Andrea Bieler | Matthias Stracke | Angelika Veddeler (Eds.)

Religion and Aging

ContactZone

Explorations in Intercultural Theology

edited by

Prof. Dr. Volker Küster

(Johannes Gutenberg-Universiät Mainz)

Volume 20

Editorial Advisory Board:

Prof. Dr. Jin-Kwan Kwon, Sungkonghoe University, Seoul, Republic of Korea

Prof. Dr. Philip Wickeri, GTU, Berkeley, CA and HKSKH, Hong Kong

Andrea Bieler | Matthias Stracke

Angelika Veddeler (Eds.)

Religion and Aging

Intercultural and Interdisciplinary Explorations

The cover design makes use of art works by Solomon Raj, Hendarto, Nyoman Darsane, André Kambaluesa, Hong Song-Dam, an unknown Ethopian Ikon painter and Lee Chul-Soo (in clockwise order and on backcover; by courtesy of the artists; photos by Volker Küster).

Bibliographic information published by the Deutsche Nationalbibliothek

The Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbiographie; detailed bibliographic data are available on the Internet at http://dnb.dnb.de.

© 2017 by Evangelische Verlagsanstalt GmbH · Leipzig

This work, including all of its parts, is protected by copyright. Any use beyond the strict limits of copyright law without the permisson of the publishing house is strictly prohibited and punishable by law. This applies in particular to reproductions, translations, microfilming, and storage or processing of the entire content or parts thereof in electronic systems.

Cover: Kai-Michael Gustmann, Leipzig

Copy editing: Andrea Bieler and Matthias Stracke, Wuppertal

Typesetting: Matthias Stracke, Wuppertal

ISBN 978-3-374-05181-6

www.eva-leipzig.de

Contents

Preface

Religion and Aging in International and Intercultural Perspectives
 – Mapping the Field

Andrea Bieler and Matthias Stracke

Interdisciplinary Horizons

The Longevity Revolution
 – Global Developments and Ways Forward

Ina Voelcker and Alexandre Kalache

Themes in Contemporary Behavioral and Social Gerontology

Hans-Werner Wahl

Debunking Myths of Aging
 – Implications for Church Participation of Older Adults

Jenny S. Y. Lee and Helene H. Fung

When Religion Matters
 – Aging, Health and Care in Indonesia and Tanzania

Peter van Eeuwijk

Theological Contributions

Discourse on Religion and Aging
 – Integrating Theological and Intercultural Perspectives

Ralph Kunz

A Paradox of Life: Finding Meaning in Aging
 – Horizons in Theological Anthropology

Ángel F. Méndez-Montoya OP

And Sarah Laughed
 – Observations on Bible, Aging and Postcoloniality

Musa Dube

“Who Do You Say that I am?”
 – People Living with Dementia in Medical De-Constructions and Liturgical Reconstructions and Play

Drea Fröchtling

Concepts, Challenges and Innovative Practice

Emerging Discourse on Aging in the United Evangelical Mission

Angelika Veddeler

Diaconic Challenges in Elderly Care on Three Continents
 – Indonesia, Germany, Tanzania and the Philippines

Klaus Pöschel

Protagonism and the Role of Older People in Policy-Making
 – A Bottom-Up Approach

Ina Voelcker

“With this Alzheimer Thingy You Can’t Walk Alone”
 – Walking with and Supporting People Living with Dementia

Drea Fröchtling

Religion and Aging in International and Intercultural Perspectives
 – A Conference Commentary and Research Prospects from a Diaconic Perspective

Beate Hofmann

Bibliography

List of Contributors

Preface

This volume gathers the revised papers of a conference in Wuppertal in December 2015. The conference grew out of a collaboration between the United Evangelical Mission and the Kirchliche Hochschule Wuppertal/Bethel. Both organizations share a commitment to engage in ecumenical activities and scholarly research that addresses pivotal religious, social, and economic issues, such as the demographic shifts that are occurring worldwide.

Focusing on religion and aging in international and intercultural perspectives requires a transdisciplinary approach. Accordingly, we invited theologians, psychologists, medical anthropologists, and gerontologists from various contexts into the discussion. They came from Botswana, Hong Kong, Tanzania, Indonesia, Mexico, South Africa, Switzerland, and Germany.

In addition, we also asked practitioners to join who brought insights from various contexts they are engaged in. The conversations were innovative, since the topic of aging has not been discussed in this constellation up to this point. They also revealed the required intellectual and affective labor as scholars and practitioners from such diverse academic fields and cultural contexts sought to understand and engage each other’s frames of thought.

