Socialcompact » Overview

Salzburg Global Seminar, in partnership with specialist international institutions, has developed a multi-year program on the roles of states and families in meeting 21st century social investment needs.
 
Intergenerational and gender justice and inclusion of marginalized populations are critical for social cohesion but come under particular strain where economic systems are confronting a "double squeeze" - how to improve start of life opportunities for all while also caring and paying for aging societies. In many countries, the greatest burden falls on the family unit; government support, where provided, is inconsistently managed between various organizations and seldom reflects forward-thinking best practices. We believe that states' and families' abilities to confront these challenges will shape 21st century economic systems, societal norms and individual wellbeing.
 
Designing a social compact’s added value is its capacity to rapidly address critical bottlenecks to progress - as identified by leading researchers, practitioners and policy makers - and link results to strategic decision points within each sector.


Advancing Innovation and Equity in Aging Societies
Advancing Innovation and Equity in Aging Societies
Salzburg Global Seminar 

Preamble

The number of people today aged 60 and over has doubled since 1980, and the number of people aged 80 years will almost quadruple to 395 million between now and 2050. With statistics like this, it is unsurprising that aging is often stated to be one of the greatest challenges we will face in the coming decades – but the challenge we are facing is not population aging, but outdated and ineffective policies and practices. We, the participants at the Salzburg Global Seminar session Aging Societies: Advancing Innovation and Equity (November 1 to 5, 2015), came together from 23 countries to examine the global, regional, national, local, and individual-led strategies needed to tackle this unprecedented rapid population aging and the associated demographic trends such as globalization, migration and urbanization. We concluded that we need to better respond to the rights and needs of older people through a holistic approach: addressing the alignment of a person’s needs, health, informal and formal care systems with their and their communities’ physical and social environment. The views expressed in this Statement are those of session participants individually and should not be taken to represent those of any organizations with which they are affiliated.

Principles and Recommendations

We urge all stakeholders, across all sectors and disciplines – intergovernmental, international, regional, national, and local (including governments, health policy leaders, communities, development partners, non-governmental organizations, health care workers, and the private sector) – and individuals to:
  • Promote improvement in the quality of life for the world’s older people, to assure their independence, health, care, income security, and well-being now and for future generations;
  • Connect stakeholders and create networks to drive innovation and change toward sustainable and purposeful outcomes for future generations;
  • Recognize that the underlying principles of human rights, equity, accessibility and non-discrimination, and social cohesion between generations must be the foundation for the future; and
  • Incorporate the voice of older people into policymaking and action-taking processes, recognizing the importance of the belief: “nothing about us without us.”
We urge consideration of the following recommendations:

1.  Growth and Prosperity in Aging Societies

In a century where demographic trends will be a significant driver for diverse changes, there is the imperative to take a more holistic approach to aging. 
  • Support healthy longevity through a greater emphasis on healthy and active aging and aging-in-place (see section 2).
  • Adapt labor market policies, particularly regarding how we view productivity, to suit the changing psychographics of older workers, and offer lifelong continuing education and training opportunities in the workplace to enable older people to remain active and productive members of the workforce (see section 3).
  • Encourage new thinking to prioritize innovations in framing social protection and security for older persons, especially for those in developing countries.
  • Recognize the potential of the “silver market” for products and services beyond older people’s healthcare, and encourage older people-led entrepreneurship focusing on products and services that improve health and promote dignity and independence.
  • Create working relationships to overcome generational gaps between older people and younger generations.
  • Recognize that ethnicity and migration are factors that shape aging experiences and outcomes, and improve culturally-specific care initiatives by making greater efforts in research and adopting policies from countries where services for multicultural older people are well established.
  • Assure support systems for vulnerable older people.
  • Recognize the inherent value of economic growth as a means to address the financial and societal challenges presented by unprecedented demographic change.  
  • Recognize the significant value in terms of economic growth, job creation, lower health costs and higher quality of life that comes from engaging the entrepreneurial community to develop new products and services for this market. 
  • Work to develop greater intergenerational understanding and engagement to encourage younger entrepreneurs to focus their attentions on this important market, and work to overcome the barriers facing all entrepreneurs as they seek to scale their solutions to meet the growing global need. 
2.  Designing Sustainable Health and Care Systems Population aging has enormous implications for how our current health and social care systems are designed, delivered and funded in order to promote wellbeing and engagement, delay disability, and provide high-value, sustainable person-centered care.                         
  • Recognize that older people are not a homogenous group and services and funding must be adapted to meet the needs of:
  • those who are relatively well and independent to remain active members of society for as long as possible;
  • those with chronic conditions who need some help with daily care, and the older old with complex illnesses and functional limitations;
  • and those facing the end of life.
  • Develop integrated models of health and social care in which services are coordinated around the needs of individuals and populations, addressing the many social determinants of health that impact health and well-being and health care costs and outcomes.
  • Establish a “culture of health” approach through which the health of the population guides public and private decision-making, and ensure inter-sectoral collaboration and media awareness.
  • Establish equity across geographic, demographic, and social sectors.  Services should embrace a rights-based rather than a needs-based approach.
  • Support and promote self-care and carers in the community by:
  • ending the disproportionate investment in acute, institutional care; and 
  • giving greater priority to self-managed care options through the use of both technological innovations and low-tech and high-touch solutions.
  • Improve the image of care, making it attractive to potential workers across age groups and genders, as well as potential investors and innovators.
  • Expand human resources for health care and training for elderly care across a broad spectrum of health care workers.

3.  The Future of Work and Markets

There remain significant obstacles to raising the productivity and labor force participation of older workers. Our workforce is poorly prepared to understand how aging, future finances, working options may impact future working opportunities, priorities and choices.
  • Recognize the value of older workers’ experiences.
  • Improve the measurement of productivity, especially of older workers, in order to adequately change working arrangements to accommodate them and keep them in the workplace.
  • End implicit bias against older workers and all forms of ageism in the workforce.
  • Encourage lifelong-learning to enable older workers to “upskill” and remain engaged in the workplace, and support the development of workforce networks that can enable people to ascend and reintegrate into their or other sectors and professions.
  • Adapt innovative strategies to encourage employers to engage and retain older people, promoting multigenerational and age-friendly workplaces.
  • Adopt employment policies that encourage “soft landings,” ensuring better transitions out of the workforce, enabling intergenerational skills and knowledge transfer, and maximizing the productivity of entering and exiting workers.

4.  The Future of Retirement

The longevity revolution has profound implications for pension systems globally. Our traditional approach of entering the retirement phase at an arbitrary age of 65 is outdated and contradictory to the increasing trends of individualization and longevity.
  • Establish alternative sources to maintain the pension systems of highly industrialized countries, e.g., a higher share of state funding based on taxes.
  • Encourage less rigid policies by providing opportunities for gradual retirement.
  • Encourage individuals to save more for retirement but remain aware of the unintended consequences of behavioral economics. It remains a challenge to secure adequate pension incomes.
  • Develop pay-as-you-go pension schemes to reduce exposure of financial assets to unpredictable capital market developments. 
  • Learn from the emerging markets which have installed non-contributory pensions to provide income security when that is most needed. Reviews of such policies have indicated that they are affordable and address the challenges of maintaining intergenerational solidarity. Older people cease to be burdens to their families – instead, they often provide the only source of regular income for the whole family and communities.

