Chair of the Latin American Committee for the Prevention of Elder Abuse (COMLATIAGG) since 1995.
• President, International Network for the Prevention of Elder Abuse (INPEA: NGOwith UN Status) since 2001 (Vancouver, Canada), and reelected till 2009 in Rio,
Brazil, 2005.
• Elected President of ILC-ARGENTINA at the International Longevity Center Alliance
Annual Meeting, Brazil 2005

• The protection of Human Rights and other fundamental freedoms, without any
violence, abuse and neglect.
• To highlight older people’s productivity and contributions to society as a whole.
• Year Organized:• 2005• Major Affiliations:
ILC-ARG is an independent aff iliate of the INPEA, the Navarro Viola Foundation, theEckman Foundation, the Barceló University and the Argentinean Gerontological Society.
• Sources of Funding:
There are not still formal sources of funding in Argentina apart of some National
Governmental Support and very few private donations.
• Major Activities/Programs:
All our activities are of life-span perspective and interdisciplinary and on National andInternational levels.
• Due to the great increase of Elder Victimization within the community during the year
2005-2006, the Eckman Foundation, the National Direction of the of Elder’s Policies,
Ministry of Social Development, INPEA-ARG and ILC-ARG developed a National
campaign on Elder’s Crime Prevention, which was launched in May 2006 raisingawareness on the subject and by means of education leaflets, posters, open discussions
at different sectors, national websites and a with a great support from the National
media.
• A more recent, intense and successful campaign to continue Preventing Elders
Victimization and Financial Abuse was launched by ILC-ARG, INPEA-ARG, theGovernment of the City of Buenos Aires, the National Direction of Elder’s Policies,
National Ministry of Social Development, the Ministry of Security and the Federal
Argentinean Police (2007).
• World Day Awareness Elder Abuse 2007 was successfully being planned for June 15that Buenos Aires DC as well as the rest of the country in conjunction with hundred of
cities all over the world.
• Since October 2005 the Eckman Foundation, ILC-ARG and the Gerontological Societyof Buenos Aires, by means of a contract with the National Direction of Elder’s Policies,
had been officially giving Courses to train and supervise new Human Resources,
mainly middleaged females as Formal Caregivers and Auxiliaries in Gerontology, as aresult of a high demand from the labor market, and as a part of one of the National
Ministry of Development Social Programs for the Aged, already being done nearly inall Argentinean’s Provinces. We just started two new courses (56 persons) and hope to88

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United States of America
FranceUnited Kingdom
Dominican Republic
India
South Africa
Argentina“HIGHLIGHTS 2007-2008”• The National Ministry of Social Development, under Resolution 215/07, delegates on
the National Direction of Elder’s Policies the responsibility of taking over Policies ofPrevention on discrimination and mistreatment towards the elderly population• Launching of the National Prevention Program on Discrimination and Elder Abuse incollaboration with INPEA-ARG and ILC-ARG advise and support (2007)• At present, ongoing National Survey on :- Elder Abuse by the National Direction of Elder’s Policies, National Ministry ofSocial Development in collaboration with INPEA-ARG and ILC-ARG (In progress)- Elder’s perception on discrimination and elder abuse (In progress)- Elder’s perception on the social representation of old age (In progress )• To sensitize on the rights of elders orientated to key actors of the community• Development a didactic kit orientated to the educators, social communicators andhealth professionals linked and working with elders, identified as key-persons for thetransformation and changing of negative images of aging and the elder population (Inprogress)Japanfollow the same pattern for the rest of 2007 and 2008. 103 Caregivers havesuccessfully finished their formal training till 2007 in our Center.We also started tocollaborate on the creation of a formal National Pool of Caregivers, this time with thefull support and compromise of the National Labor Ministry and with PAMI, which is
the National Social Insurance which covers Health and Social Services, as well as
Social Security of nearly 80% of the Argentinean elder’s population.
• Since 2005 ILC-ARG and the Eckman Foundation provides free Medical and Social
Assessment and advise elders and their families on Day Care, Home Care and Long
Term Care.
• Since 2006, a well known Psycho geriatric team provides also three Out-Patient’s
Clinics to the aged population with psychological problems for a quite small fee
donation.
• Since July 2007 started a new project: “Between Peers”. Training on Human Rights
and Empowerment, (40 elders), in partnership with INPEA-ARG and the INDESFoundation.

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IsraelGlobal Aging ReportSection 2: Profile of Ageing in the Region
1. Brief Review of Aging Demographics
According to the 2001 Population’s National Census, the Argentinean total population consistsof 36,260,130 people, Population’s density is about 13 inhabitants for km2.
Main Facts:• Argentina is one of the most aged countries in Latin America.
• People 60 years old and older are nearly 5,000,000 millions inhabitants and represents
13.4% of the total population, with a female prevalence of 57.8% over 42.2% of males.
This gap increases as they aged to a 70% of female population versus 29% of males at
the age 85 and older.
• People aged 75 and older represent 30% of the elder population.
• People 60 years old and older represent 11.8% of the total rural population, and 13.6%of the total urban population with a higher of 63% living in Buenos Aires DC and 58%
in the Buenos Aires Provincial Area.
• Life expectancy at birth was 67.3 years between 1970-1975, being 75.2 years in 2001.
• Taking gender into account life expectancy is 7.5 years longer for females than formales (M=71.56 y and F=79.06 y).
Demographic changes since 1975 are mainly due to:• Lowering of the Fecundity rate such as 23.4 births/1000 (1975) to 19.7 births/1000,(2005).
• Lowering of the Mortality rate from 9 deaths per 1000 (1970-1975) to 7.9 per 1000
(2000-2005).
• This will continue to be so till about 2025 when will raise again due to an increase of
the population ageing.
• It is expected that life expectancy at birth would be 84.5 years for females and 77 years
for males by the year 2050.
• Elders 75 and older would also have increased from a 2.3 % (1975) to an 8.4% in 2050.