The conference was made possible through the funding of the organizing bodies as well as the Stadtsparkasse Wuppertal. We are grateful for their financial support. In addition, we thank Monique Bartsch, Birte Bernhardt, and Johanna Güntter for their dedication that made the conference a success. We are indebted to Stephanie Budwey, Andreas Harth, Lisa Ketges, Anke Leopold, and Susanne Patock who assisted in the editorial process. The United Evangelical Mission supported the publication of this volume financially. Finally, we thank the main editor of ContactZone, Volker Küster, for his interest and cooperation in publishing this volume in his series.

Andrea Bieler, Matthias Stracke & Angelika Veddeler

Basel and Wuppertal, July 2017

Religion and Aging in International and Intercultural Perspectives – Mapping the Field

Andrea Bieler and Matthias Stracke

This volume explores pathways into a new field of scholarly inquiry. Reflecting on religion and aging in international and intercultural perspectives is an endeavor that has been neglected in theological as well as gerontological studies. Demographic trends as well as experiences in particular contexts, however, exhibit the urgent need to engage this field of inquiry.

Gathering under the umbrella of the United Nations in 1982, the World Assembly on Ageing already stressed that the expected demographic shifts would affect the majority of societies all around the globe. In 2002, the UN passed The Madrid International Plan on Ageing which demanded major shifts in policy making and in sociocultural attitudes concerning aging populations.

Statistics demonstrate the rapid growth of aging societies which predict the doubling of numbers of people older than 60 years by 2050. This development pertains to most regions on this planet and is accompanied with particular challenges that call for diverse political initiatives, especially in the areas of economic support systems, accessible health care, and diverse and flexible systems of social care for the elderly. Besides the demand for the shift in political interventions there is also a need for a critical reflection of the anthropological and religious assumptions that undergird prevailing attitudes towards aging populations.

So far, major distinguished research initiatives have not attended to the influence of religion on major demographic developments. Also, socio-psychological research that concentrates on the socioemotional factors with regard to attitudes towards the elderly have neglected the religious dimension. Simultaneously, gerontological research with an interest in religious questions related to the aging process has mainly focused on the European and North American context so far.

Taking these perceptions into account, this volume seeks to begin to attend to the gaps that emerge once one focuses on questions of aging and religion in intercultural and global contexts.

There are a variety of research questions that need to be addressed. First of all, on a global scale, we need to learn more about the diverse ways in which religious organizations and individuals respond to the complexities of aging societies. Assuming that aging is an intricate process that encompasses enrichment and loss, the gain of wisdom and the loss of memory, and the expansion as well as the constraint of agency, it would be crucial to analyze how these developments play out in different contexts.

Transformational processes related to aging need to be studied in an intercultural horizon that takes multidimensional and multidirectional dynamics into account. These dynamics play out on an individual as well as on a collective level. They find their particular expressions depending on the context. In addition, a culturally sensitive concept of vulnerability needs to be developed that considers the strengths and potentials that are unleashed in aging processes as well as the threats and endangerment that people are facing. These dimensions need to be addressed not only in empirical research but also in hermeneutical endeavors that seek to develop a theological anthropology that is sensitive with regards to the complex issues of aging persons. In this vein, it is important to explore the relevancy of religious practices and theological constructs in light of gerotranscendence. By gerotranscendence we mean the ability to see one’s life in a larger context and horizon that might be nurtured by religious or spiritual insights or by understandings of the cosmological order. The question then arises to what extent such diverse ways of envisioning life in light of gerotranscendence supports aging people in developing resilient, hopeful, and at the same time realistic attitudes towards the challenges that growing old might bring.

The book is divided into three parts that provide a panorama of theoretical and practical approaches to aging and religion. The first sequence of articles opens the horizon by asking different disciplines for an account of the realities (and misperceptions) of aging from their perspective, be it gerontological, psychological, or anthropological. After this interdisciplinary part, attention is focused on theology and its self-critical reassessment of the role of age and aging in practical, systematic, and biblical theology. Finally, the last part of the book asks for insights from the practice in diaconic institutions, in public policy making, as well as in an international community of churches.

Ina Voelcker and Alexandre Kalache, both working at the International Longevity Centre Brazil (ILC-Brazil), give an overview of demographic realities and changes on a global scale, such as dropping fertility rates, growing life expectancies, urbanization and technologization, and their implications on the lives of (not only) older persons. They show that there is no easy picture here, but rather point out the ambiguities of old age between the ‘silver market’ and age related poverty, marginalization, and vulnerability. In light of inter alia the neglect of older persons in humanitarian projects, they emphasize the need for a Convention on the Rights of Older Persons at the level of the United Nations that would exceed the existing instruments and plans. With the World Health Organization’s Active Ageing Policy Framework, recently updated by the ILC-Brazil, there exists, however, a guideline internationally used in policymaking. It focuses on multisectorial action in different sectors and the empowerment of individuals to influence their lives directly as well as indirectly – via policymaking.

