Preface

One of humankind's greatest achievements in the past century has been the extension of life span in every society. Coincident with falling birth rates, the world now has more people over the age of 60 than under 5, and in many countries, those over 60 will constitute 40 percent of the population by 2050.

Like climate change, demographic change is unprecedented, and will remain so for the foreseeable future, impacting the way we live, learn, work, and play; and all dimensions of the human experience. It will shape jobs, economies, and national budgets. In some societies, this change is occurring faster than others but will eventually affect everyone during their lifetime. How we now plan for life in the older age most people and societies have never had before will determine whether the outcome is an optimistic one for all, or the negative one many forecast. Fortunately, much can and must be done to ensure that societies are aging societies that are thriving and robust. This is the motivation of this report and the basis for its recommendations.

The commission was formally constituted in 2019 with members from countries representing both the North and South, East and West. Our disciplines range across science, medicine, public health, health care systems, engineering, technology, and policy. We have benefited substantially from expertise shared at our three public workshops on the social, behavioral, and environmental determinants; the health and health care systems needed; and how science and technology can enable our vision for 2050 and beyond, and from input by global economists.

The commission is aligned on the following:

• A recognition that all societies were created for a length of life half of what we will have by 2050.
• Substantial evidence supports the immense opportunity for all from longer lives, but an intentional whole of society transformation will be required to achieve these opportunities and to ensure equity in this achievement.
• The capabilities of longer lives could be a basis for societal thriving if healthy longevity is achieved. Investments in healthy longevity could extend health span for the vast majority and also support the needs we all are challenged by with older age.
• Commensurate with these longer healthy lives, older adults having the opportunities for paid work and volunteering, enabling them to assume roles to contribute to a better future for their community and family, will further contribute to well-being.
• Coalescence around the importance and urgency of this issue that changes everything else—for better or worse, depending on how societies respond.
• Timing to create the changes needed is important; there is urgency to start these changes now so as to not forfeit the opportunities, and to support human needs in our longer lives.
• The observation that unless low- and middle-income countries put aging at the center of their development agendas, these agendas are at substantial risk of not achieving their goals.

Our report envisions what societies could look like in 2050 if we applied all that we know on how societies can remain robust and even thrive because of, not just despite, demographic change. This is the basis of our “Future-Back Vision,” supported with evidence where available, and otherwise with expert opinion.

This will require us to revisit our current life stages, and instead of compartmentalization into phases of learning, working, and then retirement, consider a blended journey, where the elements of learning, working, and leisure are intertwined from early adulthood to as long as these are valued. We are heartened that a significant number of older people globally wish to remain engaged for what they can contribute to society.

This will also require significant investments, but the benefits and returns from this in human, social, and economic capital will more than justify the expenditure. This will be detailed in the chapters that follow. These investments are arguably the strongest protection we have against the fears that demography will dictate destiny.

This report builds on and reinforces recent critical efforts, especially the United Nations Decade of Healthy Ageing (2021–2030). The report aims to provide a roadmap for leaders across societies to extend health span and identify what actions will be required to ensure the success of their community as they become aging societies. Central to this success would be the need for societies to address their social compact and accomplish equity.

COVID-19 impacted the content, progress, and writing of this report. The commission planned three workshops and had just concluded their second, on Health Care and Public Health Systems for Healthy Longevity in February 2020, before global travel restrictions came into force. This was the last in-person meeting of the commission. The commission paused in April 2020, as members were involved in dealing with the pandemic, and formally restarted in May 2021. During this hiatus, we had a change of the National Academy of Medicine (NAM) supporting staff, initially led by Cecilia M. Shah, V. Ayano Ogawa, Peak Sen Chua, T. Anh Tran, Jarrett Nguyen, Stephen Chukwurah, Bridget Kelly, and Margaret Hawthorne. After the restart, they were succeeded by Maureen Henry, Johanna Gusman, Emma Lower-McSherry, Samantha Chao, and Megan Snair, supported by Morgan Kanarek. We are grateful for your superb leadership, expertise, and contributions.

In mid-2021, Dr. Jennie Popay stepped down from the commission, and Drs. Andrew Scott and Yaohui Zhao were appointed to the commission. The report greatly benefited from Dr. Popay's contributions, especially as co-chair of the Workshop on Social, Behavioral, and Environmental Enablers for Healthy Longevity, and endorses her strong vision on the importance of enhancing equity to achieve healthy longevity.

During the hiatus, the co-chairs continued discussions with each of the commissioners through video conferencing, and when the commission was formally reconstituted, commissioners made every effort to join meetings despite time zone differences. When recurrent COVID-19 waves hit countries at different times of the year, commissioners continued to contribute despite the demands of their day jobs.

We are deeply indebted to the dedication of this superb team, who shifted seamlessly from life prior to COVID-19 to organizing the third public workshop in June 2021 on Science and Technology for Health Longevity as a virtual global meeting. To say that everyone went above and beyond what would normally be expected is no exaggeration, dedicated to the shared conviction that the world needs to be, and can be, better prepared for this unprecedented demographic change of population aging.

The development of a vision for a successful future of aging societies, which is powered by longer lives with health and meaningful engagement, purpose, and dignity, involved substantial review of the evidence supporting this goal. This has created a shared optimism that this positive future is quite possible for all, but dependent on visionary and committed leadership aligned across all sectors toward individual and societal thriving through healthy longevity. This will require initial actions, some evolutionary and some transformational, as proposed in this report, and then sustaining progress to 2050. With these actions taken, the aging of society could be the basis for both a longevity dividend for our economies and a previously unimagined Third Demographic Dividend for societies.

The commission is grateful to all who made this report possible: our International Oversight Board, NAM, participants of the three workshops, input from experts around the world, and the reviewers.

We would like to especially honor Dr. Tadataka “Tachi” Yamada, a global health giant in academia, industry, and philanthropy who was a driving force in the creation of this commission. His legacy will live on in all of us and this report, which we hope will reflect his appreciation of the power of science and knowledge to make this a better world for all.

Linda P. Fried and John Eu-Li Wong, Co-Chairs

Commission for a Global Roadmap for Healthy Longevity