The Aging World

The average age of the world population is getting older, and this is very likely to have serious social and economic consequences in the countries and regions where it is most severe. However, I feel like this is very rarely discussed in politics. Politics seems to be rather specialized at not discussing the issues that are most likely to be relevant.

Anyway, I caught two articles on the aging population in the last week, and in honor of Super Tuesday I thought we should discuss the demographic trend that is most likely to shape the world over the next 100 years.

The first is by Lutz et al. in Nature. Lutz et al. wanted to create more accurate and probabilistic measures of aging in world populations. In their paper, they introduce some new numerical measures -- like proportion of individual who have less than 15 years of life expectancy -- and make probabilistic projections for the aging in the world population.

Below are just two of these projections. (Read the paper to get the full story.) The first shows the cumulative probability of a region of the world having 1/3 or more of its population be over 60 at a given time (Figure 3 from the paper, click to enlarge):

i-4d3d0d07dc5098f0e284ed77ac9f6cd7-over60small.jpg

You can see that it is basically certain that Japan, China, and Europe will have at least at third of their population be over 60 by the end of the century. For North America the increase in aging will likely be slower, and for places like Sub-Saharan Africa there is essentially zero chance for a 1/3 of the population being over 60 by the end of the century.

The second shows a probability projection for the proportion of world population over 80 (Figure 4 from the paper):

i-e3ac350c68d932611501ce529e60a798-over80.jpg

You can see that for the whole world there is about a 50/50 chance that 20% of the population will be over 80 by the end of the century. (I really like probability projections because they emphasize the inherent uncertainty in this kind of modeling. I feel like they also provide a better basis for discussion about policy because you can ask questions like "what is the most likely outcome?" and "what is the population change that we are 90% certain is going to happen?")

Why should I care about these projections, you ask?

The biggest changes as the result of an aging population are going to be in how we pay for the huge health care costs associated with an aging population. Imagine a US where a third of the population is on Medicare?

How we pay for this is going to determine a lot of how jobs are distributed. This brings me to the second article. Megan McArdle from the Atlantic wrote an article discussing the changes that have happened to her hometown now that most of the people who live there are elderly. It in miniature represents what we should expect will happen in countries as the population ages.

To wit:

Start with the stuff America makes, and the people who make it. Young people buy goods, like cars, houses, and iPods. Old people need services, like transportation, meal preparation, and health care. We have made great strides in enabling the elderly to get around -- the scooters you see advertised on daytime television, for example. My grandmother, who is blind and physically frail, was able to live at home much longer than she otherwise could have because she had Meals on Wheels, a home health aide, and a Life Alert-type necklace to call for help in case she fell.

But these services require a lot of labor. According to an analysis by McKinsey Global Institute, the number of hours required to produce an automobile in North America fell by 1.7 percent annually from 1987 to 2002, to an average of about 100 hours. Meanwhile, it still takes about the same amount of time as it always did to drive a senior to a doctor's appointment, or to help an older patient bathe and dress. Productivity growth is faster in the things that kids consume than in the things that the elderly need.

As the Boomers age, they will consume fewer of the things that we produce efficiently, and more of the things that we provide relatively inefficiently. Productivity is notoriously difficult to project, but many forces will be pushing it downward as the Baby Boomers age.

Since services are labor-intensive, and the number of service-consuming seniors will grow rapidly, we'll need a lot more workers (that's bad news for those who favor restrictive immigration policies, particularly the kind that keep low-skilled workers out). And, of course, the mix of service workers that we'll need will be different from what it is today. In effect, the next 20 years will require a massive transfer of resources and people away from the care of children, who will decline in relative number, and toward the care of old people.

This rebalancing should have already started, but it hasn't. Consider that approximately 29,000 pediatricians now work in the United States, caring for roughly 75 million children. To care for roughly half that number of patients over 65, the American Geriatrics Society reports, the country has only 7,128 board-certified geriatricians. Just 468 first-year fellowships in geriatric medicine were available in the 2006Â-2007 academic year; nonetheless, almost half of them went unfilled.

In order to compensate for an aging population, many people are going to have to change jobs from production of goods for young people to services for the elderly. And this isn't even bringing up the issue of taxation.

