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A Global Roadmap for Healthy Longevity

Older age and longer lives bring new opportunities for meaningful and purpose-driven roles and responsibilities, including roles in solving many societal challenges. The sheer scale of the demographic changes currently under way means that the proportions of older people are increasing in virtually all countries, with 16 percent of the global population projected to comprise people aged 65 and older by 2050 (UN DESA, 2019). The commission asserts that societies can thrive in this new demographic order by improving health and building new roles and expectations for older people. In conducting this study, the commission found that healthy longevity requires not only good health¹ but also a fostering of social and environmental enablers, as described in Chapters 3 through 6. Many of the goals and recommendations in this report focus on older people because improving the lives of older people improves the lives of all people, and the goal of healthy longevity offers an expanded rationale for investments. Moreover, for younger people to have optimism about their futures, they need to see that their later years can be characterized by well-being, engagement, meaning, and purpose. These investments, combined with the assets and prosocial goals of unprecedented numbers of older adults, can achieve healthy longevity for individuals and societies. The commission thus concludes that healthy older age can bring to societies around the world immense capabilities to thrive, contribute to the successes of youth, and strengthen intergenerational cohesion.

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¹ In this report, health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946), which includes the ability to function and participate fully in society.

CREATING A GLOBAL ROADMAP FOR HEALTHY LONGEVITY

In this report, the commission presents its vision for 2050 with a goal of inspiring all actors—from leaders to individuals—around the world. No country has achieved sustained healthy longevity, but the evidence now suggests this is a clear opportunity. While the scientific evidence for precisely how to do so is unproven, the empirical evidence and studies reveal promising paths. This evidence, described in Chapters 3 through 6, serves as the basis for the commission’s findings, conclusions, and recommendations. The commission emphasizes urgency of initiating planning and first-step actions, including proactive experimentation and innovation guided, not limited, by the evidence. It will also be critical to monitor progress using rigorous evaluation, metrics, and continuous improvement approaches. If societies wait for rigorous academic evidence before acting, it is likely that little progress can be made efficiently toward achieving the commission’s vision for healthy longevity.

Because today’s societies were not designed for longer lives, realizing this vision will require long-term and large-scale societal investments in the roles, systems, organizations, and norms needed to support healthier, longer lives. Investments should focus on creating the supporting structures that are necessary for healthy longevity. Countries and communities are at different stages in developing these structures and therefore will likely interpret and implement the recommendations in this report based in part on the availability of resources and the age composition of populations. The commission’s recommendations for actions in the next 5 years are flexible, enabling actors to identify structures that are needed within their country, locality, or organization and to take actions necessary to build new or shore up existing structures (see Figure 7-1). Many of the recommendations focus on older adults because, as stated above, improving their health and well-being contributes to the health and well-being of all people; healthy longevity requires life-course investments; and to have optimism for their later lives, young people need to see older people who are engaged, thriving, and productive to counter the narratives of older people as disabled and dependent. Finally, the achievement of healthy longevity for all will require the resolution of health disparities at every age.

The commission’s recommendations comprise levers for change within and across work and education; social engagement; and investment in transforming social protections, the physical environment, and health systems. The first-stage, actionable recommendations of the commission are based on evidence and the combined expertise of the commissioners and are designed to catalyze transformational change. The commission maintains that these interventions are achievable within 5 years of this report’s release (i.e., by 2027) unless otherwise stated. This 5-year target will be useful to countries as they assess progress made toward goals of the United Nations (UN) Decade of Healthy Ageing (2021–2030) and

develop plans for addressing remaining challenges. Once implemented, these first-stage recommendations can lead to the development of supporting structures to achieve the goals articulated for longer and healthier lives.

The commission recognizes the heterogeneity of countries around the world—each country has its own cultures, populations, systems, and resources and thus will have different starting points and priorities. Critical to global efforts are the relationships of unequal economic and political exchange that characterize many low- and middle-income countries, which determine and limit their economies, lead to health disparities and hierarchy of opportunity from old to young, and shape the resources they can marshal to invest in healthy longevity. Importantly, the commission does not suggest an order of importance for the Vision 2050 goals, as all are necessary, in concert, to extend the number of years lived in good health. Countries will need to address each goal based on their available resources and current investments and the overall health of their populations. Similarly, the commission refrained from prescribing detailed mechanisms for enacting the necessary policies given the unique contexts of each country, instead offering this overarching roadmap to guide country-specific paths to healthy longevity. The commission also offers two enabling recommendations that would catalyze action: a call to action and data to measure healthy longevity.

AN ALL-OF-SOCIETY CALL TO ACTION

Applying a complex systems approach, the commission recognizes that innovation in any one sector will not lead to a transformation toward achieving healthy longevity. Actions targeting the economic longevity dividend, social infrastructure, physical environment, and health systems will all be necessary, as discussed in Chapters 3 through 6. Implementing the commission’s recommendations will require an all-of-society approach, involving transformations in every sector of a nation.

Similarly, the commission calls on a multitude of actors and stakeholders to take action. Actors include governments, nongovernmental organizations (NGOs) and multilateral organizations, the private sector, local and community organizations, and researchers, as well as leaders and individuals (see Figure 7-2). Each group of actors has a unique and critical role to play; collectively, these actors have a shared accountability for achieving healthier, longer lives. Government agencies at the international, national, regional, and local levels each have distinct, important roles in policy development and overarching leadership. NGOs and multilateral organizations bring stakeholders together within and across countries, providing access to resources and guidance. The private sector, including businesses, unions, and professional societies, can translate policies and values into programs that will motivate and create incentives for individuals. Researchers can provide the evidence for what has worked and how to do better.

