NATIONAL INSTITUTE ON AGING

NATIONAL INSTITUTES OF HEALTH

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

U.S. DEPARTMENT OF STATE

Why Population Aging Matters

A Global Perspective
Contents
Foreword.................................................................................1
Overview—Our Aging World..............................................2
Introduction—The Cost of Waiting....................................4
Trend 1: An Aging Population............................................6
Trend 2: Increasing Life Expectancy..................................8
Trend 3: Rising Numbers of the Oldest Old..........................10
Trend 4: Growing Burden of Noncommunicable Diseases.........12
Trend 5: Aging and Population Decline............................14
Trend 6: Changing Family Structure................................16
Trend 7: Shifting Patterns of Work and Retirement..................18
Trend 8: Evolving Social Insurance Systems........................21
Trend 9: Emerging Economic Challenges.........................24
Endnote............................................................................27
Suggested Resources.......................................................28
Foreword > People are living longer and, in some parts of the world,
healthier lives. This represents one of the crowning achievements of the last century but
also
a significant challenge. Longer lives must be planned for. Societal aging may affect
economic growth and many other issues, including the sustainability of families, the
ability of states and communities to provide resources for older citizens, and international
relations. The Global Burden of Disease, a study conducted by the World Health
Organization and the World Bank, with partial support from the U.S. National Institute on
Aging, predicts a very large increase in disability caused by increases in age-related
chronic disease in all regions of the world. In a few decades, the loss of health and life
worldwide will be greater from noncommunicable or chronic diseases (e.g., cardiovascular
disease, dementia and Alzheimer’s disease, cancer, arthritis, and diabetes) than from
infectious diseases, childhood diseases, and accidents.

Despite the weight of scientific evidence, the significance of population aging and its global
implications have yet to be fully appreciated. There is a need to raise awareness about not
only global aging issues but also the importance of rigorous cross-national scientific
research and policy dialogue that will help us address the challenges and opportunities of an
aging world. Preparing financially for longer lives and finding ways to reduce aging-related
disability should become national and global priorities. Experience shows that for nations,
as for individuals, it is critical to address problems sooner rather than later. Waiting
significantly increases the costs and difficulties of addressing these challenges.

This reportpaints a compelling picture of the impactof population aging on nations. It

provides a succinct description of population trends that are transforming the world in
fundamental ways. We hope this information will stimulate dialogue about biomedical,
economic, and behavioral issues and encourage international study to determine the best
ways to address this universal human experience. We trust that members of the global
community will be inspired to share their recommendations and their experiences so that
we can all plan for the aging of our world’s population. We are, after all, planning for our
own futures.

Paula J. Dobriansky, Ph.D.

Under Secretary for Democracy and Global Affairs
Department of State

Richard M. Suzman, Ph.D. Richard J. Hodes, M.D.

Director, Behavioral and Social Research Program Director
National Institute on Aging National Institute on Aging
National Institutes of Health National Institutes of Health
 OVERVIEW

Our Aging World

We are aging—not just as individuals or communities but
as a world. In 2006, almost 500 million people worldwide
were 65 and older. By 2030, that total is projected to
increase to 1 billion—1 in every 8 of the earth’s
inhabitants. Significantly, the most rapid increases in the
65-and-older population are occurring in developing
countries, which will see a jump of 140 percent by
2030.
2 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE
A Host of Challenges  Family structures are changing. As people
live longer and have fewer children,
While global aging represents a triumph of
family structures are transformed,
medical, social, and economic advances over
leaving older people with fewer options
disease, it also presents tremendous challenges.
for care.
Population aging strains social insurance and
 Patterns of work and retirement are
pension systems and challenges existing models
shifting. Shrinking ratios of workers to
of social support. It affects economic growth,
pensioners and people spending a larger
trade, migration, disease patterns and
portion of
prevalence, and fundamental assumptions about
their lives in retirement increasingly strain
growing older.
existing health and pension systems.
Using data from the United Nations, U.S. Census  Social insurance systems are evolving. As
Bureau, and Statistical Office of the European social insurance expenditures escalate, an
Communities as well as regional surveys and increasing number of countries are
scientific journals, the U.S. National Institute evaluating the sustainability of these
on Aging (NIA), with input from demographers, systems.
economists, and experts on aging, identified  New economic challenges are emerging.
nine emerging trends in global aging. Together, Population aging will have dramatic
these trends present a snapshot of challenges effects on social entitlement programs,
and opportunities that clearly show why labor supply, trade, and savings around
population aging matters. the globe and may demand new fiscal
 The overall population is aging. For the approaches to accommodate a changing
first time in history, and probably for the world.
rest of human history, people age 65 and
over will outnumber children under age 5. A Window of Opportunity
 Life expectancy is increasing. Most
Some governments have begun to plan for the
countries, including developing countries,
long term, but most have not. The window of
show a steady increase in longevity over
opportunity for reform is closing fast as the
time, which raises the question of how
pace of population aging accelerates. While
much further life expectancy will increase.
Europe currently has four people of working age
 The number of oldest old is rising. People
for every older person, it will have only two
age 85 and over are now the fastest
workers per older person by 2050. In some
growing portion of many national
countries
populations.
the share of gross domestic product devoted to
 Noncommunicable diseases are becoming a
social insurance for older people is expected to
growing burden. Chronic
more than double in upcoming years. Countries
noncommunicable diseases are now the
therefore have only a few years to intensify
major cause of death among older people
efforts before demographic effects come to
in both more developed and less developed
bear.
countries.
 Some populations will shrink in the The challenges may seem daunting, but a
next few decades. While world host of opportunities await us as well. For
population instance, countries that have begun to
is aging at an unprecedented rate, address issues of population aging can share
the total population in some their experiences. There are exciting
countries is simultaneously opportunities for economic expansion and
declining. cross-national collaboration as
well, but we must act now or the costs be overwhelming.
of waiting— financial and social—will

