Abstract
“While we do our good works, let us not forget that the real solution lies in a world in which charity will have become unnecessary.”
—Chinua Achebe
H
I believe that two distinct differences between the West and the developing world have underpinned the divergent levels of interest in this topic in different parts of the world. The first is that non-Western cultures have tended to view the elderly with greater respect, as seen most clearly in the promotion of lifelong activity and social integration. That disparity shows little sign of diminishing, and it will not be my focus here. Instead, I want to consider the other difference, which is statistical.
One statistic that I have been noting for many years is that aging, when properly defined to include all the diseases of old age and not restricted to the undefined concept of “aging itself,” is the cause of over two-thirds of all deaths worldwide. But how are those deaths distributed geographically? A second statistic with which I often follow up is that in the industrialized world the proportion of deaths due to aging is around 90%. Necessarily, therefore, the proportion in the developing world is substantially below two-thirds. But hang on—how substantially?
Just recently, and perhaps belatedly, I decided to revisit the two-thirds figure and derive a rough estimate of how much it has changed in the decade or so since I've been using it. I am not often shocked by statistics, but in this case I was. According to my calculations, the proportion of deaths attributed to causes that predominantly affect those who were born a long time ago has risen past 70% and is rapidly approaching 75%. And this has occcurred, as I say, in just one decade. Another statistic that reflects the same phenomenon is the rise in life expectancy: While the industrialized world is seeing an unmistakable slowdown in the rate at which lives are getting longer, the rate of progress in the largest developing nations remains so high that overall, worldwide life expectancy has now breached the 70 barrier.
Does this mean that all nations' health problems are now basically the same? Certainly not—not yet. My recent conference engagement in India consisted of a double act with a noted epidemiologist who was born in India and now works in Canada, and whose work mostly focuses on causes of ill health and death in the age range 30–70. Illustrating his point by specific reference to his two home countries, he noted that a far higher proportion of the Indian population dies in that age range than in Canada, and he offered incontrovertible evidence that factors that can be avoided by either personal or societal choice, such as smoking and air pollution, account for the bulk of this difference. But those same statistics also reveal a different message—one that is of increasing relevance as further progress is made and that we must therefore acknowledge just as strongly if we are to ensure the long-term health of developing-world populations. If that 30–70 age range is bisected and we ask what proportions of those deaths occur below versus above age 50, India and Canada are barely distinguishable; in each case the older range includes three or four times as many deaths as the younger. What does this mean for the future?
I submit that it means the developing world's interest in combating aging is burgeoning not a moment too soon. As life expectancy in countries such as India rises from around 70 to around 80, there will be ample cause for celebration, not least because by and large the extra years will be spent in good health. But the burden of age-related ill health will not be diminished as a result: On the contrary, it will rise, as more and more people attain ages that predispose them to aspects of aging that are less influenced by environmental factors and are thus more intractable.
But this is not, ultimately, a message of doom and gloom. There are two messages here that I want to highlight, and they are both calls to action, but both are motivated by opportunity rather than desperation.
The first is addressed to the developing world itself. It is paradoxical that the respect for the elderly that is so prevalent in such regions has not translated long ago into determination to hasten the development of truly effective anti-aging medicine. My preferred explanation is that such respect is of “the wrong sort,” by which I mean that it makes it more difficult for people to think in terms of aging being a health condition. But the developing world also has notable advantages over the West in terms of its potential to contribute to the anti-aging crusade—the work ethic, the lower cost of living, and the more pragmatic attitude to new technology all play their part. As the “epidemic of aging” becomes ever more conspicuous at home as well as abroad, and the motivation to counter it thereby grows, such societies are extremely well placed to contribute greatly to this mission.
The second call to action is addressed to those in the West, and especially to those in government and the high-net-worth community who are major sources of philanthropic funding to alleviate developing-world suffering. Overwhelmingly, aid to the developing world is targeted at the aspects of suffering that we find the most shocking—which, inevitably, means those that have been effectively eliminated in the first world. But this is short-sighted. If we really want to give the greatest possible help to those in the more disadvantaged parts of the world, we must be objective with regard to what are truly their major sources of suffering. In some respects, this is already happening, as greater attention is paid to aid that enables the disadvantaged to help themselves (such as providing computer and internet access). But now is the time to go further. Now is the time to acknowledge that the number one source of suffering in the developing world is the very same as it is in the wealthiest nations. It is the ill health of old age, and we must dramatically increase our efforts to bring that ill health to an end—for everyone's sake, not only our own.