Instant Genius - What does a world with an ageing population look like? – Sarah Harper

Episode Date: July 24, 2019

We can’t reverse the slow march of time, but thanks to the wonders of technology and modern medicine, we have a lot more of it in our lives. But as people live longer, and the birth rate declines, how are we going to manage a world with an ageing population? That one of the questions Sarah Harper, Professor of Gerontology at the University of Oxford, has been trying to find an answer for. She talks to BBC Science Focus editorial assistant Helen Glenny about how we cope with dramatic shifts in population, what effect it has on natural resources and climate change, and a quirk in our retirement age that suggests we should start drawing our pension aged 103. How Population Change Will Transform Our World by Sarah Harper is available now (£9.99, OUP) Listen to more episodes of the Science Focus Podcast which we think you will find interesting: Can we slow down the ageing process? – Sue Armstrong How can we save our planet? – Sir David Attenborough Is religion compatible with science? – John Lennox What does it mean to be happy? – Helen Russell There is no Plan B for planet Earth – Lord Martin Rees How emotions are made – Lisa Feldman Barrett Follow Science Focus on Twitter, Facebook, Instagram and Flipboard Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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technological change. You're listening to the Science Focus podcast from the BBC Science Focus magazine team. With the UK's bestselling science and technology monthly, available in print and in several digital formats throughout the world. Find out more at sciencefocus.com or look out for us in your app store. Hello, I'm Sarah Rigby, online assistant at BBC Science Focus magazine. We can't reverse the slow march of time, but thanks to the wonders of technology and modern medicine, we have a lot more of it in our lives. But as people live longer and the birth rate declines, how are we going to manage a world with an aging population? That's one of the questions that Sarah Harper, Professor of Gerontology at the University of Oxford, has been trying to find an answer for.

She talks to BBC Science Focus editorial assistant Helen Glennie about how we cope with dramatic shifts in population. what effect it has on natural resources and climate change, and a quirk in our retirement age that suggests we should start drawing our pension aged 103. So my background is in anthropology and demography, and I set up a institute at Oxford which looks at population ageing. And this was slightly different. This started 20 years ago, and at that time, when we looked at aging, we tended to think of illness and health and dependency,

and very few people were looking at it demographically. In other words, what will the world be like when we have as many older people as younger people, which in fact we more or less already do? What will the world be like when over half the population of Europe is aged over 50, with a life expectancy then of another 40, 50 years? What's going to happen to the way that we run our society, to the way we as individuals live our lives, to the different generations who are all transitioning to longer and longer lives.

So I became very interested in the concept of population aging and something we coined here at Oxford called age structural change, which is the structure in the age profile of a population. And the way to think about that is you may at school have done the population pyramid where you have large numbers of babies being born, but death across the life course. So it's a pyramid with very few people in older age groups. And that's really what we all lived with for centuries and centuries until the last, the 20th century, where particularly in high-income countries, we started to change that population pyramid. In other words, the very high childbearing rates that we just typically experienced, women had lots and lots of children, many of them died in childbirth.

They died in infants. They died across childhood, and they definitely died, particularly if you were a woman in your children. midlife. That started to be reduced. Women had fewer children and we lived longer and longer. And so the population pyramid in high-income countries became more like a skyscraper. And that means that roughly every floor of the skyscraper is roughly 10 years of life. And you can say the skyscraper goes up with 10 floors from 0 to 100. And that's what we're really heading for, that we have a much more evenly balanced population. But to go from the pyramid to the skyscraper, you have to go through some kind of a very quick transition. And in some countries, particularly in Japan is the classic one,

but we're also seeing it in China because of its one child policy where they really reduce the number of young people in Korea. We're seeing it in Italy, southern, some of the southern Mediterranean countries, where we have really reduced our childbearing. We're living longer. And so we are going through more of a vase-shaped before we settle into that skyscraper shape. And the really interesting thing is that how do we cope with that dramatic shift from lots of children and very few older people to very few children and lots and lots of people in midlife and older age? So what prompted this change in the population pyramid? You talk about falling birth rates, but also people are living longer. So medicine is obviously the,