OVERVIEW—OUR AGING WORLD 3

 INTRODUCTION

The Cost of Waiting

Global aging is a success story. People today are living
longer and generally healthier lives. This represents
the triumph of public health, medical advancement,
and economic development over disease and injury,
which have constrained human life expectancy for
thousands of years.
4 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE
But sustained growth of the world’s older
population also presents challenges. Population
aging now affects economic growth, formal and
informal social support systems, and the ability
of states and communities to provide resources
for older citizens. Nations must quickly
recognize the scope of the new demographic
reality and adjust current policies accordingly.
Experience has shown that such adjustments
may be painful—changes in retirement ages and
medical benefits, for example, are not widely
popular. But experience also shows that it is European Commission and the Economic Policy
easier to address problems sooner rather than Committee submitted a report to European
later, when the cost of waiting may become Finance Ministers with new projections of
insurmountable. economic and budgetary costs for European
We can think about preparing for older Union (EU) member states. While Europe
age on both an individual and societal currently has four people of working age for
level. On an individual level, people need every older citizen, it will have only two
to focus on workers per older citizen by 2050 as a result
preventive health and financial preparedness. of the baby boom generation retiring and life
We know that many individuals approach older expectancy increasing. Given current policies,
age with little or no savings. A simple example the pension, health, and long-term care costs
illustrates the financial cost of waiting to save associated with an aging population will lead to
and the value of a more farsighted significant increases in public spending in
perspective. A 40-year-old worker who begins most member
states over the next half century. Gross domestic
to save
product growth rates are projected to fall
$10,000 per year will accumulate $700,000 by
across the EU, and in the absence of policy
the time he is 70 years old, assuming an
changes, the potential EU economic growth rate
interest rate of 5 percent per year. If he had
will be cut in half by 2030.
begun saving when he was 30 years old, he
would only have needed to save $5,500 per While some countries have initiated changes in
year to accumulate the same amount by age retirement age that promise to ease the
70. burden of public spending, the EU analysis
emphasizes that such changes alone are
Calculating the cost of waiting at the national
inadequate. During the next few years,
level is much more complex, but similar
countries must exploit a fast-closing window
reasoning applies. Just as for individuals, small
of opportunity to intensify
and gradual changes distributed over a longer
reform before demographic effects come to bear.
time horizon are more easily absorbed by a
The EU report notes that, similar to the
country than sudden and more substantial
impact of an individual worker delaying
actions required to meet a particular savings
savings, delays at the national level will
target over a shorter time horizon. Countries
increase the costs of adjustment and shift an
and international organizations are now
enormous economic burden to the next
developing detailed models in recognition of
generation of workers and taxpayers.
looming costs and the need for pension
reforms to ensure sustainable old-age support.
In 2006, the
INTRODUCTION—THE COST OF WAITING 5
 An Aging Population
TR END

1
Since the beginning of recorded human history, young
children have outnumbered older people. Very soon this
will change. For the first time in history, people age 65
and over will outnumber children under age 5 (Figure
1). This trend is emerging around the globe. Today
almost 500 million people are age 65 and over,
accounting for 8 percent of the world’s population.

Figure 1:
YOUNG CHILDREN AND OLDER PEOPLE AS A
PERCENTAGE OF GLOBAL POPULATION

2%%

6< : +* +

&*%

&%%

6< : 1 *

*%
&9*% &9+% &97% &9-% &99% 2%%% 2%&% 2%2% 2%(% 2%)% 2%*%

Source: United Nations Department of Economic and Social Affairs, Population Division. World
Population Prospects. The 2004 Revision. New York: United Nations, 2005.
6 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE
By 2030 the world is likely to have 1 billion older Figure 2:

people, accounting for 13 percent of the total THE SPEED OF POPULATION AGING
population. While today’s proportions of older Number of years for population age 65+ to increase
people typically are highest in more developed from 7% to 14%

countries, the most rapid increases in older

populations are occurring in the less developed 9 ZkZ a d e Z Y 8 dj c ig^Z h
world. Between 2006 and 2030, the number of ;gVcXZ C&-+*"&9-%> &&*

older people in less developed countries is projected

HlZYZc C&-9%"&97*> -*
to increase by 140 percent as compared to an
increase of 51 percent in more developed countries. 6jhigVa^V C&9(-"2%&&> 7(

Population aging is driven by declines in fertility JH C&9))"2%&(> +9

and improvements in health and longevity. In
8VcVYV C&9))"2%%9> +*
more developed countries, declines in fertility
that began in the early 1900s have resulted in =jc\Vgn C&9)&"&99)> *(
current fertility levels below the population
EdaVcY C&9++"2%&(> )7
replacement rate of two live births per woman.
Perhaps the most surprising demographic J@ C&9(%"&97*> )*
development of the past 20 years has been the
HeV^c C&9)7"&992> )*
pace of fertility decline in many less developed
countries. In 2006, for example, the total fertility JVeVc C&97%"&99+> 2+

rate was at or below the replacement rate in

44 less developed countries. 9 ZkZ a d e^c \ 8 d jc i g^Z h

Most of the more developed nations have had 6oZgWV^_Vc C2%%%"2%)&>

)& decades to adjust to this change in age structure
8]^aZ C&99-"2%2*>
(Figure 2). For example, it took more than a
27
century for France’s population age 65 and over 8]^cV C2%%%"2%2+>
2+ to increase from 7 to 14 percent of the total
JVbV^XV C2%%-"2%((>
population. In contrast, many less developed
2*
countries are experiencing rapid increases in the Ijc^h^V C2%%-"2%(2>
2) number and percentage of older people, often
Hg^ AVc`V C2%%)"2%27>
within a single generation. The same demographic
2(
aging process that unfolded over more than a I]V^aVcY C2%%("2%2*>
22 century in France will occur in two decades in
7gVo^a C2%&&"2%(2>
Brazil. In response to this “compression of aging,”
2&
institutions must adapt quickly to accommodate 8dadbW^V C2%&7"2%(7>
2% a new age structure. Some less developed nations
H^c\VedgZ C2%%%"2%&9>

&9 will be forced to confront issues, such as social

support and the allocation of resources across
generations, without the accompanying economic Source: Kinsella K, Gist Y. Older Workers, Retirement, and
Pensions. A Comparative International Chartbook. Washington,
growth that characterized the experience of DC: U.S. Census Bureau and U.S. National Institute on Aging,
1995; and U.S. Census Bureau. International Data Base.
aging societies in the West. In other words, some Available at: http://www.census.gov/ipc/www/idbnew.html.
countries may grow old before they grow rich. Accessed January 8, 2007.

TR END 1: AN AGING POPUL ATION 7

 T R
Increasing Life Expectancy

END
2
Some nations experienced more than a doubling of
average life expectancy during the 20th century. Life
expectancy at birth in Japan now approaches 82 years,
the highest level among the world’s more developed
countries, and life expectancy is at least 79 years in
several other more developed countries.

 A steady increase in life expectancy at birth

and at older ages; and

Less developed regions of the world have

experienced a steady increase in life expectancy
since World War II, with some exceptions in
Latin America and more recently in Africa, the
latter due to the impact of the HIV/AIDS
epidemic. The most dramatic gains have occurred
in East Asia, where life expectancy at birth
increased from less than 45 years in 1950 to
more than 72 years today.

Changes in life expectancy reflect a health

transition occurring around the globe at different
rates and alongdifferentpaths.
Thistransitionischaracterized
byabroadsetofchangesthatincludes:
 A shift from high to low fertility;
 A shift from the predominance of at older ages.
infectious and parasitic diseases Figure 3 depicts the evolution of survival for
to the growing impact of White females in the United States from 1901 to
noncommunicable diseases and 2003. In most countries, the curve shifts to the
chronic conditions. right as longevity increases.

