US National Academy of Medicine Commission Recommends ‘All-Of-Society’ Approach to Healthy Longevity
Healthy longevity will require a multidisciplinary approach and the inclusion of older people in designing systems for healthy longevity and anchoring action in the community.
The US National Academy of Medicine (NAM)’s Global Roadmap for Healthy Longevity enlists an independent international commission of experts to identify challenges and propose innovative solutions to foster healthy longevity through strategies related to the social and behavioral enablers of health, health care and public health systems, and science and technology. The 300+ page report “(1) comprehensively addresses the challenges and opportunities presented by global aging population; (2) catalyzes breakthrough ideas and research that will extend the human healthspan; and (3) generates transformative and scalable innovations worldwide.
Defined as a state in which years in good health approach the biological life span, with physical, cognitive, and social functioning that enables well-being across populations, healthy longevity minimizes societal and individual burdens while increasing human and social capital. The roadmap aligns with other overlapping global efforts currently under way, including the United Nations (UN) Decade of Healthy Ageing and the UN Sustainable Development Goals (SDGs).
The commission recognizes that healthy longevity requires multiple complex systems working together and the political, fiscal, cultural, and other factors that will facilitate, rather than challenge, a future of healthy longevity. Mitigating the challenges posed by and for the global aging population will require broad, systematic change and deliberative action across basic and translational science; clinical medicine and health care; personal, social, economic, and environmental determinants; and policy and financing.
Goals for Initiating the Transformation to Healthy Longevity
The commission identified the following changes that should occur from now to 2027 to start transformation of all of society, towards Vision 2050 and the creation of healthy longevity for all:
Creating social cohesion, social engagement and addressing the social determinants of health through social infrastructure are among the most effective determinants of slowed aging and the prevention of chronic conditions across the life course.
Financial security in older age is essential for all.
Governments, the private sector and civil society should partner to design physical environments and infrastructure that are user-centered, and function as cohesion-enabling intergenerational communities for healthy longevity. Initiatives should focus on the inclusion of older people in the design, creating public spaces that promote social cohesion and intergenerational connection as well as mobility, physical activity and access to food, transportation, social services and engagement.
By 2027, governments should develop strategies and plans to arrive at adequately sized, geriatrically knowledgeable public health, clinical and long-term care workforces, and an integration of the pillars of the health system and social services. Together, these dimensions would foster and extend years of good health and support the diverse health needs and well-being of older people.
Governments should work to build the dividend of health longevity in collaboration with the business sector and civil society, to develop policies, incentives, and supportive systems that enable and encourage lifelong learning, and greater opportunities and necessary skills to engage in meaningful work or community volunteering across the lifespan.
Other key findings:
The Virtuous Cycle of Healthy Longevity
The commission anchored the roadmap in a vision for a realistic and optimistic future with healthy longevity. In that vision, healthy longevity triggers a virtuous cycle whereby it both benefits from and enables a lifetime with meaning, social engagement, learning, and growth. Together, health and productive engagement build social, human, and financial capital. Increased capital, in turn, fuels the systems that support health, social needs, the physical
environment, education, and productive engagement through work and formal or informal volunteering, and these systems, collectively, support health and productive engagement.
Major disrupters of this virtuous cycle include ageism, disease, poverty, pollution, and inequity. Societies with healthy longevity are expected to thrive with a new social compact based on social cohesion and equity The commission concludes that healthy longevity will contribute to growth in gross domestic product (GDP), personal savings, and government coffers.
Prevention Targeting Shared Risk Factors
The most effective strategy for prevention of population-wide chronic conditions involves addressing adverse effects of social determinants of health and unhealthy environments. Also effective is changing the context by making the healthy choice for behaviors with the greatest impact on health the easy choice.
Preventing chronic conditions is most effective when public health agencies undertake multifaceted campaigns that include limits on advertising, public health and education messaging, taxes, financial incentives, and targeted community-based programs. Prevention focused on one disease at a time is less effective than efforts targeting the shared risk factors for biological aging and chronic conditions.
Labor Force Participation
To maintain current standards of living over longer lives in the face of demographic change, people will need to be healthier and engaged longer. The commission argues that increasing workforce participation among people over age 50 in high-income countries by giving people who have the desire or need to work the opportunity to do so is the best way to harness healthy longevity in service to those countries’ economies. This strategy will offset predictions that larger populations of older people will harm economies.
Restructuring of Health Care Systems
The commission recommends restructuring healthcare systems to include integrated, person-centered care, as described by the World Health Organization (WHO), delivered by a provider who is responsible for coordinating a person’s care across settings and, when possible, by an interdisciplinary team and mechanisms to promote collaborative relationships with social service providers, which can help address social determinants of health. Comprehensive and shared health records that include a care plan based on the person’s goals, preferences, and values, and health care systems that leverage data systems to inform individual and population care, monitor quality, and identify effective therapeutics and interventions for patient
A Fundamental Shift
The study points to the fact that many health systems were developed at a time when life expectancy was approximately 50 to 70 years and have not been properly incentivized to adapt to better care for people who are regularly living more than 70 years. Adapting our health systems to be able to care for the health of older people requires a fundamental shift in preparing for population aging to maximize the number of years lived in good health—not simply extend the number of years lived.
Reducing ageism, improving social cohesion, ensuring financial security, and boosting digital literacy are all critical aspects in ensuring that society is prepared to support individuals as they age. Reimagining the physical environment of our cities and communities, including housing and neighborhoods, improving access to public transportation, and combating climate.