Global Population Aging: - Specialized Research AI at MIT

Global Population Aging:
Facts, Challenges, Solutions & Perspectives

David E. Bloom, David Canning & Alyssa Lubet

Abstract: The rapid aging of populations around the world presents an unprecedented set of challenges:
shifting disease burden, increased expenditure on health and long-term care, labor-force shortages, dissaving,
and potential problems with old-age income security. We view longer life spans, particularly longer healthy
life spans, as an enormous gain for human welfare. The challenges come from the fact that our current
institutional and social arrangements are unsuited for aging populations and shifting demographics; our
proposed solution is therefore to change our institutions and social arrangements. The ½rst section of this
essay provides a statistical overview of global population aging and its contributing factors. The second
section outlines some of the major challenges associated with widespread population aging. Finally, the
third section of the essay describes various responses to these challenges, both current and prospective, facing
individuals, businesses, institutions, and governments.

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DAVID E. BLOOM, a Fellow of the
American Academy since 2005, is
the Clarence James Gamble Pro-
fessor of Economics and Demog-
raphy in the Department of Global
Health and Population at the Har-
vard T.H. Chan School of Public
Health.
DAVID CANNING is the Richard
Saltonstall Professor of Population
Sciences and Professor of Econom –
ics and International Health in the
Department of Global Health and
Population at the Harvard T.H.
Chan School of Public Health.
ALYSSA LUBET is a Research As –
sis tant in the Department of Global
Health and Population at the Har-
vard T.H. Chan School of Public
Health.

(*See endnotes for complete contributor
biographies.)

We are in the midst of an unprecedented transi-

tion in global demography. The world’s population
is aging rapidly, and older adults compose a larger
proportion of the world’s population than ever
before–a share that will only increase over the
next century. By 2050, the percentage of the United
States’ population that is aged sixty years and older
will grow from the current ½gure of about 20 per-
cent to 27 percent. The global number of centenar-
ians worldwide–those aged one hundred years and
older–is expected to more than double by 2030,
with projections of nearly 3.4 million by 2050.1 Three
major factors are driving this transition: decreasing
fertility, increasing longevity, and the aging of large
population cohorts.

Falling fertility rates are the main determinant of
population aging. Low fertility rates lead to smaller
youth cohorts, which create an imbalance in the age
structure: older age groups become larger than their
younger counterparts. Thanks to accessible and ef –
fective birth control, increased child survival, and
cultural changes, birth rates have dropped dramat-

y
t
r

d
e
g

ically in the past century. In 1950, the glob-
al total fertility rate (tfr), or the average
number of children per woman, was about
5; by 2010, that number had dropped by
50 percent. By 2050, the tfr will have
dropped even further to about 2.25 chil-
dren per woman. In many countries, fer-
tility rates are now well below the long-
term replace ment rate of just over two chil –
dren per woman.

Changes in fertility rate are accompanied
by increased longevity, another driver of
population aging. Averaging for sex and
location, a child born in 1950 had a life ex –
pectancy of only forty-seven years, while
an adult who had survived to the age of
sixty could expect to live another fourteen
years. In contrast, by 2010, life expectancy
at birth had increased to seventy years, and
continued life expectancy for those aged
sixty increased to twenty years. In a num-
ber of populations, recent increases in lon –
gevity have been attributed to falling rates
of tobacco consumption, as well as im –
prove ments in medical technologies.2 By
2050, life expectancy at birth is expected to
have risen to nearly seventy-seven years,
while life expectancy at age sixty will in –
crease to twenty-two-and-a-half years.

Meanwhile, large population cohorts,
such as the United States’ postwar baby
boom generation, are moving through
middle age and older adulthood. This
move ment can be seen in Figure 1, which
depicts the population of more-developed
countries (mdcs) broken down by sex and
age group. Males are on the left side of the
pyramid and females are on the right. The
shifting shape of the population pyramid
between the years 2010 and 2050 illustrates
the baby boom cohort’s movement from
middle into older ages.

These global phenomena–decreasing
fer tility, increasing longevity, and the aging
of large birth cohorts–combine to drive
up the percentage of older adults as a share
of the global population. In 1950, only 8

percent of the world’s population was sixty
years or older; this number increased to
11 percent by 2010. Over the next several
decades, this proportion is expected to rise
dramatically, reaching a projected 21.2
per cent by 2050. The change is even more
dramatic for the share of the world’s pop-
ulation aged eighty years or older. This
proportion climbed from just 0.6 percent
in 1950 to 1.6 percent in 2010, and is pro-
jected to make up 4.1 percent of the global
population by 2050.

