Health is wealth in an aging world

US President Donald Trump's tariff threats are likely to be the main topic of conversation among political leaders, international finance experts, development professionals, economists of all stripes, and corporate CEOs. The impact of Trump's tariffs on markets, prices, and, most importantly, people certainly warrants the topic's dominance in public and private discussions. But the looming impact on the global economy of current demographic changes, if left unaddressed, will be just as severe, and perhaps more permanent.

The fact is that humanity is aging faster than ever before. The synchronized global decline in fertility rates (expected to reach the demographic tipping point of 2.1 births per woman by 2050), combined with declining mortality rates and increasing life expectancy (as a result of advances in public health and nutrition), has accelerated this demographic shift.

Both developed and developing countries are aging at an unprecedented rate , with the global population of people aged 65 and over projected to grow by 104 percent between 2005 and 2030, compared with an increase of just 21 percent for those under 65.

Rising life expectancy is, of course, a positive development, in part because it has been strongly correlated with economic development for decades. However, the "gray hair tsunami" poses unprecedented challenges, including a dramatic increase in chronic diseases and age-related disabilities , which entails significant social and economic costs with intergenerational consequences.

And insufficient financial resources have limited efforts, especially by "geroscientists," but also by entrepreneurs and innovators in big data and artificial intelligence, to improve healthy life expectancy (the term given to the period of a person's life spent in good health).

But the tide may be turning. The Hevolution Foundation, a nonprofit organization backed by the Saudi royal family, has allocated $1 billion annually for research on how to increase healthy lifespans. This includes investing in therapies targeting the root causes of aging and supporting initiatives aimed at translating scientific advances into products or treatments that enable healthier aging.

Now, the rest of the world must follow their lead to co-create a healthier future for the aging world, so that the UN's 'Decade of Healthy Ageing' (2021-2030) becomes a reality that transcends generations and reaps the enormous benefits of the longevity dividend.

According to the United Nations World Population Prospects 2022 report, there will be more than twice as many people aged 65 and over as children under 5 by 2050. Older people will account for 16 percent of the global population, up from 10 percent in 2022. Regionally, this demographic is projected to comprise a much larger share of the population in Europe and North America (26.9 percent) and East and Southeast Asia (25.7 percent) by mid-century, as their populations are expected to peak.

But the most rapidly aging societies are in the Global South: between 2006 and 2030, the elderly population in developing countries is expected to grow by 140 percent, compared to 51 percent in developed countries . And by 2050, 80 percent of older people will live in low- and middle-income countries. While it took more than a century for the proportion of French people aged 65 and over to rise from 7 to 14 percent, many developing countries will experience the same increase in a single generation (21 years in Brazil and 26 years in China, for example). This highlights the remarkable demographic revolution that began in the second half of the last century and has accelerated in recent decades.

While it took more than a century for the proportion of French people aged 65 and over to increase from 7 to 14 percent, many developing countries will experience the same increase in a single generation (21 years in Brazil and 26 years in China, for example).

Developing countries therefore face an increasing risk of aging before becoming wealthy, raising the specter of poverty and the vulnerability of the elderly in the absence of strong social safety nets. And while the increase in global longevity represents a triumph of medical science and social and economic progress, many people aged 65 and over do not experience a healthy life expectancy.

Instead, aging has been associated with the emergence of disabilities and chronic noncommunicable diseases. This is reflected in a fundamental shift in the epidemiology of disease: conditions such as heart disease, cancer, diabetes, and Alzheimer's have overtaken infections as the leading causes of death . According to the Global Burden of Disease Study, supported by the World Bank and the World Health Organization, age-related chronic diseases will cause a substantial increase in disability worldwide.

The growing health burden of age-related diseases threatens to undermine fiscal sustainability and economic growth. The fiscal implications are already being felt acutely in rapidly aging societies, where prolonged longevity and the resulting rise in disability rates are causing health expenditures and pension outlays to skyrocket, while the working-age population is shrinking. The International Monetary Fund (IMF) forecasts that, by 2050, global spending on public pensions could depress public savings —which are essential for domestic investment and absorbing economic shocks—by more than two percentage points of GDP.