5.   The Future of Families and Communities

Support for families – in their broadest sense – remains a high priority for policymakers. The “care gap” needs to be addressed.
  • Adopt broader definitions of “family” that recognize the increasing diversity in the make-up of families (e.g., multigenerational families, geographically dispersed families, LGBT families, fractured and blended families as a result of divorce and remarriage).
  • Conduct and disseminate research on what conditions might make for positive and supportive family experiences i.e. for “age-friendly” families.
  • Recognize the diversity of care-givers within families, their roles and situations, and offer appropriately diverse support systems to improve their ability to provide care, reduce the risk of poverty, and continue their participation in the workforce. Such measures could include: flexible working conditions, tax incentives, subsidized services, training, etc.
  • Enable and promote social connectivity, encouraging intergenerational communities, and integrate communications and technology to support communities.
  • Train residents to care for older people in their communities, thereby creating employment, new models of funding, and community solidarity.
  • Adapt existing and plan for future livable “age-friendly” communities, keeping in mind culture and enabling broad participation in the design process.

6.  The Future of the Social Compact

New and innovative partnerships across sectors, government, business and communities are needed to ensure sustainable frameworks capable of meeting the challenges associated with population aging. All sectors and stakeholders should:
  • Recognize the population aging impacts on all levels of society, government and industry sectors.
  • Seek greater collaborations for solutions with other organizations in the aging sector.
  • Share resources and knowledge.
Governments should:
  • Assume responsibility for planning and implementing the strategic approaches to aging.
  • Abolish siloed approaches to aging policy, moving the portfolio from solely within health and welfare departments, and instead identify aging as a priority portfolio across departments, with co-ordination at the highest level.
  • Enable “innovative eco-systems” encouraging start-ups and social enterprises working on new technologies and solutions for ageing societies.
  • Develop innovative public-private partnership and financing models that articulate desired social objectives for adjusting to aging societies and engage the business community to develop innovative delivery services to meet these objectives.
  • Ensure that data is transparent and available to provide maximum information, capture externalities to ensure a fair market landscape and require an open and integrated approach to data, thus preventing silos.        
Business should:
  • Prioritize innovation and seek solutions that can be scaled up within either the private or public sectors.
  • Look across industry and geographic silos to find the most promising innovations, and develop models to collaborate more effectively with startup companies, as well as government and the NGO sector.  
Non-governmental organizations should:
  • Recognize and maximize their unique role in bridging the activities of government and business.
  • Develop, implement, and disseminate the creation of social innovation for aging population and a society of all ages.
Download the statement as a PDF
The Salzburg Statement of shared principles and recommendations is to be accompanied by a comprehensive report on the conversations and topics addressed at the Salzburg Global Seminar session Aging Societies: Advancing innovation and Equity, to be published in early 2016. The Salzburg Global session is part of the multi-year series Designing a Social Compact for the 21st Century. The session was hosted in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org 
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Experts Urge Holistic Approach to Aging Societies
Experts Urge Holistic Approach to Aging Societies
Louise Hallman 
Leading aging experts have issued a statement calling for a new, holistic approach to dealing with the challenge of aging populations. The “Salzburg Statement on Aging Societies: Advancing Innovation and Equity” was issued by 52 thought leaders, practitioners and innovators from social gerontology, aging-innovation, business, health and social care, workforce development, non-profits, national and local governments, and advocacy, from 23 countries. According to the jointly issued Statement, “The number of people today aged 60 and over has doubled since 1980, and the number of people aged 80 years will almost quadruple to 395 million between now and 2050. With statistics like this, it is unsurprising that aging is often stated to be one of the greatest challenges we will face in the coming decades – but the challenge we are facing is not population aging, but outdated and ineffective policies and practices.”  Through their Statement, the international experts call for “holistic approach” to “better respond to the rights and needs of older people,” promoting improvements in their quality of life and assuring “their independence, health, care, income security, and well-being now and for future generations.” The comprehensive Statement, which calls for “all stakeholders, across all sectors and disciplines – intergovernmental, international, regional, national, and local – and individuals” to heed 46 recommendations across six distinct but inter-linking areas, was issued following the four-day program Aging Societies: Advancing Innovation and Equity held by Salzburg Global Seminar, at Schloss Leopoldskron, Salzburg, Austria and an additional one-day program held at the Austrian Economic Chamber (WKÖ), in Vienna, Austria in early November.  The six sections of the Statement cover growth and prosperity in aging societies, sustainable health and care systems, work and markets, retirement, families and communities, and “the social compact” between government, business and civil society.  Echoing the holistic approach of the Statement, Alexandre Kalache, co-chair of the Salzburg Global Seminar program and president of the International Longevity Centre (ILC) in Brazil, said: “It’s over-simplified to say you provide good health and social services. It’s much more than that.”  Fellow session co-chair, Janice Chia, founder and managing director of Ageing Asia, added: “Very often we think about aging as medical care…I think that it’s also about making our society more ‘aging aware.’” This need for aging awareness was a key driver in the drafting of the final Statement. “With this Statement, we urge leaders of governments and international organizations, business, science, civil society, media, and individuals to design comprehensive and innovative approaches to aging societies, reflecting the complexity and interdependence of underlying challenges,” said Salzburg Global Program Director, Tatsiana Lintouskaya. The Statement will be sent to all Salzburg Global Fellows, as well as key figures in aging-related sectors across the world. Lintouskaya added: “We will use both the program participants’ networks in 23 countries and the larger international Salzburg Global Fellowship as a whole, to re-energize global, regional and local efforts to build sustainable and equitable aging societies.” Speaking at the close of the session in Salzburg, program participant Samir Sinha, Director of Geriatrics at Mount Sinai and University of Health Network Hospitals in Toronto, Canada said: “Most of the conversations around aging tend to focus on apocalyptic demography… But I think many of us here at Salzburg Global Seminar are really thinking about aging as an enormous opportunity.  “We were able to come up with some concrete actions that many of us were excited about taking forward… There are ten of us in particular – we’re calling ourselves Salzburg Ten – who are going to go and try to advance these issues in a comprehensive way and we actually think doing it in our own respective jurisdictions or organizations is one way to approach it, but collectively representing such a broad group of organizations, both national and local, we could have even more impact given that we all think this is a common agenda we can move forward.” The full text of the Salzburg Statement on Advancing Innovation and Equity in Aging Societies is available here: www.salzburgglobal.org/go/540/statement 