obvious one in terms of living longer, but what's prompting those falling birth rates? It's very interesting to look at what is prompting this change. In other words, a reduction in what we call fertility and mortality, that is in childbearing and death. And many people think that it's a very new phenomenon. They think that we're all living longer because of modern medicine, and that actually isn't the case. This goes back in European societies to about 200, 250 years ago. And it's called the demographic transition. And what basically happened in Europe was that we had very high childbearing and very high death in our society. And then slowly, really through very simple factors like clean drinking water, the availability of food, being able to transfer food, particularly

into more distant and urban populations, public health initiatives, slowly, slowly, the most vulnerable in our society, particularly babies and children, stop dying in the numbers that they were dying. We then were able to conquer infectious diseases. And so we found that women began to realize that if they had large numbers of babies, then those babies would grow up to be children. So if they were having these very large numbers of babies, they were going to have to bring up large numbers of children. And in response to that, we believe that they began to try to curb their child's bearing. So what basically happened was that we have mortality rates start to fall. And it takes a little bit of a delay, but then women realise that they don't have to have so many children. And so

society enables women to start controlling their fertility. A lot of this is to do with economic developments, the ability, in particular for girls to start having education, just basically us becoming more developed. And so then women start in response. to reduce their childbearing and slowly we push back death further and further across the life course. Now, there were lots of other dynamics going on in Europe, and so the European story is complicated, and Europe had a couple of centuries to adapt. And so by the time we got into the 20th century, mini European and other high-income countries, they had really begun to control their childbearing, family planning became far more acceptable. And then obviously, in the second half of the entry,

had modern ways of family planning that became acceptable. Women started being educated, started going out to work. And so in the high-income countries, very slowly we adapted to low levels of childbearing, but we also benefited eventually not only from pushing death further and further back, but then to be tackling some of those ills of old age. So if you look what happened in the 20th century, all those benefits of sanitation, clean water, good food, public health, vaccinations. We by then had conquered most of the things that killed us when we were young. And then in the second half of the 20th century, particularly in high-income countries, we introduced new farmer and drugs. We introduced geriatric medicine. And we were able to push back deaths from the kind of chronic

diseases that we tend to get in later life. And that has now escalated so that most people in most high-income countries can expect to live to about 80. And when you consider that in the middle of the 19th century, most populations in high-income countries were dead by the, sorry, half the population in high-income countries were dead by their mid-40s. We have in about 150 years pushed that back to that most populations now do not die until they reach their 80s. So there's been a tremendous pushback. But it's obviously dramatically altered the structure of our population.

So you state in the book that population change is one of the great global challenges. So can you tell me a bit about why that's a challenge? What are the problems that that throws up? When we look at this demographic shift, we can see that it is potentially a great challenge. And the reason for that is because we are shifting from a society that's very much geared up to having lots and lots of young people, lots of people of productive age and very few older adults.

Now, we can tackle that challenge by policy and behaviour. change, but it takes a while. So if nothing changes from a policy or a behaviour point of view, we will have a society where we educate young people until they're in their 20s. We enable them to stay in work till they're maybe in their 50s or 60s. And then we say, we don't need you anymore. And you're going to live another 40 years. Now, if that happens, then you have an increasingly smaller proportion of your population of working age that are being productive, that are paying taxes that are running your country, that are producing the goods and services that you need, and a growing number of older adults. So from an individual point of view, we now recognize

that it is actually quite crazy that you live nearly half your life not doing anything because you're post-retirement. But from a society point of view, you could end up with a third or even half your population not being productive in any way. So we really have to rethink a lot of our behaviour, and we have to change the policies and the institutions that frame that behaviour. To start with, we have to acknowledge that productivity isn't just being in the labour market, that we have lots and lots of older adults who are really contributing to our society through volunteering and particularly through care, care in our communities and care within families. We have to enable older adults to continue to work as long as they wish to work, and many

