The Grey Tsunami

How to Reap a Healthy Longevity Dividend

In January the World Economic Forum at Davos released a major report, “Global Population Ageing: Peril or Promise?”, forecasting an economic and social firestorm - a world growing older at a rapid pace. By 2050 two billion people will be over 60 years of age – one in five compared to one in 10 today. I welcome the WHO decision to dedicate this year’s World Health Day to “Ageing and health,” with the theme "Good health adds life to years." Whilst the ageing trend started in the developed world, it is now accelerating faster in developing countries where income levels are much lower. Developing countries will grow old before they grow rich – putting the health of millions at risk.

To talk only of an ‘ageing problem’ is a grotesque mistake. Longer lives are a triumph. What are needed are solutions that make better use of longer life – reaping the longevity dividend by recognising older people as a resource, not a burden. For instance, the International Labour Organization recently brought together business leaders and workers from the retail sector to look at the impact of ageing on a traditionally young labour supply. The result is that retailers are preparing for adjustments to take advantage of a talented older workforce.

Fostering good health in older age is central to a considered global response to population ageing. Investing in health now will lessen the disease burden, help prevent isolation and has economic benefits for society by maintaining the independence and productivity of older people.

There is no doubt population ageing will result in an increased demand for acute and primary health care, adding to the financial strain of coping with long-term and social care. In the developing world, help with meeting this need is available through the social pension, a policy advocated by the winner of the 2012 Hilton Humanitarian Prize, HelpAge International. Government-funded, regular cash income paid to all older people as their right is both a powerful and cost-effective way of empowering older people and reducing poverty. In many developing countries, up to 40 per cent of the population live in households containing older persons, and these households are often poorer than average. Thus, targeting older people is an effective way to reach poor families, reducing not only their own poverty, but also the overall household.

At present, only 1 in 5 older people worldwide receive a pension. Yet, if the age at which the pension is first paid is chosen to reflect fiscal as well as social realities, the cost of providing coverage to more people is surprisingly small. A universal social pension would cost less than 3 per cent of GDP in most of the countries in Sub Saharan Africa.

The gains from such expenditure are large. Social pensions in OECD countries reduce elderly poverty by between 30 and 60 per cent. In developing countries older people’s pensions and agricultural incomes secure the livelihoods and health of whole family networks, are invested into children’s education and economic independence, and improve access to credit. This is seen in Brazil, where social pensions contributed to a 32 per cent reduction in income inequality and to improvements in children’s nutritional status and schooling. And South Africa’s social pension has improved girls’ nutritional status, with height gains of 3-4 centimetres, and is associated with an 8 per cent increase in school enrolment among the poorest 20 per cent.

Now imagine growing old without a pension, while living with a chronic illness. The main health challenges for older people are heart disease, stroke, visual impairment, hearing loss and dementia. As our world ages, the impact of these conditions is two to three times greater for older people in low- and middle-income countries than for people in high-income countries.

Yet, the health systems in these countries are not designed to meet the chronic care needs that arise from a complex mix of diseases. High blood pressure and consequently, heart disease and stroke, are the biggest causes of years of life lost. Yet, somewhere between only 4 and 14% of older people in low- and middle-income countries are receiving effective treatment. Economic independence would help to ensure that this improves. Health and insurance systems must also adapt to ensure quality care, in and beyond the hospital, but economic independence has to support this change.

Older people must be able to afford and live in good health because they hold up our society. In the developing world, they have a critical role in raising grandchildren, especially where parents have migrated or died from AIDS; their social pension is a form of family support. In Southern Africa alone 60 per cent of orphans are cared for by older people. The great majority of these households live on or under the poverty line, with no defence to a sudden threat such as a chronic health crisis for the older caregiver. The stabilising potential of a regular income for these households is immense.

