Impact of aging research besides LEV

This is the third post of a se­ries in which I’m try­ing to build a frame­work to eval­u­ate ag­ing re­search. Pre­vi­ous posts:

1. A gen­eral frame­work for eval­u­at­ing ag­ing re­search. Part 1: rea­son­ing with Longevity Es­cape Velocity

2. Aging re­search and pop­u­la­tion ethics

Summary

Age-re­lated dis­ease and de­cline ac­count for, more or less, 30% of to­tal DALYs in the 2017 Global Disease Re­port made by the World Health Or­gani­sa­tion, and the figure is ris­ing sharply each year. Aside from DALYs lost, there’s ev­i­dence that age-re­lated dis­ease and dis­abil­ity nega­tively im­pact life satis­fac­tion. Bet­ter health­care for age-re­lated dis­eases would re­sult in so­cial and eco­nomic benefits, such as an in­creased global work­force, a de­crease of so­cial bur­den due to age-re­lated dis­eases, a de­crease in in­di­vi­d­ual health­care ex­pen­di­ture, and less strain on the so­cial se­cu­rity sys­tems, pen­sion sys­tems, and health­care sys­tems of the world’s gov­ern­ments. Cur­rently, all these vari­ables are wors­en­ing due to an ag­ing global pop­u­la­tion. Ex­am­ples of other, more sub­tle, sources of im­pact could be an in­creased con­cern for the long-term fu­ture along with more preser­va­tion of knowl­edge, which could re­sult in new break­throughs and im­proved day-to-day hu­man ac­tivi­ties.

Aging re­search would also im­pact pets in similar ways to hu­mans, as similar con­sid­er­a­tions about LEV and DALYs averted ap­ply.

DALYs averted

The last Global Bur­den of Disease re­port from the World Health Or­gani­sa­tion was made in 2017. It re­leased a handy data vi­su­al­i­sa­tion tool, from which we can ex­tract the frac­tion of DALYs at­tributable to age-re­lated dis­eases and de­cline and their an­nual per­cent change from 1990 to 2017. If you sum the per­centages, also try­ing to ac­count for the frac­tion of age-re­lated ail­ments not nec­es­sar­ily caused by ag­ing (al­though this could be un­nec­es­sary, since even if some of these dis­eases ap­pear also in the young, they share the same un­der­ly­ing char­ac­ter­is­tics), the per­centage of to­tal DALYs you get is more or less 30%. Some age-re­lated dis­eases and ail­ments ac­count­ing for a large frac­tion of DALYs are: Is­chemic heart dis­ease: 6.83%, Stroke: 5.29%, Di­a­betes Mel­li­tus: 2.71%, Back pain: 2.59%, Lung can­cer: 1.64%, Hear­ing Loss: 1.36%, Alzheimer’s: 1.22%, Blind­ness: 0.71%

The weighted av­er­age of an­nual per­cent change is pos­i­tive and sharp, as ex­pected from the ag­ing of the world pop­u­la­tion and a bet­ter con­trol of com­mu­ni­ca­ble dis­eases wor­ld­wide. The per­cent an­nual change for some of the most im­pact­ful dis­eases: Di­a­betes Mel­li­tus: +1.58% Os­teoarthri­tis: +1.53%, Alzheimer’s +1.55%, Hear­ing Loss: +0.9%, Blind­ness: +0.81%, Lung can­cer: +0.48%, liver can­cer: +0.37%, col­orec­tal can­cer: +0.56%, breast can­cer: +0.67%. Most im­pact­ful age-re­lated dis­eases that pre­sented nega­tive an­nual per­cent change: Stomach can­cer: −1.29%, Stroke: −0.22%.

It’s also in­ter­est­ing to point out that age-re­lated dis­eases are the lead­ing cause of death in the world, with car­dio­vas­cu­lar dis­eases and can­cers alone caus­ing al­most 50% of to­tal deaths. Even if the pop­u­la­tion is re­stricted to only 15-49 year olds, these two dis­eases re­main the lead­ing cause of death, and they share the same char­ac­ter­is­tics.

SarahC, the founder of The Longevity Re­search In­sti­tute, wrote an overview of the po­ten­tial cost-effec­tive­ness of the cause area, us­ing DALYs as a mea­sure of im­pact. She also wrote a more in-depth ar­ti­cle than this sec­tion, with all the rele­vant statis­tics about DALYs and deaths caused by ag­ing us­ing in­for­ma­tional graphs and pic­tures.

Im­pact on life satisfaction

Aside from DALYs lost, there’s ev­i­dence that age-re­lated dis­ease and dis­abil­ity nega­tively im­pact life satis­fac­tion. Sarah Con­stantin lays out the ev­i­dence in the sec­ond part of her ar­ti­cle about the im­pact of age-re­lated dis­eases.

While peo­ple tend to weigh phys­i­cal dis­abil­ity as less im­pact­ful on hap­piness than men­tal ill­ness, the data seems to roughly sug­gest that more se­vere DALY bur­den and mor­tal­ity goes along with less hap­piness. In fact, peo­ple en­ter­ing se­vere dis­abil­ity suffer a sus­tained loss in life satis­fac­tion. Ac­cord­ing to the Gal­lup World Poll, health is pos­i­tively cor­re­lated (r=0.25, p<0.01) with life satis­fac­tion across coun­tries, but it’s not the largest effect; so­cial sup­port and GDP have larger cor­re­la­tions. Ac­cord­ing to the World Values Sur­vey, self-re­ported “ex­cel­lent health” had the sec­ond-largest effect size on life satis­fac­tion, and ac­cord­ing to a 43-coun­try Pew Re­search poll, peo­ple in emerg­ing mar­kets were most likely (68%) to rate as “very im­por­tant” good health among var­i­ous op­tions, such as good ed­u­ca­tion (65%) for chil­dren, safety from crime (64%), and own­ing a home (63%). Ac­cord­ing to a Gal­lup poll, Amer­i­cans rate fam­ily and health as the most im­por­tant as­pects in life, more than work, friends, money, re­li­gion, leisure, hob­bies, and com­mu­ni­ties.

