Today, for the first time in history, most people can expect to live into their 60s and beyond (1). When combined with marked falls in fertility rates, these increases in life expectancy are leading to the rapid ageing of populations around the world.
These changes are dramatic and the implications are profound. A child born in Brazil or Myanmar in 2015 can expect to live 20 years longer than one born just 50 years ago. In the Islamic Republic of Iran in 2015, only around 1 in 10 of the popu- lation is older than 60 years. In just 35 years’ time, this will have increased to around 1 in 3. And the pace of population ageing is much faster than was the case in the past.
A longer life is an incredibly valuable resource (2). It provides the opportunity for rethinking not just what older age might be, but how our whole lives might unfold. For example, in many parts of the world, the life course is currently framed around a rigid set of stages: early childhood, studenthood, a defined period of working age and then retirement. From this perspective, it is often assumed that the extra years are simply added to the end of life and allow a more extended retire- ment. However, as more and more people live into older age, there is evidence that many are rethinking this framing of their lives. They are looking instead to spend the extra years in other ways, perhaps in further education, a new career or pursu- ing a long neglected passion. Moreover, as younger people start to expect longer lives, they too may plan things differently, for example by starting careers later and spending more time earlier in life to raise a family.
Yet the extent of the opportunities that arise from increasing longevity will depend heavily on one key factor: health. If people are experiencing these extra years of life in good health, their ability to do the things they value will be little different from that of a younger person. If these added years are dominated by declines in physical and mental capacity, the implications for older people and for society are much more negative.
Unfortunately, although it is often assumed that increasing longevity is being accompanied by an extended period of good health, there is little evidence to sug- gest that older people today are experiencing better health than their parents did at the same age.
However, poor health does not need to dominate older age. Most of the health problems that confront older people are associated with chronic conditions, particularly noncommunicable diseases. Many of these can be prevented or delayed by engaging in healthy behaviours. Other health problems can be effectively man- aged, particularly if they are detected early enough. And even for people with declines in capacity, supportive environments can ensure that they live lives of dignity and continued personal growth. Yet, the world is very far from these ideals.
Population ageing therefore demands a comprehensive public-health response, although debate on just what this might comprise has been narrow, and the evidence on what can be done is limited (3, 4). But this does not mean that nothing can be done now. Indeed, the need for action is urgent. This report looks in detail at what we do know about health and ageing, and builds a strategic framework for taking public-health action, with a menu of practi- cal next steps that can be adapted for use in countries at all levels of economic development.
In doing so, it approaches the changes associated with ageing in the context of the entire life course. However, given the unique issues that arise in older age and the limited attention this period has traditionally received, the report focuses on the second half of life.