This coverage gap is rightly seen as a central challenge, but one which can be solved. Social pensions are economically and administratively feasible even in poor countries. Relatively small amounts of money invested in older people also are investments in children, livelihoods and economies, thus sowing the seeds for the longevity dividend. We must learn now that what makes sense economically is also morally the right thing to do.

Follow HelpAge International on Twitter: @helpage

Elderly people dance during an afternoon get-together in Berlin. Credit: Getty

Institute Professor Emeritus at the Massachusetts Institute of Technology and 2010 Nobel laureate in economics.

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Metro mayors can help Labour return to government

Labour champions in the new city regions can help their party at the national level too.

2017 will mark the inaugural elections of directly-elected metro mayors across England. In all cases, these mayor and cabinet combined authorities are situated in Labour heartlands, and as such Labour should look confidently at winning the whole slate.

Beyond the good press winning again will generate, these offices provide an avenue for Labour to showcase good governance, and imperatively, provide vocal opposition to the constraints of local government by Tory cuts.

The introduction of the Mayor of London in 2000 has provided a blueprint for how the media can provide a platform for media-friendly leadership. It has also demonstrated the ease that the office allows for attribution of successes to that individual and party – or misappropriated in context of Boris Bikes and to a lesser extent the London Olympics.

While without the same extent of the powers of the sui generis mayor of the capital, the prospect of additional metro-mayors provide an opportunity for replicating these successes while providing experience for Labour big-hitters to develop themselves in government. This opportunity hasn’t gone unnoticed, and after Sadiq Khan’s victory in London has shown that the role can grow beyond the limitations – perceived or otherwise - of the Corbyn shadow cabinet while strengthening team Labour’s credibility by actually being in power.

Shadow Health Secretary and former leadership candidate Andy Burnham’s announcement last week for Greater Manchester was the first big hitter to make his intention known. The rising star of Luciana Berger, another member of Labour’s health team, is known to be considering a run in the Liverpool City Region. Could we also see them joined by the juggernaut of Liam Byrne in the West Midlands, or next-generation Catherine McKinnell in the North East?

If we can get a pantheon of champions elected across these city regions, to what extent can this have an influence on national elections? These new metro areas represent around 11.5 million people, rising to over 20 million if you include Sadiq’s Greater London. While no doubt that is an impressive audience that our Labour pantheon are able to demonstrate leadership to, there are limitations. 80 of the 94 existing Westminster seats who are covered under the jurisdiction of the new metro-mayors are already Labour seats. While imperative to solidify our current base for any potential further electoral decline, in order to maximise the impact that this team can have on Labour’s resurgence there needs to be visibility beyond residents.

The impact of business is one example where such influence can be extended. Andy Burnham for example has outlined his case to make Greater Manchester the creative capital of the UK. According to the ONS about 150,000 people commute into Greater Manchester, which is two constituency’s worth of people that can be directly influenced by the Mayor of Greater Manchester.

Despite these calculations and similar ones that can be made in other city-regions, the real opportunity with selecting the right Labour candidates is the media impact these champion mayors can make on the national debate. This projects the influence from the relatively-safe Labour regions across the country. This is particularly important to press the blame of any tightening of belts in local fiscal policy on the national Tory government’s cuts. We need individuals who have characteristics of cabinet-level experience, inspiring leadership, high profile campaigning experience and tough talking opposition credentials to support the national party leadership put the Tory’s on the narrative back foot.

That is not to say there are not fine local council leaders and technocrats who’s experience and governance experience at vital to Labour producing local successes. But the media don’t really care who number two is, and these individuals are best serving the national agenda for the party if they support A-listers who can shine a bright spotlight on our successes and Tory mismanagement.

If Jeremy Corbyn and the party are able to topple the Conservatives come next election, then all the better that we have a diverse team playing their part both on the front bench and in the pantheon of metro-mayors. If despite our best efforts Jeremy’s leadership falls short, then we will have experienced leaders in waiting who have been able to afford some distance from the front-bench, untainted and able to take the party’s plan B forward.