In the absence of significant reform and a shift toward a multisectoral and multidisciplinary approach to extending healthy life expectancy, the gray hair tsunami will only exacerbate macroeconomic imbalances and further depress domestic consumption and investment, putting countries at risk of secular stagnation. A 2022 study shows that aging has been one of the most significant sources of downward pressure on price levels and per capita output in Japan, where people aged 65 and over already account for 30 percent of the population.

Several countries have attempted to mitigate the looming costs of rapid population aging by adopting policies aimed at increasing fertility rates and improving the long-term sustainability of pension systems. But measures to reverse the declining birth rate—namely, targeted financial incentives—have largely failed. Pension reforms, such as raising the eligibility age, increasing the contribution rate, and reducing benefits, have performed slightly better.

However, pushing people to extend their working lives will not necessarily sustain high productivity or bolster fiscal sustainability if these additional years of work are dominated by declines in physical and mental capacity. Globally, disability-adjusted life years—a metric that includes years of life lost due to ill health—increased by 32 percent between 1990 and 2019 and are expected to rise by 55 percent between 2004 and 2030. These policies could have the opposite effect, dragging down overall labor productivity and undermining fiscal sustainability as aging-related public spending continues to rise relative to tax revenues.

The United Kingdom's National Health Service, for example, lacks sufficient home care for the country's aging population, forcing 855,000 elderly people into hospitals each year, with enormous economic costs and serious health consequences. In the United States, where sustained immigration has partly offset the costs of aging, public health spending has been one of the fastest-growing items. The Congressional Budget Office projects that total health care spending will increase from 16 percent of GDP in 2007 to 37 percent in 2050.

The most sustainable solution would be to focus on increasing healthy lifespans, thereby compressing morbidity into a shorter period at the end of life. Medical research has identified aging—when a wide variety of molecular and cellular damage accumulates, leading over time to a gradual decline in physical and mental capacity—as the predominant risk factor for most chronic diseases that drive morbidity and mortality rates. This suggests that "geroprotection" (slowing biological aging) in healthy people could help maximize the benefits of longevity.

In November 2023, the Hevolution Foundation organized the first Global Healthspan Summit (GHS) in Riyadh, Saudi Arabia, to highlight the tremendous advances in geroscience (the study of how aging leads to chronic diseases) and the growing number of potential interventions to slow the physiological processes of aging. Key breakthroughs presented included the identification of conserved molecular pathways that impact aging; mammalian studies that have generated a more detailed understanding of age-associated pathological changes; and interventions that can extend lifespan while improving aspects of health.

Perhaps the most promising advances discussed there concerned medications. Senolytic drugs, for example, have the potential to eliminate senescent cells that accumulate during aging and contribute to the onset of age-related disorders and chronic diseases. Delegates were equally excited by rapamycin, the first drug shown to consistently slow the early development of age-related diseases in experimental animals. The Hevolution Foundation is supporting further research to understand how rapamycin induces autophagy, a cellular process that degrades damaged or superfluous components, and to develop strategies for testing the drug in humans. It is also helping to investigate other agents that promote longevity.

A large body of biometric data on centenarians points to the importance of pursuing this line of research, with a growing body of evidence suggesting that age-related diseases are rare and delayed among the oldest living people. A study of younger centenarians (aged 100–104 years), semi-supercentenarians (aged 105–109 years), and supercentenarians (aged 110–119 years) found that the older the age group, the later the onset of chronic disease and cognitive and functional decline. This supports the hypothesis that as the limit of longevity approaches, morbidity is compressed into a shorter period and healthy life expectancy begins to approximate life span.

The lives of famous centenarians, such as the late former U.S. Secretaries of State George Shultz and Henry Kissinger, provide further anecdotal support for the idea that people who live to extreme old age are more likely to enjoy the benefits of prolonged healthy life. Shultz, the first of two to join the exclusive club of centenarians, led an extremely productive life. In an insightful essay written on the occasion of his centenary, he reflected on the importance of trust in families, racial integration, conflict resolution, and foreign relations—a valuable lesson for strengthening social cohesion and creating the international environment of cooperation needed at this critical juncture.