While the population of virtually every
country is aging rapidly, there remains
con siderable variation at both regional and
country levels, with strong correlations
to differing income levels. mdcs trend
toward low fertility and high longevity, and
less-developed countries (ldcs) trend to –
ward the opposite. At the low end of the
fertility range are the mdcs found in Eu –
rope and East Asia, with Bosnia, Herze-
govina, and Singapore tied for the lowest
tfr of 1.28 children per woman. Mean-
while, Sub-Saharan Africa has a regional
tfr of just over 5, while also hosting the
highest country-level fertility rates: So –
malia (6.61), Mali (6.86), and Niger (7.58).
As for longevity, Japan is in the lead with
a current life expectancy at birth of eighty-
three-and-a-half years, in stark contrast
to Sierra Leone, where life expectancy at
birth is slightly over forty-½ve years.

Tables 1 and 2 depict the percent of the
elderly population in the world’s most
and least population-aged countries, now
(2010) and projected in the future (2050).
The 2050 ½gures are based on a medium
fertility projection, which assumes that fer –
tility in all major areas will stabilize at re –
placement level (at slightly over two chil-
dren per woman). This comparison reveals
stark differences in age pro½les between
countries. For example, currently 23 per-
cent of Germany’s population is aged sixty-
½ve years and older, while the correspond –
ing ½gure for Qatar (with its large expa-

David E.
Bloom,
David
Canning
& Alyssa
Lubet

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144 (2) Spring 2015

Global
Population
Aging:
Facts,
Challenges,
Solutions &
Perspectives

Figure 1
Population Pyramids for More-Developed Countries, 2010 and 2050

2010

2
2
0
Population (%)

2050

FEMALE

MALE

FEMALE

MALE

e
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A

100+
95-99
90-94
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4

e
g
A

100+
95-99
90-94
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4

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Population (%)

Source: United Nations Department of Economic and Social Affairs Population Division, Population Estimates
and Projections Section, World Population Prospects: The 2012 Revision (New York: United Nations Department of
Economic and Social Affairs, 2014), http://esa.un.org/unpd/wpp/index.htm.

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triate worker population) is only 1 percent.
These rankings are projected to shift con-
siderably in the next half century, with only
Japan holding over in the top ½ve most
population-aged nations.

Rapid population aging is accompanied

by several distinctive challenges in health,

labor supply, and economic growth. The
economic and social consequences of
great er numbers and increased shares of
the elderly will be seen in rich and poor
countries alike.

Nations with swiftly aging populations
may ½nd themselves with a growing dis-
ease burden on their hands: nearly one-

Dædalus, the Journal of the American Academy of Arts & Sciences

Table 1
The World’s Most and Least Population-Aged Countries, 2010: Actual Population Percentages

Country % of population aged 65+ % of population aged 80+

David E.
Bloom,
David
Canning
& Alyssa
Lubet

Top 5
Japan
Germany
Italy
Greece
Latvia

Bottom 5
Kuwait
Eritrea
Bahrain
Qatar
United Arab
Emirates

23
21
20
19
18

2
2
2
1
0.3

6
5
6
5
4

0.2
0.2
0.3
0.1
0.1

Table 2
The World’s Most and Least Population-Aged Countries, 2050: Projected Population Percentages
(Medium Fertility Model)

Country % of population aged 65+ % of population aged 80+

s
f

Top 5
Japan
Republic of
Korea
Spain
Portgugal
Cuba

Bottom 5
Chad
Somalia
Timor-Leste
Mali
Niger

37
35

35
34
34

4
3
3
3
2.5

16
14

13
12
15

0.4
0.4
0.7
0.1
0.3

144 (2) Spring 2015

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Global
Population
Aging:
Facts,
Challenges,
Solutions &
Perspectives

quarter of the world’s burden of disease
is attributable to illness in adults aged sixty
and over. In turn, the majority (nearly 70
percent) of the older-adult disease burden
is due to noncommunicable diseases
(ncds) such as heart disease, cancer,
chron ic respiratory disease, musculo –
skeletal conditions, and mental disorders
such as Alzheimer’s and dementia.3 Ad –
ding to and signi½cantly complicating
the concerns posed by ncds is the issue of
multimorbidity, which affects a majority
of older adults with ncds.4 The increasing
burden of these health problems reflects
the epidemiological transition that has tak –
en place over the last century and that is
still occurring in many developing nations,
de½ned by a fundamental shift in the pre-
dominant causes of morbidity and mor-
tality away from infectious diseases and
malnutrition and toward ncds.