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Elder Population in the Argentinean Republic
60 years and over: 4,871,957
Represents 13.4% of the total population

FranceDistribution by gender
Females 58%

Males 42%
United Kingdom
Dominican Republic

Fuente: INDEC, Censo 2001

India

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Regarding Incapacity rate it was found that 28.3% of people 65 years and over have some kindof incapacity and between 75 and over this increase to a 37.8%.

South Africa

A. Health/Medical Care
Argentina has a National Public Health system available to all people which every citizen has
the right to access and use.
Other ways of Health care, including Social Services, are provided for trade workers within theformal market, and finally the Private Health Insurances.
77% of elders are under PAMI, the major entity of Health and Social Services for Retired
people and other kind of Pensioners.
According to all Public Health Hospital discharges registered in 2000, the most common
causes of the elder population’s morbidity are: brain vascular diseases, hypertension, related
liver’s diseases, pneumonia and influenza, and injuries of the upper and lower limbs.
Primary case of deaths of 60 years old and over are cardiac failure with a rate of 480.7deaths
per/100,000 inhabitants, followed by ACV and pneumonia with rates of 344 and 247
respectively. (National Ministry of Health, Statistic and Information Department, 2000).

Argentinean Elder Population
65 years old with Disabilities
75 years and over Represents 37.8%.

With disability 28%

Without disability 72%

N=3,061,425
Reference: INDEC. First National Survey of Disabled Persons 2002-2003 Complementary to the 2001, Ceunsus

DISABLE ELDER POPULATIONFirst National Research on Elder’s Incapacity (2002-2003)

One incapacity 63%

Two incapacities 28%
Three incapacities
and more 9%

Life expectancy without incapacity for sexagenarian’s elders is different according to gender
being 15.5 years for males and 17.2 years for females

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B. Long-Term Care Insurance System
Only 2.3% of elders 60 and over live in Residential Care.

Old People Homes 61%

FranceOther sort ofelder’s living
arrangements
17%

United Kingdom
Dominican Republic

Religious Homes 4%

Nursing Homes 18%

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This economical crisis has created “an unexpected and inadequate way of living within aArgentina

Some have to leave and move with their own children to their parent’s homes. Many occasions
they took over their parents household management and slowly but steadily elders lost “theirplace within their own territory” and even sometimes, due to this new conflicted living
arrangements, have to leave the premises in a pretty bad condition like going to live in a muchsmaller place, sharing with another relative or even getting admitted to a Old People Home.

South Africa

The deep socio-economical crisis of the last decade, mainly the 2001 crisis in Argentina has
specially affected the middle-aged generation with marked unemployment, few chances ofgetting a new job and the “extreme situation” of loosing their homes.

India

Most elders go on living at home, remaining fairly active and as part of their own communities.
The percentage of homes run by elders has grown significantly:
1. 60 and over: 29%
2. 65 and over: 21%
3. 17.3% of elders, 60 and over are living on their own and 55% of the kinds of living
arrangements (one person basis) are elders.
To “own a house” and have a better life were the main objectives and the “lei motive” of ourimmigrant’s generation.

family”, which promoted conflict when facing the new intergenerational exchange. These
forced living arrangements have generated also a reversal from the role that was historicallyand socially structured and programmed. (Daichman L., 2002)
C. Employment and Retirement
1. 73% of males, 65 and over and 60% of females, 60 and over have an official retirement
pension.
2. Percentage of retired pensioners raises with age being more than 80% from 75 and over
Mandatory.
3. Retirement age is 65 for males and 60 for females.
4. Since 2003, there has been significant changes regarding Elder’s Social Security due toa new governmental Law Nº 13,478 by the Ministry of Social Development for a
Benefit Pension to cover all elders 70 and over without any other economical resources;
by June 2006 this benefit was covering 147,933 persons.
5. By the creation of “PROFE”, a Federal Health Program from the Ministry of National
Public Health, this same people have been granted all medical necessities at primary,second and third level of care.
6. There has been also a considerable increase of the amount of money regarding
retirement pensions, mainly the lower ones, which were nearly unacceptable, and thisnew approach allowed diminishing approximately 50 % of poverty in Argentinean
elders. (SIEMPRO, 2005).
7. There have been some measures taken by the private sector to encourage workers towork longer by re-training programs or part-time positions and rather few by the public
sector.
8. For those wanting and able to retire there are opportunities for meaningful volunteer
activities and work.
9. Regarding employment 17% of the elder population, 60 and over are still working.
10. 52% of males (60-64) are still in the labor market and only 19% after 65. Only 21% offemales (60-64) are “officially” working and this falls abruptly to 6% after 65.
11. A significant 12% of elders (60 and over) are still working and don’t perceive any
kind of retirement pension. (INDEC-2001, Census).
D. Status of Older Women
The Argentinean female generation which is elders now, had to go through a great amount ofsocio-cultural changes that implied modification of inherited principles and a generation which
had not many chances to copy “significant models”.
Due to the fact that most elder Argentineans “descended from the ships”, a good number ofthat immigrant population had left their parents behind in the “old world” and only those, who
succeed economically were able to bring their parents and other relatives much later, so many

