A Vision for Individual Healthy Longevity

Imagine a world in 2050 in which the science supporting healthy longevity has been incorporated into everyday life. In this future, all people enjoy overall well-being, decreased disease burden, effectively controlled diseases and conditions, maximized intrinsic capacity and function, and years of good health that approximate the lengthened life span. At the individual level, experiences are shifted such that the life course is not segmented into distinct stages of life experiences (e.g., early childhood, education, work, retirement). Rather, education is lifelong, work careers are fluid, and people have time to do what they find meaningful. People at all stages of life have equal access to health, education, good jobs with a living wage, opportunities to contribute to their family's and community's well-being, and the ability to live their lives with meaning, purpose, and dignity. Synergies across generations are woven into society, and people engage with others and contribute to societal well-being in ways that previous generations may not have imagined.

In Vision 2050, people in the first half of their lives acquire skills and experiences, take risks appropriate to their life stage, and create positive life paths. Young adults have more employment opportunities than they do today, because more people are working longer in the workforce and due to new economies born from the aging of society spur innovation, businesses, and jobs.

Older people live a previously unimagined range of paths aligned with human and societal development and well-being. Because employers recognize their capabilities and value the experience they bring to organizations, older adults have more opportunities to work for pay, and many choose to do so. In a world of healthier, longer lives, people contribute to societies by remaining in the workforce longer, volunteering, or engaging in caregiving or other roles. Individuals are retrained as needed, with greater flexibility in how retraining can be done. Employees experience heightened satisfaction and cohesion and contribute increased innovation and productivity at the workplace as a result of better health and workplaces that accommodate their needs and foster intergenerational teams. Importantly, workplace accidents and occupational disabilities are also reduced. At older ages, people are connected through advances in both technology and transportation, and have time to engage in personally meaningful and societally beneficial activities (e.g., supporting younger generations, preserving the environment), free from policy, cultural, or other barriers. For those who are sick or have impaired function, care is provided in a manner and location that are personalized and supportive of their goals.

In a world of healthy longevity, people are active partners in and managers of their own health care. They engage in prevention throughout their lives, supported by modernized public health that creates conditions that promote health and make healthy choices possible. Care, including long-term care, is culturally appropriate and accessible when needed. Even with impaired functioning, people enjoy lives of autonomy, meaning, and dignity. Affordable options for receiving care are available, and family caregivers receive training and support, including financial support when possible.

Advances in science and technology enable the identification of those at increased risk of disease, allowing for prevention or early detection so that preventive and therapeutic options can be maximally effective. Enabling technologies within communities allow people to integrate health and well-being into everyday life, with health facilities being not in one physical location but available everywhere via mobile-enabled platforms.

In 2050, societies value the capabilities and assets of older adults for what they do for others, not just what they contribute to economic growth. Equitable opportunities exist for them to experience a full range of engagement, both in paid work and in civic and other roles and relationships with others within and across generations. Younger and older people benefit from intergenerational collaboration, mentorship, and valued roles. And with increased connection and satisfaction from these intergenerational relationships, loneliness is an exception, not a default part of aging.

A Vision for Societies of Healthy Longevity

Imagine a world in 2050 in which the health of older adults is recognized as an asset for nations and societies. Older adults bring transformative potential for intergenerational well-being and productive engagement, underpinned by unique assets associated with aging. With a rebalancing of resources and investments in social determinants of health, healthy longevity enables vibrant and healthy later life, with opportunities for meaningful roles and responsibilities. After decades of focus on equity, families, communities, and societies are flourishing. The economic well-being of nations is bolstered by the success of young adults, often fostered by the mentorship and partnership of older adults, which results in intergenerational cohesion. Societies have made sustainable investments and built institutions to create a state of well-being across the full and extended life course. In this aspirational future, societies prosper as a result of a virtuous cycle whereby young and old work together to solve challenges. An expanded workforce drives thriving economies, greater investment in public goods using resources freed from national health care budgets, stronger communities, and families benefiting from grandparents and great grandparents nurturing grandchildren.

Healthy longevity relies on a life-course approach to addressing and investing in health and functional, psychological, and social needs from the beginning to the end of life. Health systems work together to prevent, slow the progression of, and manage chronic conditions, enabling older people to be active and engaged members of society. In 2050, societies have a global public health enterprise, characterized by globally unified collective action to protect health for all people from, for example, risk factors for chronic diseases, frequent novel infectious agents that cause pandemics, and climate change. The resolution of health disparities, creation of strong public health systems, development of lifelong quality education, and social protections enable all people to live long lives with health and function. Personalized health services, including long-term care, are available to all who need them. Care for older adults is provided by health professionals knowledgeable in geriatrics, and countries adopt care delivery models that support accessible, affordable, quality care. Precision public health systems use big data and advanced analytics for surveillance and development of interventions to prevent infectious diseases and chronic conditions. All countries have significantly reduced the costs of medical care through better prevention and earlier optimal intervention that averts complications or the need for more resource-intensive therapy.

All people benefit from the combined investments in essential social protections. For example, people benefit from enhanced education systems across the life course, inclusive of higher education, which is a predictor of health, cognition, function, and social engagement. Older adults are financially secure, and financial supports are available at a level that supports, at least, people's basic survival. Economic returns on these investments are reaped into the oldest ages, such that people experience longer lives with the benefits of healthy longevity and the ability to spend their later years in pursuits they value. Thanks to greater inclusion of older adults in the user-centered design process, more digital technologies and tools are used by people of all ages.