The growing ncd burden could also be
a signi½cant path through which popula-
tion aging slows economic growth. The
treatment and care of people suffering
from ncds weighs heavily on government
expenditure and household wealth and
also results in decreased investment. In –
deed, where losses are quanti½able, the
projected economic cost of ncds is stag-
gering, particularly in low- and middle-
income countries: recent projections show
that India stands to lose US$4.58 trillion, while China stands to lose US$23.03 trillion
due to ncds in the period between 2012
and 2030; during this time each country’s
proportion of adults aged sixty-½ve and
older is expected to double.5 On an indi-
vidual level, ncds prevent people from
working as long, hard, and productively as
they otherwise might; this is reflected in
decreased labor participation rates at older
ages (see Figure 2).

A key factor in determining the effects
of population aging is the “compression of
morbidity,” predicted in the 1980s by pro-
fessor of med icine James Fries. His theory

postulates that increasing life expectan-
cies will result not only in deaths at later
ages, but also in fewer years of life lived in
the presence of disease and reduced phys –
ical and cognitive functioning, resulting
in healthier, as well as extended, old age.6
So far, analyses of existing data to test the
compression of morbidity hypothesis have
not been conclusive. Some studies have
shown that certain populations–such as
centenarians, adults with active cognitive
lifestyles and social connections, and those
with healthy lifestyles–do indeed seem
to experience fewer years of illness and
disability at the end of their lives.7 How-
ever, other recent analyses found that in
the United States, disease prevalence has
increased along with average lifespan, and
that years of life lived with disease and loss
of mobility function have increased along
with life expectancies.8 Meanwhile, a
number of studies using data from low-
and middle-income countries show no evi –
dence of compression of morbidity; con-
versely, an expansion of morbidity is also
a possibility, threatening increased bur-
dens on governments, health systems, and
households.9 It is clear that more research
into the compression of morbidity will be
necessary and that, in any case, healthy liv –
ing must be emphasized.10

Another economic challenge presented
by population aging is the falling labor
supply. In many countries, labor-force par –
ticipation falls off drastically at older ages
(see Figure 2). As a result, population aging
may slow national economic growth, re –
duce asset values, strain existing pension
and health care systems, and weigh down
younger generations in the process. In the
United States, labor-force participation
rates for both sexes peak between the ages
of forty and forty-four: in 2010, the rate for
this group was 82.3 percent. From there,
rates drop gradually along with age, before
falling precipitously from 72 percent for
adults aged ½fty-½ve to ½fty-nine to 55 per –

Dædalus, the Journal of the American Academy of Arts & Sciences

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Figure 2
Labor-Force Participation Rate by Age Group, 2010

e
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a
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–
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a
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100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

David E.
Bloom,
David
Canning
& Alyssa
Lubet

Developed

Developing

Least Developed

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

Age Group

Source: International Labour Organization, ILOSTAT Database (Geneva: International Labour Organization, 2014),
http://www.ilo.org/ilostat.

cent for those aged sixty to sixty-four (un –
fortunately, after age sixty-½ve, labor-force
participation rates are generally no longer
available in ½ve-year bands as they are for
younger age groups).11 Similar drops can
also be seen in less-developed, but still
aging, countries. In India, the participation
rate of the sixty to sixty-four age group is
nearly 50 percent, a dramatic drop from
the 64 percent participation rate of those
aged ½fty-½ve to ½fty-nine. In contrast, the
more population-aged Japan sees a falloff
from 80 percent to 61 percent participation
between the ½fty-½ve to ½fty-nine and six –
ty to sixty-four age groups. While this de –
crease reflects a greater change in percent –
age points, higher overall proportions also
point to longer working lives for a greater
number of individuals.

The low labor-force participation of the
elderly means that their consumption is
½nanced out of either government pen-
sions, family transfers, or their own sav-
ings. A dif½culty with transfers such as pay-
as-you-go pensions or informal transfers
from children to their elderly parents is
that they may become unsustainable as the
ratio of elderly to working age population

increases. This can be avoided if people
save real assets for their own retirement;
but rather than accumulating real re –
sources, many government pension sys-
tems promise pensions based on future tax
receipts. As well as money transfers to the
elderly, there are often larger transfers in
the form of publicly provided access to
health care, which if not ½nanced through
savings must be funded through a tax bur –
den on younger workers.