Kissinger also had a very productive (if controversial) lifespan that was largely free of morbidity and disability (apart from some heart difficulties). He wrote and co-authored many articles and books, including one on AI in 2022. A few weeks before his death, aged 100, Kissinger met with Chinese President Xi Jinping in Beijing in an attempt to thaw Sino-US relations at a time of growing geopolitical uncertainty and great power rivalries.

But centenarians are few and far between. They represent only 0.03 percent of the U.S. population and an even smaller proportion of the global population, as most live in advanced economies. Research shows that, on average, one-fifth of a person's life will be lived with morbidity, which often creates highly stressful conditions for them and their loved ones, in addition to the implied social and economic costs. Spending 20 percent of one's life in poor and declining health may be an excessively long time, and that period increases as life expectancy grows.

That's why investing in medical research and innovation to boost global health is the most important mission of our time. These investments could reduce the life expectancy gap between the world's richest and poorest countries (estimated at nearly 20 years) and increase overall life expectancy. And in places where healthcare costs are fueling poverty, the well-being benefits of expanding healthy life expectancy will be even more pronounced. In the United States, for example, medical bills pushed eight million people, most of them uninsured, into poverty in 2018. The risk of medical impoverishment is even greater in the Global South, where high poverty rates increase vulnerability to health-related shocks.

Beyond increasing healthy lifespans, investment in life expectancy research can help reduce inequalities throughout life by leveling the playing field of well-being, regardless of geographic and socioeconomic variables. After all, healthspan and life expectancy are two sides of the same coin, and interventions that extend the former will also increase the latter.

Creating a healthy aging future for all is also likely to produce substantial economic benefits. For most countries, increasing life expectancy by one year could increase GDP by about 4 percent. Simulations based on U.S. data show that delaying aging could increase life expectancy by 2.2 years, generating about US$7.1 trillion in economic value over 50 years. Extending healthy lifespans is not just a moral imperative. It is also a matter of smart economics.

Extending healthy life expectancy isn't just a moral imperative. It's also a matter of smart economics.

Despite the consensus among participants at the inaugural GHS that slowing biological aging is a realistic goal, they lamented the lack of investment in anti-aging research. Limited financial support is one of the biggest barriers for those seeking to develop therapies targeting the root causes of aging. Fortunately, through its initial investment in the Hevolution Foundation, Saudi Arabia has already begun accelerating global change by supporting innovation focused on biological aging, rather than disease.

This includes grants and early-stage investments to foster independent research and entrepreneurship in the science of healthy lifespan, increase the number of safe and effective treatments coming to market, shorten the timeline for drug development, and increase accessibility to therapies that extend healthy lifespans. On the final day of the GHS, the Hevolution Foundation pledged $100 million in research grants to drive breakthroughs in the field of aging science. Since then, the Foundation has made several additional pledges, bringing its total commitments to date to more than $400 million.

The Hevolution Foundation also supports the development of platforms and technologies to harness the power of big data, AI, and machine learning to develop a better understanding of individual risk factors and more targeted interventions.

For example, researchers using data from the University of Michigan's Health and Retirement Study found that education has long-term health benefits, helping older adults keep dementia at bay and their memories intact. Another study of diverse datasets provided new insights into the genetic underpinnings of aging-related verbal memory performance. Researchers are also leveraging big data to identify and understand the functions of previously unknown mitochondrial genes, with the goal of developing treatments for Alzheimer's, diabetes, and other chronic diseases.

The increasingly data-intensive approach to geroscience and gerontology has made it possible to address some of the challenges that have impeded progress in the field. Researchers are using these methods to quantify biomarkers of aging, develop a frailty index, develop a genome-wide scan to detect depressive symptoms in older adults, and calculate how genetic and environmental factors contribute to age-related cognitive changes. Applying these new technologies and computational tools to large amounts of biological data, coupled with advances in our understanding of human biology, can also foster interdisciplinary collaboration.

Such an integrated research model could revolutionize the study of aging, which is driven by codependent multivariate factors, such as genetics, behavior, and contextual influences, such as socioeconomic status and familial adversity. The goal would be to understand individual risk factors, identify the role of genes in disease, and ultimately foster the development of patient-specific interventions to address genetic and lifestyle issues.