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It is still our hope to be able to start as soon as possible a:
Worldwide Research, (may be between at all ILC-Centers), on:• Female Ageing, Poverty, Discrimination, Human Rights and Empowerment. We would
like to know how people age in a large city like Buenos Aires, particular life styles andSouth Africa

Due to financial difficulties, which hadn’t able to be solved yet, ILC-ARG is still finding rather
hard getting sufficient funding to develop more projects for the near future.

India

Section 3: Current and Future Needs for Research/Training/Policy Change in the Region

Dominican Republic

E. Poverty and the Elderly• 17.3% of the Argentinean older population is absolutely poor for insufficient earnings,
meaning 910,540 people lives under “the known poverty line”.
• 4.9% of elders are in a state of indigence and 11.8% of elders 60 years and over isconsidered POOR according to the unsatisfied basic necessities criteria.

United Kingdom

Most elderly women are often in not very good health, disproportionably represented among
the very old and quite vulnerable as they are particularly poor and more likely than men to beon their own.
They have more chances to have a poor education, nutritional status, and the labor market inearlier life have often left them with very few resources in their old age. (Daichman L., 2004).
Illness and a reduced quality of life as women age is largely the result of living conditions andgender discrimination in earlier life, combined with ageism in later life.
Being female and old is double jeopardy in many cultures and Argentina is not the exception...
Being female, old and poor is triple jeopardy. These discriminations are compounded when
one is a member of an ethnic or racial minority group and alone.
Belonging to the rural areas, having a non-European racial background might also be causeof discrimination in Argentina.

FranceDemographic changes could also mean that “successful ageing will inevitably result in more
people at risk...”Structural inequalities in both, the developed and developing countries that have resulted in low
wages, high unemployment, poor health services, gender discrimination, and lack of
educational opportunities have contributed to the vulnerability of older persons. For elders in
the developing world, the risk of communicable diseases still exists and environmental hazards
present yet another threat. At the same time they will be subject to the long-term, incurable andoften disabling disease associated with old age in the developed countries. (Daichman L., Wolf
R. & Bennett G. 2002).

socio economical differences.
• We also hope to do some research and be able to get more accurate data regarding “Thereal cost of Home Care versus Residential care” as well as “The true Cost of
Dependency”.
• Try to encourage cooperation among the different specialized international agencies,
Intergovernmental organizations, other NGO, Universities and Academia in order toapproach the research in a coherent manner.
Other policies include:“The Unspoken Right of Learning”
According to our national Constitution every person has the RIGHT TO EDUCATION• To continue stimulating education of Argentinean Elders within our Universities
special programs on related issues and other desirable options. (About 20% of elders
are already in these programs, 2007)• To alphabetize elders who never had the chance to really learn have to read and write
properly, due to poverty, recent or past immigration) and/or complete primary andsecondary school if they wish it to do so...
• To be able to continue with more and even better training of Primary Health Care
Workers related to the population aging.
• To create new and validate already existing tests, to better evaluate the Health State ofour growing LA population, and then monitor its changes.
The grey longevity revolution is a global event and a great achievement and the ILC Global
Alliance must work together and learn from one another about how to best respond to thesedemographic changes and their impact throughout the world.
Act on an ongoing and coordinated basis at all levels by promoting strategic alliances between
the State, Civil Society and Older Persons’ organizations, and even engaging the private sector
in the implementation of the strategy, while bearing in mind that the primary responsibility falls
on National Governments. (Report of the Regional Intergovernmental Conference on ageing:
Towards a regional strategy for the implementation in Latin America and the Caribbean of the
Madrid International Plan of Action on ageing, Chile, Nov, 2003)
Section 4: Proposal of an Agenda to Help Resolve the Concerns Outlined in Section 3
It is hoped that we would come up in the near future with some more concrete action plans,suggest adequate and specific policies and work to ensure the budgetary support needed to
implement the measures envisaged in policies and programmes for older persons, while neverforgetting all Advocacy which could all of us as always undertake.

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Japan
FranceUnited Kingdom

Jacques H. Schraven• Former president of Royal Shell Netherlands• Former President of the Confederation of theNetherlands