The gerontologist Hans-Werner Wahl rather focuses on individual developments of aging seen as a psychological and social process. He provides an overview of main themes of behavioral and social gerontology. Again, aging proves to be ambiguous and cannot be simply understood as a deterioration of social and cognitive parameters. Hence, for example, old people keep gaining so called crystallized intelligence (e.g., verbal abilities and life experience) while their fluid intelligence (e.g., processing speed) declines at a rate no faster than in earlier years. Similarly, gerontological research of the past two decades disproved the long assumed decline of subjective wellbeing in later life. And though older persons do indeed have less social relations, they remain proactive toward maintaining social relations, especially in their families. Research on AARC (Awareness of Age- Related Change) shows that stereotypes of aging not only do harm as external effects but, internalized, also affect, for instance, live expectancy. The author also includes an outlook on current efforts in gerontology to combine theology, diaconal studies, and psychology in order to provide suggestions on how societies can better provide opportunities for older persons.

From another psychological angle, Jenny Lee and Helene Fung deepen the understanding of aging as a multifaceted stage of life by debunking the myths of old age-related loneliness, depression, and memory loss. Against the background of church realities in Hong Kong and New Zealand and psychological findings they suggest steps to make churches more welcoming, inclusive, and empowering for old people – something, they assert, people of all age groups would benefit from.

Critically questioning whether mainstream scientific perceptions of and approaches to aging do good in neglecting cultural and especially religious factors, Peter van Eeuwijk focuses on the regulative, integrative, and interpretive influence of religion and spirituality and the respective practices on aging and elderly people’s health. Accordingly, he presents insights from two case studies he conducted in Indonesia and Tanzania and underlines that “the belief in God, Allah, or Buddha represents meaningful ‘explanatory models’ for the elderly in Indonesia and Tanzania when they reflect good health, longevity, frailty, chronification of disease, changes in their body and mind, and pain and/or disability with regard to the aging process and old age.” Prayer here is one mode of care among others. Van Eeuwijk then discusses the ‘social body’ of old people and the interwovenness of faith, individual behavior and lifestyle, and the societal (e.g., gender) norms ambiguously affecting inter- as well as intragenerational care in families (and beyond); care is both an interrelational social practice as well as a relational religious doing. In a third step, van Eeuwijk examines the under-researched role of faith-based organizations in social welfare for older persons and highlights their importance both for the provision of complimentary care structures as well as for the social life of elderly people, including their leisure activities.

Following on from these broad range of approaches to aging we put Ralph Kunz’s article first in the second part of the book. He is likewise interested in the ambiguities of aging and introduces us to two very different people, Martha and Bob. He argues that adding a religious perspective does not mean having an easy assessment instrument, but rather calls for a comparative-critical approach that implies listening to these and other people and their religious stances between devoted church going and anti-aging campaigning. Yet, as a theologian, Kunz does not stop here, but brings into play the Christian particular universal claims and hence testimony of God in narrative form showcasing the story of Adam, Eve, and the snake and its implications for our understanding of aging.

Ángel F. Méndez-Montoya takes the biblical narratives as a starting point to reflect on the paradoxes of life and the potentials of aging, contrasting the Bible’s positive approach to aging and care for others with current forms of ageism. Asserting the need to think about aging beyond Western epistemologies, to hybridize it, he explores aging in the Mexican context, and underlines the need to also listen to voices from ‘below’ and the power that can be found at the margins, as becomes visible in the role of elderly people in the context of the 43 students made disappear in 2014.

From a postcolonial perspective, Musa Dube describes the Bible itself as an ambiguous resource. In the biblical texts and the communities reading and living with them, one finds voices resisting and embracing the empire and hence also different approaches to aging, the latter a largely neglected field, as she points out. She underlines the need for an intersectional analysis of the texts that, for instance concerning the person of Sarah, brings to light both the infirmities of old age as well as the power that older persons may use to exploit younger ones and how this relates to categories such as gender, class, and ethnicity. Dube connects her biblical reflections with the realities of displacement and migration in postcolonial contexts such as in Botswana: “Empire has had an impact on the quality of aging experienced by those impacted by colonialism.”

