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Cracking the Code

Social consequences of manufactured longevity

Riaz Hassan

The signs are that advances in biomedical sciences will add more years of "manufactured time" to life expectancy in industrialised countries, resulting in unprecedented rates of survival into older ages. Increasing longevity will force economic and social changes and the 20th-century revolution in social roles looks set to continue into the 21st century.

MJA 2000; 173: 601-603

Life expectancy in rich and poor countries - Economic effects of longevity - Longevity and social structure - References - Authors' details
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  In 1825, a British actuary, Benjamin Gompertz, discovered a distinctive pattern in human mortality statistics. He found that the probability of dying was high at birth, and then continued declining until sexual maturity, after which it increased at an exponential rate. He and other demographers speculated that the exponential rise in the risk of death following sexual maturity was the result of a natural law of mortality.1,2

Ever since, scientists have been looking for evidence of a "universal" law of mortality that applies to all living things. Now there is evidence which suggests not only that a law of mortality may exist, but that the life span of human populations may have already exceeded the limits implied by such a law -- "a product of the survival time manufactured by medical technology and lifestyles modifications".3

For much of human history, life expectancy was around 25 to 30 years. The mean human life expectancy in industrialised countries has changed from 25 years in the 18th century to 50 years in 1900, and to about 75 years now.4 Over two-thirds of the improvements in longevity in the entire world, from prehistoric times until the present, has taken place since 1900.5 These changes in human populations raise a paradox: if evolutionary theories of senescence are correct and survival into the post-reproductive period serves no useful purpose, why is the human life span so much greater than the age when reproduction ceases?3

If, however, senescence is in fact the product of evolutionary neglect rather than evolutionary intent, then there is good reason to be optimistic that the process is modifiable, either through direct manipulation of crucial genes or, more indirectly, by controlling or manipulating the products of gene expression. Both of these interventions are a major focus of current biomedical research, boosted by the Human Genome Project. There may be a price to pay when only the progression or expression of senescent disease is modified. Such interventions may simply shift the burden of senescence to other forms of lethal or debilitating senescent diseases.3


Life expectancy in rich and poor countries

The distribution of the "manufactured time" being added to human life expectancy as a result of advances in biomedical sciences is highly skewed in favour of industrialised countries. In poor countries, most deaths occur in the young, and result from infectious and parasitic diseases, wars and starvation.4 In rich countries, most deaths occur as a result of the diseases of old age, such as cancer, strokes and heart disease.4,6 The populations of the rich countries will be the major beneficiaries of the new biomedical advances. Overpopulation will once again become the concern of the wealthy countries, rather than just the poor countries with high fertility rates.4,7,8


Economic effects of longevity

In the first half of the 20th century, when mortality began to fall, survival rates improved not only at the oldest ages but also in childhood and during the working years. Under these circumstances mortality decline is less costly for the State as it does not require major public welfare transfers. Greater mortality decline in the early years of life substantially increases the labour force, which helps to pay the aged pension costs and healthcare of the elderly. In the second half of the century, mortality decline slowed in the working ages, and accelerated in older ages. This is the pattern which now characterises the industrial countries.9 This change (which may be further boosted by the Human Genome Project) is likely to have major economic implications for the industrialised countries and will change their economies drastically over the next three to five decades.

For example, in Australia, if present trends continue, the proportion of people aged from 20 to 39 years will increase by only 2% between 2001 and 2051. In the same period, proportions of populations aged 60 to 79 years and 80 and over will increase by 122% and 307%, respectively. By 2051, one in three Australians will be aged 60 and over. Never before have such proportions been reached in large human populations.10

The developed countries will have difficulty meeting the costs of supporting an increasingly larger proportion of elderly. Under these conditions, according to a World Bank study of the macroeconomic effects of aging populations, the industrial economies should see higher aggregate consumption relative to income and higher real interest rates.11 To avoid a fall in people's standards of living, economic productivity would need to be increased, and new tax policies would be needed to aid the process of capital formation. If the tax rates remain unchanged, government debt will increase substantially, resulting in higher real interest rates. Under these conditions, the real gross national product per capita in most industrialised countries will decline significantly.11,12

Healthcare costs will be increased by the addition of more years of life in the older age groups. Some healthcare workers argue that healthcare for the elderly places an unsustainable economic burden on national budgets, and one method of control would be rationing healthcare for older people, and even denying it to those who are 80 years of age or older. These arguments are supported by data from the United States -- 28% of Medicare bills are paid to only 6% of those Medicare-eligible, who die within a year.13

An intriguing aspect of healthcare spending in industrialised countries is that, in general, healthcare costs as a percentage of gross domestic product (GDP) appear not to be associated with population aging. Spending on healthcare is highest in the US, constituting about 14% of its GDP. However, the US has the lowest percentage of elderly (12.6%) people among the 12 most industrialised countries. In comparison, Sweden, with 17.8% of the population older than 65 years, spends 7.5% of its GDP on healthcare.