Religious institutions can help guide a community’s culture and values and can be used to mobilize community action. And individuals, their families, and communities must take responsibility for engaging in the opportunities thus provided to help drive the years lived in good health to approach life span and to build the opportunities for meaningful and productive engagement that people may want. Transformation of this complex system has to be approached from both the “bottom up” and “top down,” with dialog among citizens and stakeholders.

The commission believes strong commitments to healthy longevity by governments are essential to stimulate and initiate actions by each sector and set of actors. Governments can lead by recognizing that humanity has an opportunity now to plan and prepare for the demographic shifts toward longer life expectancy and a larger proportion of older people. Specifically, governments can commit to enabling healthy longevity, creating a vision and agenda that explain how long lives are beneficial for all ages; communicating the value older people can bring; and building the necessary systems, environments, and opportunities.

The commission recommends that governments initiate processes now that will lead to the establishment of calls to action by 2023. Countries should begin implementing the plans resulting from those calls to action by 2027. Whenever possible, these all-of-society plans should connect to and be integrated with and/or transform existing policies and services. At a minimum, plans should include synthesis or coordination of policy responses in the areas identified in this report and indicate where investments will be made. For example, one component of a plan could involve governments working with the private sector to develop innovative, scalable, and sustainable societal initiatives designed to facilitate working longer for those who want to; enable social protections; and catalyze intergenerational connections, social capital, and productive engagement of older people. Communities could work together to address how cross-sector changes, such as actions to combat climate change, can be implemented efficiently and leverage any shared resources. Communication campaigns could be conducted to urge older adults to contribute to younger generations’ success and younger generations to contribute to prior generations’ well-being. As described in Chapter 3, the commission believes that the resulting social and economic capital from these efforts will generate returns on investment.

Ongoing research will be needed to better understand how to achieve healthy longevity equitably in each of the above areas and in culturally appropriate ways across domains. In the near term, all-of-society plans can create healthy longevity, and to support older people will benefit the success of future generations by increasing the amount of human, social, and economic capital, which in turn will

expand the economy and help fund future efforts to promote healthy longevity. While strategic action plans for aging societies exist in many countries, the commission believes many are not heeded because the challenge is viewed as applicable for a single sector or age group, and changing complex systems requires immense effort and political will. There also has not been wide acknowledgment of the value to people of all ages of viewing healthy longevity across the life course. While financing and political will are beyond the scope of this study, the commission argues that healthy longevity can be achieved only by aligning forces and taking collective action across sectors.

DATA TO GUIDE DECISION MAKING

Data and metrics are needed to measure progress toward achieving healthy longevity at both the individual and population levels, but current metrics do not adequately capture the key domains addressed in this report. A core set of metrics thus needs to be collected to enable evaluation of progress toward increasing years lived in good health and achieving the goals of healthy longevity. Most useful, where possible, would be direct measures reflecting the impact of differences in services and environments across countries. Useful as well, where relevant, would be appropriate country- or region-specific metrics able to capture particular contexts and forms that healthy longevity and requisite investments will take. Leadership will be critical for identifying metrics all countries can use. International bodies and professional organizations will have essential roles in coordinating efforts to identify meaningful measures of outcomes.

The commission calls on the World Health Organization (WHO) to lead this effort while working with other multilateral organizations, such as other relevant UN agencies (e.g., UN Department of Economic and Social Affairs) and the World Bank. As an agency of the United Nations, WHO has the objective of “the attainment by all peoples of the highest possible level of health” (WHO, 1946). Although their core missions are not to collect data, WHO and other aligned agencies can use their ability to convene countries and peoples from around the world to mobilize efforts toward identification of a global set of metrics for measuring healthy longevity and progress toward this goal. These metrics need to capture not only the health of populations but also ways to evaluate human and social capital and societal returns on investment. Measuring and monitoring

progress along these measures will allow the world to better harness the human, social, and economic capital of populations. New metrics and systems of monitoring will likely be required.

As no single measure of healthy longevity adequately addresses the array of enablers identified in this report, a core set of metrics and measures consistent across countries would facilitate the identification of outcomes and compilation of best practices, effective interventions, and policies that promote healthy longevity. Importantly, global metrics can allow countries to benchmark their performance, characterize return on investment, and compare across countries to assess the success of interventions. Core data should be made publicly available to the extent possible to enable decision making on next-stage investments and research needs. Individual-level data will be most useful if stratified by gender and age bands across the life span.

Data collection at the population level is resource intensive but important to enable continuous assessment and evaluation that can aid in identifying opportunities for intermediate change. Countries will need to consider efficient methods for gathering high-quality data. For example, digital data collection could be more efficient than traditional methods and yield more robust data.

TRADE-OFFS

Making investments to achieve healthy longevity requires making trade-offs. Individuals and families, communities, and societies must weigh the benefits and costs of prioritizing healthy longevity. Similarly, each society will need to align its decisions with the vision of this report while remaining cognizant of local factors such as the relative age of its population and available funding.

Also important to note are the existential societal challenges that societies will face, such as climate change, unsustainable inequity, and wars. In the context of finite resources, the realities of political will, and other efforts such as the pursuit of the UN Sustainable Development Goals (UN, 2021), priorities will need to be continuously evaluated and investments refocused. The commission contends that healthy longevity will generate returns on investment and provide immense social and individual benefits, and that a focus on healthy longevity will better enable success in other areas.

CONCLUSION

Health is complex and the result of a multitude of factors, requiring attention not just to health systems but to all socioeconomic determinants of health. It is imperative that countries act now to achieve healthy longevity as the human life span is extended. By taking an all-of-society approach, countries can seize the opportunity to align efforts addressing all of these factors to increase the number of years lived in good health.

REFERENCES