older people want to be productive and contribute to their society from an employment point of view well into their 60s and even 70s. And that will work because we're pushing back the onset of disease and disability. In other words, we're increasing not only life expectancy, but something that we call healthy life expectancy, which will enable people to do that. And we're also, if you like, taking the strain of those, that working generation to have to provide the taxes which pay for the pensions and pay for the healthcare that support an older population. So the way to think about it is that most societies have what we call a generational contract. And that works that when you are an adult, typically you will have children and you will invest time and money in those children,

their child dependence. And when those children grow up and you become old, so those children will look after you because you become an older dependent. So we have active, healthy people within our society caring for both young and old dependents. Now, that works in traditional societies within the household. Many older people live with adult children, and those adult children give them money and income and feed them and care for them and look after them. And in a more economically advanced society, like a high-income country, we do that through taxation.

So we pay taxes, and those taxes go to healthcare and the kind of pension system that we have that supports people who are not able any longer to look after themselves. Now, that goes out to kilter if you reduce the number of productive people. And that's why people are very worried about what they call the dependency ratio, and that is the number of younger productive adults in a society. You can care for the growing number of older dependents. But if you, through policy, get rid of things like age discrimination, you stop people being forced to retire when actually they would like to have the choice to go on.

you increase their health so that we don't have such a chronic health burden on our society by lots of older frail individuals, but lots of people who actually fit healthy and independent, then to a certain extent it doesn't matter that as we shift the average age of the population up, actually we're not increasing the dependency ratio at the end. So you mentioned that health span is increasing as well as lifespan. So there are quite a few older adults who would want to work past that retirement age that's generally 65. Do you know why that was set at 65 in the first place? How is that decided? So the way in which retirement ages were decided, and let's just look at the European

situation, because in a way that's where it really all started. Those retirement ages were very much linked into pension ages. And if we look at what happens when we set both beverage in this country and Bismarck even earlier in the 19th, century in the European system. That was because the majority of male manual labours, and remember most work was actually economic paid work, was done by men and most of it was manual. They could work up to their mid-60s, but very few of them could work at 70. And so they thought, right, let's set this at 65 because then we know that we will be able to pay for through some kind of a pension arrangement for those last three, four, five years before, typically they

died because although we had a pension age, let's take when the pension age was set in the middle of the 19th century by Bismarck. So he set that at 65. Half the population was dead by their mid-40s. So we were just talking about the very few who had lived on, the vast majority of whom were only going to make it into their very, very early 70s. So that's why they decided on 65. That's completely out of kilter with a society where half the population isn't dead at 40. It makes it to 80. And in fact, if you want to do the sums, if you're going to have half your population living till it's 80,

then actually the state pension age in high-income countries should be 103, not 65. If we kept it in line with all that thinking when it was introduced. So the state pension was simply to protect the few people who were still alive, and unable to work, just to give them a means of income. But what's happened is that we have pushed back, back, back the onset of disability and disease and the onset of death. And retirement, instead of being something that was just really very much when you could no longer work, people now see it as some form of a right to have 30, 40 years of leisure at the end of their lives.

And I don't think anyone is arguing that we should go back to the fact that you worked till you dropped. No one's saying that, but we're saying, given that many, many, many people in high-income countries are going to be active throughout their 60s and definitely probably well into their 70s, we should be enabling those older adults to work as long as they would like to, not if they're frail or dependent, because obviously some people will fall into that category, but the majority won't. And what we have to also understand is that particularly in European society, because we had the baby boom populations coming along immediately after the war,

in the 80s, we had them all entering the workplace, and we faced youth unemployment. And the easy way to cope with youth unemployment was to say to older adults, look, you can retire in your 50s. And so in the 80s and 90s, in many European societies, and in the States and in Australia and New Zealand and similar societies, we had people withdrawing from the labour market in their 50s and living another 40 years. on pensions. And that's why we now have a pension burden, but it was artificial. It was created by policy. And the very, very time that we were suggesting people could withdraw from the labour market earlier in order to make room for the large numbers of young people coming in and solving youth unemployment. So we had those people living longer and longer. So many societies are now rebalancing