Ending the sequence of these theological accounts, Drea Fröchtling focuses on dementia and the question how to think about the personhood of those who do not fully know who they are. She contrasts the widely prevalent ‘biomedical reductionist paradigm,’ qualifying dementia as a deterioration process and leading to a high prevalence of dementia-related depression, with what she calls a ‘liturgical-reconstructionist paradigm.’ Therefore, Fröchtling elaborates on different theological approaches to personhood and remembrance. Drawing on her own research in South Africa, Germany, and Ghana, she shows that people living with dementia often take their own approaches to an otherwise very word-centered religion. Fröchtling highlights the comforting and supporting dimension of religious activities and rituals that also make space for bodily sensations inclusive for people living with dementia. She argues for a ludic (e.g., a clownish) approach that allows us “to dance coram Deo, celebrating the scope of freedom granted by a God who turned the logics of this world upside down.”

The articles opening the next part of the book both stem from the context of the United Evangelical Mission (UEM). Angelika Veddeler gives an insight into how aging became a topic among the members of the UEM through HIV and AIDS and the awareness that the elderly were not targeted in their programs. She describes the process of international exchange that led to identifying contextual challenges and opportunities, but also the need of better training and more research to support churches that, as became clear, play an important role in shaping perceptions of old age. Klaus Pöschel takes a closer look at the Philippines, Indonesia, and Germany, identifying contextual needs. He describes how diaconic institutions in the UEM exchanged answers regarding the needs of institutionalized care and related ethical questions, such as the modalities of a nurse exchange in times of care drain.

Ina Voelcker gives an overview on bottom-up approaches in policy making that involve older people in decision-making processes at all levels, for example, in the quest for age friendly cities. Campaigns such as Age Demands Action have both a local and international dimension as can be seen on October 1st – the United Nations International Day of Older Persons. Voelcker also fleshes out important parameters for participative approaches in policy making as well as future research questions.

Drea Fröchtling comes back to the topic of dementia and provides an overview of different therapy concepts from Reality Orientation Training, music and milieu therapy, to snoezelen. On the road towards more cultural sensitive approaches to dementia care, she pleads to start with the perspectives of people living with dementia and presents different illness narratives she derived from encounters in the field, such as demon-based, ancestor-related, and bio-medical interpretations of dementia.

This collection of essays is concluded by a conference commentary with a twist; Beate Hofmann introduces the perspective of diaconic science and a spatial approach to social work that aims at establishing caring communities in a region or neighborhood.

Interdisciplinary Horizons

The Longevity Revolution – Global Developments and Ways Forward

Ina Voelcker and Alexandre Kalache

Population aging is one of the most important global trends marking the twenty-first century. Many countries are living a real ‘longevity revolution,’ associated with ever-growing proportions of older people who are living longer and longer. Consequently, existing notions of older age are changing rapidly, especially as the Baby Boomer generation is now living what used to be considered ‘old age.’ Never before have so many older people been alive at once. Today, only Japan has a population with over a third being aged 60 and over.1 By 2050, 61 countries will have a third of their population aged 60 and over. This list will cover 30% of the world’s countries, including China, Thailand, and Vietnam.

1. Rethinking Aging in Light of Demographic Changes

Why are existing concepts changing? Why does this revolution, as an “overthrow of social order in favor of a new system,” require us to abandon the prevailing notions of old age and retirement?2 Given the additional 30 years of life that populations have gained on average during the last century, existing systems have become unsustainable. In some countries, this gain in life expectancy happened during the course of a century (mostly European countries, but also Argentina, Canada, and New Zealand), but in others this will happen in just half a century (such as China, India, Indonesia, Iran, and Bolivia). In Brazil, for instance, someone born today can expect to live an additional 20 years compared to someone born in the 1960s. Against this backdrop, individuals and groups who start to rethink existing structures are becoming more and more common.3

In order to understand this demographic trend towards older populations, however, it is first and foremost important to grasp the two main contributors to population aging: increasing life expectancy and decreasing fertility rates. Globally, life expectancy has increased 8.5 years just during the last 30 years. Life expectancy has never been higher than it is today. In some countries it is as high as 82 years, in others as low as 49 years. Today, there are 36 countries in the world with a life expectancy at birth of 80 or above. By 2050, almost half of the world’s countries will be part of this group. Further, while fertility rates are still high in many countries, half of the world’s countries already have fertility rates below the replacement level of 2.1 children per couple.

Against this backdrop, it is important to question how old age and retirement are perceived and what implications this has for public policy. Due to the enormous social and economic challenges resulting from population aging, it is becoming a central issue to global and national policymaking. Indeed, to respond to these challenges arising from the longevity revolution, various other global trends that occur in parallel have to be understood simultaneously. Each time more people are living in cities, for instance, and in a world as globalized as it is, local issues can no longer be solved in isolation. Migration has, especially with the continued crises in the Middle East and Southern Asia, become a contemporary and at the same time controversial topic. The number of international migrants today would take Brazil’s position as the fifth most populous country in the world.4

This chapter will conclude with recommendations for multisectorial action in response to the longevity revolution, involving not only the public sector, but also the private sector, the media, academia and civil society, as well as intergovernmental organizations which also have an important role to play. One of the core recommendations is to empower individuals so they can influence their own lives, not only directly but also indirectly via policymaking.

