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Ageing Populations - Lawrence Sacco


Lawrence Sacco

Lawrence is a PhD student at the Institute of Gerontology, Department of Global Health and Social Medicine, King’s College London. He graduated in Medical Science at the University of Birmingham (BMedSc) and gained a MSc in Demography and Health at the London School of Hygiene and Tropical Medicine.

Lawrence is interested in the consequences that extending working lives may have on people’s health and social roles within the family and the community, such as care-giving and volunteering. Within this context he wants to understand the role that socioeconomic inequalities have in shaping older adults’ engagement in unpaid activities. More broadly he is interested in the debates on the potential benefits and disadvantages of ageing populations. He is also interested in the statistical analysis of longitudinal data in life course research.



Hello I’m Nigel Warbuton. Joining me today is Lawrence Sacco, an ESRC sponsored PhD candidate in the department of global health and social medicine at King’s College London. The topic we are going to focus on is ageing populations. Lawrence perhaps you could begin by saying what’s happening in the world in terms of the ageing populations. 

Over the world this is a global phenomenon. The population is becoming older and in particular the proportion of older people is increasing throughout the world. Now 8% of the population is over the age of 65, but in 2050 this will double to 16%. 

So what you’re saying is that in the total population of the world, we’re going to get to a stage quite soon where 16% of the people alive will be over 65%? 

Yes, and actually if we look at the single countries, especially in Europe and Japan, this proportion is even higher. In countries like Italy, Spain and Japan, we’re expecting that the proportion of people over 65 will go over 30%. 

So, just to get clear, now, what is the proportion of people over 65 in the UK? 

That’s interesting because population ageing in the UK is not as a large phenomenon as in southern European countries, or Japan, where fertility is much lower. So in the UK, 18% of the population is currently over the age of 65, and this is not projected to go beyond 30%, like in countries where population ageing is much more pronounced.  

So, you’ve already suggested that the UK is different from a number of other countries. Why are we getting these fluctuations between countries in terms of ageing populations? 

Firstly, because population ageing is not only determined by longevity, but also by fertility. So in countries where fertility is very low, much lower than replacement fertility, like Italy, Spain, eastern European countries, Japan, population ageing proportionally is much more pronounced. Then if we look also at lower and middle income countries, because we often think that population ageing is an issue only for rich countries, actually we are going to see that population ageing is going to affect also lower and middle income countries, where there have been much faster demographic changes, in particular the decrease of mortality and the decrease of fertility. For example, much of the increase of older people, globally, will be concentrated in countries like China and India, where the absolute number of older people is going to treble or more. This includes countries like Pakistan and Bangladesh, which we usually think of as very young countries, that they are proportionally, but then if we look at the number of people over the age of 65, there is a massive increase.  

Why are we getting such a dramatic increase of older people in countries like China?

There reason that underlies population ageing is an historical change that has happened in most countries in the world, but at different paces, the demographic trasition, which is the transition from a high mortality and high fertility society to a low mortality and low fertility society. In historical Europe for example this has happened slowly over a long period of time, but in countries like China, this has happened really fast where mortality has decreased really fast for infants but also fertility has decreased massively in a very short period of time. So this is causing two different demographic changes at the same time, While China population for example expanded a lot, at the same fertility decreased a lot. So all these people who were born 30-40 years ago are now becoming older. This is the case not only for China, but also for Bangladesh, it was also partly the case for Japan where fertility decreased really fast after world war 2. 

I can see with China as well, the single child policy introduced by the state, must have had some influence on the kind of fertility levels that were around in that country.    

Yes, that’s true, even though fertility in China was decreasing before the introduction of the one child policy. But definitely the one child policy had a role in keeping fertility low.  

An increasing number of older people is usually seen as a bad thing for a country, obviously if most people who are in employment are younger people, you have a larger group of people who are dependent on the state and health services, and a smaller group of people who are able to work on a daily basis. So is that an accurate picture? Is it something we should be concerned about? 

Firstly, we should recognise, having talked about all these demographic facts, that population ageing is something that we should celebrate. It shows our human achievements in living longer, decreasing mortality, live longer lives and improving health. It also shows our ability to control fertility at a population level. Regarding the challenges that are caused by this impressive phenomenon, they are often overplayed and maybe we don’t focus on the positives. Regarding employment for example, we often focus on the fact that the proportion of people over the age of 65 is increasing compared to people aged from 15 to 65. This is called the dependency ratio, which is actually very misleading. First of all, not everybody over the age of 65 is dependent, a lot of people are actually working or they are doing productive activities like informal care or volunteering. Then also, we should consider unemployment: not everybody in the 15-65 age range is working, a lot of them are unemployed. There is also a lot of diversity in the levels of employment over the age of 65 between different countries. For instance, the levels of employment are much higher in Japan where there is much better health at older ages.  

I suppose focusing on employment, runs the risk of failing to recognise that older people can make huge contribution to society outside of employment, outside of formal paid employment.   

Yes, that’s right. Especially if we look at the UK census data among people over the age of 50, there is a much higher proportion of individuals who provide informal care, which also from the economic point of view is very important, as the cost of informal care has been estimated to be higher than the overall value of the NHS. There is also volunteering. A lot of people do volunteering activities at older ages. And this is important both for individuals, as it gives a role and a sense of purpose, and also to society from an economic point of view.  

So, are we suffering from a misleading picture of the consequences of an ageing population? 

Not entirely, because there are also challenges for an ageing population. For example, about health, we should think as we are living longer lives, whether we are also living better lives. Demographers talk about the compression of morbidity. So as we are living longer, whether the period we live with diseases, illnesses or disabilities is also increasing. Some studies are showing that actually that might be occurring in some samples and populations. But there is also some evidence against that. There is a number of reasons for this variation. First of all, there are differences in different countries. In some countries this might be occurring but in others it may not. In some countries people may be living longer but they are not living better lives because of health and social care at older ages. But also an important issue are inequalities. For example, there are huge inequalities which are often documented for life expectancy, but there are also huge inequalities, at times even larger inequalities, for healthy life expectancy. That is also true for the UK. 

Generally, the picture that we get of old age is of physical decline, mental decline, gradual removal from society in many ways. Is there a positive picture around, is there a better way of thinking about old age?  

I think there should be, there is a lot of focus on population ageing as a challenge, and there hasn’t been enough thinking about this for what the positives could be. Actually one of my favourite thoughts about this does not come from demography or epidemiology but comes from an historian. His name is Theodore Roszak, he is famous for writing how to make a counter culture, and this is a book that has defined the 60s especially in North America the baby boomers; but then 30 years later he wrote how to make an elder culture, and he makes some bold statements, but I think he provides a nice, somewhat utopian, thinking, of how an elder culture could bring some improvements to society. For example, he argues that the boomers will bring social change in their older age. For example as older people are going to fight for entitlements, for pensions, as there is an argument to increase the pension age or remove welfare. Older people might help to extend those entitlements, in his case that is the USA, he talks about extending health care services throughout the population, or giving entitlements that are typical of old age to everybody. There is also a more social argument. He says [T. Roszak] that an elder culture would be more humane and more focused on compassion. I mentioned informal care, for example, he says that with a larger proportion of older people there will be more people available to provide care. And also an older culture would contrast the stereotype of the alpha male. As people have to recognise their physical limitations, they will have to be able to ask for help. So, he envisions a society based on help, care, and compassion. I think that while it may sound very utopian, it is also very interesting and exciting.    

Lawrence Sacco, thank you very much.

Thank you. 

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