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In 1965 in the UK, the most common age at death was in the first year of life. Today, the most common age at death is 87. This startling statistic comes from a remarkable new book. The obligation of longevityAndrew Scott of the London Business School points out that while a newborn baby in Japan has a 96% chance of living to age 60, the average life expectancy of a Japanese woman is closer to 88. Japan is an outlier. But life expectancies are rising around the world. Currently, the average life expectancy worldwide is 76 for women and 71 for men (obviously, men are weaker).
This new world was born of a sharp decline in youth mortality. In 1841, 35% of boys in Britain died before reaching 20, and 77% did not live to age 70. By 2020, those figures had fallen to 0.7% and 21% respectively. We have largely overcome the causes of premature death with cleaner food and water, vaccinations, and antibiotics. I remember when polio was a major threat. It has been almost completely eradicated, as has smallpox, which was once a much bigger threat.
This is mankind's greatest achievement. Yet our primary reaction is to worry about the costs of an “aging” society. Do young and middle-aged adults want to know that they, or worse, their children, will never know when they will die? We know the answer to this question.
Certainly, the new world we live in creates challenges. But the key point Scott makes is that it also creates opportunities. We, as individuals and as a society, need to rethink old age. We cannot consign large segments of society to unproductive, unhealthy “old age.” We, as individuals and as a society, can and must do better. This is his “duty.” Barring a disaster, there will be many more super-old people. In 1990, there were only 95,000 people in the world over the age of 100. Today, that number is over 500,000 and growing.
The big question is: how do humans age? Do they live out their old age in good health and then suddenly die, or do they “lose their eyes, their teeth, everything” and live for years in helplessness and despair? Scott envisions four scenarios: the first is Jonathan Swift's Struldburg, immortal but ageing forever; the second is Oscar Wilde's Dorian Gray, who lives young and then suddenly ages and dies; the third is the eternally young Peter Pan; and the fourth is Marvel Comics' Wolverine, who has the ability to regenerate.
We can agree that the first is terrible. But that seems to be the way it is: the longer we live, the more likely we are to gradually decline. But a combination of better diet, more exercise, and medical advances might offer another possibility. Scott argues that this is where the effort should be, and that we should strive to prevent, rather than treat, or even worse, simply manage, the diseases of old age. Medical advances alone will not be enough for this: Rising inequality is not only a social and economic problem, it is also a health hazard.
China's life expectancy is currently 82 years for women and 76 years for men. Surprisingly, this is roughly the same as in the United States. American life expectancy is shockingly low for such a wealthy country, and this is due to large health disparities. According to Scott, “In the United States, the difference in life expectancy between the richest 1 percent and the poorest 1 percent is 15 years for men and 10 years for women.”
But we don't just need to change the way we age, we need to change the way we think about age.
The world of Dorian Gray is ideal but unlikely. But the worlds of Struldburg and Peter Pan would be frightening. This is true in the first case because most people would not want to end their lives in old age, which would inevitably put a huge burden on the younger generations of society. It is also true in the second case because few people would want to live alongside their great-great-grandparents. Immortality is not for us.
What is equally clear is that a world in which most people might live into their 90s or longer would need to be thoroughly rethought. The idea of 25 years or so of education, 35 years of work, and, say, 35 years of retirement is impossible for either individuals or societies. It is certainly too costly, and likely to result in empty old age for a large proportion of the population.
Naturally, people will need to work longer. They will also need to change careers several times over their lifetime. Instead of one period of education, work, and retirement, it makes sense to blend the three. People will repeatedly return to study. They will repeatedly take time off. They will repeatedly change their jobs. This is how we make a longer life affordable and, just as important, bearable.
To achieve such a world, education, labor, pension, welfare state, and health systems would need to be reorganized. People would no longer, for example, attend university or begin training only when they become young adults; this would become a lifelong activity. Also, mandatory retirement ages would no longer make sense; people would have to be given the choice to work or not work at different stages of their lives. Life expectancy is so unequally distributed that simply raising the retirement age across the board would be inefficient and unfair. Pension contribution rates would also need to change; currently they are generally too low. Health systems would also need to fully incorporate public health, which will become increasingly important as societies age.
We are moving towards a new, and old, world. This is a great achievement. But there is also a real danger, for individuals and societies, of a strudelbruck future. If this is the case, we must rethink how we think about the priorities of protecting life.
Email: martin.wolf@ft.com
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Letters in response to this column:
“Second Life” makes a valuable contribution to the economy / James Hanshaw, Zurich, Switzerland
Don't get too ahead of yourself when predicting lifespan / Professor Alok Bhargava, School of Public Policy, University of Maryland, College Park, USA
The “problem” of aging is also a positive side of climate change / From Rex Liefel (Washington DC, USA)
Human arrogance faces a showdown with nature / Robin Cook Harle, London SW11, UK