India

The Netherlands

Dominican Republic

President

South Africa
Argentina
The Netherlands
IsraelReport from ILC-Centers

ILC-Netherlands
Section 1: Profile of ILC-Netherlands• Contact Information:
International Longevity Center- Netherlands (ILC-NL)
Stichting ILC Zorg voor Later, Postbox 680, 3720 AR Bilthoven
Visiting address: Bronckhorstlaan 10, 3723 MB Bilthoven
Tel: +31 30 - 2296 070
Fax: +31 30 - 2296 089
info@ilczorgvoorlater.nl
www.ilczorgvoorlater.nl• President:
J.H. (Jacques) Schraven, former president of Royal Shell Netherlands and president of theConfederation of the Netherlands Industry and Employers (VNO-NCW) from 1999-2005.
• Mission Statement:
The Foundation ILC Zorg voor later is dedicated to interdisciplinary research and publicdebate and actions in the field of longevity and population ageing, aiming at influencing public
opinion, decision-makers and politics. The Foundation supports organisations and individuals
by providing up-to-date know-how and practical support• Year Organized:• 2006• Major Affiliations:
Vereniging AEGON, Royal Holland Society of Science and Humanities, Jan Brouwer Fonds,
Vereniging Het Zonnehuis, Deloitte en Touche, Portaal, OPG (Pharmaceuticals).
• Sources of Funding:Core funding has been secured in 2007 for an office and a small staff (1.5 FTE) for three years
by Vereniging AEGON and some other contributors. ILC Zorg voor Later is building up its
portfolio of activities, f inanced through grants and donations by Deloitte and Touche,
Zonnehuis Groep and other sponsors.
• Major Activities/Programs:
ILC Zorg voor Later is the co-organiser of the annual Jan Brouwer Conference on diverse
aspects of population ageing. The next conference on Solidarity between the Generations will

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Japan
FranceUnited Kingdom

take place in January 2009. Reports of these conferences with an English summary have been
published. Public debate is organised through the website on ‘Planning your future.’ Based on asurvey and expert meetings a study into the Productive Engagement of the next generation of
third agers has been published in 2007 (titled ‘Generatie op komst’). Expert meetings havebeen organised on issues such as creative solutions for long-term care and living arrangements.
An expert meeting on ‘Working longer — healthy for everybody’ has been organised and its
results have been discussed with associations of employers and employees. ILC-NL does not
employ research staff, but commissions work out to researchers of universities or otherscientific organisations. Presently a study on age barriers and age related opportunities incommunication has been carried out for ILC Zorg voor Later by Communication Concert. ILC
Zorg voor later is involved directly in a major (85 million Euros) Programme for thedevelopment of Geriatrics in The Netherlands and also in other programmes on IT and on
Ambient Assisted Living.
Section 2: Profile of Ageing in the Region

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A. Health/Medical CareThe Dutch health care sector is a 54 billion euros industry, providing jobs for 11 percent of theworking poulation and still growing rapidly in terms of expenditure and employment. If thesector would continue to do so, expenditure would grow from nine to 14 percent of GDP, andaccording to some scenarios the sector would then employ 17 percent of the working
population. That is why the whole system is under reconstruction. The government wants tobuild in incentives for cost awareness, efficiency and effectiveness. But growing staff-shortages
due to the booming economy and population ageing are threatening the development of thesector, the level of services and the quality of long-term care. The fact that geriatrics is not
fully integrated in healthcare is another challenge for the future.

India

2. Summary of the Main Trends/Issues of Ageing in the Nation

Dominican Republic

1. Brief Review of Aging Demographics
According to the national agency for population and labour market statistics (CBS), the numberof households in The Netherlands with an average of 2.2 persons will grow from 7.1 million in2007 to 8.1 million in 2035. From then on the number of households will start to decline. The
number of 65-year olds is expected to rise from 2.4 million (14 percent) to 4.3 million (25percent) of the population in 2038. It will then equal 47 percent of the working population in
The Netherlands. The CBS predicts a further growth of life expectancy for men from 77.6
years in 2006 to 81.5 years in 2050 and for women from 81.7 years to 84.2 years. However,these f igures are debated since ILC board member professor dr Rudi Westendorp cited
alarming reports indicating a decline of life expectancy from the age of 65 years onwards in
The Netherlands and the US.

As of January 2006, a new insurance system for curative healthcare came into force in The
Netherlands, replacing the mixed system of public and private insurances. The new system is a
private health insurance with public limiting conditions, operated by private health insurancecompanies. All residents of The Netherlands are by law obliged to take out health insurance.
The insurers are obliged to accept every resident, enabled to do so by a (public) system of risk
equalisation. People with low income who cannot pay the fixed premium can apply for a careallowance.
Chief aim is to make care more efficient and affordable in the long term and to offer morechoice. Market parties have greater freedom to compete for the business of the insured. It issaid that insurers will push for higher standards of their contracts with care providers in termsof quality and cost. The government remains responsible for the accessibility, affordability andquality. The insured pay a fixed nominal premium to the health insurer of on average 1,050
euros per year (2006) and an additional contribution of 6.5 % of their income (maximised on
2,000 euros per year) to a Health Care Insurance Fund. Employers are obliged to reimburse thiscontribution to their employees. (Self-employed persons and pensioners pay 4.4 percent). As
from 1 January 2008, there is a compulsory excess of 150 euros a year, which will be collectedby the health insurer. People with unavoidable long-term health expenses, for example due tochronic illness or disability, will be compensated financially.
B. Long-Term Care Insurance System
Expenditure for long-term care was about 1.5 percent of GNP (465 billion euros) or 8 billion
euros in 2007. Two third is spent in long-term institutional care; one-third in long-term homecare. The overall policy is to take care of frail older people in their own home and environment
as much as possible. The general financial system for long-term care is reconstructed in steps.
The responsibility for part of the system is shifted to local communities who have to arrange
technological, living and household provisions to support patients and informal carers. The
government is compensating the communities for that task. A personal budget system wasintroduced some time ago and is growing in popularity. Important trends are reconstructing
nursing homes with more privacy for residents (each resident has his own apartment), morefiscal and professional support for our 2.4 million informal carers, introduction of instrumentsfor quality development, prevention and strengthening responsible citizenship. Furthermore, ITsolutions will be introduced for work performance, information and networking.
C. Employment, Retirement, and Pension/Economic Security
Employees in The Netherlands retire on average between 55 and 65 years of age. The medianretirement age is now 61.5 years and slowly rising. Only 11 percent of the workers continue towork after the age 65, mostly in part-time jobs. The three-pillar pension system consists of abasic pension (for presently 2.6 million) citizens of 65 years and older, a company or industry
pension and private savings. A single person receives 915 Euros net in basic pension, married