that. And many European societies are actually encouraging people to work later. And state pension age is going up in this country, 66, 67, it eventually will go to about 68 and possibly even to 70 within probably the next 30, 40 years. Yeah, so you mentioned that some people see it as a form of a right that you can retire at 65 and go on and have 30 years of leisure. I imagine that, you know, my generation has grown up seeing their parents retire in their, you know, 65, the latest, some in the early 60s. they might not be too happy with being told that they have to work to 70 or 75.

Is there a way to change those attitudes? I think the attitudes of most young people is very realistic. So I belong to a generation. My father retired in his early 50s, as did many, many of his friends. And he was a pensioner longer than he was in employment. And he died at nearly 90. To be perfectly honest, most of his friends, I think felt they didn't have the same. status, they didn't make the contribution that they could have made if they had not retired.

And I think we're seeing a very different trend coming into working lives, particularly among younger people. The idea that you leave school or you leave university and you start working for a firm and you will stay with that firm in one job until you are 70, nobody, I think, is thinking of that. Because what we're seeing among younger adults at the moment, is far more flexibility. We have a tremendous, obviously, rise in the SMEs and the startups. People will go, they will do training with one company. They will then leave and set up their own startup. They then may take a sabbatical because they want to do some positive parenting. They may come back into another organization. They may go back to their original company. They may completely retrain and go into the

professions. We're seeing these far more flexible working lives. And because the other trend that we're also seeing is we live in the kind of world where you have to upgrade your skills the whole time. Technology is forcing us to have to do that. And I think we are seeing generations, even people in their 50s and 60s, who are now constantly retraining upskilling. And the idea of a sort of lifetime of education and skills upgrading is very much something that a lot of policymakers and I think individuals are asking for. And I think you need to look at it the other way.

Nobody is, I think, really suggesting that people are going to have to work into real old age. but I think that if you drop out of contributing to your society in your 50s and you then live till you are 90, I don't think that's very good for your psychology. I don't think it's very good for your mental well-being. And all the surveys that we have done here in Oxford, the one thing that older people who've been retired for quite a while have said is that I would like to contribute. When I left the labour market, my status went. And so I think it's more that people will want to be contributing. to their society.

And we'll want to have that opportunity. But we're going to see flexible working and part-time working and mixing work and education and leisure stroke time out for care or for education across our lifetimes. And I think it's that more flexible future rather than saying, I mean, what I hear from my colleagues is that, you know, they don't want to be forced to retire. Just because you hit a chronological age, it doesn't mean anything, actually. the diversity among people in their 50s and 60s is huge. And you'll find a 55-year-old who shouldn't really be working any longer.

You'll find a 40-year-old who shouldn't really be working because they're not up to the job. And you'll find people in their 60s and 70s who are perfectly capable of working. So we need far more flexibility in our system. And that in many ways will cope with trends from demographic change, from new technology, and just from the more flexible society we now live in. When you put it like that, it is a very compelling argument. That does make it sound quite nice. So now some countries are starting to push retirement age up.

Do you think that's the right first step to take? Well, it isn't. In many countries, people are abolishing retirement ages, but they're pushing up pension ages, state pension ages, and that means that the occupation on private pensions may well follow. And I think that is the way to go. The only thing that I would caution about is that we have huge inequalities in our countries. Let's just look at the UK, for example. There's been some concern recently

that life expectancy at birth is not continuing to increase in the way that we thought it was. I mean, to put it in perspective, until 2015, life expectancy was increasing between two and two and a half years a decade. That's roughly quarter of an hour for every hour you live. Your life was increasing. That has started to flatten at the national level. And what we now think, it's probably because of inequality in our society. That is the difference between those people who live in the more deprived areas of our society, maybe with lower income, less education, more poverty,

their life expectancy may even be going down, although the life expectancy of the highly educated, professional, managerial people living in more affluent areas is continuing to increase. So that also is affecting healthy life expectancy. And I did some work for the government recently, And one of the things that we did was look at modelling using ONS data, where we modelled life expectancy and healthy life expectancy in different regions of the UK. And if we take a 65-year-old man who is living in one of our most deprived areas, then he may well live until he is 80.