Download the statement as a PDF
The Salzburg Statement of shared principles and recommendations is to be accompanied by a comprehensive report on the conversations and topics addressed at the Salzburg Global Seminar session Aging Societies: Advancing innovation and Equity, to be published in early 2016. The Salzburg Global session is part of the multi-year series Designing a Social Compact for the 21st Century. The session was hosted in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org 
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Janice Chia - Aging is a social and economic opportunity, not a demographic disaster
Janice Chia speaks at the session on Aging Societies
Janice Chia - Aging is a social and economic opportunity, not a demographic disaster
Heather Jaber 
For many, the first thing that comes to mind with aging societies is health. But aging not just about medical care, says Janice Chia, founder and managing director of Ageing Asia Pte Ltd, Singapore. “Today we all believe that we can age in place, we can live a fulfilling life, and we can be stronger as we age,” she says. “There are so many things that we could adopt as ideas that will make aging better.” For that reason, Chia, the co-chair of the Salzburg Global session on Aging Societies: Advancing Innovation and Equity, founded Ageing Asia with the hope of changing the future of aging in the Asian context. The organization looks at models of aging in other contexts to adapt better practices. Chia and her colleagues focus on market development, idea sharing, and media engagement in their goal to change the image and industry of aging.  The market potential of aging in the Asia-Pacific region alone is a lucrative one, says Chia. According to the Asia Pacific Silver Economy Business Opportunities Report produced by Ageing Asia, the untapped market potential for the aging market in Asia Pacific is forecasted to be a $3.3 trillion dollar industry by 2020. “What are people aged over 60 likely to spend as they age?” asks Chia. “And not just on health care services, because I always believe that aging is more than just medicine. It’s everything that an older person spends on that will make their lives happy.” The ways to achieve this happiness may lie in products and services that will enhance health longevity, says Chia, but also services like leisure activities, learning opportunities, and employment opportunities. In the workplace, explains Chia, it is important to shift the ways we think about productivity when we consider aging societies. “I think it’s about putting their roles into project roles where it’s determined by the outcomes of the KPIs [Key Performance Indicators] that you deliver rather than by how many hours a day spent,” she said. “So if the jobs are remodeled into tasks and projects, then that’s a different way in terms of measurements.” One way that Chia has worked to re-envision aging as an opportunity rather than a problem has been through her project ASPIRE55, Asia’s first virtual retirement village. The initiative replicates the clubhouse of a retirement village in a virtual sense. While retirement homes may provide accommodation and care, the new generation of older people are less connected to their neighbors than the generation before, explains Chia, so there is a greater need to connect to community. “It was an initiative to keep people out of nursing homes and to enable people to age in place in their own homes. The biggest challenge of aging in place is dying in place,” she adds. What distinguishes this from other services for the elderly is its focus on the social issues that arise with aging, such as feelings of isolation, the loss of networks, and the affordability of care. Of her experience at the session, Chia says it was useful for the opportunity to engage in intellectual thought and develop new ideas on aging. “I think right from the start jumping into the discussions with people with different experiences from around the world showed us that it’s not so different how people want to age in one country compared another country, and everyone is facing same issues and challenges of aging…Here at Salzburg, the environment allowed a lot of interaction and open exchange of ideas.”
Janice Chia was co-chair at Aging Societies: Advancing Innovation and Equity, which is part of the multi-year series Designing a Social Compact for the 21st Century. The session was held in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org
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Aging Societies - Day 4: Collaborations for a Social Compact
Fellows of Session 540 pose for the traditional group photo on the Schloss Terrace
Aging Societies - Day 4: Collaborations for a Social Compact
Louise Hallman 
To ensure a robust, sustainable framework capable of withstanding the challenges facing aging societies, collaborations will be needed that work across silos and bring together government, business and civil society. These three sectors of society have distinct but vital roles to play in building a “social compact,” as discussed by the final panel of the Salzburg Global Seminar session on Aging Societies: Advancing Innovation and Equity, “What is the Future of the Social Compact?” Currently, one panelist suggested, there is not enough emphasis on cross-sector collaboration, “Everyone sticks to their own patch,” they added. Collaboration is needed however, as all these sectors will be impacted by aging – and all can have a positive impact on aging. All sectors and stakeholders should recognize this impact and seek collaborative action, as well as find more ways to share knowledge and resources. Governments, it was suggested, should assume responsibility for planning and implementing strategic approaches to aging. To better do this, all countries’ governments should abolish their currently siloed approaches to aging policy, by moving the portfolio from solely within health and welfare departments, and instead identify aging as a priority portfolio across departments, with co-ordination at the highest level. National and local governments should also enable “innovation ecosystems,” encouraging start-ups to work on new technologies and solutions. The business community, in turn, should prioritize innovation and seek solutions that can be scaled up within either the private or public sectors. Finally, civil society and non-governmental organizations should recognize and maximize their unique role in bridging the activities of government and business.

