Appendix C

Regional and Economic Interviews

REGIONAL INTERVIEWS SUMMARY

The commission invited experts from across the globe to respond to a questionnaire to garner a broader range of regional perspectives of healthy longevity. Topics included roles of older adults in the family, ageism, intergenerational cohesion, engagement in the workforce, and government efforts to improve healthy longevity. In August–September 2021, a total of 15 experts responded to the questionnaire (12 individual interviews were conducted by staff, 3 experts submitted written responses). A summary of the responses was shared with the commission to inform its deliberations.

Questionnaire

1. How do people in your country generally perceive:
   1. Older adults’ contributions to family, community, and society, including paid work, unpaid caregiving (e.g., for older adults, family members with disabilities, children), and/or volunteering?
   2. The prevalence and impacts of ageism?
   3. The degree of intergenerational cohesion?
2. Describe the engagement of older adults in the workforce:
   1. Do older people want to stay in the paid workforce longer than they are able? If yes, what are the barriers to staying in the paid workforce?
3. Are there current efforts under way to improve healthy longevity in your country?

4. How open are government officials or policymakers to prioritizing healthy longevity in your country?

Experts Responding to the Questionnaire

Tareef Al-Aama, Ministry of Health, Saudi Arabia

Heung Bong Cha, International Association of Gerontology and Geriatrics, South Korea

Angelique Chan, Duke–National University of Singapore, Singapore

AB Dey, Institute of Medical Sciences, India

Aisen Etcheverry, Chilean National Agency for Research and Development, Chile

Roseline Kihumba, HelpAge, Kenya

Naoki Kondo, Kyoto University, Japan

Rintaro Mori, United Nations Population Fund, Thailand

Hiromasa Okayasu, World Health Organization, Japan

Pip O’Keefe, University of New South Wales, Australia

Franklin Quijano, National Commission of Senior Citizens, Philippines

Neena Raina, World Health Organization, India

Luis Miguel Gutiérrez Robledo, National Institute of Geriatrics, Mexico

Abla Mehio Sibai, American University of Beirut, Lebanon

Findings

• Older adults are valued and respected by family and community members.
• Older adults’ workforce participation varies across regions; however, all experts agreed with the notion that lower-income adults tend to remain in the workforce past retirement age out of necessity, while higher-income adults are likely to continue to work voluntarily, unless companies have age-based forced-retirement policies, which are often not based on physical/mental capabilities and stem from ageist thoughts and beliefs.
• By promoting intergenerational cohesion through workplace cohorts and educational campaigns in communities, older and younger adults can break down ageist thoughts and beliefs.
• Across regions, older adults who retire often remain active in their communities through formal and informal roles, which helps to combat isolation and loneliness. Frequently, grandparents become the caregivers for grandchildren, a trend influenced by an increase in female workforce participation and by generation gaps in Africa caused by HIV/AIDS.
• Lower- to middle-income countries advocate for family caregiving and community-based supports rather than institutional care, as many older adults do not have access to adequate care facilities or pension programs to help cover the costs of care.

• Additionally, all experts agreed that it is important for governments to invest in and address social determinants across the life course. Domains identified include public education campaigns that promote access to nutritious foods, clean air, adequate education, and opportunities to be physically active.

ECONOMIC INTERVIEWS SUMMARY

The commissioners identified economic experts whose research focuses on areas not already represented by members of the commission in order to broaden the set of perspectives on how economics influence opportunities to improve healthy longevity, and how healthy longevity impacts economic policies. Each expert received a questionnaire exploring various economic aspects of healthy longevity: workplace policies, pensions, and retraining and education. In September 2021, a total of six experts responded to the questionnaire (five written submissions, one interview with staff). A summary of the responses was shared with the commission to inform its deliberations.

Questionnaire

1. How best can the economy support healthy longevity?
   1. What do you think would be the most valuable social gains arising if more people had robust health, function, and well-being in the second half of life?
   2. What financial measures can be taken to support healthy longevity?
2. How can healthy longevity support the economy?
   1. What additional or new economic benefits would be predicted if more people had robust health, function, and well-being in the second half of life?
3. What levels of support should governments give people in older age (e.g., long term care, retirement income)? What economic and financial policies would ensure that supports are sustainable and broadly available? How would this differ between low- and middle-income countries compared to high-income countries?
4. What are the most important policy recommendations you would make for your country to support healthy longevity?

Experts Responding to the Questionnaire

David Cutler, Harvard University, United States

Eric French, University of Cambridge, United Kingdom

Ralph Koijen, University of Chicago, United States

Moshe A. Milevsky, York University, Canada

James Poterba, Massachusetts Institute of Technology, United States

Stijn Van Nieuwerburgh, Columbia Business School, United States

Julie Zissimopolous, University of Southern California, United States

Findings

• Boosting healthy longevity is good for the economy because older adults gain additional years of healthy living and rely less on pensions and social security.
• Healthy longevity is good for the well-being of older adults. Avoiding the adverse effects of morbidity and mortality, spending more time with family, and making social gains may be the most important benefits, but they are also the most difficult to measure in economic terms.
• Benefits of healthy longevity on economies include labor supply, decreased care and productivity costs, financial security, and increased gross domestic product if older adults stay in the workforce longer.
• Interventions that improve healthy longevity across the life course include public and private investments in early-childhood education, coupled with job retraining, reliable insurance, medical care, and workplace policies that promote health and well-being.
• A well-functioning market for long-term care and for long-term care insurance is vital to ensuring the well-being of the elderly. Experts suggest that this can be achieved through private, long-term care insurance markets in which companies compete on price and quality of insurance plans, and effectively reduce the burden on governments.
• The cost of providing health insurance for older workers may exceed the marginal revenue generated by employing them. If U.S. Medicare programs became the primary health insurance provider for adults aged 65 and older regardless of work status, the employer would not take on the burden of insurance costs and the demand for workers would likely rise.