Another challenge posed by population
aging is the prospect of slowed economic
growth by way of diminished labor and
lower savings rates. There are strong life-
cycle patterns in work and saving, and
older generations do not work and save as
much as younger adults do. One dire pre-
diction is that population aging will slow
or perhaps even reverse the engines of na –
tional economic growth. Reduced labor
sup ply due to population aging may result
in economies having to pay “dividend”
back in the form of health care, long-term
care, and capital deaccumulation as the
elderly seek resources to ½nance their con –
sumption in old age. Economies may also
be burdened by increased social protec-

144 (2) Spring 2015

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Global
Population
Aging:
Facts,
Challenges,
Solutions &
Perspectives

tion expenditures, such as increasing pen –
sion costs. Indeed, public pension expen-
diture as a share of gdp is projected to rise
steeply in the coming decades due to pop-
ulation aging and to earlier changes in pen –
sion coverage and bene½t rates.12
The problems outlined above may be off –

set by accompanying demographic devel-
opments, especially if countries are pre-
pared to take advantage of these opportu-
nities. One challenge posed by population
aging is an altered age dependency ratio,
or the ratio of people of working-age (ages
½fteen to sixty-four) to young children and
older adults in a population. However, in –
creased elderly dependency will be offset
in many economies by a reduced youth
dependency ratio. The elderly dependency
ratio in the United States, for example, has
grown from seventeen adults aged sixty-
½ve and older per one hundred working-
aged adults in 1980 to twenty-one elderly
per one hundred working-aged in 2013. In
the same time period, the ratio of children
under age ½fteen to working-age adults has
decreased from thirty-four per one hun-
dred to twenty-nine per one hundred.13
Between 1980 and the present, the United
States’ overall age dependency ratio has
re mained relatively constant, contracting
from 51 percent to 50 percent.14 With a
lower youth dependency burden, invest-
ment can be redirected from social spend –
ing on children to investment in physical
capital, research and development, and in –
frastructure–all classic drivers of econom-
ic growth.

Individuals may also respond to popu-
lation aging through behavioral changes,
such as increased rates of saving, higher
educational attainment in anticipation of
longer lives, and increased labor-force par –
ticipation from women and the elderly.
The typical “working lifespan” between
the ages of ½fteen and ½fty-nine is the
prime period for saving, and people may

respond to population aging through be –
havioral changes in this period. Greater
longevity leads to longer retirements and
increased incentives to save during work-
ing years in anticipation of retirement.
There is some evidence that people in aging
societies have already adjusted to this re –
ality. Figure 3 shows that, for all countries
in the aggregate, savings as a percentage of
gdp rises along with the share of a coun-
tries’ population aged sixty-½ve years or
older.15 In economic terms, savings trans –
lates into investment, which fuels the ac –
cumulation of physical and human capi-
tal and technological progress, which are
the classic drivers of economic growth.

Individuals and households may also re –
spond to population aging through in –
creased investment in human capital, such
as through education and training. Even
while a more aged population can lead to
a smaller workforce, investment in edu-
cation can make this workforce more ef –
fective. Lower fertility rates lead to fewer
chil dren per family, and these children
are typically healthier and better educat –
ed. Healthy, well-educated children gen-
erally grow up to be more productive
adults.16 A workforce with higher human
capital has the potential to lead to increased
productivity, wages, and standards of liv-
ing.17 Other human-capital investments
in health will generally also lead to more
productive working adults, offsetting the
reduction in the labor force as adults age
and fertility rates decline.

While reduced fertility rates have shrunk
workforces in some countries, lower fer-
tility has also facilitated greater labor-force
participation by women. In that sense,
low er fertility is tantamount to an increase
in the effective labor force. This will fur-
ther offset the negative effects of popula-
tion aging on workforce numbers. Older
people may also choose to work beyond the
statutory retirement age, further mitigat-
ing this challenge. In the United States,

Dædalus, the Journal of the American Academy of Arts & Sciences

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Figure 3
Savings by Age in Developed and Developing Countries

-20

-40

,
)

P
D
G

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%

(
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1
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2
–
7
0
0
2

-60

Income group:

High

Low & Middle

All

Population Aged 65+ (% of Total)

David E.
Bloom,
David
Canning
& Alyssa
Lubet

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Source: David E. Bloom, Somnath Chatterji, Paul Kowal, Peter Lloyd-Sherlock, Martin McKee, Bernd Rechel,
Larry Rosenberg, and James P. Smith, “Macroeconomic Implications of Population Ageing and Selected Policy
Responses,” The Lancet 385 (9968) (2015): 649–657.

labor-force participation rates of older in –
dividuals have been increasing for the past
two decades, especially among those with
higher levels of schooling.18

In addition to individuals and house-
holds, businesses can respond to popula-
tion aging by adjusting human resource
protocols and implementing technological
innovations to assist and incentivize older
workers. As older people make up greater
numbers of the workforce, businesses can
shift human resources practices to meet
older employees’ needs for flexible roles
and schedules. Other developments may
include reallocating more physically de –
manding tasks to younger employees, of –
fering opportunities for continuing edu-
cation of older employees, and instituting

worker wellness programs as a way of in –
vesting in employee health to cut down on
health care and absenteeism costs.19 Firms
may also take advantage of new business
opportunities that will accompany popu-
lation aging, such as the design and mar-
keting of products and services geared to –
ward older adults.

