Raise awareness of environmental health issues in order to better protect our children and future generations.

22 January 2013

World Economic Forum 2013 : Global Risks : "the X Factor" of the "Costs of Living Longer"

The World Economic Forum in Davos, Switzerland, will begin tomorrow,
23 January 2013. The last section of a Forum report, "Global Risks 2013" considers five “X factors” beyond high-risk concerns of the moment which could present serious future risks - or opportunities : runaway climate change, significant cognitive enhancement, rogue deployment of geoengineering, costs of living longer, and discovery of alien life. The Report makes interesting reading and is available here. See also the cover page of the World Economic Forum site which offers a short video on global risks. 

Following is the section on “costs of living longer”. Perhaps I am paranoid, but reading the description and assessment of these risks makes me wonder whether discussion of these issues will lead to a human-centered approach to dealing with these risks (current and future) or a harsher reaction which would include ways to cut down on health care costs, as we see happening in the United Kingdom.  The rogue geo-engineering risk, which will be posted later, is disturbing because events seem to be moving in this direction. Several years ago, the Bill & Melinda Gates Foundation requested patents on methods to control hurricanes, which would offer 18 years of legal rights to the idea for Bill Gates and co-inventors. This sounds very much like placing weather control into the hands of a few private individuals, as the report says, “a well funded individual with good intentions who may take matters into their own hands.”

Costs of Living Longer – extract from “Global Risks 2013”

We are getting better at keeping people alive for longer. Are we setting up a future society struggling to cope with a mass of arthritic, demented and, above all, expensive, elderly who are in need of long term care and palliative solutions?

The blessings of 20th-century medicine look set to explode with the deciphering of the genome and attendant advances. It is hoped that big inroads against common banes such as heart disease, cancer and stroke, may be in the offing. Consider the impact on society of a growing number of elderly infirm who are protected from the most common causes of death today, but with an ever deteriorating quality of life as other ailments that do not kill, but seriously disable, start to dominate.

Current trends are already setting the stage for such a future scenario in the West. Already, the demographics of the Baby Boom are working against us: conservative estimates say that the number of Americans afflicted with Alzheimer’s disease will at least double, to 11 million, by mid-century.

Similar rises are projected for many countries, with the global population of the demented expected to double every 20 years until it exceeds 115 million in 2050.

A key driver will be increasing elderly populations and potentially declining fertility rates in low and middle income countries.

The looming expense of caring for these masses is mind boggling, especially in high-income countries. The UK, for instance, spends nearly as much each year caring for the demented (£23 billion) as it does on stroke (£5 billion), heart disease (£8 billion) and cancer (£12 billion) combined.

And the numbers afflicted with all of these maladies are only going to grow. Consider Medicare, the US health programme for the elderly. Assuming no policy changes – for instance, no increase in the age of eligibility – the programme’s outlays are expected to exceed its taxpayer-funded income by more than US $24 trillon over the next 75 years.

The spending trend is not limited to government support, either. In the US, the cumulative total of public and private consumption by the elderly has ballooned in the last half century. The burden is accentuated in rapidly-aging countries like Germany, where the ratio of effective producers per consumer is projected to decline nearly 25% by 2030.

Life expectancy has increased steadily in every decade since 1840, but these gains do not necessarily portend better health in later life. Thus, a new wave of disabled seniors may be on the way. The proportion of Americans aged 50 to 64 who reported needing help with personal care activities – things like getting into and out of bed, and climbing ten steps – increased significantly in the decade ending in 2007. Arthritis was the top cause, and diabetes played a prominent and growing role.

Are there fixes that can avert the coming storm? There are well-known but difficult-to-implement preventive measures that could help us live both longer and better quality of lives:  paramount among them is exercise, with its near-universal benefits for our physiologies and for warding off pathology.

Obvious ways to mitigate cost implications would include raising the eligibility ages for the programmes that support the elderly from the public purse – retirement income, social support services or reduced-cost health care – and raising the retirement age, requiring older adults to be productive economically for longer. One recent analysis, using a “delayed aging” model, found that hundreds of billions of dollars in increased costs to the US Medicare and Social Security programmes could be entirely offset by raising the eligibility ages for Medicare and Social Security by a few years (from 65 to 68, and from 67 to 68).

However, raising eligibility ages for public services is not a panacea, in part because financial costs are not the only challenge. The impacts of aging populations will be felt throughout society, from changing best practices in urban planning to impacting social norms around care-giving. More research is needed to turn chronic conditions to acute conditions (i.e. by developing curative treatments), and find solutions that increase the capacity of all citizens to manage chronic conditions and to create wealth at the same time.