By Janice Lynch Schuster

In April 2019, the National Academy of Medicine (NAM) launched a Global Grand Challenge, a multimillion dollar competition to accelerate improvements and innovation in the realm of healthy longevity – although the definition of that term is loose and not always clear. It will be left to competitors from NAM’s projected pool of “science, medicine, public health, technology, entrepreneurship, public policy, social engineering, and beyond” to define the term.

In November, NAM’s president, Victor Dzau, introduced the Grand Challenge’s partner project, the Global Roadmap, stating that he sees the project as “an audacious goal.” For Dzau, this means extending the human lifespan. This seems plausible, coming from the man whose seminal work led to the creation of ACE inhibitors. In any case, the Roadmap will be a report, scheduled for release in 18 months, highlighting findings from three global meetings and drawing on experiences, knowledge, and insights of academicians, practitioners, and policymakers worldwide. The Grand Challenge will award significant prizes to participants – up to $50,000 for 500 grants in the catalyst phase, and $5 million to the grand prize winner.

The scope of the challenge – to even consider what is meant by healthy longevity, much less how to achieve it – was clear at the first meeting, held in early November in Washington, D.C. Speakers from countries facing challenges of aging as diverse as those of Rwanda and the United Kingdom spoke to policies their countries are implementing. Representatives from Thailand, Nigeria, and Japan spoke of on-the-ground endeavors in their nations. And academicians described the challenges an aging population presents in terms of the workforce, retirement planning and social justice. Finally, one speaker addressed the insidious nature of ageism, its prevalence, and what might be done about it.

What is healthy longevity? Organizers had agreed not to spend time on the semantics engendered by defining “healthy longevity,” as people believed they had a sense of what they meant. As one organizer said, the challenge of translating various terms led the group to agree on “healthy longevity.” The world of international development and global health accepts the WHO definition of health: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

But the question of “longevity” is more fraught. Is it sheer length of life? Length of life in good health? Adequate health? Relative health? Community health? Is it good health for elders at the expense of others in the society, with massive investments in elder care at the price of investments in infrastructure such as education and transportation?

I asked Jennie Popay, workshop co-chair and Distinguished Professor of Sociology and Public Health at Lancaster University in the United Kingdom, about the definition and when it would be discussed, but she said that the group had decided not to bring it to the forefront, as there was so much else on the table.

The disparity among countries in terms of lifespan alone almost made the question seem offensive. The deputy mayor of Rwanda, Nadine Gatsinzi Umutoni, vice mayor of socio-economic affairs for Kigali, reported that the average lifespan in her country has gone from 29 years in 1994 to 66 years in 2019. Meanwhile, in Japan, nearly 26% of the population is aged 65 or older, and where the average life expectancy in 2018 was 87.32 for women.

Social determinants of health/environmental justice  

In the 1970s, Professor Sir Michael Marmot conducted studies of the effect of social status on health among civil servants in the UK; among students of public health. These studies became known as “the Whitehall Studies;” in the popular press, they became known as “the Status Syndrome.” In his book, Marmot concluded:

“The lower in hierarchy you are, the less likely it is that you will have full control over your life and opportunities for full social participation. Autonomy and social participation are so important for health that their lack lead to deterioration in health.”

This work became the foundation for Marmot’s work to understand social determinants of health, a field in which Marmot is a global leader. He gave a keynote address at the Global Roadmap meeting, speaking about social determinants of health – housing, food, transportation, and access to health.

Marmot focused his attention on the importance of early childhood as a stepping stone to healthy adulthood, and of the critical need to invest in programs for equity in early childhood, ensuring that all children have opportunities to learn, grow, and thrive in healthy and safe communities. Absent that, he suggested, countries around the world will be forced to cope with future generations of old people who have chronic disease and illness, and the conditions research has shown to be related to adverse childhood experiences (ACEs), such as poverty, untreated mental illness, and more, will persist.

Marmot has been at this work for decades, and was adamant that as a society and as a global culture, we must focus on today’s children if we are to hope for healthy long lives in the future.

In terms of longevity, Marmot noted that life expectancy may not be the best indicator: Cuba has a longer life expectancy than the United States. Globally, it is 80.3, but in the U.S. it has dropped to slightly more than 78 years. Marmot challenged listeners: “Why treat people and send them back to the conditions that made them sick?”

It is this ideal that underlies the effort to reduce the rate of preventable readmissions in the United States. As Marmot concluded: If we cannot offer safe and healthy homes and communities and the kinds of interconnection that humans need, we cannot focus on longevity, he suggested, noting that “…we don’t just want to live longer, but with a better quality of life.”

Changing philosophies

Four speakers in particular spoke of the need to change approaches and ideas about aging, either in the approach to public policy and policy makers, or in the approach to public education:

• Anna Dixon, chief executive of the Centre for Ageing Better, U.K., whose organization is working on a vision for 2040 that focuses on people most at risk for poor outcomes as they reach late mid-life. Dixon said that healthy aging builds on being able to live a full life, which requires being able to live a full life in a connected community. The organization is working to demonstrate an economic argument that demonstrates the benefits older adults bring to the economy, rather than responding to older adults just as a problem.
• Debra Whitman, chief public policy officer, AARP, is involved in scores of programs, but of particular interest is a new focus on the realization that we now have four to five generations working together in the workplace, and how to train individuals to work well together. AARP remains involved in education, partnership projects, advocacy at the state and federal level.
• Liat Ayalon, professor and deputy director of the School of Social Work, Bar-Ilan University, Israel, described the array of ways that ageism affects older adults, from their exclusion from clinical trials to the way they are presented in media. She mentioned that in 2006, WHO ran a campaign to combat ageism – but that was 13 years ago.
• Laia Becares, co-director of Centre for Innovation and Research in Wellbeing, senior lecturer in Applied Social Science, University of Sussex, U.K. presented a talk on the need to “map the margins” of life for LGBTQ elders, saying that unless this is done, there can be no equity in aging.

Resources

Ayalon, L. & Tesch-Römer, Taking a closer look at ageism: Self-and other-directed ageist attitudes and discrimination.  C. Eur J Ageing, 2017

Bécares L, Zhang N. Perceived Interpersonal Discrimination and Older Women’s Mental Health: Accumulation Across Domains, Attributions, and Time. Am J Epidemiol. 2018

Marmot, M. The Health Gap: The challenge of an unequal world. The Lancet, 2015.

Marmot, M. Just societies, health equity, and dignified lives: the PAHO Equity Commission., Lancet. 2018

Story ideas

• What is your state doing to improve the lives of aging people? Are there new laws on the books or being written specifically aimed at improving the social or financial well-being of elders and their families?
• Look into tying what is being done for children and youth–limiting adverse events–into how this might play out into a healthier old age. Can limiting stress in midlife and older life lead to a healthier old age?
• Does your community offer innovative intergenerational programs that reinforce community connections and ties? Are programs underway to forge community connection and continuity? Are programs underway to serve LGBTQ elders? Are these programs effective? Do they attract participants? Find out what participants have to say about them.
• For elders who cannot afford to retire, find out how they feel about working. Are they enjoying it? Is it difficult? Do they feel it is the result of actions they took? Or problems in the pension system? Did they expect to be working at 65 or 70 or 75?

Janice Lynch Schuster, an award-winning nonfiction writer, was a senior writer for Altarum from 2008 to 2014. In addition to the expertise that she provided in covering topics such as multiple chronic conditions, aging, end-of-life care, and hospice and palliative care, she has written about many public health issues.