The health transition shifts the human Increases in the probability of survival raise
survival curve so that the chances of questions about limits to life expectancy and the
surviving another year are higher at potential for human lifespan. Despite assertions
every age. In early nonindustrial that life expectancy must be approaching a limit,
societies, the risk of death was high at data on female life expectancies from 1840 to
every age, and only a small proportion 2000 show a steady increase of 3 months per
of people reached old age. In modern year (Figure 4). The country with the highest
survival curves for industrialized average life expectancy has varied over time—in
societies, most people live past middle 1840 it was Sweden, and today it is Japan—but
age, and deaths are highly concentrated the

8 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

 Figure 3:
WHITE FEMALE SURVIVAL IN THE UNITED STATES: 1901 AND 2003
&%%%

-%%
2% %(

& 9%&
+%%

)%%

2%%

%%
6<: &% 2% (% )% *% +% 7% -% 9% &%%

Source: Glover J. United States Life Tables, 1890, 1901, 1910, and 1901-1910. Washington: Bureau of the
Census, 1921. Available at: http://www.cdc.gov/nchs/data/lifetables/life1890-1910.pdf; and Arias E.
United States Life Tables, 2003. National Vital Statistics Report: 2006;54(14):1-40. Available at:
http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_14.pdf.

Figure 4:
linearity of the pattern (also seen for males) is HIGHEST NATIONAL LIFE
remarkable. While HIV/AIDS, obesity, and EXPECTANCY AT BIRTH: 1840–2000
similar trends may temper expectations for Life expectancy in years
continued increases in longevity, several
findings encourage a more optimistic outlook. -*

These include:
-% LDB :C
 Studies showing that death rates at very
old ages level off or decline; 7*
 The explosion in the number of
7%
centenarians worldwide;
 The finding that, even at older ages, +* B:C

mortality rates are malleable and amenable

to social interventions; and +%

 Evidence that medical advances and

**
new drugs are increasing life
expectancy. *%

Recent research raises other questions about )*

the future of life. Researchers have been able &-)% &-+% &--% &9%% &92% &9)% &9+% &9-% 2%%%
to experimentally increase lifespan in insects Source: Adapted from Oeppen J, Vaupel JW. Broken Limits
and to Life Expectancy. Science. 2002;296;1029-1031.
animals through gene insertion, caloric
restriction, and diet. It remains to be seen
whether similar increases can be replicated in
humans.
TREND 2: INCREASING LIFE EXPECTANCY 9
 T R
Rising Numbers of the Oldest Old

END
3
An important feature of population aging is the
progressive aging of the older population itself. Over time,
more older people survive to even more advanced ages.
For research and policy purposes, it is useful to
distinguish between the old and the oldest old, often
defined as people age 85 and over. Because of chronic
disease, the oldest old have the highest population levels
of disability that require long-term care. They consume
public resources disproportionately as well.

The growth of the oldest old population United States, India, Japan,
has a number of implications:
 Pensions and retirement income will need
to cover a longer period of life.
 Health care costs will rise even if
disability rates decline somewhat.
 Intergenerational relationships will
take on an added dimension as the
number of grandparents and great-
grandparents increase.
 The number of centenarians will grow
significantly for the first time in history.
This will likely yield clues about individual
and societal aging that redefine the
concept of oldest old.

The oldest old constitute 7 percent of the world’s

65- and-over population: 10 percent in more
developed countries and 5 percent in less
developed countries. More than half of the
world’s oldest old live in six countries: China, the
 Germany, and Russia. In many countries, the
oldest old are now the fastest growing portion of
the
total population. On a global level, the 85-and-
over population is projected to increase 151
percent between 2005 and 2030, compared to a
104-percent increase for the population
age 65 and over and a 21-percent increase
for the population under age 65 (Figure
5). Past population projections often
underestimated

10 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

decreases in mortality rates among the oldest become more common. The aging of the baby
old; therefore, the number of tomorrow’s boom generation, for example, is likely to
oldest old may be significantly higher than produce a great-grandparent boom. As a result,
anticipated. some working adults will feel the financial
The percentage of oldest old will vary and emotional pressures of supporting
considerably from country to country. In the both their children and older parents and
United States, possibly grandparents simultaneously.
for example, the oldest old accounted for
While people of extreme old age—that is,
14 percent of all older people in 2005. By 2030,
centenarians—constitute a small portion of
this percentage is unlikely to change because the
the total population in most countries, their
aging baby boom generation will continue to
numbers are growing. The estimated number
enter the ranks of the 65-and-over population. In
Europe, some countries will experience a of people age 100 and over has doubled each
sustained rise in their share of oldest old while decade since 1950 in more developed countries.
others will see an increase during the next two In addition, the global number of centenarians
decades and then a subsequent decline. The is projected to more than quintuple between
most striking increase will occur in Japan: By 2005 and 2030 (Figure 5). Some researchers
2030, nearly 24 percent estimate that, over the course of human
of all older Japanese are expected to be at history, the odds of living from birth to age 100
least 85 years old. Most less developed may have risen from 1 in 20 million to 1 in 50
countries should experience modest long-term for females in low-mortality nations such as
increases in their 85-and-over population. Japan and Sweden.

As life expectancy increases and the oldest old

increase in number, four-generation families

Figure 5:
PROJECTED INCREASE IN GLOBAL POPULATION BETWEEN
2005 AND 2030, BY AGE

%"+)

+*+

-*+

&%%+

% &%%% 2%%% (%%% )%%%

Source: United Nations Department of Economic and Social Affairs, Population Division.
World Population Prospects. The 2004 Revision. New York: United Nations, 2005.

TREND 3: RISING NUMBERS OF THE OLDEST OLD 11

 Growing Burden of
T R Noncommunicable Diseases

END
4
In the next 10 to 15 years, the loss of health and life in
every region of the world, including Africa, will be greater
from noncommunicable or chronic diseases, such as
heart disease, cancer, and diabetes, than from
infectious and parasitic diseases. This represents a
shift in disease epidemiology that has become the
focus of increasing attention in light of global aging.
44 percent of the burden of disease in low- and middle-
income countries. Noncommunicable

The myth that noncommunicable diseases

are diseases of affluence is dispelled by the
results of the Global Burden of Disease
project, which combines information about
mortality and
morbidity to assess the total loss of healthy
years of life due to disease and injury. In 2002,
the project estimates, noncommunicable
diseases accounted for 85 percent of the
burden of disease in high-income countries
and a surprising
 noncommunicable diseases already account for
more than 87 percent of the burden for the over-
diseases already account for as 60 population in low-, middle-, and high-income
much of the burden of disease in countries. The critical issue for low- and middle-
low- and middle-income countries as income countries
all communicable diseases, maternal is how to mobilize and allocate resources to
and perinatal conditions, and address noncommunicable diseases as they
nutritional conditions. By 2030, continue to struggle with the high prevalence of
according to projections, the share communicable diseases.
of the burden attributed to
There is extensive debate about the relationship
noncommunicable diseases in low-
between increased life expectancy and disability
and middle-income countries will
status. The central question is: Are we living
reach 54 percent while the share
healthier as well as longer lives, or are our
attributed to communicable diseases
additional years spent in poor health? Some
will fall to 32 percent (Figure 6). If
researchers posit
we restrict attention to older ages,

12 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

 Figure 6:
THE INCREASING BURDEN OF CHRONIC NONCOMMUNICABLE
DISEASES: 2002–2030

Adl" VcY
B^YYaZ">cXdbZ &2% &)%
8djcig^Zh
))% (2%
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=^\]">cXdbZ
8djcig^Zh 9%
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+%

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Source: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, eds. Global Burden of Disease and
Risk Factors. Washington, DC: The World Bank Group, 2006.