The Salzburg Global session Aging Societies: Advancing Innovation and Equity is part of the multi-year seriesDesigning a Social Compact for the 21st Century. The session is being hosted in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org
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Aging Societies - Day 3: The rise of the portfolio career and wisdom workers
Fellows gather on the Schloss terrace in the autumn sunshine for working group discussions.
Aging Societies - Day 3: The rise of the portfolio career and wisdom workers
Louise Hallman 
The world of work has changed drastically in the past few decades. But what will the future look like – and where will older people fit in?  This was the issue at hand for the panel “The Future of Work and Markets: Technology and Innovations to meet 21st Century Social Needs” on the third day of the Salzburg Global Seminar program on Aging Societies: Advancing Innovation and Equity. Gone are days of going to the factory or the mine, and even going to the office on a daily basis is starting to wane as more people work from home, for themselves, or in the more informal “Uber” economy. Far from further excluding the older generation from the workplace, these changes could potentially (re-)include them into the workforce.  A greater number of older people are healthy enough to work – and willing to continue working. Although “fluid intelligence” (e.g. cognitive function, speed, and flexibility) declines as we age, “crystalline intelligence” (such as knowledge and experience) increases. Thus, older workers may be less productive than younger workers (if productivity can truly be measured), but their experience should still prove valuable.  Greater flexibility of working hours and location should better allow for workers’ changing levels of productivity, allowing them a “soft landing” rather than retiring from work entirely.  This greater flexibility should also be offered in terms of tasks; routine has been found to be a key reason for falling productivity. Rotation schemes within companies may help maintain versatility. More lifelong learning or “upskilling” should be encouraged, either in the workplace (enabling companies to retain skilled workers for longer) and outside, enabling workers to shift careers if needed. As businesses are unlikely to support workers in acquiring non-task-related skills, for which they will see little-to-no return-on-investment, considerations need to be made regarding who will pay for this training – individuals or governments?  This shift in careers is also likely to become a greater trend as “jobs for life” become much more scarce. The “portfolio of careers” will become the norm, and “wisdom workers” should be highly valued. More mentoring schemes and the introduction of “Chief Elder Officers” into businesses, especially start ups, could help greater intergenerational knowledge exchange.  For those workers who wish to stay in their workplace, rather than work from home or for themselves, these workplaces should become more “age-friendly,” some participants suggested. However, such suggestions were met with the counter-argument: by making our workplaces more comfortable and easily accessible, we have also developed a more sedentary workforce – making workers less healthy and thus more likely to retire early through ill-health. The unintended consequences need to be more carefully considered!