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Francepeople receive 630 Euros net per month each. Seventy percent of the people entitled to a basic
pension receive an occupational pension as well. Retirement income may amount to almost
eighty percent of the last income just before retirement, for those with a lifetime career with
one employer. Most final pay systems have been replaced by average pay systems. Fiscal
support of early retirement has been abolished. Early retirement schemes were replaced byflexible retirement schemes in order to reduce the burden for younger working generations.

60
50
40

United Kingdom

Percentage

Labour market participation 55-64 (CBS 2006)

30
20
10
0

Man
Total

1900

1995

2000

2005

2010

Year

Dominican Republic

1985

Woman

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However, negative attitudes towards older workers are still deeply rooted in Dutch society. One

South Africa

Employment agenda — Since the mid nineties the topic Employment and Retirement is risingon the social and economic agenda in The Netherlands. Labour market participation of older
workers (55-64) has been extremely low since the seventies and eighties, in comparison withother European countries, Japan and the US. This was a result in the first place of the heavy useof preretirement schemes meant to solve youth unemployment problems. Secondly the equally
heavy use of disability insurance schemes by the social partners contributed to reducing thenumbers of older workers. Since the mid nineties, however, policies were redesigned tostimulate labour market participation of older workers, to reintegrate disabled workers andcreate more opportunities for women. In 2007, 43 percent of 55-64 year old was employed.
There is a boundary line soon after sixty. The Netherlands are aiming to reach the Lisbon goalof 50 percent in 2010. A range of policies, measures and instruments have been developed inorder to reconstruct the social system, so that retirement and social security systems encourage
people to keep working up to the age of 65 years and beyond. Since 2001, several taskforces
worked on the issue of the participation of older workers. One of these taskforces (Commissie
Bakker) proposed in June 2008 to raise the official retirement age to 67 years in a rate of one
month per year from 2014 onwards.

of these symptoms is that an unemployed person between 55 and 64 years has only 4 percent
likelihood of finding a new job within one year. Other symptoms are a low job mobility andlow participation in education and training. Since 2004 the Equal Treatment on grounds of Ageat Work Act is forcing social partners to review industrial agreements and practices in such a
way that barriers for older workers are taken away and social investments are concentrated nolonger on leaving but on life long work ability, employability and mobility. Severe changes ofthe social system have forced Companies to fight absenteeism and disability of workers. Huge
investments for reintegration programmes for chronically ill and disabled workers weresuccessful, at least for the younger cohorts. The next step is concentrating on lifelong health bystimulating preventive instruments, attitudes and mechanisms. For that purpose the Finnish
Work Ability Concept is being introduced in The Netherlands on a large scale. It includes astronger role of occupational health services. Diversity management is another item on theindustrial agenda.
D. Status of Older Women
The Netherlands come from a very traditional society were the roles and tasks of men andwomen were strictly divided. The graphic shows labour market participation of older men andwomen. The rise in older women’s participation is mainly due to long-term effects of womenentering the labour market since the sixties and gradually working more hours per week. This
reflects women’s emancipation and EU directives on equal treatment in that period. Women are
now strongly represented in health care, welfare work and the educational sector. But we have along way to go with respect to combined effects of age and gender. Older jobless women’s
chance to find a new job is practically zero. Older women are not equally represented in many
areas of societal and political life, in leading managerial positions and in the way society isreflected in the media. The picture is different in informal care and voluntary work.
E. Voluntary Sector
Shortages of labour will put pressure on the voluntary sector and the informal care sector,
where The Netherlands have a strong record with 4 million active volunteers and 2.4 million
informal carers who care at least 3 hours per week or longer than 3 months per year. There are
numerous possibilities here to tap into the potential of baby boomers’ talents. ILC is preparing
the dialogue between the voluntary sector and social partners, in order to identify barriers andintroduce incentives for older unemployed people to become active in voluntary work and betrained for new tasks and new networks. Giving workers the possibility to switch from paid to
unpaid work and vice versa and using part time retirement schemes could give older people amore meaningful, purposeful and healthier live, while tackling serious problems of society. ILC
tries to stimulate the development of social applications of IT, first in the area of informal andformal health care.

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In the framework of a training program on health literacy for all ages we should include strong
incentives for long-term support of a healthier lifestyle and prevention of (age-related) healthproblems. Here public health services and occupational health services must together engage inpolicy development;• Industrial agreements should reflect equal opportunities, diversity and proactive
strategies aiming at life long workability, employability and mobility.
• Third agers have an important role to play in planning the future of a personal andpublic care environment that offers choice, quality and opportunities to engage inproductive engagement and dignified ageing.
• The Netherlands need fast development and integration of geriatric care in the healthcare system. Focussed additional education and training of a leading edge of talented
young doctors could raise the profile of geriatric care.
• We need susceptible attitudes and policies that allow identification and adaptation ofvalidated social and health innovations from abroad (for instance the Finnish Work
Ability Concept).
• We need companies and trade unions to adapt new roles, and corporate social agendas
should reflect the silver potential for sustainable social, economic and ecologicalsystems.
• This would also mean flexible arrangements for productive engagement and freemobility of older persons in and between paid work, voluntary work and informal care.
• Research is important into IT support and fast development of social IT applications
for intergenerational community and participation development in an ageing society.