With respect to public policy, it is natural
for people to respond to longer and health –
ier lifespans by planning on longer work-
ing lives. But since most of the world’s so –
cial security systems create strong incen-
tives for retirement between the ages of
sixty and sixty-½ve, public policy has been
extremely sluggish in adapting to new
dem o graphic realities. For example, data
on public pension systems in twenty-three

144 (2) Spring 2015

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Global
Population
Aging:
Facts,
Challenges,
Solutions &
Perspectives

European countries between 1965 and 2005
show that while male life expectancy in
those countries increased by an average of
seven years, the mean legal retirement
age did not change.20 Fortunately, sever-
al countries–including France, Ireland,
Greece, Sweden, and the United Kingdom
–have recently raised the normal legal re –
tirement age or have increased incentives
to delay retirement.

Some countries have also considered ad –
justing their pension systems. For exam-
ple, in Norway, new cohorts of older peo-
ple will receive a pension calculated as the
accumulated entitlement divided by a life
expectancy indicator. Thus, as life expec –
tancy increases, the annual pension will
de crease.21 In addition, some countries are
moving toward fully funded systems in
which contributions are saved in real assets
that generate future pension income, rath –
er than simply transferring contributions
of the young to ½nance pension receipts of
the old. Countries could also encourage and
complement behavioral shifts by investing
in schooling that will enlarge the effective
labor force or by emphasizing healthy liv-
ing and disease prevention throughout
life.22

Institutional changes are also needed
to address the new demographic realities.
Government-initiated policies and educa –
tional programs to promote ½nancial lit-
eracy among older adults may help them
make better choices about the forms, ac –
cessibility, and security of their assets. Old –
er people must make these choices while
facing uncertainty about individual lon gev –
ity and the availability of government ben –
e½ts; furthermore, they must make these
choices during a phase of life that is asso-
ciated with reduced cognitive function.

Health system reform also has great po –
tential to mitigate the negative effects of
population aging; in 2002, the United Na –
tions’ Madrid International Plan of Action on
Ageing called on governments to recognize

“the growing needs of an ageing popula-
tion” by way of new policies geared to –
ward the health of older adults.23 In devel –
oping countries, especially those in which
family and social structures are undergo-
ing rapid transformations, there is a great
need for developing basic packages of cost-
effective health services suited to the needs
of older people, including a realignment
of primary health care programs to match
changing demographic and epidemiolog-
ical patterns.24 There is also opportunity
to reform health care ½nancing mecha-
nisms to ensure greater fairness and sus-
tainability while also promoting risk pool –
ing and increasing ef½ciency. This has the
potential to reduce the ½scal pressures as –
sociated with an older population, and will
improve the lives of older individuals by
providing access to more and better ser –
vices. In more-developed countries, a great –
er concern is securing coverage for the
costs and services associated with long-
term care. Governments could consider re –
ducing reliance on costly institutional care
by promoting self-care, in-home caretaker
training, and other services that would en –
able older people to remain in their own
homes.

Reforming health education and re –
search is an important health systems–
related solution. Currently, most medical
curricula focus on disease cures and spe-
cialization. A potential source of cost sav-
ings and increased quality of life is to re –
orient medical education toward a holistic
emphasis on prevention and early detec-
tion, especially given the increased burden
of ncds and the prevalence of multimor-
bidity. An additional focus on healthy liv-
ing and a general understanding of co –
morbidities, treatment interactions, and
palliative and end-of-life care, as well as
research on the physical and cognitive
tran sitions associated with aging, would
meet the needs of the growing elderly pop –
ulation.