Sharing ideas at the knowledge cafe

In addition to the panel-led discussions, country/region-focused team work and thematic dialogue groups, participants in Salzburg also took part in a “knowledge cafe,” with six Fellows leading discussions on a variety of topics and participants cycling around several tables. Samir Sinha, director of geriatrics at Mount Sinai and the University of Health Network Hospitals in Toronto, Canada led conversations on how to move “From Ideas to Strategies for Action.” At another table, UK-based international policy advisor Ann James addressed “Aging Societies: Applying Human Technology Approach to Critical Issues.” Idea exchanges around “Generational Gaps and Conflicts” were led by Moon Choi, assistant professor of aging and technology in the Graduate School of Science and Technology Policy at the Korea Advanced Institute of Science and Technology (KAIST). Associate professor at Nanjing University’s School of Business, Maoliang Bu asked his table of Fellows: “How can the silver industry potential be better used for China?’ Stanislawa Golinowska, professor at Jagiellonian University in Krakow, Poland held a table discussion on “Health Promotion and Prevention of Risk-Actions for Seniors.”
The Salzburg Global session Aging Societies: Advancing Innovation and Equity is part of the multi-year seriesDesigning a Social Compact for the 21st Century. The session is being hosted in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org
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Alexandre Kalache - “We can no longer afford receiving all the care and not providing any”
Alexandre Kalache - “We can no longer afford receiving all the care and not providing any”
Heather Jaber 

“I was brought up in a maternity that today is a geriatric hospital,” says Alexandre Kalache, touching on the rapid demographic shift of Brazil in the past few decades. “I have a great chance of ending up where I first started — this is how fast the whole thing is.”

Kalache, co-chair of the Salzburg Global session Aging Societies: Advancing Innovation and Equity and president of the International Longevity Centre (ILC) in Brazil, was born in a country which faces a rapidly aging society. “Brazil is going to double the proportion of older people in 20 years,” he said. “This is stunning. We do not have models — we cannot look and say, ‘Let us copy how Denmark or Japan or France has done.’”

