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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Theresa May gambles that the EU will blink first

In her Brexit speech, the Prime Minister raised the stakes by declaring that "no deal for Britain is better than a bad deal for Britain". 

It was at Lancaster House in 1988 that Margaret Thatcher delivered a speech heralding British membership of the single market. Twenty eight years later, at the same venue, Theresa May confirmed the UK’s retreat.

As had been clear ever since her Brexit speech in October, May recognises that her primary objective of controlling immigration is incompatible with continued membership. Inside the single market, she noted, the UK would still have to accept free movement and the rulings of the European Court of Justice (ECJ). “It would to all intents and purposes mean not leaving the EU at all,” May surmised.

The Prime Minister also confirmed, as anticipated, that the UK would no longer remain a full member of the Customs Union. “We want to get out into the wider world, to trade and do business all around the globe,” May declared.

But she also recognises that a substantial proportion of this will continue to be with Europe (the destination for half of current UK exports). Her ambition, she declared, was “a new, comprehensive, bold and ambitious Free Trade Agreement”. May added that she wanted either “a completely new customs agreement” or associate membership of the Customs Union.

Though the Prime Minister has long ruled out free movement and the acceptance of ECJ jurisdiction, she has not pledged to end budget contributions. But in her speech she diminished this potential concession, warning that the days when the UK provided “vast” amounts were over.

Having signalled what she wanted to take from the EU, what did May have to give? She struck a notably more conciliatory tone, emphasising that it was “overwhelmingly and compellingly in Britain’s national interest that the EU should succeed”. The day after Donald Trump gleefully predicted the institution’s demise, her words were in marked contrast to those of the president-elect.

In an age of Isis and Russian revanchism, May also emphasised the UK’s “unique intelligence capabilities” which would help to keep “people in Europe safe from terrorism”. She added: “At a time when there is growing concern about European security, Britain’s servicemen and women, based in European countries including Estonia, Poland and Romania, will continue to do their duty. We are leaving the European Union, but we are not leaving Europe.”

The EU’s defining political objective is to ensure that others do not follow the UK out of the club. The rise of nationalists such as Marine Le Pen, Alternative für Deutschland and the Dutch Partij voor de Vrijheid (Party for Freedom) has made Europe less, rather than more, amenable to British demands. In this hazardous climate, the UK cannot be seen to enjoy a cost-free Brexit.

May’s wager is that the price will not be excessive. She warned that a “punitive deal that punishes Britain” would be “an act of calamitous self-harm”. But as Greece can testify, economic self-interest does not always trump politics.

Unlike David Cameron, however, who merely stated that he “ruled nothing out” during his EU renegotiation, May signalled that she was prepared to walk away. “No deal for Britain is better than a bad deal for Britain,” she declared. Such an outcome would prove economically calamitous for the UK, forcing it to accept punitively high tariffs. But in this face-off, May’s gamble is that Brussels will blink first.

George Eaton is political editor of the New Statesman.