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On a larger scale, international migra-
tion policies have the potential to amelio-
rate the economic effects of population ag –
ing, insofar as youthful developing-coun –
try populations can ½ll job vacancies in
aging developed countries. The bottom-
heavy population pyramids of Africa and
the top-heavy pyramids of Europe ½t to –
gether hand in glove. However, integrat-
ing the two over the next twenty-½ve years
would require immigrant flows from Af –
rica to Europe that are more than ten times
higher than current levels.25 Unfortunate-
ly, most countries have gone in the oppo-
site direction and have instituted barriers
to immigration, usually in an effort to pro –
tect their economies from low-wage work –
ers, to preserve traditions, to maintain cul –
tural and ethnic homogeneity, or to re –
spond to anti-immigrant sentiments.
Mean while, Japan, another of the world’s
most rapidly aging countries, has also had
dif½culty attracting even highly skilled mi –
grant labor, in part due to language and
cultural factors and corporate promotion
and pension systems designed around life –
time, rather than medium-to-long term,
em ployment.26 It will be necessary to re –
evaluate these priorities in order to pro-
duce migration policies that can meet both
the employment demand of young work-
ers from developing countries and the
care needs of older people in developed
countries.

Encouraging research on population
aging will lead to long-term solutions;
there are still many unanswered questions
in this ½eld. A great source of data for cur –
rent and future research lies in the family
of Health and Retirement Studies (hrs).
Beginning with the ½rst hrs in the United
States, these longitudinal studies aim to
collect rich and detailed data sets on older
adults and their families, covering every-
thing from physical and mental health to
economic status and life histories. Coun-
tries with the most rapidly aging popula-

tions–including Japan, Korea, and those
in the European Union–run their own on –
going sister studies, allowing for interna-
tional harmonization and comparisons.
More recently, low-income and middle-
income countries such as South Africa,
China, and India have also begun their own
hrs surveys, which will provide a valuable
look at population aging in emerging econ –
omies, for which data of this type are sore-
ly lacking.

Counteracting the potential negative

con sequences of population aging will in –
volve some combination of behavioral and
policy changes. These may include in –
creased rates of savings during the work-
ing years; increased labor supply from
wom en, older people, and immigrants;
thoughtful policy programs; increased re –
tirement ages; and other adjustments. The
combination of interventions chosen will
determine how costs are divided among
current and future generations of older
peo ple. Countries can ensure a smoother
transition to an older population by initi-
ating policy and institutional reforms
sooner.

The solutions explored above may not
only ameliorate the potential economic
bur den of population aging, but may also
enhance the well-being of older people,
which is an independently valuable result.
Increased longevity can also be of great
bene½t to society. Older people are repos-
itories of work experience, knowledge, and
culture. Regarding them as a resource is
crit ical to cultivating a more effective
work force and offsetting labor shortages.
In a globalized world where knowledge
and human capital provide an advantage,
the experience of older workers is valuable.
Positive perceptions of aging individu-
als, their overall integration with society,
and mitigation of ageist beliefs will also
ben e½t their quality of life. Indeed, sub-
jective well-being–life satisfaction, feel-

David E.
Bloom,
David
Canning
& Alyssa
Lubet

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144 (2) Spring 2015

Global
Population
Aging:
Facts,
Challenges,
Solutions &
Perspectives

ings of happiness, and sense of purpose
and meaning in life–has been shown to be
closely related to physical health, a link
that is particularly important at older ages
and is associated with longer survival.27
Shifting the perspective away from an
ageist view of burden and diminished val –
ue and toward a positive view of older peo –
ple who offer experience, wisdom, and
lead ership will enhance their lives and lead
to behaviors and policies with the power
to resolve or offset the challenges present –
ed by aging.

Adopting policies that allow for healthy
living throughout life and into old age will
encourage this more positive perspective
to take hold. Population aging has vastly
different potential for bene½t or harm to
societies depending on whether aging pop –
ulations are independent and healthy or
are disabled and in need of costly long-
term care. As discussed above, it remains
to be seen whether increased longevity will
introduce improved quality of life and a
higher proportion of healthy years. While
disability traditionally does increase along
with age, research in the United States has

shown that in recent decades the incidence
of disability at older ages is declining.28
Policy interventions can reinforce this
grow ing trend: higher socioeconomic sta-
tus and higher levels of education among
older men and women across multiple
countries correlates with reduced disabil –
ity and chronic disease incidence.29 High-
er education levels and improved health at
older ages has led to such sayings as “sev-
enty is the new sixty,” a sentiment rein-
forced by ½ndings that the average self-
reported health of a sixty-nine-year-old
man in the United States in the 2000s was
the same as that of a sixty-year-old-man
in the 1970s.

