Academic journal article Generations

Can Populations Age Better, Not Just Live Longer?

Academic journal article Generations

Can Populations Age Better, Not Just Live Longer?

Article excerpt

Infectious and parasitic diseases may be waning, but chronic illness is on the upward swing. How do we maintain good health and social care?

As both the proportion of older people and the length of life increase worldwide, important health-related questions arise. Will population aging be accompanied by a longer period of good health, a sustained sense of well-being, and extended periods of social engagement and productivity-or will it be associated with more illness, disability, and dependency? How will aging affect healthcare and social costs? Is a dire future inevitable, or can we act to establish a physical and social infrastructure that might foster better health and well-being in older age? How will population aging play out differently for low-income countries that will age faster than their more developed counterparts have, before they become industrialized and wealthier?

Most of Us Are Living Longer

The dramatic increase in average life expectancy during the twentieth century ranks as one of society's greatest achievements. While most babies born in 1900 did not live past age 50, life expectancy at birth now exceeds eighty-three years in Japan-the current leader-and is at least eightyone years in several other countries (United Nations, 2011). Less developed regions of the world have experienced a steady increase in life expectancy since World War II, although not all regions have shared in this increase. One notable exception was a fall in life expectancy in many parts of Africa from deaths caused by the HIV/AIDS epidemic. The most dramatic and rapid gains have occurred in East Asia, where life expectancy at birth increased from less than fortyfive years in 1950 to more than seventy-five years today.

These improvements are part of a major transition in human life encompassing a broad set of changes, including a decline from high to low fertility, a steady increase in life expectancy at birth and at older ages, and a shiftin the leading causes of death and illness from infectious and parasitic diseases to noncommunicable diseases and chronic conditions. In early non-industrial societies, the risk of death was high at every age, and only a small proportion of people reached old age. In modern societies, most people live past middle age, and deaths are highly concentrated at older ages.

The victories against infectious and parasitic diseases are a triumph for public health projects of the twentieth century that immunized millions against smallpox, polio, and major childhood killers like measles. Even earlier, better living standards, especially more nutritious diets and cleaner drinking water, began to reduce serious infections and prevent deaths among children. More children were surviving their vulnerable early years and reaching adulthood. In fact, more than 60 percent of the improvement in female life expectancy at birth in developed countries between 1850 and 1900 occurred because more children were living to age 15, not because more adults were reaching old age.

It was not until the second half of the twentieth century that mortality rates began to decline within the older ages. Between 1950 and 1975, about one-half of the increase in life expectancy at birth occurred because of lower mortality rates among those ages 50 or older. Research for more recent periods shows a surprising and continuing improvement in life expectancy among those ages 80 or above.

Demographers did not anticipate the progressive increase in survival in these oldest age groups. Questions arise about how high the average life expectancy can realistically rise and about the potential length of the human lifespan. While some experts assume that life expectancy must be approaching an upper limit, data on population life expectancy in the country with record life expectancy between 1840 and 2007 show a steady increase averaging about three months of life per year (Oeppen and Vaupel, 2002; Christensen et al. …

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