Population aging is a worldwide phenomenon that has wide reaching effects. By 2030, 1 billion people, representing 1 in 8 people globally, will be over 65 years old. This increase in older adults is accompanied by a concomitant decline in the proportion of persons under 15. Reasons for this population shift are 3-fold. First, medical advances have lead to increased longevity. Since 1900, lifespan has increased dramatically as a result of control of infectious diseases; vaccinations; improvements in sanitation, drinking water, and food handling; and recognition of hazards such as tobacco and unsafe transportation. Global life expectancy was a mere 31 years in the early 20th century but has more than doubled to an average of 67.2 years. The United States ranks 50th in life expectancy, with an average of 78.37 years.
Wide variations in life expectancy across the globe are attributed to war, starvation, and diseases, particularly AIDS and malaria. Risk reduction and early detection and treatment of cardiovascular disease (CVD) and stroke have led to a 51% decrease in deaths from these causes, with the highest gains in developed countries.
Second, declines in infant and child mortality rates are attributed to improved nutrition, hygiene, and advances in neonatal and maternity care. As a result, United States infant mortality has declined 90% and maternal mortality 99% since 1900.
Finally, birth rates have declined because of access to family planning, improved education and opportunities for women, increasing urbanization, and decreased reliance on children to finance life after retirement. Together, these changes have led to declining population numbers in 59 countries.
Marked differences exist between industrialized countries and less developed nations. In industrialized countries older adults already outnumber younger persons; by 2050 this shift will be a global phenomenon. Among older adults, the fastest growing age group worldwide is the oldest-old (> 80). In industrialized regions, nearly 20% of the population was over 60 years old in 2000. The proportion will increase to 33% by 2050. In contrast, in less developed regions only 8% of the population was more than 60 years old in 2000, with a projected rise to 20% by 2050. The pace of population aging is faster in less developed nations and occurring at lower socioeconomic levels than in industrialized regions.
Population aging has profound implications for societies. In the economic arena, it will affect cash flow and economic growth as greater numbers of persons will be retired and out of the labor market. Figure 1 depicts US aging trends. As the data indicate, the number of persons under 20 is declining. This group represents a future workforce that will be available to generate income and contribute to the financing of health programs. The current adult workforce (20–64 years old) is also decreasing in representation. Yet individuals of retirement age are steadily increasing.
Data Derived From US Census Bureau
Furthermore, the global recession, which began in 2008, has caused high unemployment and falling incomes. Employment-based health insurance is the predominant form of US health coverage. As unemployment has risen, fewer people have access to private insurance due to declining incomes. Those that remain employed pay an increasing share of the cost of care and frequently receive lesser coverage. The result is increased reliance on public systems that are largely financed through taxation.
Although elective care can be deferred, an older population is more likely to have health problems that demand immediate attention. As a result, hospitals, providers, and funding systems (whether government or private) are forced to bear the burden. Since it is difficult to cut staff (for safety reasons) or salaries (for political reasons), health care services are forced to cut services, capital investments, or research. Savings, investments, and endowments will also be negatively affected.