A World of Growing, but Constantly Unequal, Life Expectancies

Globally, life expectancies are increasing. Today, the global average life expectancy is above 70. While much of the increase in life expectancy is due to improved survival in younger ages associated with improvements in hygiene, sanitation, and medicine – particularly in less developed countries – it is increasingly, and in particular in more developed countries, influenced by the improved survival of older people. Mortality patterns are changing. In less developed countries, deaths occur primarily in early childhood and are then spread equally across other ages, while in more developed countries most deaths occur in older age. The causes of death also change as countries develop. Non-communicable diseases are becoming more prominent in both developed and developing countries, while communicable disease continue to be a significant cause of mortality in less developed countries.

Concurrent with mortality patterns that differ between more and less developed countries, there is also a strong association between socioeconomic development – represented by GDP per capita – and life expectancy at birth.5 In countries with a high GDP per capita, life expectancy already exceeds 80 years. Today, there are more than 30 countries around the world where life expectancy exceeds 80. About 30 years ago, not one country had such a high life expectancy. Only Japan had a life expectancy close to 80 (77 years in 1985).

In 1950, the highest life expectancies (around 70 years) were experienced in Northern Europe. Today, people living in Korea, Belize, Russia, and Ukraine, for example, have similar life expectancies to people in, for example, Finland in the 1950s. Comparing today’s life expectancies across countries also demonstrates stark inequalities. While people in the most developed countries can expect to live, on average, over 80 years, people born in some of the poorest countries in the world, like Swaziland, Lesotho or the Central African Republic, can expect to barely live to 50. This does not, however, mean that there are no older people in these African countries. While this is a frequently held assumption, over five percent of the population in these countries are made up of people aged 60 or older and as elsewhere these figures are increasing. Indeed, by 2050 the number of older people in sub-Saharan Africa is expected to triple.6 A better way of understanding aging in sub-Saharan Africa is to look at life expectancy at age 60. One can see here that, indeed, once a person has passed early child- and adulthood, their chances of survival increase. In the above-mentioned countries in sub-Saharan Africa, a person aged 60 can expect to live on average for another 15 years.

Nonetheless, inequalities in life expectancy also continue to persist at older ages. Older people in some of the most developed countries have 10 more years of life to live than people aged 60 in these sub-Saharan African countries. In France, for instance, someone aged 60 today has an average life expectancy of 25 years.

While there are inequalities in average life expectancies at birth and at age 60 across countries, these differences persist within countries and among sexes. Globally, women who are 72 years old have four years longer to live than men. This gender gap is higher in more developed countries than in less developed countries. Furthermore, a clear social gradient can be observed within country- or even city- borders. In London, for example, the gap between life expectancy at birth in different parts of the city is over 17 years.7

Despite these inequalities, there is good news: we have more years to live, more years to be a child, an adolescent, an adult, and an older adult. However, if we live healthier lives is a question that remains to be answered. Current research evidence on this question is not consistent; it varies across geographic regions, populations, and indicators used to measure health.

Dropping Fertility Rates

The increase in life expectancy alone does not yet result in population aging. The main contributing factor to population aging is rapidly decreasing fertility rates. At a global level, fertility halved between 1950 and 2015. It fell from almost 5 children per woman to around 2.5. In many African countries, fertility rates remain high with 5 to 6 children per woman. In others, mainly European and richer Asian countries, fertility rates are as low as 1.2 to 1.3 children per woman.

As of 2010, 75 countries in the world had fertility rates below the replacement level of 2.1 children per woman. Low-income countries represent 30 of these 75 countries. These changes in fertility rates are likely the result of an increasing realization that children have higher chances of survival, of growing access to contraception, and changing gender roles linked to higher education and labor force participation rates among women.

While life expectancy patterns explain a social gradient, for fertility rates a strong association to education attainment can be observed. For instance, the fertility rate among Brazilian women with seven years or less of schooling was as high as 3.07 children per woman, while for those with eight years or more of schooling it was almost half (1.69).8

Migration – A Third Direct Determinant of Population Aging

While mortality and fertility are the main contributing factors to population aging, migration also contributes to changes in a country’s age structure and to the total population. Within the European Union, for instance, in five of the twelve countries that reported population decline in 2014, negative net migration was the main reason for population decline.9

The impact of migration on population aging is more apparent at the regional level. In particular, migration away from rural towards urban areas mostly leads to exacerbated population aging in rural areas.