But he will go into ill health at 70. So all his 70s, he will probably be have quite a high degree of ill health and disability. If you take that same man and he's living in one of our more affluent areas, he'll probably live to his late 80s and he will not go into ill health till he hits about 80. So his 70s will be in pretty good shape, pretty independent, very little disability independency. So if you have a situation where you are pushing up state pension age in line with general life expectancy, you are going to penalise those poorer people who have lower life expectancy and lower healthy life expectancy. expectancy and are the ones who are more dependent on the state pension. Roughly about a third of our population, we think by about 2020, 30, 20, 35 will be dependent on the state pension. And therefore, if you're not careful, you are going to increase the number of people in their

60s who may well have to rely on disability benefit, for example, whilst waiting for their state pension. So I do think we should be increasing state pension ages in line with healthy life expectancy. But I think we have got to recognise the inequality in our society as we do that. What other possible solutions are there to this challenge? I think the thing is not to think of it so much as a challenge, but to say this is a trend and demographically we're going to see this trend occur. And we've got to take a whole society view. And we've also got to accept that it is happening in line with other trends, climate change, technological change, real social changes within our society. So one of the things we look at is that we have to, or one of the things we've

suggested here at Oxford, is that we have to look at it from a all-life perspective. This is a life course perspective. We have to start with very young children helping them to understand that they probably will live far, far longer than their grandparents and far far longer than their parents did. And what are they going to do with these long lives? We have to look at the way in which we design, if we're going to have half our population over 50 in Europe by about 2035, with a life expectancy at 50 of probably another 40, maybe even higher number of years, if we're going to have half the babies born in this country, probably making it to 100, then what we have to say is, is our country fit for purpose, are our institutions fit for

purpose? So take our education system, we have 100 years of life potentially, why do we stop education at 20? Surely we should be looking at lifelong education. We've looked at the world of work. Surely we should have a more flexible workplace. But what about the world of design? Are our houses suitable for these very, very long lives? Are we encouraging, in our public spaces, age segregation or age integration? What are we doing about intergenerational equality? In other words, we know that there is intragenerational inequality. In other words, often socio-economic equality. We know that there is huge. economic differences within cohorts and generations. But what about the problem of smaller birth cohorts coming up behind larger birth cohorts, which may be sucking away the resources? So how do we cope with what we call generational succession? So generational succession is this idea that we pass down assets, wealth, status and power down through the generations in quite a regular system. But if we're going to have very, very long lives, if we're going to have people still at work nearly

until they're 80, people still empower, people within families where you still have, you know, your great-great-grandmother alive and still in charge of everything and you are, you know, 70 and you're still not the head of the family. How are we going to adjust societies and people's expectations that actually is going to take a lot longer maybe to become the CEO of your company or to make your first million or whatever? So generational succession, changing the design of the houses that we live in, changing the design of our workplaces, changing the way in which we work, changing the way in which we're educated, looking at our own life courses, and understanding that we may be fit and healthy for a lot longer. There are very little bits of our, or very little aspects

of our society that actually aren't really going to be affected by this tremendous shift from a younger population to an older population. Now, when we start to think about the environment, falling birth rate seems like a really good thing. Does this mean that overpopulation is something that we don't need to worry about so much? I think it's very interesting the recent debate that there's been about falling fertility rates or falling childbearing rates, particularly in the European context. And we have had some governments who, I think, ill-advised, have tried to encourage women to have more children. If we put this into the bigger demographic picture, this is what is going to happen. So we're currently at about 7 billion. We will almost undoubtedly go to 10 billion by the