a “compression of morbidity”—a decrease in the and Development (OECD) member countries

prevalence of disability as life expectancy documents three patterns of disability trends
increases. Others contend an “expansion of among older people over the past 5 to 10 years:
morbidity”—an increase in the prevalence of  A reduction in severe disability rates in
disability as life expectancy increases. Yet others Denmark, Finland, Italy, The
argue that, as advances in medicine slow the Netherlands, and the United States;
progression from chronic disease to disability,
there is a decrease in the prevalence of severe  Stable rates, even as the population has
disability butan increase in milder chronic aged, in Australia, Canada, and France; and
diseases.  An increase in severe disability rates
in Belgium, Japan, and Sweden.
A significant reduction in disability has
accompanied the increase in longevity in the There is a great need for cross-national efforts to
United States. However, a recent NIA-sponsored monitor these trends and understand the causes.
analysis across the Organisation for Economic
Cooperation

TREND 4: GROWING BURDEN OF NONCOMMUNICABLE DISEASES 13

 T R
Aging and Population Decline

END
5
While the global population is aging at an unprecedented
rate, some countries are witnessing an historically
unprecedented demographic phenomenon: Simultaneous
population aging and population decline.

More than 20 countries are projected to over is projected to increase by 8 million between
experience population declines in the upcoming 2006 and 2030. The proportion of older people in
decades. Japan should therefore grow from 20 percent in
Russia’s population, for example, is expected to 2006 to about 30 percent in 2030.
shrink by 18 million between 2006 and 2030, a
Population declines in more developed
decrease of nearly 13 percent. Nine other
countries are primarily the result of low
countries are projected to experience a decline of
fertility. Russia and Japan, for instance, have
at least 1 million people during the same period
total fertility
(Figure 7).
rates of 1.4 births per woman, significantly
While Japan’s total population is projected to below the rate needed to replenish a
decrease by 11 million, the population age 65 population
and

Figure 7:
PROJECTED POPULATION DECLINE
BETWEEN 2006 AND 2030 (IN MILLIONS)
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Source: U.S. Census Bureau International Data Base. Available at:

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14 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

"&#*
 Figure 8:
PROJECTED AGE-SPECIFIC POPULATION CHANGE
BETWEEN 2006 AND 2030 IN RUSSIA
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Source: U.S. Census Bureau International Data Base, Available at:

http://www.census.gov/ipc/www/idbnew.html. Accessed January 8, 2007.

in the absence of migration. In contrast, less schools. Most notable is the large decline in
developed countries facing population declines the number of younger adults of working age.
are experiencing increased mortality largely The working-age population, which contributes
due to HIV/AIDS. Life expectancy in South to economic growth and the pension system,
Africa fell from 60 years in 1996 to 43 years in is shrinking at the same time that the older,
2006, and current projections suggest that nonworking population is increasing. As a
South Africa could lose nearly 6 million people result, economic expansion could be hampered
between 2006 and 2030. Clearly, reversing the as businesses struggle to attract new workers.
trend toward population decline in South Africa
and other affected nations will depend on the This shift in age structure is seen in many of
pace of innovations targeting HIV/AIDS, the more developed countries, including those
particularly with regard to the efficacy of that are not expected to face population
antiretroviral declines
drug regimes. in the near future. Both France and the United
Kingdom, for example, will experience population
In the face of overall population decline, increases between 2006 and 2030; nevertheless,
officials and policy planners must be their age structure is expected to shift much
especially attentive to age-specific changes like Russia’s with nonworkers outnumbering
within populations. workers. These changes have many implications
In Russia, for example, the population under for the development and funding of social
age 60 is likely to decrease in size between programs, including those addressing potentially
2006 and 2030 as the size of older age groups contentious issues such as fertility and
increases (Figure 8). It therefore appears international migration.
likely that the demand for health care
services in Russia will outweigh the need to
build more
TREND 5: AGING AND POPULATION DECLINE 15
 T R
Changing Family Structure

END
6
As people live longer and have fewer children, family
structuresaretransformed.
Thishasimportantimplications in terms of providing
care to older people.
boom
generations in the West, the family unit may take a
Most older people today have children, and
variety of shapes. This reflects higher rates of divorce,
many have grandchildren and siblings.
remarriage, blended and step-family relations, and adults
However, in countries with very low birth
who have never married or
rates, future
generations will have few if any siblings. As a
result of this trend and the global trend toward
having fewer children, people will have less
familial care and support as they age.

As life expectancy increases in most nations, so

do the odds of different generations within a
family coexisting. In more developed countries,
this
has manifested itself as the “beanpole family,” a
vertical extension of family structure
characterized by an increase in the number of
living generations within a lineage and a
decrease in the number of people within each
generation. As mortality rates continue to
improve, more people in their 50s and 60s likely
will have surviving parents, aunts, and uncles.
Consequently, more children will know their
grandparents and even their great-grandparents,
especially their great-grandmothers. There is no
historical precedent for a majority of middle-aged
and older adults having living parents.

While the picture of the nuclear or extended

family that stays together through life is still
the norm in most nations, it is changing in
many countries around the world. Among baby
 Nonmarried women are less likely than
nonmarried men to have accumulated assets
are voluntarily childless. Further, many
and pension wealth for use
couples and single mothers delay
in older age, and older men are less likely to form
childbearing until their 30s and 40s,
and maintain supportive social networks.
households increasingly have both
adults working, and more children are Childlessness is another important factor that
being raised in single-parent will affect caregiving but has received
households. relatively scant attention. In modern societies,
around 20 percent of women do not give birth.
People currently divorced constitute a
Rising percentages
small proportion of older populations.
of childless women are seen in Europe and North
This will soon change in many
America and, increasingly, in Latin America and
countries as younger populations with
Southeast Asia as well. Research among
higher rates of divorce and separation
European adults age 18 to 39 shows that, in some
age. In the United States, for example,
countries, more than one-third either intend to
9 percent of the 65-and-over population
remain childless or are uncertain about
is divorced or separated compared to 17
remaining childless. Given the variation in family
percent of people age 55 to 64 and 18
structure worldwide, it will be increasingly
percent of people age 45 to 54. This
important to distinguish
trend has gender-specific implications:

16 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

between the various reasons for childlessness— migration of adults after extended periods of
voluntary, involuntary coerced, involuntary employment in other countries.
natural, or loss of children due to HIV/AIDS. Each
has different implications for care arrangements Long-term care for older people has become a
as middle-aged women reach older age. key issue in the West and also in many less
developed, middle-income nations. Such care
Older people’s living arrangements reflect their involves a range of support mechanisms such as
need for family, community, or institutional home nursing, community care and assisted
support. Living arrangements also indicate living, residential care, and long-stay hospitals.
sociocultural preferences—for example, some While the cost of long-term care is a burden to
choose to live in nuclear households while others families and society, there are other concerns as
prefer extended families. The number, and often well. For example, the staffing needs of caring
the percentage, of older people living alone is for aging populations have increased the
rising in most countries. In some European migration of health workers from lower income
countries, more than 40 percent of women age to higher income nations. Clearly, it is not
65 and older live alone. Even in societies with premature to talk about the globalization of
strong traditions of older parents living with support for older persons.
children, such as
in Japan, traditional living arrangements are Figure 9:
becoming less common (Figure 9). In the past, LIVING ARRANGEMENTS OF PEOPLE
living alone in older age often was equated with AGE 65 AND OVER IN JAPAN:
social isolation or family abandonment. However, 1960–2000
research in many cultural settings shows that
>c Vc ^chi^iji^dc dg l^i] cdc"gZaVi^kZCh>
older people, even those living alone, prefer to 6adcZ
be in their own homes and communities. This L^i] hedjhZ dcan
preference is reinforced by greater longevity, L^i] bVgg^ZY X]^aY dg di]Zg gZaVi^kZCh>

expanded social benefits, increased home &%%%

ownership, elder-friendly housing, and an
emphasis in many nations on community care.
-%%
While multigeneration households are dwindling
in the more developed world, two- and three-
generation households are still the norm in most +%%
less developed countries. Despite the apparent
robustness of such living arrangements for older
people, concerns are emerging. For example, )%%
unmarried women or widows without children
can have little support and nowhere to live if
extended family will not take them in. Further, 2%%
changes in household structures occurring in the
face of large numbers of AIDS deaths in parts of
&9+% &97% &9-% &99% 2%%%
Africa and Asia %%

may leave many orphans living with and Source: National Institute of Population and Social
Security Research. Population Statistics of Japan 2003.
supported by grandparents. There also are Available at: http://www.ipss.go.jp/index-e.html.
broader concerns related to young adult Accessed January 18, 2007.

migration to urban areas, levels of intrafamily

remittances, and return
TREND 6: CHANGING FAMILY STRUCTURE 17
 Shifting Patterns of Work
T R and Retirement

END
7
No set of issues has stimulated public discourse about
population aging more than work, retirement, and
economic security in old age. In Western democracies,
in Eastern Europe’s transitional economies, and in
much of the less developed world, policymakers
struggle with the balance between public and private
income security systems.
world is the shrinking of the workforce relative

The precariousness of security in old age can be

seen in stagnant and declining real pensions in
transitional economies, in the fate of
pensioners during the collapse of Argentina’s
economy in 2001, in the high poverty rates
among Japanese elderly, and perhaps most
vividly in the lack of formal social safety nets
for most older people in Africa and Asia.

A prominent economic concern in our aging

 countries are inconsistent, the most common
picture shows workforce participation rates
to the number of pensioners. decreasing for older men and increasing for
Typically, this ratio declines as older women. The latter trend
people live longer and as their will have important implications for the
participation in the workforce falls. ability of women to accumulate and control
From the 1950s to the mid-1980s, economic resources in older age.
workforce participation rates for
older men declined in most of the One central issue for policymakers in regard
more to pension funds is the relationship
developed countries. But beginning in between the official (statutory) retirement
the 1990s, this trend reversed. Among age and
women in more developed countries, actual retirement age (the average age at
there has been a steady increase in which retirement benefits are awarded). Over
workforce participation at older ages several decades in the latter 20th century,
for the past two decades (Figure 10). many of the more developed nations lowered
Although data on less developed the official age at which people become fully
entitled to

18 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

public pension benefits. This was propelled by for another 14 years before retiring
general economic conditions, changes in completely at age 68.
welfare philosophy, and private pension trends.
Despite the recent trend toward increased As life expectancy has increased through the
workforce participation at older ages, a 20th century, retirement ages have decreased.
significant gap between official and actual Consequently, people are spending more time in
ages of retirement persists. This trend is retirement. The OECD, using data from 15
emerging in rapidly aging developing countries member countries, divided the lifespan into four
as well. In Taiwan, for example, the average periods:
actual retirement age dropped below 55 in  Years before entry into the
2004, the lowest level workforce (primarily spent in
on record. school)
 Years not working due to unemployment
Just as the tendency to work at older ages
or economic inactivity
varies from country to country, so do the
 Years in the workforce
routes workers take to retirement. These
routes may  Years in retirement

involve working part time, leaving career jobs In 1960, men on average could expect to spend
for transition jobs, or leaving the workforce 46 years in the workforce and a little more
because of disability. In South Korea, the than one year in retirement. By 1995, the
average worker leaves company employment at number of years in the workforce had
age 54 but then engages in part-time or low- decreased to 37 while the number of years in
wage employment retirement had jumped to 12.

Figure 10:
EUROPEAN UNION EMPLOYMENT RATE, AGES 55-64:
1994–2005 (15-COUNTRY AGGREGATE)

+%%
B:C

*%%

)%%
LDB :C

(%%

2%% &99) &99 &99 &99 &99 &99 2%% 2%%& 2%%2 2%% 2% 2%%*
* + 7 - 9 % ( %)

Source: European Statistical System (EUROSTAT). Available at: http://epp.eurostat.ec.europa.eu.

Accessed January 8, 2007.
TREND 7: SHIFTING PATTERNS OF WORK AND RETIREMENT 19
 Estimates for Italian men in the year 2000 series of studies in 11 industrialized countries
suggest a median retirement age of less (Belgium, Canada, France, Germany, Italy,
than 59 years and a retirement duration of Japan, The Netherlands, Spain, Sweden, the
nearly 21 years. United Kingdom, and the United States)
If official retirement ages are increased, documents that in most countries public
considerable attention will focus on the pensions provide enormous disincentives for
productivity of older workers. As a result, continued work at older ages and encourage
continuing education, workplace design, and early retirement (Figure 11). This ongoing
part-time employment opportunities for older research shows that in spite of cultural
workers will become more important. Rising differences across countries, there is an
retirement ages also will spur reconsideration important relationship between the incentives
of early retirement provisions. Studies of for workforce participation of older workers and
retirement rules around the globe suggest the provisions of social security programs. The
that increasing workforce participation at study highlights the analytical power of focusing
older ages will require policy changes in on the design of national retirement systems
national social security systems. A major and the importance of incentives.
ongoing NIA-funded

Figure 11:
PUBLIC PENSION INCENTIVES TO LEAVE THE LABOR
FORCE FOR MEN IN 11 COUNTRIES
Percent of men age 55 to 65 not working

7%% 7Za
\^jb
;gVcXZ

+%% J@ >iVan
I]Z CZi]ZgaV cYh

*%%
HeV^c <ZgbVcn
8VcVYV
)%%
JH
HlZYZc

(%%

2%% JVeVc

1 ADL E jW a^ X EZch^ dc > c X Zci^ kZ i d GZi ^gZ : V gan =><= 3

&%%

Source: Gruber J, Wise DA, eds. Social Security and Retirement around the World. Chicago, IL:
University of Chicago Press, 1999.

20 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

 T R
Evolving Social Insurance Systems

END
8
In response to escalating pension expenditures, an increasing
number of countries across the development spectrum
are evaluating the sustainability of old-age social
insurance systems.