Businesses recognize the evidence that older adults are valuable workers and that the decline in the younger workforce due to shrinking population sizes can be offset by the contributions of older workers. Accordingly, they redesign the workplace to be less physically taxing and offer more flexible schedules, which benefit workers of all ages. Intergenerational teams are established as the norm for business processes based on the evidence for beneficial outcomes from this approach. Investments in designing appropriate training and retraining enable career development for people of all ages, allowing older people to remain in the workforce longer. Fears that older workers will take jobs from the young have dissipated with the realization that larger workforces strengthen economies and increase opportunities for younger workers. Older workers have become key employees. The concept of “retirement age” has been eliminated, and people can elect to work for as long as they want or need.

In the year 2050, critical connections made between health and the physical environment endure. Urban planning and design are equitably implemented in housing options and cities, using principles of universal design and supporting social cohesion at the community level. People living in lower-socioeconomic regions or neighborhoods have the same ability to commute and travel as those living in upper-income areas. An explosion of the most up-to-date interfaces with the internet in public and private places allows younger and older people to connect with one another and use the wealth of digital information and resources. While climate change remains an ongoing concern across the globe, mitigation and monitoring efforts are ongoing. When disasters do occur, older adults are targeted for early evacuation or provided with provisions to stay safe.

In 2050, societies recognize that older age is the “pay-it-forward” stage of life, as older adults display great concern for others and prioritize emotionally and humanly meaningful goals and a desire to “give back” for future generations. Leveraging these assets of older people, coupled with their lifetimes of experience and desire to leave future generations better off, the world has unleashed the potential of the unprecedented large numbers of older people by fostering high-impact roles for them at scale. People of all ages contribute regularly to the community to solve shared concerns, intentionally drawing on the capabilities and assets of each age group to bring people together across generations to learn from one another and create solutions. Civic participation strengthens appreciation of interdependence and successful communities. Governments recognize and invest in efforts to coalesce their citizens around a set of prosocial values and roles that support a transformed society. Countries recognize the effects that demographic forces and ageism have had on segregating generations. Intentional approaches to resolving disparities, improving cohesion, and valuing the contributions of each age group are deployed. New norms for engagement by older adults have been amplified through the development of roles that use their capabilities, metrics that value the in-kind contributions of older people, and evidence-based policies that recognize the importance of both in-kind contributions and paid work by older adults for societal well-being.

The glue that holds societies together is the social compact. This often implicit agreement among members of a society delineates what they expect from one another and from governing bodies. The social compact is codified in a society's institutions, regulations, and laws, and embodied in its culture. In 2050, social compacts around the world are grounded in the promise of thriving aging societies. The social norms for societies and their cultures prioritize helping all people attain basic living needs through health promotion and provision of care, lifelong learning opportunities, and protection against financial vulnerability. As depicted in Figure 1-4 in Chapter 1, the social compact is at the center of the virtuous cycle for healthy longevity. By being based on social cohesion and equity, a new social compact can fuel healthy longevity.

Principles and Goals for Healthy Longevity: Developing Systems to Realize the Potential of All People

The population shifts described in Chapter 1 necessitate both investments in healthy long lives for all and new norms and programs to foster the full social engagement of mid- to older-age adults. Healthy longevity in fact requires a life-course perspective and necessarily impacts people of all ages—particularly the youngest and oldest members of society. If recognized through a life-course approach, the value of healthy longevity could motivate action. As described throughout this report, however, the current systems supporting societies around the world were generally not developed for healthier, longer lives. Therefore, health systems, education, social protections, and work and economies will need to be re-envisioned and adapted to support and realize the potential of healthy longevity. Innovation in any one sector will not be sufficient to lead to a transformation. Transformation of all sectors will be needed and can be achieved by viewing healthy longevity as a complex system wherein these seemingly independent systems interact, build on each other, and create supporting networks toward a common goal (Bar-Yam, 1997; Miller and Page, 2007). By involving all sectors of society through a complex systems approach, the commission believes that its vision for a world of healthy longevity can be achieved by 2050.

Achieving this vision will require intentional and sustained commitment and dedicated resources. However, the commission believes the return on investment will be substantial. Importantly, any such transformation will have to be designed to account for the heterogeneity of (1) people—from those who are robust to those who are frail, disabled, or living with cognitive decline; (2) cultures and contexts; and (3) political realities. In transforming systems, societies will need to weigh many trade-offs and consider how to prioritize investments. These considerations and resulting decisions will differ widely among countries, particularly low- and middle-income countries, as every country has different priorities and needs. The commission believes that by solving the challenge of healthy longevity across relevant domains, societies can generate more value for less overall investment in the long term.

Recognizing the varying approaches that will be taken by countries around the world, the commission has formulated a set of goals that, if achieved, will result in systems changes across societies to achieve healthy longevity, enabling people of all ages to live life with meaning, purpose, and dignity underpinned by improved health (see Box 2-1). Collectively, these goals can guide the requisite transformation of systems and form the backbone of the commission's roadmap for global healthy longevity. To enact a future of healthy longevity, countries will need to be cognizant of local factors and carefully balance resources with the requisite benefits. Central to achieving these goals are a strong social compact, good and effective governance, and investments in science and technology. Through evaluation and future research, societies can measure the impacts of their efforts on the health of their populations.

BOX 2-1

Principles and Goals for Achieving Healthy Longevity.

Many of the goals in the commission's vision for 2050 align with the UN SDGs. The commission believes that by realigning resources and building on efforts to achieve the UN SDGs, countries can achieve these goals for healthy longevity. At the same time, the pursuit of healthy longevity will support achievement of the UN SDGs.