The country’s rapid rate of aging and relative level of poverty mean that creative solutions are required to deal with demographic shifts. “It’s over-simplified to say you provide good health and social services. It’s much more than that,” says Kalache, who was director of the Department Aging and Life Course in the World Health Organisation from 1994 to 2008.

“The main obstacle is discrimination, the stereotypes,” he says. “The belief that older people don't have anything to add or to contribute…is deep-rooted. But before recently, it wouldn't be very apparent because the proportion of older people in any society was very small.”

Kalache touched on studies he conducted with medical students in the UK to try and measure attitudes towards aging before and after they began working in geriatrics for one month. The results showed that exposing medical students to geriatric patients was counterproductive. 

“In focus groups, they would always say the same. ‘Are you surprised? We are young. We came to medicine because we are interested in life, not death.’” Their lack of familiarity with their own older relatives also contributed to their difficulty in understanding the geriatric patients.

The answer, says Kalache, is not to put medical students in contact with older geriatric patients, but instead with older people. Rather than viewing older people as patients, they would then build relationships with the individuals and thus have greater familiarity with their needs. Kalache reflects that his own experience growing up taking care of his grandmother who suffered from cancer has helped shape his view of aging.

One of the potential solutions to dealing with aging societies in impoverished areas following this logic of familiarity. In the favelas in Brazil, the approach suggests targeting community members who are familiar in a given community to act as informal care-takers and liaise with primary health care in the area. These care-givers, primarily women who would have previously expected to find work as nannies, would connect with a handful of older people and would be trained by primary health centers. The care-recipients’ families could pool their resources together to compensate for their time. In this way, there is potential to provide economic relief in the way of job opportunities, affordable care for impoverished communities, and a system of trust and familiarity. 

This type of approach may be more impactful than top-down policy, says Kalache. “It was not something somebody cooked up with introspection and meditation. It was something we found out by asking older people, ‘What is it like getting older in our community?’”

In focus groups done in Copacabana, Rio de Janeiro, Kalache explains, older people commonly expressed feeling closer to their doormen than their own families, at least in terms of day-to-day contact. Thus, care-giving by familiar community members may bring about more of a lasting impact.

“I remember an older woman saying: ‘Every evening I go to bed I pray for my porter not to die before me,’” says Kalache of one focus group participant. “'Because he is getting older and if he dies before me, I’m lost.’” 

Thus, adds Kalache, it is not enough to say that you offer good medical care — a holistic approach to aging encompasses much more than this. “We can no longer afford receiving all the care and not providing any.”


Alexandre Kalache was co-chair at Aging Societies: Advancing Innovation and Equity, which is part of the multi-year series Designing a Social Compact for the 21st Century. The session is being hosted in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org
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Aging Societies - Day 2: Rethinking Care
Aging Societies - Day 2: Rethinking Care
Louise Hallman 

For sustainable health systems we need a “culture of health”

For too long, in too many countries, promotion of health has focused on acute care delivered in hospitals. This is the most costly point of care, and if we are to support an aging society, with all the ensuing co-morbidities, we need to find a more sustainable approach to health care.  For many of the speakers and participants on the panel on “Designing Sustainable Health and Care Systems,” the answer was not an overhaul of the system or a major new innovation. “Do we need more innovation or to simply better implement what we already know?” asked one panelist. We need a “culture of health” and a greater sense that “we’re all in it together,” posited another speaker. This culture of health means moving away from the acute, institutional and most costly care, and investing more in “self-care”, informal care from family caregivers [see adjacent article], and community care. This includes promoting health – rather than just health care – to enable more people to live more healthily for longer. The longer we live, the more co-morbidities we will suffer; our health is not just a series of incidents which require immediate, one-off interventions, but often ongoing, interrelated conditions, exacerbated in old age by conditions such as dementia. This investment needs to come not only from the state, but also from individuals themselves, their families, communities and the businesses they work for. Individuals need to adopt healthier lifestyles. Businesses can also help though simple measures such as installing (or in some cases, re-installing) water coolers, offering their workers a healthier alternative to sugary sodas from the vending machine. This is in businesses’ interests as a healthier workforce can be more productive and ultimately work for longer, rather than retiring early [see next article]. This culture of health needs people to also think outside of the box and include communities beyond immediate families. One such suggestion has been to train the doormen in high-rise apartment blocks in Copacabana; not only are they able to notice when Mrs. Silva doesn’t pick up her mail, but perhaps provide a link between the home and emergency care.