Expenditures in today’s 25 EU countries the early 1990s were entitled to draw pensions at a
consumed one-eighth of gross domestic product younger age than men in most countries. About 60
in 2003 (Figure 12). In the future, the economic percent of countries now have the same pensionable age
well-being of older populations will depend on a for both men and women. While the trend is to raise
combination of income sources—earnings from
continuing to work, social insurance programs,
occupational pensions, and private savings. Public
policies affect each of these sources, and
proposed policy reforms have both costs and
benefits. More empirical research, including
cross-national comparative research, is needed to
inform the developmentof policy.

Many countries already have taken steps toward

reforming their old-age social insurance
programs (see box on page 23, “The Chinese
Experience”).
One common reform has been to raise the
age at which workers are eligible for full
public pension benefits. In 1983, the United
States changed
the age at which workers are eligible for full
retirement benefits to increase incrementally
beginning in 2003. Japan raised the pension age
for men from 60 to 65 and for women from 57 to
65
in the past 15 years. The highest current
statutory pensionable age is 67 for workers in
Norway and Iceland. Increases in pensionable
age have focused on women, who as recently as
 than the statutory pensionable age for men and, in
most cases, also for women.

Another strategy for bolstering economic

security for older people has been to increase
the contribution or tax rate on workers. Twenty-
four countries (two-thirds of which are in
Europe)
now have payroll tax rates that equal or
exceed 20 percent of wages. While payroll
taxes raise needed revenues, they have the
potential to discourage work in the formal
sector. Other measures to enhance income for
the pensionable age, nearly one-third of
older people include new financial instruments
African countries that offer social
for private savings, tax incentives for
insurance benefits to their older
individual retirement savings, and
populations have a life expectancy less
supplemental occupational pension

TREND 8: EVOLVING SOCIAL INSURANCE SYSTEMS 21

 Figure 12:
PENSION EXPENDITURES IN THE EUROPEAN UNION AS
A PERCENTAGE OF GROSS DOMESTIC PRODUCT: 2003
>iVan &*#&
EdaVcY &)#(
<ZgbVcn &(#)
;gVcXZ &(#%
HlZYZc &2#7
Edgij\Va &&#9
HadkZc^V &&#2
CdglVn -
HadkV`^V #-
7#*
>gZaVcY (#
9

:J C2*>
&2#+
*% &%% &*%

Note: Pensions include old-age, anticipated old-age, partial, and disability benefits,
as well as early retirement benefits due to reduced capacity to work.
Source: European Statistical System (EUROSTAT). Available at: http://epp.eurostat.ec.europa.eu.
Accessed January 8, 2007.

plans. Eight countries already have chosen to A trend toward defined contribution plans (in
make occupational pension plans mandatory. which employees contribute a portion of
earnings, sometimes with matching
Sixteen countries, primarily in Asia and the
contributions from employers, into investment
Pacific, have a Provident Fund, a compulsory
accounts that they control) rather than defined
savings program that is funded fully with
benefit plans (in which employers guarantee
investments typically managed by the
specified levels of pension payments in the
government. Most existing Provident Funds
future) is evident. Among private-sector workers
were established in the 1950s; very few have
covered by an occupational pension plan in the
been established since 1985. Instead, countries
United States, 40 percent
wishing to achieve a closer link between
were in a defined benefit plan in 2000, down
contributions and benefits have adopted some
from 84 percent in 1980. In contrast, the
form of individual accounts. Chile, in the early
number of workers in defined contribution plans
1980s, was the first to introduce individual
increased nearly fivefold from 1975 to 1998. In
accounts as part of a defined contribution plan.
the private sector, the popularity of defined
More than 20 other countries, mostly in Europe
contribution plans is not driven by population
and South America, have since followed suit. In
aging but by increased job mobility, global
some countries, however, individual accounts
competition, and the growth in the number of
are notional—in other words, no real
smaller firms. An important question
accumulation of wealth exists because workers’
concerning this trend is whether defined
contributions fund existing pension obligations.
contribution plans, which shift risk and
Depending on their design, individual
decisionmaking to the employee, will provide
retirement accounts may
adequate income security for the duration of
be risky for account holders who make
retirement.
uninformed decisions about diversification.
22 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE
The Chinese Experience: Rethinking Social Security
in an Emerging Market Economy

A
lthough China is rapidly urbanizing, it defined contribution individual account. Owing
remains a predominately rural country. to the unfunded liabilities of the former
The system,
majority of Chinese workers are not yet
individual accounts have remained largely notional
covered by any formal pension system. Among
as today’s workers pay for today’s pensioners.
those who have been and are now covered,
there has been Social security reforms in China were brought
a steady rise in the number receiving formal about primarily because of the restructuring of
pensions during the past 25 years. State-owned enterprises and changes
Concurrently, there has been a sustained associated with the movement toward a market
decline in the ratio of covered workers to economy. However, new pressures have
pensioners in China, a trend that threatens emerged in light of the rapid pace of population
the well-being of the Nation’s formal old-age
aging. Researchers are calling for a higher
security system (Figure 13).
retirement age to counter the falling ratio of
Following a decade of experimentation, a new workers to pensioners. The Government is also
framework for old-age security emerged in the considering converting to a system with a fully
mid-1990s. The intent is twofold: (1) To replace funded component, which raises questions
cradle-to-grave support provided by State- about funding the transition to a new system.
owned enterprises with an expansion of Another concern with this approach is where
coverage beyond the State sector and (2) to to invest funds that will accumulate in
introduce pooled funding, which deflects risk. individual accounts, given that China’s capital
The new system includes a defined benefit markets are relatively immature.
pension providing a 20-percent replacement rate
of the average wage and a

Figure 13:
CHINA’S DECLINING RATIO OF COVERED WORKERS
TO PENSIONERS
&* +%
G6I>D D; LDG@:GH B>AA>DCH
ID E:CH>DC:GH D; E:CH>DC:GH
*%
&2

)%

9
(%

+
2%

( &%

% %
É-% É-& É-2 É-( É-) É-* É-+ É-7 É-- É-9 É9% É9& É92 É9( É9) É9* É9+ É97 É9- É99 É%% É%& É%2 É%( É%) É%*

Source: China Ministry of Labor and Social Security and China National Bureau of Statistics. China
Labor Statistics Yearbook. Beijing: China Statistics Press, various years; and China National Bureau of
Statistics. China Statistical Abstract. Beijing: China Statistics Press, 2006.
TREND 8: EVOLVING SOCIAL INSURANCE SYSTEMS 23
 T R
Emerging Economic Challenges

END
9
Population aging will have dramatic effects on local,
regional, and global economies. Most significantly, financial
expenditures, labor supply, and total savings will be
affected.