Although demographic change is daunt-
ing and has historically introduced signi½ –
cant obstacles to societal cohesion and eco –
nomic growth, the bottom line is that de –
mography is not destiny. Individuals, bus –
inesses, and governments have the option
to adapt in the face of change, and many
solutions are within reach. The sooner pol –
icy changes are considered and implemen –
ted, the sooner population aging can trans –
form from a challenge into an opportunity.

endnotes
* Contributor Biographies: DAVID E. BLOOM, a Fellow of the American Academy since 2005,
is the Clarence James Gamble Professor of Economics and Demography in the Department
of Global Health and Population at the Harvard T.H. Chan School of Public Health. His many
publications include recent articles in such journals as JAMA: The Journal of the American Medical
Association, Finance & Development, and Science.
DAVID CANNING is the Richard Saltonstall Professor of Population Sciences and Professor
of Economics and International Health in the Department of Global Health and Population
at the Harvard T.H. Chan School of Public Health. His many publications include recent ar –
ticles in such journals as Journal of Political Economy, Journal of Applied Statistics, and Journal
of International Development.
ALYSSA LUBET is a Research Assistant in the Department of Global Health and Population
at the Harvard T.H. Chan School of Public Health. Her research interests include economics,
women’s health and reproductive health, and population studies.

Authors’ Note: Preparation of this manuscript was supported by Harvard University’s Program
on the Global Demography of Aging, which receives funding from the National Institute on
Aging, Grant No. 1 P30 AG024409-09.

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1 Unless otherwise stated, population ½gures are drawn from United Nations Department of
Economic and Social Affairs Population Division, Population Estimates and Projections
Section, World Population Prospects: The 2012 Revision (New York: United Nations Depart-
ment of Economic and Social Affairs, 2014), http://esa.un.org/unpd/wpp/index.htm.
2 Colin D. Mathers, Gretchen A. Stevens, Ties Boerma, Richard A. White, and Martin I. Tobias,
“Causes of International Increases in Older Age Life Expectancy,” The Lancet 6736 (14) (2014).
3 Martin J. Prince, Fan Wu, Yanfei Guo, Luis M. Gutierrez Robledo, Martin O’Donnell, Richard
Sullivan, and Salim Yusuf, “The Burden of Disease in Older People and Implications for
Health Policy and Practice,” The Lancet 6736 (14) (2014): 100–111.

4 Sube Banerjee, “Multimorbidity–Older Adults Need Health Care that Can Count Past One,”

David E.
Bloom,
David
Canning
& Alyssa
Lubet

The Lancet 6736 (14) (2014).

5 David E. Bloom, Elizabeth T. Ca½ero-Fonseca, Mark E. McGovern, Klaus Prettner, Anderson
Stanciole, Jonathan Weiss, Samuel Bakkila, and Larry Rosenberg, “The Macroeconomic Impact
of Non-Communicable Diseases in China and India: Estimates, Projections, and Comparisons,”
The Journal of the Economics of Ageing 4 (2014): 100–111.

6 James F. Fries, “The Compression of Morbidity,” The Milbank Memorial Fund Quarterly 61 (3)
(1983): 397–419, reprinted under the same title in The Milbank Quarterly (83) (4) (2005):
801–823.

7 Stacy L. Andersen, Paola Sebastiani, Daniel A. Dworkis, Lori Feldman, and Thomas T. Perls,
“Health Span Approximates Life Span Among Many Supercentenarians: Compression of
Morbidity at the Approximate Limit of Life Span,” The Journals of Gerontology: Biological Sci-
ences & Medical Sciences 67 (4) (2012): 395–405; James F. Fries, Bonnie Bruce, and Eliza
Chakravarty, “Compression of Morbidity 1980–2011: A Focused Review of Paradigms and
Progress,” Journal of Aging Research 2011 (2011); and Riccardo E. Marioni, Michael J. Valenzuela,
Ardo van den Hout, Carol Brayne, Fiona E. Matthews, and the mrc Cognitive Function and
Ageing Study, “Active Cognitive Lifestyle is Associated with Positive Cognitive Health Tran-
sitions and Compression of Morbidity from Age Sixty-Five,” PLOS One 7 (12) (2012): e50940.
8 Eileen M. Crimmins and Hiram Beltrán-Sánchez, “Mortality and Morbidity Trends: Is There
Compression of Morbidity?” The Journals of Gerontology: Psychological Sciences & Social Sciences
66 (1) (2010): 75–86.

9 Somnath Chatterji, Julie Byles, David Cutler, Teresa Seeman, and Emese Verdes, “Health, Func –
tioning, and Disability in Older Adults–Present Status and Future Implications,” The Lancet
6736 (14) (2014).

10 David E. Bloom, Axel Boersch-Supan, Patrick McGee, and Atsushi Seike, Population Aging:
Facts, Challenges and Responses, Program on the Global Demography of Aging Working Paper
No. 71 (Cambridge, Mass.: Harvard School of Public Health, 2012), http://www.hsph.harvard
.edu/pgda/working.htm.