Japan

Section 3: Current and Future Needs for Research/Training/Policy Change in the Region

Section 4: Proposal of an Agenda to Help Resolve the Concerns Outlined in Section 3South Africa
Argentina

ILC Netherlands proposes to transform chapter 3 into an agenda aiming at fast and large scale
implementation of know-how, innovations and best practices, involving national, regional andlocal governments, social partners and social organisations. Strategy development andcommunication, aimed at influencing decision-making, should put to use the energy andknowledge of third agers and build on their responsibility for a sustainable future for all ages.

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FranceUnited Kingdom

Sara Carmel, M.P.H., Ph.D.
President and CEO• Professor of medical sociology and gerontology at Ben-Gurion
University of the Negev in Israel

Dominican Republic• President of the Israel Gerontological Society• Chairperson of the Fund for Research in Aging, Ministry for
Senior Affairs

IsraelThe Netherlands

Argentina

South Africa

India

IsraelUnited States of America
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Report from ILC-Centers

ILC-Israel
Section 1: Profile of ILC-Israel
FranceUnited Kingdom• Contact Information:
International Longevity Center-Israel (ILC-Israel)
The Center for Multidisciplinary Research in Aging (CMRA)
Faculty of Health Sciences
Ben-Gurion University of the Negev
POB 653
84105 Beer Sheva, Israel
Tel: +972-86477428, +972-86477987
Fax: +972-8-6477426

India
South Africa
Argentina• Mission Statement:• Enhance multidisciplinary and interdisciplinary research in aging• Promote knowledge about and awareness of the issue of aging in the region andthroughout the nation• Initiate and support interventions directed to improving treatment and services for the
aged• Contribute to the development of the future leadership in gerontology and geriatrics• Influence policymakers and key persons in the services to improve current services anddevelop new ones

Dominican Republic• President:
Sara Carmel, MPH, Ph.D. is a professor of medical sociology and gerontology at Ben-Gurion
University of the Negev in Israel, the president of the Israel Gerontological Society, thepresident of ILC-Israel, and Chairperson of the Fund for Research in Aging, Ministry for
Senior Affairs. She is the author of more than a hundred fifty scientific publications includingedited books, and has served on national and international committees for academic and policy
affairs. Prof. Carmel established and directed the first MA programs in Sociology of Healthand in Gerontology in Israel, and the Israel National Fund for Research in Aging at the
Ministry of Senior Affairs. Her recent research focuses on effects of immigration, gender andethnic origin on elderly persons’ will to live, health, survival and well-being; end-of-life carerelated preferences and practices of patients and medical personnel; doctor-patient relationshipand communication; and evaluation of health and welfare services.

The Netherlands• Year Organized:• 2007IsraelGlobal Aging Report 105

• Major Affiliations:• The Center for Multidisciplinary Research in Aging, Ben-Gurion University of the
Negev, Beer-Sheva• Maccabi Healthcare Services• The Association for the Planning and Development of Services for the Aged in Israel(ESHEL)• The Center for Research on Aging at the Myers- JDC-Brookdale Institute in Jerusalem• Dept. of Nursing, Steyer School of Health Professions at Tel Aviv University• The Herczeg Institute on Aging, Tel Aviv University• Israel Gerontological Society• The Israel Geriatrics Association• The Center for Research and Study of Aging and the Department of Gerontology,
Haifa University• Yad Sarah• Israel Ministry for Senior Affairs• Sources of Funding:
So far funding is from the member organizations. We are seeking outside funding for the
future.
• Major Activities/Programs:
Our major activity for this first year is the establishment of the organization and creating aframework for operations, i.e. writing the by-laws, establishing a web site, organizational
meetings, seeking funding, defining topics for future working papers on aging in Israel.

Section 2: Profile of Ageing in the Region
1. Brief Review of Aging Demographics
In 2006, 9.9% of the Israeli population was age 65 and older, and 2.6% were age 80 and older.
Of those 65 and older, 42.8% were male and 57.2% were female. In the Jewish population,
11.5% of the total were 65 and older, whereas in the Israeli Arab population 3.2% were 65 andolder. Israel is a country of immigrants, so that in the aged population, 90% are Jews, andwithin the Jewish population, 85.9% are immigrants to Israel. Thirty six percent of the aged
population are Holocaust survivors.
Israel differs from other developed countries in the pace of the demographic changes. In 1948
at the establishment of the State of Israel, the elderly population accounted for 4% of its total
population. In three decades this percent more than doubled.
Life expectancy in Israel is relatively high — 82.2 for women and 78.5 for men. 94 percent of
the elderly live in urban settlements.