In the past 5 years, academics and product devoted to social entitlements for older
policymakers have begun to direct attention to populations. In some cases, this share more than
the potential economic impact of doubles as a result of population aging.
unprecedented demographic change. Currently,
As countries reach a relatively high level of population
however, we do not fully understand the
aging, the proportion of workers tends
interaction between policies and economic
growth. A good deal will depend on how well
markets function.
Population aging will strain some national
budgets. Countries with extensive social
programs targeted to the older population—
principally health care and income support
programs—find the costs of these programs
escalating as the number of eligible recipients
grows and the duration of eligibility lengthens.
Further, few countries have fully funded
programs; most countries fund these programs
on a pay-as-you-go basis or finance them
using general revenue streams. Governments
may be limited in how much they can
reshape social
insurance programs by raising the age of
eligibility, increasing contribution rates, and
reducing benefits. Consequently, shortfalls may
need to be financed using general revenues.
Projections of government expenditures in the
United States
and other OECD countries show major
increases in the share of gross domestic
to decline. Some European developed countries may be more constrained.
countries, including France,
Because countries age at different paces, it is
Germany, Greece, Italy, Russia, and
possible for the elements of production—labor
the Ukraine, already have seen an
and capital—to flow across national boundaries
absolute decline in the size of their
and mitigate the impact of population aging.
workforce. And in countries where
Studies predict that, in the near term, surplus
tax hikes are needed to pay for
capital will flow from Europe and North America
transfers
to emerging markets in Asia and Latin America,
to growing older populations, the tax
where the population is younger and supplies of
burden may discourage future
capital relatively low. In another 20 years, when
workforce participation. The impact
the baby boom generation in the West has
on a country’s gross domestic
mostly retired, capital likely will flow in the
product will depend on increases in
opposite direction. However, these studies rest
labor productivity and that country’s
on the uncertain assumption that capital will
ability to substitute capital for labor.
flow easily across national boundaries.
Less developed countries can shift their
economies from labor-intensive to Traditionally, labor is viewed as less mobile
capital-intensive sectors as population than capital, although migration could offset
aging advances. Options for more partially

24 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

the effects of population aging. Currently, Retirement resources typically include public and
22 percent of physicians and 12 percent of private pensions, financial assets, and property.
nurses in the United States are foreign born, The relative importance of these resources
representing primarily English-speaking African varies across countries. For example, a
countries, groundbreaking study revealed that only 3
the Caribbean, and Southeast Asia. The foreign- percent of Spanish households with at least one
born workforce also is growing in most OECD member age 50
countries. Over the next 10 years, the European or older own stocks (shares), compared to 38
experience will be particularly instructive in percent of Swedish households (Figure 14). The
terms of the interplay of aging and migration. largest component of household wealth in
The life-cycle theory of consumption and many countries is housing value. This value
savings is that households accumulate wealth could fall if large numbers of older
during working years to maintain consumption homeowners try to sell houses to smaller
in retirement. The total of a country’s numbers of younger buyers.
individual life-cycle savings profiles determines Financial markets need to be flexible and
whether households in that country are net innovative to meet the needs of aging
savers or nonsavers at any point in time. A populations. Undoubtedly, population aging
country with will create new economic pressures. At the
a high proportion of workers will tend to be same time, however, it will create exciting
dominated by savers, placing downward pressure opportunities for expanding our collection of
on the rate of return to capital in that economy. financial tools to accommodate a changing world
Countries with older populations will be tapping (see box on page 26, “Expanding Opportunities
their savings and driving rates of return higher for Economic Growth”).
because of the scarcity of capital.

Figure 14:
PERCENT OF OLDER HOUSEHOLDS OWNING MUTUAL FUNDS
(UNIT TRUSTS) AND STOCKS (SHARES): 2004

+%% HlZYZc
BJIJ6 A ;JC 9H
*%%
HID 8 @H
)%%
9ZcbVg`
(%%
Hl^ioZgaVcY
I]Z
CZi]ZgaVcYh
2%% ;gVcX
<ZgbVcn Z
&%% 6jhig^V >iVan
HeV^c <gZZXZ
%%

Note: Data refer to households with at least one member age 50 or above.
Source: Börsch-Supan A, Brugiavini A, Jurges H, Mackenbach J, Siegrist J, Weber G, eds. Health, Ageing and Retirement in
Europe. First Results from the Survey of Health, Ageing and Retirement in Europe. Mannheim: Mannheim Research Institute for the
Economics of Aging, 2005.

TREND 9: EMERGING ECONOMIC CHALLENGES 25

Expanding Opportunities for Economic Growth

B
ecause of fertility declines, nearly all that demographic dividends, if fully exploited, would
countries have experienced, or will
soon
experience, a large increase in the share of
their population concentrated in the working
ages.
This increase should raise per capita
income and government tax revenues,
leading to the first demographic dividend.
An analysis of
228 regions suggests that the first dividend
lasted 30 to 35 years in most developed and
transitional economies. It was considerably
longer in much of Asia and Latin America, and it
likely will be longer still in sub-Saharan Africa.
The economic gain resulting from large numbers
of young workers critically depends on the
policy environment. In several countries in East
and Southeast Asia, for example, large birth
cohorts reached working ages with valuable
skills and high educational attainment, and
export-oriented economies were flexible
enough to put their skills to productive
uses. In other countries, however, weak
educational systems and labor market rigidities
have resulted in a youth employment crisis
rather than the
hoped-for demographic dividend.
In the decades following the youth bulge in
the labor force, as the large cohorts move
into their middle and later working years, a
second
demographic dividend is possible. This is
because the peak productive ages in a modern
economy are also peak ages for saving, and in a
modern economy, savings can be mobilized for
productive investment. With an unusually large
proportion of the population consisting of
workers in their 40s and 50s, countries should
be able to increase their
savings rates, and thus investment rates, which
can produce a long-lasting increase in national
output. As with the first demographic dividend,
the second one works only in the right
institutional and policy settings. Many countries,
including the United States, did not experience
higher personal savings rates during the decades
when Baby Boomers were in their 40s and 50s.
Researchers differ in their estimates of the
importance of these dividends. One estimate is
have contributed between 1 and 2 account for transfers across generations,
percentage points to income growth examine savings patterns, estimate spending on
between 1970 and 2000 for most public programs, and assess the burden of family
regions of the world. However, support for older people.
demographic dividends are not
automatic; they depend on the Figure 15:
existence of strong institutions and ECONOMIC LIFE CYCLE OF
policies that transform population A TYPICAL THAI WORKER
aging into
Annual per capita labor income and consumption (in baht)
economic growth. Weaknesses in the
governance and management of pension &%%!%%%
A 67 DG >C
8 DB:
programs—for instance, significant tax
evasion and unsustainable increases in -%!%%%
public pension benefits—can offset the
benefits of demographic dividends, as
+%!%%%
can persistent high levels of
unemployment and underemployment.
)%!%%% 8 DCHJBE I >D C
As a result, governments and
employers may be tempted to make
promises to the working-age population 2%!%%%
that prove difficult to keep.
%
A useful tool for understanding 6<:
% &% 2% (% )% *% +% 7% -% 9%
dividends and their impact is to +
estimate production and consumption Source: Chawla A. National Transfer Account Estimates for Thailand,
as reported in Lee R, Mason A, eds. What Is the Demographic
over the life cycle (Figure 15). Dividend? Finance and Development. 2006:43(3). Available at:
Researchers can use these estimates to http://www.imf.org/external/pubs/ft/fandd/2006/09/basics.html.