Long-term trends like aging are the elephant in the room of political debates. They are never talked about, but they change so much of the outcome of what societies look like. Whether or not the Boomers continue to work well past retirement age is going to determine a lot of whether this country remains solvent or not over the next 80 years. And similar issues are at play in other countries. When you have half-as-many people paying for those on social services, it changes taxation, it changes policies for health insurance, it even changes the incentive to work. Look at countries like Italy. The Italians are going to have trouble making ends meet in a couple of years, and something -- either increased taxation or decreased services -- is going to have to give.

Anyway, on this Super Tuesday as we are considering the variety of Presidential candidates, we will discuss their stances on a variety of issues. Most of these issues won't make a lick of difference in 40 years. But their stands on issues related to dealing with an aging population will matter.

Make sure to consider that when you decide who to vote for...

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This is a burden the world can't carry, even if we are smart with our votes. What it boils down to is that most of us are going to die horribly without access to even palliative care. The only non-elderly population is Africa, and they can't help us because they're already dying horribly without access to even palliative care.

By Panglossian world (not verified) on 05 Feb 2008 #permalink

The problem with any prediction about the future is that is essentially depends upon projecting current trends. That, of course, misses all the most important changes that can occur. For example, if such a projection had been made or attempted a century ago, it would have missed the medical advances that are a significant factor allowing more people to live to a greater age and the advances that allow people with significant physical problems to continue to live beyond what could have been expected. The first has to do with allowing younger people to survive medical conditions that would have killed them in the 1800 and, indeed, even into the 1900s. The second involves keeping severely physically handicapped people alive for long periods. Many of these people would have died because there simply would have been no way to take care of them.

This in no way eliminates the need to plan, but in my view, it draws the planning horizon somewhat closer.

Britney Spears rocks

One of the most depressing aspects of our political system is that if a harm directly proceeds from an action, even an action that is necessary, no one wants to initiate it and be perceived to be responsible for the harm, but if a harm is a hidden and indirect result from an action, this won't stop anyone from taking it.

Keeping a third of the population on Medicare is probably not possible... so we'll have to cancel Medicare, whether we want to or not, because we simply will not have the resources to sustain it.

No one will want to be the person who pulls the plug, though.

By Caledonian (not verified) on 05 Feb 2008 #permalink

Caledonian, perhaps we should consider canceling the incredibly, stupendously, irrationally high military budget. We're already cutting back social programs so we can feed the military-industrial complex. I guess you saw that the current budget calls for nearly $1 trillion for the military. That is a cost we really won't be able to bear.

Interesting post -- this is an issue that has been in the background for a while, and there are two major components: fertility and mortality. I'll restrain my comments to the former.

In 2006 the IPPR (a British think-tank) published a report ('Population Politics') suggesting that that governments ought to be more forthright in encouraging people to have children. Though this might offend various libertarian sympathies, it should be noted that existing tax, education, maternity and health policies already alter (and in most cases, reduce) the cost of rearing children for the individual.

Specifically, all welfare-to-work programmes I know of treat parents more generously. The reason is that childcare costs are considered to be a significant barrier to labour market participation. A more recent idea is to subsidise childcare directly.

One convenient thing is that current policy trends are very compatible with encouraging childbearing: reducing child poverty through encouraging work, policies helping mothers to have both a career and a family, and so on. However, the IPPR's major point was that governments ought to explicitly consider the fertility effects of these policies. Currently these are ignored, by the UK government at least.

(Incidentally, I think it's going to be important who has these children, both economically and socially. I intended to address this in a chapter of my PhD but I don't know if I will now have the chance.)

Returning to the effects of the fertility transition, I cannot help but think it is a rather Malthusian story. Let me be clear: Malthus was wrong. Technological change has always outpaced population growth. (See my letter to the Guardian, linked on my website.)

Many jobs once considered services now are now obviated by machines. The washer-woman, and (perhaps less fortunately) the professional musician are just two examples. It is reasonable to expect that such progress will continue, and we will make up some of the 'shortfall' in labour with capital instead. (As an aside, the Economist has occasionally noted that Japan's obsession with robots may be driven by its ageing crisis for this reason.)

On the other hand, the story is likely to be more nuanced outside Western Europe and Japan. The former Soviet countries and China (due to the one-child policy) face ageing before full development. Making predictions about what will happen there is more difficult.