One of the striking features of Covid-19 is how it acts as a viral form of ageing, with the relationship between its fatality rate and age mimicing closely that of all cause mortality. That explains why in Pennsylvania nearly twice as many people over the age of 100 have died from Covid than those under 45.
Given every country is expected to see an increase in its average age between now and 2100, along with an increase in the proportion aged over 65 and 80, Covid-19 is acting both as an accelerant and a stress test for an ageing society. That is revealing which countries are well placed and what issues need to be addressed.
The first lesson to be drawn is just how much society values those older lives. Governments have chosen lockdown policies which have triggered trillion dollar declines in GDP in order to save mainly older lives. That has a major corollary – in response to an ageing society we need to focus not just on GDP but on indicators that measure society’s ability to keep people safe, healthy and alive.
Such a focus reveals enormous differences in the ability of countries to support an ageing society. Best practice life expectancy is defined by the country with the highest average life expectancy at birth. That is currently Hong Kong, where female life expectancy is 87. As of today, Hong Kong has experienced 88 deaths from Covid-19 and on that basis its life expectancy statistics so far will be little affected. Meanwhile in the US ‘excess’ deaths have reached over 200,000 and in the UK over 60,000. That will bring about a further divergence in their life expectancy trends relative to best practice. As the unfolding tragedy in care homes reveals, many countries do not have the institutions to support the longer lives we are currently living.
This leads to a further lesson– the need to promote healthy ageing. Pulmonary illness, diabetes and hypertension are all important determinants of fatality from Covid-19, even conditioning on age. Lockdown policies were introduced to ‘bend the curve’ of how Covid-19 would spread, but another curve urgently needs to be flattened – the rate at which health co-morbidities rise with age.
Crucial to achieving that is an emphasis on preventative health. With an ageing society, as with Covid, the emphasis has to be on supporting the ‘wellderly’ and not the ‘illderly’. Lockdown policies have tried to achieve that through keeping people out of hospital, aiming to avoid scarce health resources becoming blocked and overwhelmed. An ageing society requires a health not a hospital system, a focus on maintaining wellness and not treating illness.
But there is a further health curve that needs bending – the relationship between how we age and income. Life expectancy differs by 15 years in the US between the richest and poorest 1%. Covid-19 has reinforced those inequalities. In the UK, the fatality rate from Covid amongst the bottom 10% of the income distribution is twice that of the top 10%. Given that Covid-19 has revealed a strong preference for saving lives over GDP, consistency requires an equally substantive economic approach to tackling the 160,000 ‘deaths of despair’ in the US in 2018.
This leads to the third and perhaps most important insight from Covid. Just as the pandemic has shown we can’t have a healthy economy until we have a healthy and safe population so the same holds for an ageing society. The gains from ‘successful ageing’, of supporting health and productivity for longer, are enormous – estimated as worth $7.1trillion over fifty years. In the case of both Covid and an ageing society, it is a mistake to think there is a trade off between healthy ageing and a healthy economy.
Achieving this longevity dividend has become all the more important given the impact of Covid on the economy and government debt. A key channel for longevity dividend will be supporting the employment of older workers. In the decade before Covid-19 the over 55s accounted for 100% of all employment growth in the G7. That was achieved though in the face of low unemployment rates.
Rightly concern has focused on the huge increase in unemployment amongst the young. However, whilst those aged under 25 are worst affected, those aged over 55 have seen the largest proportional increase in unemployment. Given age discrimination in hiring , this will have substantial permanent effects on this group’s employment and retirement savings. Policies aimed at age discrimination, updating the skills of older unemployed workers, encouraging flexible working policies as well an increasingly important role for the gig economy will be crucial to maintain employment growth for these ages.
This in turn will require creating a new narrative around age and challenging deep seated ageist assumptions. Reformulating our social concepts of what it means to be ‘old’, recognising the contribution of older citizens and above all understanding that the key challenge of ageing is in diversity of how people age. The irony in the popularity of #BoomerRemover at the same time as the UK celebrates the achievements of 100 year old Colonel Sir Tom Moore in raising nearly $50mnfor charity is striking.
As a stress test of an ageing society, Covid-19 has revealed major weaknesses in many countries. Its also revealed what is needed to succeed, not just during a pandemic but in the decades ahead. A focus on measuring and achieving healthy life expectancy, ‘bending’ the curve of ageing through precautionary health and tackling inequalities and shaping a new narrative that tackles ageism and recognises age diversity. Above all it has revealed that without ‘successful ageing’ there will be neither a healthy population nor a healthy economy.