Health and Healthcare Systems

An economist explains how ageing societies should respond to pandemics

An elderly couple wear masks as they get some exercise in a park during the outbreak of the coronavirus disease (COVID-19) in Signal Hill, California, U.S., April 23, 2020.      REUTERS/Mike Blake - RC2IAG9D9T0C

An elderly couple wear masks as they get some exercise in a park. Image: REUTERS/Mike Blake

Andrew Scott
Professor of Economics, London Business School
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  • More than 10% of the US population is over 70 today, compared to just over 2.5% in 1920, during the Spanish flu.
  • This shift has major implications for how COVID-19 spreads, how many people will die, and how we should respond to this and future pandemics, writes Professor of Economics, Andrew Scott.
  • Learning from previous pandemics is important, but a unique, tailored approach is needed now.

The global fight against COVID-19 has triggered a surge of interest in the 1918-20 influenza pandemic that killed more than 50 million people around the world. But while we can learn lessons from the past, we must recognize what is different this time and tailor our response accordingly.

Above all, society is aging. In 2018, for the first time in history, the world had more people aged over 65 than under five. Whereas just over 2.5% of the US population was over 70 in 1920, that share is now more than 10%. This shift has major implications for how the coronavirus spreads, how many people will die, and how we should respond to this and future pandemics.

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Consider the number of expected COVID-19 fatalities in the United States. One recent high-profile study concluded that, absent policy changes in the US, the coronavirus would lead to 2.2 million deaths. But if today’s US population was the same size, but with the (younger) age structure of 1920, that number is reduced to 740,000. That difference highlights the potential greater gains today from social-distancing measures to combat COVID-19, further justifying the approach even if it results in heavy economic losses.

When the US government evaluates environmental or public-transport safety measures, it uses the concept of the value of a statistical life (VSL) to gauge cost-effectiveness. Taking this approach, Michael Greenstone and Vishan Nigam of the University of Chicago calculate that social-distancing measures which save the lives of 1.7 million Americans are worth $7.9 trillion, or 37% of US GDP – outweighing even Great Depression-size declines in the economy.

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By 2050, more than 17% of the US population will be over 70. Image: United Nations

These numbers reflect the aging of US society. Using the 1920 age distribution, the gains from social distancing would be less than half as large; so, any lockdown would be less than half as long. Even using the US population’s age structure from 1970 would yield gains of only $5.7 trillion. From an economic perspective, therefore, the aging of society over the last 50 years warrants a 40% longer period of social distancing.

The issue is not just the growing elderly population, but also the fact that people are living longer. That makes it more valuable to save lives at all ages, because more people have more years ahead of them. The VSL for an American in their 60s has risen by $2 million compared to 1933 mortality rates, and by more than $1.25 million compared to 1970. Even those in their 80s have experienced an increase in life expectancy over this period valued at more than $300,000 compared to 1933, and at more than $150,000 since 1970. These longevity gains further increase the benefits of social distancing and the acceptability of associated economic losses.

Moreover, these gains are set to increase further in the decades ahead. By 2050, more than 17% of the US population will be over 70 – boosting the economic value of social distancing to $9.5 trillion, or 44% of today’s US GDP.

Population aging also has important implications for who reaps the benefits of social distancing. Based on the 1920 US age structure, only 22% of the gains would flow to those over 70 years old. Today, however, that share is just over one-third, and will rise to nearly one-half by 2050. And with labor-market layoffs disproportionately affecting the young, COVID-19 is starting to fuel a political debate pitting generations against one another.

But attempts to spark intergenerational conflict are exaggerated, for several reasons. For starters, the young and the old are part of the same families, and often the same households. Many of the countries that have been most severely hit by the pandemic, such as Italy, have been affected precisely because of their high levels of intergenerational mixing.

Furthermore, the young eventually become old. In fact, the chances of that happening are now much greater than ever before. Back in 1920, a 20-year-old in the US had only a 50% chance of living to 70, compared to an 80% chance today. Young people today should therefore be much more interested than their predecessors a century ago in how society looks after the health of the elderly during a once-in-50-years pandemic.

That doesn’t mean policymakers should ignore intergenerational issues. Ensuring targeted support for the young both now and after the pandemic is essential, especially in the case of college graduates entering the labor market. One way to do this is by giving priority to younger workers as social-distancing measures are gradually eased. Given that more than ten million US workers are aged over 65, such a phased approach would minimize both the economic and public-health costs of such a policy.

As societies continue to age in the coming decades, we also need to invest in the future differently. First, we must strengthen our medical capacity to fight pandemics by increasing the supply of intensive-care beds, ventilators, and other essential goods and equipment. As the costs of pandemics increase, so, too, should investment in medical mitigation.

Second, policymakers must focus more on improving how their countries’ populations grow older. While the COVID-19 mortality rate rises with age, it is not just chronological age that matters, but also underlying health conditions. Heart disease, cancer, obesity, and diabetes all increase the fatality risk, and their incidence tends to rise with age.

Focusing on public-health measures and research that slow the rate of biological aging is paramount if society is to exploit fully one of the greatest advances of the last century – the increase in healthy life expectancy. Such efforts will also be crucial to minimizing the costs of future pandemics that will occur over the course of these long lives.

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