26 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

Endnote > DATA FOR AN AGING WORLD
Ten years ago at the Summit of the Eight in Denver, Colorado, the Group of Eight (G8)
leaders recognized the importance of population aging. The Denver Communique
encouraged nations to collaborate in biomedical and behavioral research and to
learn from one another how policies and programs can help strengthen pension,
health, and long-term care systems. With support from the U.S. National Institute on
Aging, three important cross-national efforts have emerged to provide policymakers
with information essential for understanding the complexities of our aging world.

The Survey of Health, Ageing and Retirement in Europe (SHARE) is an

interdisciplinary longitudinal data set covering people age 50 and over. Modeled after
the U.S. Health and Retirement Study (HRS) and the English Longitudinal Study on Ageing
(ELSA), SHARE allows comparison of the effects of different pension and health care
systems on the lives of middle- aged and older Europeans. Already underway in 15
European countries, SHARE is designed to cover all 27 members of the European Union,
plus Israel and Switzerland, in 2008.

The International Network for the Demographic Evaluation of Populations and Their Health
(INDEPTH) comprises 37 sites in Africa, Asia, and Latin America that monitor populations
living in distinct geographic areas. Combining demographic surveillance with
innovative techniques, INDEPTH sites provide mortality data otherwise lacking for the less
developed world, especially with regard to adult populations. The longitudinal nature of
these data is essential to understanding emerging patterns of adult mortality and
noncommunicable diseases and will help shape chronic disease prevention and control
programs.

Launched by the World Health Organization, the Study of Global Ageing and Adult Health
(SAGE) is a longitudinal study in six countries: China, Ghana, India, Mexico, Russia, and
South Africa. SAGEfollowsgroupsofindividualsage 50 andoverfor 10 to 15 years
toexaminechanges in their health and well-being and determine predictors of change, such
as economic activity, life transitions, and social cohesion. SAGE will be linked to data from
INDEPTH sites in Asia and Africa to enhance the breadth and analytic potential of both
data sets.
 Suggested Resources

Readings Organisation for Economic Cooperation and

Federal Reserve Bank of Kansas City. Global Development (OECD) Directorate for Employment,
Demographic Change: Economic Impacts and Policy Labour and Social Affairs. Disability Trends among
Challenges. Symposium proceedings. August 26–28, Elderly People: Re-Assessing the Evidence in 12 OECD
2004. Available at: http://www.kc.frb.org/Publicat/ Countries (Interim Report). Paris, France: OECD,
sympos/2004/sym04prg.htm. forthcoming 2007.

Gruber J, Wise DA, eds. Social Security and Retirement United Nations Department of Economic and Social
around the World. Chicago, IL: University of Chicago Affairs, Population Division. World Population Ageing
Press, 1999. 1950–2050. New York: United Nations, 2002.

Gruber J, Wise DA, eds. Social Security Programs

and Retirement around the World. Micro Estimation. Web Resources
Chicago, IL: University of Chicago Press, 2004.
English Longitudinal Study of Ageing
Hermalin A, ed. The Well-Being of the Elderly in http://www.ifs.org.uk/elsa/
Asia: A Four-Country Comparative Study. Ann
European Statistical System (EUROSTAT)
Arbor, MI: University of Michigan Press, 2002.
http://epp.eurostat.ec.europa.eu
International Monetary Fund. The Economics of Health and Retirement Study
Demographics. Finance and Development. September http://hrsonline.isr.umich.edu/
2006;43(3). Available at:
http://www.imf.org/external/ International Network on Health Expectancy and the
pubs/ft/fandd/2006/09/. Disability Process
http://www.prw.le.ac.uk/reves/
Kinsella K, Velkoff VA. An Aging World: 2001.
Washington, DC: National Institute on Aging and U.S. Survey of Health, Ageing and Retirement in Europe
Census Bureau, 2001. http://www.share-project.org/

United Nations Expert Group Meeting on Social and

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray
Economic Implications of Changing Population Age
CJL, eds. Global Burden of Disease and Risk
Structures
Factors. Washington, DC: The World Bank Group,
http://www.un.org/esa/population/meetings/
2006.
EGMPopAge/EGMPopAge.htm
Manton KG, Gu X. Changes in the prevalence of
United Nations Second World Assembly on Ageing
chronic disability in the United States black and
http://www.un.org/esa/socdev/ageing/waa/
nonblack population above age 65 from 1982 to
1999. Proceedings of the National Academy of U.S. Census Bureau International Data Base
Sciences 2001; 98; 6354-6359. http://www.census.gov/ipc/www/idbnew.html

National Institute on Aging. Growing Older in America: U.S. National Institute on Aging
The Health and Retirement Study. Bethesda.MD: http://www.nia.nih.gov/
National Institute on Aging, National Institutes of World Health Organization Study on Global Ageing
Health, forthcoming 2007. and Adult Health
National Research Council. Preparing for an Aging http://www.who.int/healthinfo/systems/sage/en/
World: The Case for Cross-National Research. index.html
Washington, DC: National Academy Press, 2001.

28 WHY POPULATION AGING MATTERS: A GLOBAL PERSPECTIVE

CREDITS
Support for the development of this publication
Many other individuals reviewed the report, contributed
was provided by the National Institute on Aging,
data, or provided valuable guidance and assistance:
National Institutes of Health.
David Bloom, Majid Ezzati, Jonathan Gruber, David
Laibson, and David Wise, Harvard University; James W.
Writing, editing, and production oversight by Rose Maria
Vaupel, Max Planck Institute for Demographic Research,
Li (Managing Editor), Amy C. Iadarola (Writer/Editor), and
Rostock, Germany; Joseph Chamie, Population
Christine C. Maisano (Editor), Rose Li and Associates,
Associates, Inc.; William Butz and Barbara Boyle Torrey,
Inc.
Population Reference Bureau; James P. Smith, RAND
Design and layout by Monica Snellings, Greg Sitzmann, Corporation; Laura L. Carstensen and Adele M. Hayutin,
Kerry McCutcheon, and John Vance, Levine & Associates. Stanford University; Axel Börsch-Supan, University of
Mannheim, Germany; Robert Schoeni, University of
Staff members of Federal agencies who reviewed the Michigan; and Samuel H. Preston, University of
report or provided data and other assistance include Pennsylvania.
Vicky Cahan, John G. Haaga, Freddi Karp, Evelyn Neil,
Photos: Inside front cover, Veer; Page 2, © 2001 Todd
Georgeanne Patmios, and John W. R. Phillips, National
Shapera, Courtesy of Photoshare; Page 4, Greg Baker/AP
Institute on Aging; Kevin Kinsella, Loraine A. West,
Images; Page 5, Andy Manis/AP Images; Page 8, Getty
Victoria
Images; Page 10, © Lutheran World Relief, Courtesy of
A. Velkoff, and Manisha Sengupta, U.S. Census Bureau;
Photoshare; Page 12, © 2001 Marcel Reyners, Courtesy of
and Jed D. Meline, Paul Brown, Walter B. Kelly, Diana A.
Photoshare; Page 18, Anjum Naveed/AP Images; Page 21,
McCaffrey, Andrew W. Reynolds, and Michael D.
Alastair Grant/AP Images; Inside back cover, Getty Images.
Rosenthal,
U.S. Department of State.
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NATIONAL INSTITUTES OF HEALTH

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