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2. Summary of the Main Trends/Issues of Ageing in the Nation

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India

C. Pension/Economic Security (Social Security System)
All elderly citizens (men aged 70+ and women 65+, and according to income test, men aged
65+ and women 60+) are eligible for a basic pension benefit from Israel’s National Insurance

Dominican Republic

B. Long-Term Care Insurance System
In 1988, the Community Long-Term Care Insurance Law (CLTCI) was implemented. Services
included under the law are a defined list of community services including: personal care,housekeeping, emergency alarm systems in the home, etc. In 2006, 14.9% of the aged
population were entitled to benefit under the CLTCI. In addition, community services in mostmunicipalities provide assistance to older people including: nurse’s aides, Meals-on-Wheels,volunteers’ assistance, social clubs for healthy persons and day care centers for handicapped. In
some municipalities programs of supportive communities have been implemented.
Institutionalization of the aged is considered a last resort when community services no longer
suffice. Older persons who are incapacitated become eligible for institutionalized long-termcare when their social or medical conditions no longer permit them to remain in thecommunity. Institutionalized long-term care is available through both nonprofit and for-profit
organizations. A wide range of institutions for elders exists including sheltered housing,nursing homes, and geriatric hospitals. Institutionalized long-term care is covered by the NHCL
only in severe illness conditions, otherwise, it is paid for by the Ministry of Health and/or
family, contingent on the patient’s and his/her children’s income.
Long-term care is one of the major unresolved problems in Israel, due to the existing
multiplicity of public and private services, which overlap in terms of responsibility, ownership,provision of different kinds of services, entitlement criteria, and financing. This situation
creates duplications and fragmentation in continuity of care, which are ineff icient andconfusing to the disabled persons, their families, and their formal caregivers. This constellationof services also reduces accessibility.

United Kingdom

Health and well-being: In 2005, 37% of the elders self-rated their health as very good or good
(44% of the men and 33% of the women), in comparison to 77% of persons aged 20 and over.

FranceA. Health/Medical Care
Since 1995, universal health care coverage and a defined set of basic services are mandated
under the National Health Insurance Law (NHCL) for all Israeli citizens through four Sick
Funds (similar to the HMO’s in the USA). The National Health Insurance Law does not fully
address health care needs and needs arising from the disability of elderly persons. For example,
dental services are expensive and are not covered by this law. People unable to pay for dental
care and assistive devises have to turn for support to the local social security authorities. Also
hospice care is scarce and not provided to all of those who need it.

System, even if they did not work previously. Elders who live solely on this minimal pension(about $460 a month) are eligible for supplementary financial support from the government —up to 13% of the average national income for a single person and 17% for a couple. Some
Holocaust survivors are eligible for economic assistance from the Treasury. In addition, social
services are provided according to need by the Ministry of Welfare and by local municipalities.
Under the Elderly Citizens’ Act (enacted in 1989) elders are eligible for financial benefits suchas discounts on local taxes, tickets for cultural events and public transportation.
In general, elderly Israelis, especially elderly new immigrants, are a relatively poor populationgroup. However, the percent of elders receiving supplementary financial support has decreased
over the years (from 27% in 1990 to 18% in 2006). Significant differences in socioeconomic
status exist within the aged population. For example, in 2006, 52% of elderly men received
pensions from their workplaces on a regular basis, as compared to only 28% of elderly women.
The current laws help reduce poverty among old persons. However, under the prevailing cost ofliving in Israel, old persons with such income levels still have difficulties in meeting their basic
needs.
D. Employment and Retirement
In 2003 the official retirement age in the civilian sector was changed from 60 for women and65 for men to 67 for both genders. This change has not yet affected the percent of working
persons in the aged population. In 2006, only 10% of elders aged 65+ worked for pay — 17%of the men and 5% of the women. Twelve percent of the elders were volunteering on a regularbasis.
E. Status of Older Women
In 2006, women comprised 57.2% of Israel’s population aged 65 and older. The percentage
was lower among Arabs (54%), and higher among the new immigrants from the former Soviet
Union republics (62%). Women live longer than men, at the age of 65, women have on averageanother 20.1 years to live, while men only 17.9 years. In comparison to men, old women are
disadvantaged in almost all indicators of well-being (objective and subjective) including
education, income, health status, feelings of loneliness, satisfaction with life and self-esteem.
F. Family Caregivers
Families have to take care of their parents by law, including all kinds of support. If
institutionalization is needed, according to the current law, children have to participate in thefinancial support according to their income. Neglect is considered abuse and prohibited by law.
The Sick Leave Act of 1993 protects family caregivers at their workplace by ensuring fulldismissal compensation in case of resignation due to parental illness and a paid absence leave
up to six days per year.

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G. Major issues unique to the nation:
The major issue unique to Israel is the question of security and the constant threat of war andterrorist activity from the neighboring countries. Since a significant part of the national budget
is devoted to security and the military, fewer resources are available for social issues, among
which the services for the elderly are often the first to be cut.

FranceSection 3: Current and Future Needs for Research/Training/Policy Change in the Region

Argentina
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South Africa

Manpower: Currently, neither geriatrics departments nor geriatric hospitals are authorized
without certified geriatricians. All four medical Schools have included mandatory courses in

India

Considering the expected changes in the population of elderly persons, including theirincreased numbers especially in the older ages, the prevalent diseases and functional limitationsin these ages, and the increasing needs for formal and informal caregivers, research has to bepromoted in all areas of aging. Areas of focus include: economics, finance and pension
policies; clinical and rehabilitative aspects; evaluation of needs of various social groups, interms of ethnic and cultural origin, type of settlement, and religion; formal and informal
caregiving needs and solutions; evaluation of old and new models of policies and services(medical and social) including their availability, effectiveness and accessibility for various
social groups.