Population Aging – More Older and Less Younger People

Increasing life expectancy and decreasing fertility rates are the main contributing factors to a growth of the older population. The population pyramid tends to invert, with bigger generations of older people and less children. While Japan is still the only country in the world that has already reached the mark of 30 percent of its population being aged 60 or above, a third of the world’s countries will reach that mark by 2050. Within the next five years, another six countries are expected to have populations with around 30 percent being 60 years and older, including mainly European countries (Greece, Finland, Portugal, Germany, and Italy) as well as Martinique.

While almost all countries are experiencing population aging, its speed greatly varies. Some countries, like France, doubled its older population from 10 to 20 percent in almost 150 years. Others, like Japan, China, and Brazil, have experienced this demographic change in just 25 years. While most of the countries whose populations aged slowly had time to put social welfare systems in place, most of the rapidly aging and less developed countries are still confronted with other substantial challenges, such as the establishment of public health care systems and old-age social protection mechanisms.

The way populations are composed is completely changing. Already today there are more people aged 60 and over in the world than children below five and, within the next 30 years, older people will outnumber children and adolescents below the age of 15. In Germany, there are already more people aged 60 and over than people below 25. But even countries with a still relatively small population of older people – due to the unprecedented speed of population aging – will experience the same demographic change over the coming decades. Today in Brazil, in comparison, there are almost twice as many children than older people, but by 2050, it will have the same age composition as Germany today.

2. Global Converging Trends

While the world is faced with population aging, it simultaneously has to tackle other converging and interdependent global trends. Obviously, these trends bring many opportunities but also risks that have to be considered in parallel. The technological revolution, for instance, contributes to substantial improvements for all areas of life from alimentation to work. On the other hand, it also leads to a number of risks, such as cyberattacks, the misuse of technologies, data fraud,10 or digital exclusion.

In order to provide effective recommendations on how to enhance the opportunities population aging offers, the interplay with these and other long-term patterns such as urbanization, globalization, migration, technological advances, environmental and climate change, armed conflict, poverty and inequality, epidemiological transitions, as well as the evolution of human rights has to be understood.

Urbanization

Until the industrial revolution in the nineteenth century, the majority of the world’s population lived in rural areas. In 1800, only about three percent of the world’s population lived in cities. This figure multiplied five-fold until 1900 and doubled again until 1950, so that 30 percent of the world’s population lived in urban areas.11 Now, urbanization is high up on the list of global trends with already more than half of the population being urban dwellers. By 2050, two-thirds of the population will be living in cities.12

Some of the world’s most urbanized countries are in the Americas and Europe. Asia and Africa remain largely rural, but are expected to urbanize at a much faster speed. In less developed countries, including many African and Asian countries, the speed of urbanization is unprecedented so that by 2050, two-thirds of the population in less developed countries will live in cities, an increase of almost 30 percent from 52 percent today. Today in more developed countries, in contrast, almost 80 percent of the population already live in cities. While these countries are also expected to continue with this trend, it is happening at a much slower speed, so that by mid-century 86 percent of the population are expected to live in urban areas. A recognizable proportion of urban dwellers are older people. In more developed countries, one in five city dwellers were already aged 60 and over in 2005.

While cities provide better access to services as well as opportunities for economic, cultural, and social participation, living in cities is, however, also associated with higher rates of crime and traffic accidents, inequality, unhealthier life styles, air pollution, and extreme heat – all of which determine health. For one in three city dwellers who are living in slums or informal settings, life is even more hazardous due to overcrowded and poor housing, inadequate sanitation, and a lack of water, food, and access to services.13

While cities are growing and becoming more densely populated, rural areas are becoming depopulated. Given that primarily the younger generations move away from rural areas in search for better opportunities in the cities, rural populations are faced with increasing proportions of older people that remain behind. This trend can be observed both in more and less developed regions of the world. In China, for instance, by 2030, almost 22 percent of rural populations will be comprised of persons aged 65 and over as opposed to 15 percent of urban populations.14

The age composition of a population influences local community planning as well as local markets which – depending on the demand – will offer different services and products if there are predominantly older or younger people, or a good balance of both. Indeed, the disproportionate population aging along with a general decrease of the populations in rural areas demonstrates a huge challenge for maintaining infrastructure.15 In many smaller municipalities in Germany, for instance, alternative models – oftentimes relying on volunteerism – have developed in order to attend to an ever older and decreasing population.16

Globalization

Another major trend determining our lives today is globalization, which is leading to a highly interconnected world with growing flows of goods, information, ideas, capital, services, and people.17 While globalization has led to various improvements in quality of life, it also brings many challenges, such as the spread of communicable diseases which are no longer stopped by oceans. Crises that used to be local now have an increasingly global impact.