The “New Normal” –  Who cares for our aging societies?

As we age, we face not only the question of how will we pay for our retirement and our health care, but also who will provide day-to-day care? Traditionally this care has been provided within families, especially daughters, with elderly relatives moving in with their children in the later years of their life. However, smaller and more dispersed families means fewer people able to care for their elders. “It is assumed families should just get on and do it – but that is becoming less possible,” remarked on participant. There is a growing “care gap” with the number of people needing care far outstripping the number of people who can give care. In the UK, as with many Western nations, if you’re poor, care is paid for by the state; if you’re rich, you are likely able to pay for your own care – but what do we do about the majority of people who are in the middle? Even for those who are able to live with younger family members, they often remark on the sense of isolation they continue to feel, especially those who are immigrants and disconnected from the unfamiliar suburbs they find themselves spending their empty days. Increasingly, these family caregivers are not just middle-aged stay-at-home daughters caring for their elderly parents. One in four carers in the US is a millennial, 40% are men. 22% of family caregivers are offering more than 20 hours of care with an average of 61 hours – often also working a paid job. One option is to increase the number of people working in the care profession, especially encouraging more men into caregiving jobs, but in many countries these services are poorly regulated and workers poorly trained. As more of us need care as we age, this issue needs to be urgently addressed.

What sort of retirement do we want? And how will we pay for it?

As life expectancy increases, so too does the time most people will spend in retirement. But how do we want to spend this time and how will we pay for whatever it is we do? “You can’t go on a cruise for 30 years, but I don’t want to watch TV every day either,” remarked one participant at the panel-led discussion “The Future of Retirement: How can Pensions Schemes Remain Viable?” The decline in manual labor means many more jobs are suitable for people to continue working beyond 65 – an age that has “stubbornly” stuck around since Bismarck, and in most countries is not a mandatory retirement age but the age at which people can collect state pensions. Ending age discrimination and wrong-headed policies that favor younger workers over older professionals could help more people work longer, should they choose to do so. Some pensioners are finding alternative employment in the so-called “Uber economy”, driving their cars for Uber or renting out their homes or spare rooms for Airbnb.   For some over 65s this participation in the informal workplace is a way to keep busy and maintain a purpose. For others it is a necessity as their own savings or private pension schemes have proven insufficient to live on after the end of their formal job.  People are not saving enough for their own retirement. £30,000 of savings for a retirement which might last 30 years leaves only £1000 to live on. “Do we need more paternalism?” asked one Fellow; should the state intervene and take more in taxes specifically to pay for pensions? It would be a bitter pill to swallow for many taxpayers, especially in countries where 20-year-old workers are being told that their retirement at 65 and a state pension is no longer guaranteed. Greater reassurance that this support will still exist in another 40 years might help reduce this inter-generational conflict, maintained one speaker.  But knowing what plans to put in place now to deal with retirement in 40 years is tough; mortality is easy to forecast, morbidity is not. Experiments and innovations will have to continue.
The Salzburg Global session Aging Societies: Advancing Innovation and Equity is part of the multi-year series Designing a Social Compact for the 21st Century. The session is being hosted in partnership with Wirtschaftskammer Österreich and is sponsored by TIAA-CREF Financial Services and Tsao Foundation. More information on the session can be found here: www.salzburgglobal.org/go/540. For more information on Designing a Social Compact for the 21st Century, please visit: socialcompact.salzburgglobal.org
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