Financial constraints are not the only obstacle to slowing the aging process. The first edition of the GHS identified four particularly prominent obstacles. First, medical research and investment priorities have been heavily biased toward disease models and need to be rebalanced to reflect current demographic pyramids and the enormous challenges posed by the "gray hair tsunami." While disease models have led to an increase in life expectancy, they have done so at the expense of health. The survival of modern health care systems depends on combining disease models, which remain important, with late-life aging models to prevent the onset of age-related diseases.

Second, effectively addressing aging involves moving away from the current approach to disease-by-disease medical treatment and toward a more integrated approach. Many older adults suffer from multiple interacting morbidities that are not addressed by one-dimensional care. Adopting new therapeutic models for multiple chronic diseases and, more importantly, focusing on prevention efforts, particularly those that promote early intervention, would significantly alleviate the social and economic burdens on aging populations and maximize the longevity dividends.

Third, as healthcare systems begin to combine disease models with models of late-life aging, it will be crucial to design clear methodological guidelines for clinical trials involving older adults with multimorbidity. The development of effective treatments that can prevent the onset of multiple chronic diseases associated with aging, or that simultaneously target multiple age-related diseases, creates enormous growth opportunities for the pharmaceutical industry and, in turn, new challenges for regulators . Close collaboration between industry and regulators could produce gold-standard treatments for aging populations, revolutionizing healthcare services and transforming economies.

Finally, and perhaps most challenging of all, is the necessary shift in mindset. For centuries, older people have been viewed through the prism of the age dependency ratio (the ratio of young and old people to the working-age population). But to ensure a better, more productive future for all people in our rapidly aging world , we must shift our perspective on aging. Societies must view this growing cohort as a valuable asset and direct more resources toward anti-aging research and innovation. Furthermore, increasing intergenerational dependency will bring economic benefits.

The sustainability of pension systems depends on reforms that raise the retirement age and extend life expectancy. This is especially important because the accelerated compression of aging in developing countries will reduce international migration, which for years has partly offset the effects of population aging in advanced economies. The continued employment of older workers could also keep firms on a long-term growth path by enhancing mutual learning, closing the digital divide between generations, and reducing the loss of institutional knowledge.

On a societal level, young people could end up spending several decades actively interacting with their grandparents and great-grandparents, which would have significant implications for the transfer of knowledge and values ​​in a new world of overlapping generations. The first step toward achieving these longevity dividends is debunking negative myths about older people and overcoming ageism. The second half of life should be viewed with the same hope, expectation, and rigor as the first half.

The second half of life should be viewed with the same hope, expectation and rigor as the first half.

Time is running out: The number of older adults affected by irreversible, age-related chronic diseases is increasing significantly. According to the U.S. National Council on Aging, nearly 95 percent of Americans age 60 and older have at least one chronic condition, while about 80 percent have two or more. Much of the damage is often done by the time these diseases are diagnosed, making them difficult to treat.

Failure to act now will only exacerbate the challenges facing aging societies. Catalyzing the shift toward more health-related research initiatives and interventions that could prevent or delay the onset of age-related chronic diseases requires global commitments and a proactive multi-stakeholder partnership. This community of policymakers and experts should approach the task of building a healthier future with the same spirit and sense of urgency that drove the Manhattan Project in the race to develop the atomic bomb before Nazi Germany. Saudi Arabia has given a major boost to these efforts; however, more must be done to shift morbidity to the end of life and extend people's productive years, enabling them to remain economically active into old age.

Life remains a one-way street—there's no turning back—but when a person thrives, life is always worth living. Our goal must be to ensure that every person's journey on Earth remains bright and productive for as long as possible. To that end, we must use Saudi Arabia's large-scale investment in research on healthy lifespans to galvanize greater global support for this agenda. To paraphrase a saying often attributed to playwright George Bernard Shaw: "We don't stop working because we grow old; we grow old because we stop working."

(*) Former chief economist at the African Export-Import Bank, member of the Sustainable Development Solutions Network at Columbia University.