Migration

Globalization also interplays with another global trend which is of utmost importance in the context of population aging: migration. While people have always migrated, internal and international migration is turning into a trend from which no one remains untouched. According to the United Nations, for the first time there are as many refugees, asylum seekers, and internally displaced people as after World War II.18 Indeed, large-scale involuntary migration was recognized as one of the five most likely and most impactful risks in the 2016 World Economic Global Risk Assessment.19

The interface between aging and migration can be illustrated by the following groups of migrants: older people that are aging in a foreign land (for example, Italians that came to Germany in the 1950s and 1960s and decided to stay), older persons that move for better life styles (e.g., English seniors who move to Spain due to the warmer climate), people returning to their country of origin who then find themselves ‘foreigners in their home countries’ after having spent decades away, people that follow their adult children, and those that escape crises or natural disasters, or are left behind by younger generations who decide to leave.

Technological Revolution

Closely interrelated with globalization and urbanization are technological advances that determine our daily lives in many facets. While technological innovations have always been influencing the way people live, the changes that populations are faced with today are happening much faster.20 Innovations in the field of information and communications technology, for instance, have not only altered personal communication, but have also influenced medical interventions and passenger transportation, to name only two examples. The statistics of many global enterprises such as Facebook, Twitter, Instagram, and WhatsApp are staggering. Within a few years they have changed how people interact and are no longer limited to the private sphere. In just one year (from 2012 to 2013), for example, the number of local business profiles increased 100 percent.21 New jobs and new marketing strategies have been created with the emergence of social media. Traditional communication has so drastically changed that readers now want to learn from their peers as much as from traditional media sources.22 Social media has also facilitated recent political debates – for example, the Arab Spring movement in the Middle East23 – and more generally speaking political action.24

The interface between population aging and technology, which used to be a niche, has now turned into a powerful market. In the United States alone, the market is estimated to be as strong as US$ 30 billion by 2017.25 More and more start-ups are emerging and big companies are increasingly paying attention to their older customers’ needs and developing devices and services that advance older people’s functional capacity and contribute to their ability to avoid dependence and loss of autonomy for as long as possible.26 These innovations range from wearables, sensor-equipped smart-homes over apps, to support caregivers, to robotic aids or pets. Population aging is also one of the major challenges for the future of the automobile industry, which is already responding to demographic changes by investing in research and the development of self-driving and easily accessible cars.27

While technological advances have always envisioned facilitating our lives and have created many opportunities, they have also led to challenges and risks. More and more sensitive personal data are stored in the cloud, including health and financial data.28 There are questions around security and privacy, as well as risks for digital exclusion, in particular among older people. A study on older persons’ adoption of technology, for example, found 10 determinants: value, usability, affordability, accessibility, technical support, social support, emotion, independence, experience, and confidence.29 All of these factors have to be kept in mind when developing products and services.

Environmental Changes

The likeliness and impact of global trends related to the environment, such as extreme weather events, natural catastrophes, and the failure to mitigate climate change, has gained importance over the last decade.30 The natural environment is visibly suffering from the consequences of human-made changes and the negative impact on health is undeniable, for example, on respiratory health due to high levels of pollution and on the mortality risk during heat waves and other extreme weather conditions. The analysis of the two global trends of population aging and environmental change in parallel is becoming particularly relevant for two reasons: first, populations in places of increased risk are aging at unprecedented speed and second, older persons are particularly vulnerable to these risks.

Geopolitical Risks

Geopolitical risks, including armed conflict, are high on the political agenda. In 2016, the Global Risk Report by the World Economic Forum identified interstate conflict with regional consequences as the fourth most likely global risk for 2016.31 Similarly to natural disasters, older persons in armed conflict are particularly vulnerable due to generally lower levels of functional capacity which reduce their ability to escape and to access emergency relief. In addition, they might exceptionally suffer due to discontinued medication, medical treatment, or access to walking aids or glasses. Despite this increased vulnerability, a study conducted by HelpAge International shows that older people are targeted in less than one percent of funded humanitarian projects.32 Only 154 of over 16,000 projects implemented between 2010 and 2014 included at least one activity which specifically targeted older persons.

Epidemiological Transitions

Over the past decades, global mortality and morbidity patterns have changed. An epidemiological transition is under way, so that worldwide more than two thirds of deaths at any age are now due to noncommunicable diseases.33 The leading diseases for deaths due to chronic diseases are cardiovascular diseases, cancer, respiratory disease, and diabetes.34 In more developed countries, most deaths occur above the age of 70, while in low-income countries, early childhood continues to be the most common age of death.35 Independent of socioeconomic development, the predominant causes for death and disability in older age are non-communicable diseases, occurring earlier in less developed countries than in more developed countries.36

In low- and middle-income countries, however, communicable diseases continue to be an important cause of death. Worldwide, almost a quarter of all deaths are due to communicable diseases, including lower respiratory infections, HIV/AIDS, diarrheal diseases, malaria, and tuberculosis.37 Low- and middle-income countries are therefore faced with the double burden of disease, one where health care needs to attend to both communicable and non-communicable diseases.

