From a leading expert on longevity, an urgent call for individuals, institutions, and society to adapt to the reality of living longer lives Thanks to increases in life expectancy, we can now expect to live for a long time. Most of us would welcome an extra day in the week, so why do so many of us view the prospect of additional years with fear and skepticism? The reason is society is not currently structured to support long lives. Rather than thinking in terms of the needs of a rising number of older people, we must instead support the young and middle-aged to prepare differently for the longer futures they can expect.   

The Longevity Imperative outlines the innovations needed to make the most of these longer substantial changes to our health system, economy, and financial sector, as well as in how we manage our careers, health, finances, and relationships. Instead of seeing longevity as a problem, economist Andrew J. Scott challenges us to view it as an opportunity. This book charts a course to address the individual, social, political, economic, and cultural changes required so that all of us—regardless of age—can live lives that are not just longer but healthier, happier, and more productive. 

The Longevity Imperative Book Review

Although Andrew Scott is a world leading economist, The Longevity Imperative is not a text book or academic work, it's a thought-provoking popular economics book with some really useful advice on how to start planning for longer lives - both for governments and, more importantly for the reader, at a personal level too. For example, he examines the various trade-offs around financing a longer life - not prescribing a specific action plan, but noting the options for people with different views on how they want to live their lives. And he's not hidden away in an ivory tower, he regularly highlights inequality in society and how changes needed due to longer lives could also benefit everyone.

The financially minded may find it a bit repetitive in places, but these are big changes to the way we think about work and retirement, so they need to be reinforced several times over. For people, like me, that are mainly focused on the biology of ageing and improvements in rejuvenation treatments, this is a useful book to start considering what impact this will have on us financially, and therefore how our careers and retirement planning could change.

Highlights

Here are 101 key points from The Longevity Imperative:

• The fastest-growing demographic in the world is people aged a hundred or more.
• The better we get at growing old, the more we will want to live for even longer in better health.
• Since the 1880s best practice life expectancy has increased on average by two to three years every decade.
• Today in the US and UK, the total fertility rate has fallen to an average of only 1.65 births per female lifetime.
• A quarter of all countries will experience a declining population between now and 2050.
• Most of the gains to life expectancy are now concentrated at older ages.
• Increasing midlife mortality (aka deaths of despair) has played a significant role in America’s poor record on life expectancy.
• After getting through childhood our risk of dying doubles roughly every seven or eight years.
• It is older workers who account for the majority of employment growth in richer countries.
• Historically, mortality rates were so high at all ages that it was dying of old age that was seen as unnatural.
• Modern health systems have become more successful at keeping us alive but not in reducing the incidence of disease.
• Another factor that the Blue Zones have in common and which explains their remarkable number of centenarians. Bad recordkeeping.
• In the US, obesity prevalence is estimated at more than 40 percent.
• People who have a positive concept of aging go on to live longer than others.
• Being lonely or unhappy adds up to 1.65 years on your biological age.
• It is healthy life expectancy we should focus on and not life expectancy.
• A naked mole rat isn’t immortal - it has a near constant mortality rate, not a zero one.
• If the chance of dying each year is less than one in a thousand then life expectancy stretches far out into the next millennium.
• UK male mortality rate at seventy is 2 percent - if this continued then life expectancy would be 106.
• In the UK, if a treatment can add one more QALY (quality-adjusted life years) to a patient’s life, it is deemed to represent good value if it doesn’t cost more than £ 30,000.
• Health is valuable to us in its own right regardless of its financial implications.
• In 2022 the United States government pegged the VSL (value of a statistical life) at $ 11.4 million per life.
• The gains from slowing down how we age far exceed those from eradicating any single disease.
• We need a health system genuinely focused on health and prevention, not disease and intervention.
• Slowing down biological aging so as to produce one extra year of life expectancy with improved health at all ages is worth the equivalent of around 3–4 percent of GDP in a single year (for most countries).
• The biggest contributor to global deaths and disease is now age-related illnesses.
• We have fashioned a society that doesn’t invest enough in later years because for most of human history only a minority reached those ages.
• Only around 2.5 percent of total health expenditure in high-income countries is focused on prevention.
• Preventing a problem doesn’t get the same recognition as intervening to solve a problem.
• Tackling obesity as a health problem will be far from easy but then neither was achieving reductions in tobacco use.
• Sugar, salt and additives in particular will be subject to growing taxation and regulation.
• In the UK around one in five adults aged over forty are providing some form of adult care.
• We need to be sure that lowering measured biological age is the same thing as genuinely lowering our biological age.
• Aging isn’t recognized as a disease.
• The TAME trial methods have been designed to provide an FDA-approved template for the evaluation of drug targeting aging.
• Funding of longevity companies is increasing rapidly, reaching $ 5.2 billion in 2022.
• As a fifty-seven-year-old I find it perfectly reasonable to expect that I will still be around to benefit from these developments in terms of healthspan and maybe even lifespan.
• However well we sleep or exercise, getting to 150 will depend entirely on major breakthroughs in geroscience.
• There is currently zero evidence that the [maximum] human lifespan can be increased by even a day.
• For the vast majority of us longer lives require longer working careers.
• The key challenge for financing a longer life it is how to maintain our earning capacity for longer.
• Older people are disproportionately involved in volunteering and caring.
• Investing in health and education at older ages will be part of how we realize the economic longevity dividend.
• Raising the retirement age does nothing to actually make it possible for people to work for longer.
• Lengthening working careers without extending purpose and increasing productivity is undesirable.
• One in seven men aged sixty-five years in the UK are still working.
• It is imperative that governments should link retirement age to healthy life expectancy, not life expectancy.
• Older workers place a higher value on occupations with greater autonomy, the ability to set their own schedule, flexible hours, fewer physical demands and lower levels of stress.
• Only if there is a fixed number of jobs does older people working longer lead to unemployment for the young.
• Your motivation for working will shift at different ages and so too will what you seek in a job.
• There is no simple correlation between older workers and productivity.
• The workforce of the future will have a much more even spread across the ages.
• New career paths may also need to incorporate term limits on executive roles, ensuring turnovers at the top and chances of advancement for younger employees.
• In the UK, the government estimates 12.5 million individuals are undersaving given their retirement needs.
• People living for longer means pensions must be paid for longer.
• Globally, pension funds are estimated to have $ 56 trillion under management.
• Some people can work for longer and want to. Others can’t or don’t.
• To help with your financial planning you need to keep updating your likely longevity.
• Longer working careers require more education so more people are starting work later and with more debt.
• we need to start thinking about living insurance— finding ways to ensure we don’t outlive our resources in the event we live to a very old age.
• Pensions are vulnerable to rising prices; wages offer a better hedge against inflation.
• An annuity provides living insurance and avoids the need for everyone dying with money in the bank.
• A tontine in its purest form ends up with those who survive seeing their income grow so long as they outlive others.
• Life insurance companies like it when we live for longer, so some companies have already begun to offer incentives to keep you fit and well.
• Investing in biotech start-ups might be a form of living insurance. If geroscience companies make breakthroughs that extend your life expectancy then their share price should surge.
• In the UK, 54 percent of consumer spending is by the over fifties (£ 319 billion).
• In a 2022 IPSOS Mori poll of the British public only one in three hoped to live to be a hundred.
• Simone de Beauvoir believes the lack of purpose we fear when old is not a natural component of old age itself, but a reflection of the agism embedded in our culture and institutions.
• We cannot look to geroscience and technology to ensure a long life becomes a good life.
• Aristotle believed older people to be cynical because they had the misfortune of living long enough to see their hopes disappointed.
• Shouldn’t all forms of aging be considered successful given the alternative is dying?
• Old age might be redefined in thanatological terms as less than ten years left to live.
• The evergreen view is that not everything declines as you age and not everything that does decline matters.
• My identity hinges on psychological continuity, not physical regeneration.
• We struggle to identify with old age because it is about a future person who is different from whom we are today.
• When an older generation lives for longer it has an impact on younger generations.
• In your twenties you have other priorities and worrying about how you age is unlikely to be one of them.
• We need to ensure that paying to support their elders does not leave one generation better off at the expense of another.
• Older workers are now almost as likely to have college degrees as Gen Zers... bringing to an end decades of progress whereby children could expect to be better off than their parents.
• In the UK, for much of the second half of the twentieth century, the average house was worth around four times average earnings. By the end of 2022 that had risen to nine times average earnings.
• One opinion poll found that nearly three out of five Americans supported age limits on public service.
• A focus on access to opportunities at younger ages becomes an ever more important leveling policy in an evergreen era.
• Having all ages more equally represented in voting patterns is a key component and a means to intergenerational fairness.
• The main obstacle to serious reform is that governments continue to focus on aging issues in terms of pension and health care costs.
• Failing to recognize the diversity of health, wealth and capability in older age groups doesn’t make sense in an evergreen world.
• The UK is now five years behind best practice life expectancy and the US more than eight.
• Setting a target for healthy life expectancy would be the first step to directing our health system to healthy outcomes in an evergreen manner.
• Our knowledge will increase faster than any increase in the complexity of human biology.
• Economists categorize health as a “luxury good.”
• We need governments to start developing some moonshot thinking around aging and longevity.
• In Japan the number of empty homes is expected to reach 10 million in 2023.
• Already a number of countries are providing financial incentives to boost fertility.
• In Hungary, women are given a lifetime exemption from income tax if they have four or more children.
• An increasingly popular BirthStrike movement that advocates childlessness as an important step toward sustainability.
• The tendency for fertility rates to fall with longer lives limits the increase in population that comes from extending life expectancy.
• Derek Parfit's Repugnant Conclusion is the idea that it is better to see a larger number of people existing even if they have lives that are barely worth living than seeing a smaller population with a higher quality of life.
• If we live unsustainably, we will eventually reach a tipping point however many children we do or don’t have.
• Hopefully future generations will thank us for the progress we make [towards evergreen lives].
• Don’t underestimate the capacity of your later years.
• Society will adapt to a new reality but not as fast as you can.
• Life goes on, but today it goes on for longer.