Furthermore, healthcare spending does not necessarily rise with an increase in the percentage of elderly persons in the population. In Japan, the elderly population increased by more than 30% between 1980 and 1990, yet only a 1.6% increase in the proportion of its GDP during this period went to healthcare. In the US, where the proportion of those aged 65 and older increased by about 10% in the same period, healthcare spending went up by 31.5%.4,13

This means that more egalitarian industrialised countries like Sweden and Japan have not only longer life expectancies compared with the less egalitarian countries like the United States, but they are also more likely to be successful in coping with further increases in life expectancy in the future. The problems of high costs of healthcare arising from longer life expectancies are likely to be serious public issues in countries with greater social and economic inequalities. In this respect Australia is well situated to cope with the economic and social costs of increasing longevity of its population.4


Longevity and social structure

As human life expectancy began to increase in the 20th century, it also began a revolution in shaping social roles at different stages of life-cycle. Life course began to become age-graded and differentiated. One consequence was the reduction in labour force participation among both the old and the young. The trend has been towards concentration of education in youth, work in early to middle adult years, and recreation in the post-retirement years. Human society became increasingly age-segregated. Although this had had many beneficial effects, such as expansion of education, greater economic productivity and innovation, it has also transformed industrial societies into rigidly age-segregated societies. The social patterns of modern life are now testing the usefulness of this structure of life course.14-16

In countries like Australia, growing numbers of elderly people are rejecting the age constraints on paid work and biases against active participation of older people in society. Similarly, many young people are seeking "adult" roles in work, family and entertainment. These changes are increasing pressures for the development of age-integrated social structures. Unlike age-segregated structures, age-integrated structures do not use chronological age as a criterion for entrance, exit or participation. Sociologists have proposed an alternative model of life course that would allow learning, work and leisure to be integrated in the lives of individuals throughout the entire life course (Box).17

This life-course model is much more suited to the conditions of our society, which is adding more "manufactured time" to human life, producing unprecedented longevity. The evidence from Australian universities' enrolment statistics shows that education is becoming increasingly age-integrated and is now widely defined as "life-long". Barriers to work are also being relaxed, as evidenced by the increasing proportion of high school and university students who are in paid work. There is growing evidence that repudiates widely held beliefs about the inevitable and universal intellectual decline with aging, and ways to prevent the decline that does occur are being suggested.18,19

The most visible challenge to the age-segregated life course has come from women. Women have introduced a number of innovations which have made their life course flexible and age-integrated. Increasing proportions of women are combining work, education and family. If this transformation in sex-role attitudes and behaviours continues, it will affect every facet of modern life. Many middle-aged women today are performing more roles than men and will reach old age with greater role flexibility.19

An age-integrated society, with its accompanying cross-age interaction and flexible life course, will be conducive to promoting deeper understanding among people and reduce intergenerational conflict. It may lead to the development of more civil society. New social values will evolve when people from different age groups get accustomed to sharing work and family responsibilities, leisure time and cultural pursuits. These values may produce a greater sense of connectedness in the community and thus reduce loneliness, excessive individualism and materialism. Utopia may or may not result, but, of all the available futures, this appears the most promising for all ages. Whether we fear it or welcome it, this manufactured longevity will change our lives and human culture pervasively.

References
  1. Gompertz B. On the nature of the function expressive of the law of human mortality and on a new mode of determining life contingencies. Philos Trans R Soc Lond 1825; 115: 513-585.
  2. Carnes BA, Olshansky SJ, Grahn D. Continuing the search for a law of mortality. Popul Dev Rev 1996; 22: 221-264.
  3. Olshansky SJ, Carnes BA, Grahn D. Confronting the boundaries of human longevity. Am Scientist 1998; 86: 52-61.
  4. Fossil M. Reversing human aging: it's time to consider the consequences. Futurist 1997; 31: 25-28.
  5. Preston SH. Mortality patterns in national populations. New York: Academic Press, 1976.
  6. Najman JM. The demography of death: Patterns of Australian Mortality. In: Kellehear A, editor. Death and dying in Australia. Melbourne: Oxford University Press, 2000.
  7. Roush W. Live long and prosper. Science 1996; 273: 42-46.
  8. Wilmoth JR. The future of human longevity: a demographer's perspective. Science 1998; 280: 395-397.
  9. Lee R. Long-term population projections and the US social security system. Popul Dev Rev 2000; 26: 137-143.
  10. Australian Bureau of Statistics. Australian demographic statistics. Canberra: ABS, 1999. (Catalogue no. 3101.0.)
  11. Mason PR. Long-term macroeconomic effects of aging. Finance Dev 1990; 27: 6-9.
  12. Mason PR, Tryon RW. Macroeconomic effects of projected populations aging in industrial countries. IMF Working Paper WP/90/5. Washington DC, 1990.
  13. Marwick C. Longevity requires policy revolution. JAMA 1995; 273: 1319-1320.
  14. Uhlenberg P. Introduction: why study age integration? Gerontologist 2000; 40: 261-265.
  15. Kohli MR. Social organization and subjective construction of the life-course. In: Sorensen AB, Weiner FE, Sherrod LR, editors. Human Development and the life cycle. Hiilsdale NJ: Erlbaum, 1988.
  16. Riley MW, Foner A, Riley JW. The aging and society paradigm. In: Bergtson VL, Schaie KW, editors. Handbook of theories of aging. New York: Springer, 1999.
  17. Riley MW, Riley JW Jr. Age integration: conceptual and historical background. Gerontologist 2000; 40: 266-270.
  18. Schaie WK, editor. Longitudinal studies of adult psychological development. New York: Guilford Press, 1983.
  19. Riley MW, Riley JW Jr. Longevity and social structure: the added years. Daedalus 1988; 115: 51-74.


Authors' details

Flinders University, Adelaide, SA.
Riaz Hassan, PhD, FASSA, Professor, Department of Sociology.

Reprints: Professor R Hassan, Department of Sociology, Flinders University, GPO Box 2100, Adelaide, SA 5001.
Riaz.HassanATflinders.edu.au

©MJA 2000
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Social structures
Figure 1
Our current society is age-segregated -- we receive our education when we are young, we work until we are 60 or so, and then retire and spend our time in leisure. With increasing longevity, a better social structure would be age-integrated, in which education, work and leisure are all life-long activities.
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