Population aging, the global ‘spread’ of unhealthy lifestyles, and rapid urbanization with overpopulated and poorly planned urban environments are contributing to the emergence of non-communicable diseases. Unhealthy lifestyles – in other words, modifiable behavioral risk factors – are responsible for physiological changes that increase the risk for non-communicable diseases.38 While evidence is still scarce, there is proof that unhealthy lifestyles are disproportionally common among the poor.39

Poverty and Inequalities

Poverty and inequality are closely related to health outcomes. In other words, there is a social gradient in health meaning that the reduction of inequalities will have positive consequences on healthy life expectancy. However, while absolute poverty has decreased, relative poverty, measured by income inequality, is growing. According to a study by Oxfam, 70 percent of the world’s population live in countries where income inequalities grew during the last thirty years.40 Looking at cities only, three quarters of the world’s cities have higher levels of income inequalities today than 20 years ago.41

There are inequalities between nations and within nations among men and women and between social groups. There are also inequalities between generations, but there is no clear link. In some countries, poverty rates among older people are substantially higher than among the general population (e.g., in Australia and the Republic of Korea); in others, such as Brazil or Canada, old-age poverty rates are much lower than those for people of all ages.42

While, on the one hand, a huge part of wealth belongs to older persons and the ‘silver market’ is therefore recognized as an enormous potential, old-age poverty is an issue of growing importance in many parts of the world. In particular, among younger generations, the fear of living in old age in poverty is widespread. A representative study of the German population, for example, shows that two thirds of young adults (aged 18 to 34) believe that their financial situation in old age will not be secure.43 This fear is linked to attempts to reform pension systems and questions around the sustainability of existing systems.

Advances in Human Rights

Since the adoption of the Universal Declaration of Human Rights in 1948, the discourse on human rights has gained prominence, and a real paradigm shift from a needs-based to a rights-based approach to development has happened. This approach means a move away from service delivery. The establishment of international legal instruments, such as conventions on the rights of specific population groups – for instance, people with disabilities – goes along with this shift. During the last years, specifically since 2010 when the Open-Ended Working Group on Aging at the United Nations was established, a growing awareness of the challenges resulting from population aging and of the rights of older persons have been increasingly recognized. While the Open-Ended Working Group continues to consider the existing framework for older persons’ rights, it is also identifying gaps and studying the feasibility of further international instruments, as existing instruments are argued to not suffice by several member states of the UN and by civil society.

On the one hand, existing instruments, such as the Vienna and Madrid International Plans on Action on Ageing from 1982 and 2002, respectively, are comprehensive international policy instruments which specifically address older persons’ human rights, but they do not have any legal power. They are legally non-binding ‘soft law.’ On the other hand, there are other legally binding international instruments, such as the Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families that do explicitly prohibit age discrimination. This Convention is, however, only applicable to this specific population group.

This is why there is an increasing push towards an International Convention on the Rights of Older Persons. Since the establishment of the OEWG, important steps have been made towards the recognition of older persons’ rights, including the creation and appointment of the new post of an Independent Expert on the Enjoyment of All Human Rights by Older Persons in 2013 and 2014 respectively, and the adoption of the Inter-American Convention on Protecting Human Rights of Older Persons in 2015.44 As of yet, no legally binding instrument has been developed at the international level.

3. Policy Action in Response to the Longevity Revolution

One of the most popular roadmaps to formulate policy action on population aging is the World Health Organization’s Active Ageing Policy Framework, published in 2002, and recently revisited by the International Longevity Centre Brazil (ILC-Brazil). The framework, which aims at promoting active aging through a holistic approach towards policymaking, is in use across the world to guide policy. In Australia, for instance, provincial governments are committing to the concept of active aging and its practical application of age-friendly cities. In Brazil, a federal law was abolished in 2013 which commits the government to establishing an interministerial committee on active aging. And in Malta, a National Strategic Policy for Active Aging has been developed to guide policy until 2020.

Active Aging, as defined by WHO, is the process of optimizing opportunities to participation, health, and security as people age.45 Due to an increasing focus on lifelong learning and empowerment, a fourth pillar of active aging has recently been added, so that the following definition is increasingly used: “Active Aging is the process of optimizing opportunities for health, lifelong learning, participation and security in order to enhance quality of life as people age.”46

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