11 International Labour Organization, ILOSTAT Database (Geneva: International Labour Orga –

nization, 2014), http://www.ilo.org/ilostat.

12 Benedict J. Clements, David Coady, Frank Eich, Sanjeev Gupta, Alvar Kangur, Baoping Shang,
and Mauricio Soto, The Challenge of Public Pension Reform in Advanced and Emerging Market
Economies, International Monetary Fund Occasional Paper 275 (Washington, D.C.: Interna-
tional Monetary Fund, 2012).

13 David E. Bloom, David Canning, and Günther Fink, “Implications of Population Ageing for

Economic Growth” Oxford Review of Economic Policy 26 (4) (2010): 583–612.

14 The World Bank, “World Bank Open Data,” http://data.worldbank.org (accessed January 26,

2015).

15 David E. Bloom, Somnath Chatterji, Paul Kowal, Peter Lloyd-Sherlock, Martin McKee, Bernd
Rechel, Larry Rosenberg, and James P. Smith, “Macroeconomic Implications of Population
Ageing and Selected Policy Responses,” The Lancet 6736 (14) (2014): 1–9.

144 (2) Spring 2015

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16 Gary S. Becker and Nigel Tomes, “Child Endowments and the Quantity and Quality of Chil-

dren,” Journal of Political Economy 84 (4, pt. 2) (1976): S143–S162.

17 Klaus Prettner, David E. Bloom, and Holger Strulik, “Declining Fertility and Economic Well-
Being: Do Education and Health Ride to the Rescue?” Labour Economics 22 (C) (2013): 70–79.
18 Henry Aaron and Gary Burtless, eds., Closing the De½cit: How Much Can Later Retirement Help?

(Washington, D.C.: The Brookings Institution, 2013).

19 David Bloom and David Canning, “How Companies Must Adapt for an Aging Workforce,”
Harvard Business Review, December 3, 2012, https://hbr.org/2012/12/how-companies-must
-adapt-for-a/.

20 The World Bank, “World Bank Open Data.”
21 Organisation for Economic Co-operation and Development, “Linking Pensions to Life Ex –
pec tan cy,” in Pensions at a Glance 2011: Retirement-Income Systems in OECD and G20 Countries
(Paris: oecd Publishing, 2011), http://www.oecd-ilibrary.org/docserver/download/8111011e
.pdf?expires=1422285516&id=id&accname=guest&checksum=CB440CD4A7F88C0E9274E171
B76C99BD.

22 Clements et al., The Challenge of Public Pension Reform in Advanced and Emerging Market Econ –
omies; and Ronald Lee and Andrew Mason, “Fertility, Human Capital, and Economic Growth
over the Demographic Transition,” European Journal of Population 26 (2) (2010): 159–182.
23 The United Nations, Political Declaration and Madrid International Plan of Action on Ageing, Second

World Assembly on Ageing, Madrid, Spain, April 8–12, 2002.

24 David E. Bloom and Karen N. Eggleston, “The Economic Implications of Population Ageing
in China and India: Introduction to the Special Issue,” The Journal of the Economics of Ageing 4
(2014): 1–7.

25 David Bloom, David Canning, and Jaypee Sevilla, The Demographic Dividend: A New Perspective
on the Economic Consequences of Population Change (Santa Monica, Calif.: rand Corporation,
2002), http://www.rand.org/pubs/monograph_reports/MR1274.html.

26 Nana Oishi, “The Limits of Immigration Policies: The Challenges of Highly Skilled Migration

in Japan,” American Behavioral Scientist 56 (8) (2012): 1080–1100.

27 Andrew Steptoe, Angus Deaton, and Arthur A. Stone, “Subjective Wellbeing, Health, and

Ageing,” The Lancet 6736 (13) (2014).

28 National Research Council of the National Academies, Committee on the Long-Run Macro-
economic Effects of the Aging U.S. Population, Aging and the Macroeconomy: Long-Term Impli –
cations of an Older Population (Washington, D.C.: The National Academies Press, 2012).
29 Ahmad Reza Hosseinpoor, Jennifer Stewart Williams, Ben Jann, Paul Kowal, Alana Of½cer,
Aleksandra Posarac, and Somnath Chatterji, “Social Determinants of Sex Differences in Dis –
ability Among Older Adults: A Multi-Country Decomposition Analysis Using the World Health
Survey,” International Journal for Equity in Health 11 (52) (2012).

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