Ageism, Health and Economics

By Michael Hodin

If it’s May in Geneva, you can be certain of two things: the spring thaw will have fully given way to that beautiful walk between the lake and the Alps, and all 194 health ministers will descend on The Palais de Nations for their World Health Assembly (WHA). Since passing the Ageing and Health Strategy in 2016, each year is marked by progress toward their 2020 assembly, when the Decade of Healthy Ageing: 2020–30 will be declared. At this historic occasion, the greatest barrier to healthy aging will not be health policy itself — nor even the scientific and medical advances needed to fully address the exploding prevalence of age-related diseases like Alzheimer’s, diabetes and heart failure.

Instead, we will need to confront a far subtler, more stubborn and powerful foe: the culture of ageism. It is this culture that perpetuates two related myths: that we must decline and deteriorate as we age; and, that whatever decline does take place can be defined simply as “old age” out of society’s mainstream. The culture of ageism assumes that heart failure, as well as skin, oral, vision, hearing, bladder, muscle and bone mass deterioration, are inevitable parts of the aging process; moreover, it invigorates false beliefs about how we should see that journey and where it should take place.

In other words, ageism both relies upon and argues for a set of assumptions about what it means to be old. And these assumptions have no place in a world where lives will routinely stretch to the 100s. For the first time in human history, we can expect to grow old — and we must prepare for it.

The numbers tell the story: a billion people over 60, two billion by mid-century; the over-80s as the fastest growing demographic; birth rates below replacement levels pushing us ceaselessly toward a world with more old than young. And, therefore, it is our economic health too that is in peril if we don’t adapt our institutions, public policies, society and culture to the realities of 21st century age demographics. Ageism is “defining out” of economic life our soon-to-be largest age population group, a trend which is both unsustainable and self-defeating.

More than any other institutional counterpart — IMF, World Bank, OECD or the UN itself — the WHO well understands the global age demographic transformation, and it has changed its view of health policy to fit this century’s demands. In preparation for the Global Decade of Healthy Aging, the WHO defines the metric for public health success as “functional ability.” This marks a sea-change in global public health philosophy. No longer are we in a black-and-white world where health outcomes are defined by the presence-or-absence of disease.

Thus, the task at hand is nothing short of re-imagining what it means to grow old — transforming health policy to relegate to the dustbin of history the culture of ageism that represses an active and healthy 21st-century aging. Such an accomplishment would set the foundation for success for everyone across society, creating a world where old and young can prosper alongside each other and create new wealth rather than compete over finite resources.

The solution for ageism, therefore, is not victimhood and special pleading for the old, but precisely the reverse — the creation of an atmosphere where innovations to stop or mitigate the conditions of aging are understood to be as important as finding cures for the diseases of aging. And where, should some of those conditions continue, they are not barriers to independence, activity, engagement and happiness as we grow old:

1. Let’s pay for health innovation that enables functional ability as defined by independence and doing what we want at any age. Even someone with Alzheimer’s, diabetes or heart failure is far better off if their vision, skin, hearing or bladder is healthier.
2. Businesses could integrate into their growth strategies the idea that there is a market based on this “aging demographic.” Exorcising ageism from society will be usefully assisted if employers think differently about markets, work and retirement. Nor is it a small point that active aging leads to healthier aging, which itself will mitigate those exploding health and pension costs no one can afford.
3. Stop using extraordinary, oftentimes peculiar anomalies as the examples of healthier and active aging. It’s great if an 80-year-old runs the marathon or jumps from a plane, but most will not. All at 80 should be given the opportunity to be as independent, active and happy as they can be, whether that means reductions in pain, enjoying grandchildren or starting a new company.

So if you’re in Geneva this May, enjoy the delightful air. But also look for the most innovative public health policy we’ve seen in decades, from which all of us will reap benefits. Aging as a driver of innovation and change — wow, who would have thought?