Global Aging Report Threats to Longevity
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Global Aging Report Threats to Longevity United States of America Japan France United Kingdom Dominican Republic India South Africa Argentina The Netherlands Israel TheThe InternationalInternational LongevityLongevity CenterCenter GGloballobal AllianceAlliance Contents A Call to Action 3 Coda 18 Appendix I – Tables Table 1 Life Expectancy in 50 Locations, Both Sexes........................... 20 Table 2 Populations of Countries with At Least 10 Percent of Their Population Age 65 and Over ..................................................... 21 Table 3 The New Longevity: Life Expectancy from Age 60 ................. 23 Table 4 Ten Nations with Largest Populations: Selected Demographic Characteristics .......................................................................... 24 Table 5 Healthy Life Expectancy (HALE) at Birth, Both Sexes, in Selected WHO Member States ........... 24 Appendix II – Reports from International Longevity Centers United States of America (founding member) .............................. 26 Japan (founding member) .............................................................. 37 France (1996) ............................................................................. 45 United Kingdom (1997) ............................................................. 55 Dominican Republic (1998) ....................................................... 67 India (2004) ................................................................................ 72 South Africa (2005) .................................................................... 78 Argentina (2005) ........................................................................ 86 The Netherlands (2006) ............................................................. 97 Israel (2007) ...............................................................................104 GLOBAL AGING REPORT Threats to Longevity A Call to Action 2009 The International Longevity Center Global Alliance Preface The International Longevity Center Global Alliance comprises ten centers – the United States of America, Japan, France, the United Kingdom, the Dominican Republic, India, South Africa, Argentina, The Netherlands, and Israel. Together, we are engaged in an effort to understand and address the profound consequences of population aging and advancing longevity. This report is a collaborative effort of all ten centers, presenting a detailed portrait of the realities of population aging around the world and articulating a call to action from an intergenerational and lifespan perspective. 2 A Call to Action Geography of Longevity a. Population aging One of the dramatic events of the 20th century has been the unprecedented aging of populations around the world in both the developing and developed countries. In less than a century and particularly in the developed world there has been an average 30-year gain of life expectancy. Nearly 20 percent of that gain was from a base age 65, in addition to the sharp reduction in maternal, childhood and infant mortality rates. By the year 2020 one fourth of the population in many nations will be over 60, and by 2050, every fifth person on the planet will be over 60. At the same time, many developing countries are experiencing a significant downturn in their birth rates, increasing the percentage of older persons in these countries. In contrast to the developed world, which grew rich before it grew old1, the developing world, where 81 percent of the world’s population lives, will grow old before it grows rich, with older persons among the poorest and most vulnerable. On average, men and women in the developed world live 75 years, although this could change in the event of an epidemic or pandemic or because of poor health habits that result in obesity.* In the developing world, however, life expectancy is substantially less, averaging 53 years for least developed countries and 64 years for less developed regions,** with enormous economic, social and personal consequences that include significant trade disadvantages. Currently, in 18 nations, (17 nations in Africa, and Afghanistan) life expectancies are less than 50 years and disability-free life expectancies or active life expectancies are less than 46 years. b. Shortgevity The populations of many poor nations suffer from shortgevity, and indeed, poverty and shortgevity move in the same direction. Sierra Leone, for example, has an average life expectancy of 40 years and a disability-free life expectancy of only 29 years. In addition, although it is unusual for a nation to reverse a longevity trend several nations of the former Soviet Union (FSU) have indeed lost life expectancy, largely resulting from the AIDS epidemic, and an increase in the incidence of alcoholism caused by the despair and loss of purpose that befell these societies at the breakup of the Soviet Union. Mozambique is another nation that has lost previously gained years of life. Nations experiencing shortgevity have lower productivity and are at a disadvantage in * Alex Kalachi, World Health Organization ** Source; UN Population Division Global Aging Report 3 Male life expectancy in the Russian Federation is now 60. It is the lowest of any nation in the developed world. the global economy because they are limited in their ability to produce, exchange, buy and sell products and services to the developed world. Threats to Longevity a. Diseases of Developed Nations With the advent of mass vaccinations and advances in public health, developed nations have in large mea sure overcome acute diseases. Chronic diseases, the so-called diseases of affluence, have replaced diseases like polio, diphtheria, and smallpox. They include obesity, coronary heart disease, diabetes and smoking-related diseases. The World Health Organization reports that tobacco is the leading cause of death worldwide. David J.P. Barker theorized2 that chronic diseases in later years have their origins in fetal life and early infancy. Low birth weight, which is a function of poor nutrition as well as other adverse prenatal environments, and conditions during infancy, have a direct bearing on the development of risk factors for adulthood diseases. Childhood infections may have a long- term effect on adult mortality, and there is a strong correlation between childhood diseases and later health problems. In fact, many diseases generally considered “geriatric” did not suddenly emerge in old age but have a long history. It might be more appropriate to refer to them as “disorders of longevity”, and to intervene early in life. Osteoporosis, for example, may be seen as a pediatric disease that originates in pubescence and adolescence, when, ideally, bone density is achieved and “banked.” In part, the disease is the cumulative outcome of a lack of anti-gravity exercise, calcium and vitamin D. Heart disease and even type II diabetes, particularly when associated with obesity, may take root in infancy and later childhood culminating in death. b. Diseases of Developing Nations Not long ago public health experts optimistically predicted the end of infectious diseases. But in the developing world pulmonary and diarrheal diseases (especially in children), tuberculosis (including the extremely resistant form), malaria and acquired immune deficiency 4 A Call to Action syndrome (AIDS) remain common, debilitating and deadly. It unfortunately remains true that only 10 percent of disease-related drug research in the developed world focuses upon diseases that affect 90 percent of the world population. For example, hepatitis B vaccine was developed in 1981 but 2 decades passed before it was introduced in the poor nations. Indeed, despite the progress that has been made in bringing vaccine inoculations to poor and remote areas, 20% of the world’s children are not vaccinated against vaccine-preventable diseases: measles, polio, tuberculosis, diphtheria, whooping cough, and tetanus. 700,000 children die of pneumococcal disease annually in developing countries. AIDS More than 15 million children under the age of 18 have lost one or more parents to AIDS, with the greatest burdens being borne by Sub-Saharan Africa and parts of Asia. In Sub- Saharan Africa the cumulative number of AIDS orphans is estimated to be 12.1 million.3 HelpAge International reports that in Sub-Saharan Africa 60 percent of AIDS orphans have a grandparent as a principal guardian. In many locations orphanages do no exist at all, and in addition to caring for their terminally ill adult children, older persons are the best and often only realistic solution to meeting the needs of their grandchildren and other orphans in the community. The consequences of the erroneous assumption that older persons are not sexually active can have tragic consequences because they do not receive policy attention, and are not targeted for HIV prevention messages. Older persons are also excluded from many statistics on HIV/AIDS that typically does not include anyone over age 50, such as data from UNAIDS and WHO 2006. Not only are older persons often sexually active, they are also at risk of infection through their role as caregivers. In affected developing countries the impact of HIV/AIDS on older people has been particularly severe. When adults in the prime of their lives die of AIDS- associated illness, they leave behind two vulnerable populations, their children and their aging parents. During the time older persons care for their ill adult children, the physical demands Global Aging Report 5 and emotional strain can seriously affect their health. In the