middle of the century and we may hit 12 or even higher by the end of the century. And this is because although we have falling fertility in our high income countries and increasingly, I have to say also in many of our Asians and Latin American countries, we still have very, very high birth rates in sub-Saharan Africa. So two-thirds of the world's countries, women are now at near or below replacement. That is there roughly about two children on average. And part of that is because an increasing number of women are not having children. So childlessness is playing into that. But in sub-Saharan Africa, we have child-bearing rates between four and eight per woman on average. And so one of the things that we're seeing is that we have all in other parts of the world gone through what we call

the fertility transition, but the poorer people, particularly those in sub-Saharan Africa, still in many cases, the fertility transition hasn't quite started, or if it has started, it's very, very slow. So our African population is going to increase, we believe, quite considerably. And also when we look at the 21st century, I think it's inconceivable, or I hope it's inconceivable, that by the end of the 21st century, we will still be in the situation that we are at the moment, where, to put very generally, about a billion people are dying through malnutrition, famine because they don't get enough calories and they mainly are in low-income countries. And we have similarly about a billion people who are dying through over-consumption of calories,

obesity leading to diabetes, cancer, cardiovascular disease. And they're typically in high-income countries. We're going to have to distribute our consumption of food, water, goods, services in a far more equal way. So even if our population does flatten, because we know that the middle and low-income countries are going to increase their consumption, pressure on the environment is going to increase. So we have pressure on our environmental resources. We have climate change, which is very much affecting the lower and middle-income countries, just because where they are in the world, that's where the heat spots and the flooding and the droughts are much more likely to be. That undoubtedly is going to put pressure on the northern hemisphere because I think we're going to. We are going to see an increase in people who will want to move into the more developed area,

which happens to be the Northern Hemisphere. So that whole sort of population picture means that we should not be encouraging women in individual countries to increase their fertility. In the modern world, the idea that large numbers means increasing productivity has very little salience. You don't need a large population in order to drive your economy. If anything, we're going to be facing huge unemployment because of technological change. So all countries should be looking at reducing their population, but having higher quality, higher skilled, educated people with a much higher quality of life, able to cope with our modern technologically driven world, rather than encouraging women to have large numbers of babies.

And the idea that, oh, we can't cope with our aging population unless we boost the number of children, it's going to take 20 years before those children are able to be productive in the labour market. And if you're not careful, these countries, and I'm thinking particularly hungry, you know, the president there has just come up with this big push to try and get more children born. He will have large number of older dependents, large number of child dependence. So his total dependency ratio is actually going to go up and he is going to be responsible for putting more pressure on our environment by boosting his population. So I think that's a lot of the boosting childbearing is not a good solution for the 21st century.

And do you know, so we're going through this period of change at the moment, but do you know whether or not this will stabilise? Will we all end up, will developing nations catch up and we'll all end up with this skyscraper demographic population? The demographic predictions are that by the end of this century or early next century, most countries, if not all, countries will be much more a skyscraper shape. And that is, if you like, the end of the demographic transition. The end from having societies which had very high childbearing but very high deaths

to societies that reduce their childbearing, but compensated, if you like, or were able to compensate by very, very long lives. So we have fewer people being born, but those people having a far better quality of life and living far, far longer. So the 21st century is a time of transition and therefore there is a time of adaptation and population ageing is one of the big megatrends that sits along environmental change and technological change. That was Professor Sarah Harper talking about how will accommodate an ageing population.

Her book, How Population Change Will Transform Our World, is available now. To fill those extra minutes and an ever-increasing lifespan, why not fill it with the latest science and technology from this month's issue of BBC Science Focus packed full of features, news and interviews to help you make sense of the world around you. In the summer 2019 issue, we explore what the future of space exploration holds. There is, of course, much more inside. But if you just can't wait to get hold of a copy, then check out our many, many previous Science Focus podcast episodes.

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