Dominican Republic• The Belle and Irving Meller Center for the Biology of Aging at the Weitzman Instituteof Science. The Center is dedicated to investigation in the biology of aging.
• The Herczeg Institute on Aging at Tel Aviv University. The Institute fosters
interdisciplinary research projects and exchanges of views concerning universal andlocal issues in gerontology and lifespan processes at large.
• The Center for Multidisciplinary Research in Aging (CMRA) at Ben-Gurion
University of the Negev. The creation of CMRA has facilitated the advancement ofmulti and interdisciplinary research projects on the local and national levels.
• The Center for Research and the Study of Aging at Haifa University conducts research,
formulates and promotes social policy, and develops educational resources in the fieldof aging.
• In 2007, the government Ministry for Senior Affairs established a fund for encouraging
research in aging, chaired by Prof. Carmel. In 2008, the first grant money was awarded
to researchers in the field.

United Kingdom

Research: Several institutions in Israel carry out research in gerontology. In addition to the
JDC-Brookdale Institute of Gerontology and Human Development, which is a national center
for applied research on aging, health policy and social welfare, all the major universities haveresearch centers for aging and gerontology:

geriatrics. However, not all of them include training in acute geriatrics, long-term care,rehabilitation, and community services. A program for the specialty of Geriatrics in medicine
has been developed for specialists in family medicine and internal medicine. Courses in
Geriatrics have also been introduced to nursing and social work schools. In 1999, the first two
MA programs in Gerontology were opened at the Ben-Gurion (Beer-Sheva) and Haifa
universities. Since then, the number of certified gerontologists is steadily growing. In addition,formal and informal courses for nurse’s aides, directors of nursing homes, day care center
personnel, and volunteers exist all over the country. These courses are sponsored either byEshel, the Minister of Labor and Welfare, or the National Insurance Institute. Although it is notmandatory, most of the qualified nurses and social workers do complete formal courses ingeriatrics and gerontology. Despite all these efforts, a severe shortage in geriatricians andgeriatric nursing staff is expected in the near future.
Section 4: Proposal of an Agenda to Help Resolve the Concerns Outlined in Section 3
Developing knowledge about aging, implementing it in policies, education and services should
become important objectives of Israeli society considering the demographic trends. Currently,
Israeli society is slow in adapting and implementing effectively and efficiently the accumulated
and updated knowledge in any of these fields.
Education and caregiving: Significant efforts have to be invested in order to persuade young
persons to study geriatrics and gerontology and work in this f ield. In addition,
geriatrics/gerontology have to become part of mandatory learning and training for physicians
specializing in family and internal medicine, nurses, social workers and other members of teams
providing care to old persons, whether in medical clinics or other services and institutions.
Palliative care has to be added to curricula of medical, nursing and social work schools.
Certified learning and training in geriatrics should be a prerequisite for formal caregivers(professionals and nonprofessionals) according to their specific roles. Courses and supportive
programs should be developed for family caregivers.
Services: In recent years the sick funds have become aware of the special needs of the growing
numbers of old patients. Some of them started to develop community geriatric services. For
example, geriatric centers were established for conducting comprehensive diagnoses andproviding consultation. Special clinics for cognitive diseases have been founded as well for thesame purposes. Hospice services provided in institutions or at home are currently limited.
These initiatives have to be further developed and expanded.
Human rights: More efforts have to be invested in reinforcing the aged population by increasingelderly persons’ awareness to their rights and practical ways to become actively involved inreclaiming their rights in case of need, whether in the medical system, or in other national, public
or private services, including using available legal planning tools.

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Changes in these domains will ensure access to comprehensive, continuous, and efficient care
to all, providing more efficient protection for elderly persons, enhanced active involvement ofelderly persons in claiming their rights and improved quality of life for senior citizens in Israel.

Japan

Policies and laws: In order to address unmet current needs, such as the provision of long-termcare and continuum of care, a numbers of amendments have to be made to the current laws:• Adding long-term care to the basket of services under the NHCL will significantly
reduce the fragmentation in care and the multiplicity of organizations involved inproviding it, and become an incentive for the Sick Funds to increase prevention andhealth promotion programs.
• Increasing the weekly hours of home care under the CLTCI law will enable more
people with disabilities to age in place.
• Adding to the current law a reference to abuse in institutional contexts and financial
abuse, will cover all possible ways of abuse or neglect by action or omission.
• Although the official retirement age in the civilian sector was recently prolonged to 67
years for both genders, this has to be totally canceled, allowing old persons to work aslong as they can and wish. Further reforms in the pension system have to be introduced
in order to reduce dependence of the aged population on the national resources.

India
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Global Aging Report
Threats to Longevity

Published by: International Longevity Center Global Alliance, Ltd.
60 East 86th Street, New York, NY 10028, USA
E-mail: masakoo@ilcusa.org
URL: http://www.ilc-alliance.org/© Copyright International Longevity Center Global Alliance
All rights reserved. No part of this book may be produced in any form or by any electronic ormechanical means including information storage and retrieved systems without permission inwriting from the publisher.

Global Aging Report
Threats to Longevity