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24 September 2022

We are living longer than our predecessors – policy must catch up

Why the government must fundamentally rethink its vision for our ageing society.

By Martin Carkett

If you had the choice, how long would you choose to live for? One hundred  years? Two hundred? Forever? From time immemorial, immortality has allured but alluded us. In the past, emperors and kings sought fabled elixirs of life. Today, their modern-day equivalents in Silicon Valley seek the same thing in their stated ambition to “solve death”.

But beyond the myth and science fiction, some genuine, grounded science is beginning to make progress on extending the quality and quantity of human life. The nascent field of longevity research aims to unravel the biological mechanisms that age us, to find ways to delay the onset of ageing and age-related diseases, so that we can live not just longer, but  “younger” for longer.

It’s not about defying death, but making more of life – extending health, more than prolonging our time, though that may be an added benefit. And far from merely a vanity project for the rich and powerful, longevity speaks to an existential question that advanced economies must answer in the coming decades as their increasingly ageing populations become ever more dependent on the state.

We are already living much longer than our predecessors thanks to the social and medical advances of the 20th century. Life expectancy is more than 20 years longer now han it was 100 years ago in the UK, and around 13 years longer than when the NHS was created in 1948. This, in itself, is problematic for a healthcare system designed in the immediate post-war era.

But more problematically still, increases to healthy life expectancy (the period of our lives we live in “good health” as defined by the World Health Organisation) have failed to keep pace. British males can now expect to live 16.5 years in poor health, females, a staggering 19.8 years. This puts immense long-term pressure on the health service, and we’re already beginning to feel the strain.

Health spending will account for around 44 per cent of all day-to-day public expenditure in the UK by 2024. Almost half of this is likely to be spent on those aged 65 or over – a demographic forecast to grow by 30 per cent between 2018 and 2030. Meanwhile, the pensionable age has remained virtually static since 1946, and on current plans is set to increase by just three years, to 68, by 2046.

Taken together, we’re living longer, but often in poorer health. This means that, as we age, we are placing increasing demand on the healthcare system and are less able to, and less expected to, contribute to the tax base and economy that maintains that healthcare system, relative to previous generations.

The younger, working population, who will need to foot this growing bill, is facing its own challenges. A shocking 17 per cent of the current working-age population are reporting as long-term sick, exerting a significant toll on the labour force and on economic activity. Worse still, without increasing immigration, this population is set to rapidly decline in the coming decades due to a massive, anticipated crash in global fertility rates, already visible in many advanced economies. This double-edged sword will have profound macroeconomic, political and societal impacts. You only need to look to Japan to see its effects.

We must therefore make every effort to help society age younger, as well as to keep those of working age in good health, to reduce burdens on the state and enable people to remain more economically active for longer. This should be a core focus in any new growth strategy, and this is where longevity research can play a vital role.

Scientists have already made incredible progress. In the past two decades we have identified nine hallmarks of ageing, providing foundational knowledge on why we age at a cellular level. We have defined molecular clocks that can accurately distinguish biological age from chronological age to give us real time readouts of how our lifestyle choices, or new drugs, can alter how quickly we age. And we have developed an arsenal of tools in genomics, AI, and genetic and cell engineering that promise to transform our approach to treating general ageing as well as more targeted regenerative medicine.

The field of longevity remains in its infancy though, and we shouldn’t expect a silver bullet to come overnight, or possibly at all. But the steady march of progress will reveal insights that, bit by bit, will develop our understanding, find new drug targets and, ultimately, deliver clinical results to tackle multiple age-related diseases at once. Just look at what has been achieved in the field of cancer, where basic and translational research has seen cancer survival rates double in the UK in the past 40 years.

Greater urgency is needed, however. Boosting the UK’s offering in longevity research, to match that of the US or Germany, must become a key pillar of the government’s life sciences strategy. We also need to change our approach to national health more broadly, using more interventionist public health strategies to proactively keep people in good health rather than respond to sickness, and develop economic strategies that put much greater emphasis on the growing over-50 population.

The government needs to fundamentally rethink our societal and economic model and set out a positive, grounded and equitable vision for an ageing society. Counterintuitively, and contrary to the government’s libertarian ideals, this will require the state to step up in its role in the near term, to avoid the need to become even larger further down the road.

[See also: When will Liz Truss and Rishi Sunak get real about the NHS?]

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