The longevity dividend

The term “longevity div­i­dend” is of­ten used to re­fer to the health, so­cial, and eco­nomic benefits that re­sult from de­layed ag­ing. Here, I will use it to re­fer to the so­cial and eco­nomic benefits.

Let’s go through some ob­vi­ous ones: peo­ple would be able to con­tribute to the econ­omy for longer and would be less of a bur­den on it. In­di­vi­d­ual health­care ex­pen­di­tures would fall, since half of life­time ex­pen­di­ture on health­care is made in the last ten years of life.

Some so­cietal is­sues, which would be amelo­ri­ated by bet­ter treat­ment of the dis­eases and dis­abil­ities of ag­ing, are cur­rently wors­en­ing due to an in­creas­ingly aged world pop­u­la­tion. This trend is due to de­creas­ing mor­tal­ity due to in­fec­tious dis­eases and other causes of death along with a fer­til­ity rate de­creas­ing hand-in-hand with im­proved stan­dards of liv­ing all over the world.

Cur­rent geri­atric medicine isn’t able to ad­dress these prob­lems. On the con­trary, it wors­ens them, since it lets peo­ple live longer in ill health. The goal and the di­rec­tion of mod­ern biogeron­tol­ogy, in­stead, is to pro­long life in good health. In fact, this anal­y­sis is about the im­pact of ad­vanc­ing ag­ing re­search and not in­creas­ing geri­atric health­care fund­ing.

Ac­cord­ing to the United Na­tions Pop­u­la­tion Prospects:

The global pop­u­la­tion is age­ing as fer­til­ity de­clines and life ex­pec­tancy in­creases. In 2015, 12 per cent of the global pop­u­la­tion, or 901 mil­lion peo­ple, were aged 60 or over. The num­ber of older per­sons is grow­ing at an an­nual rate of 3.3 per cent, faster than any other age group. Due to a pro­jected over­all re­duc­tion in fer­til­ity, pop­u­la­tion age­ing will con­tinue at high lev­els globally, and by 2050, 22 per cent of the to­tal pop­u­la­tion, or 2.1 billion per­sons, will be aged 60 or over. Cur­rently, Europe has the high­est per­centage of pop­u­la­tion aged 60 or over (24 per cent), but rapid age­ing will oc­cur in other parts of the world as well. All ma­jor ar­eas of the world, ex­cept for Africa, will have nearly a quar­ter or more of their pop­u­la­tions aged 60 or over by 2050. Coun­tries need to an­ti­ci­pate and plan for pop­u­la­tion age­ing and en­sure the well-be­ing of older per­sons with re­gard to the pro­tec­tion of their hu­man rights, their eco­nomic se­cu­rity, ac­cess to ap­pro­pri­ate health ser­vices, and for­mal and in­for­mal sup­port net­works.

The trend is prov­ing true all over the world, less de­vel­oped na­tions in­cluded.

Less-de­vel­oped na­tions cur­rently don’t have the eco­nomic means to face the bur­den of an ag­ing pop­u­la­tion and are already fac­ing in­creased mor­tal­ity form age-re­lated dis­eases. This poses a very se­ri­ous prob­lem for these na­tions’ health­care sys­tems and so­cial se­cu­rity sys­tems.

In his ar­ti­cle on Global Risks In­sight, pro­fes­sor of Fi­nance and Eco­nomics An­to­nio Guar­ino sums up the prob­lems that are in­creas­ingly aris­ing in so­cial se­cu­rity, pen­sions and health­care due to an ag­ing pop­u­la­tion.

Se­cu­rity sys­tem and pen­sions:

One key eco­nomic im­pli­ca­tion of an ag­ing pop­u­la­tion is the strain on so­cial in­surance pro­grams and pen­sion sys­tems. With a large in­crease in an ag­ing pop­u­la­tion, many na­tions must raise their bud­get al­lo­ca­tions for so­cial se­cu­rity. For ex­am­ple, In­dia’s so­cial se­cu­rity sys­tem presently cov­ers only 10 per­cent of its work­ing-age pop­u­lace, but its sys­tem is op­er­at­ing at a deficit with more funds ex­it­ing than en­ter­ing. In the United States, pro­jec­tions state that the level of so­cial se­cu­rity con­tri­bu­tions will start to fall short of leg­is­lated benefits this year.
In other words, the amount of money com­ing into so­cial se­cu­rity will lessen due to fewer con­tri­bu­tions from work­ers and more funds go­ing to an ag­ing re­tired pop­u­la­tion. In Europe, in or­der to fund their so­cial se­cu­rity sys­tem, 24 na­tions have pay­roll tax rates equal­ing or ex­ceed­ing 20 per­cent of wages. The situ­a­tion is also pre­car­i­ous for pen­sions. As the global pop­u­la­tion for el­derly and re­tired work­ers in­creases, pen­sions must provide more in­come to these re­cip­i­ents so that they can en­joy at least a rea­son­able stan­dard of liv­ing.
The prob­lem for pen­sions is the de­clin­ing num­ber of younger work­ers thus re­sult­ing in lower funds be­ing con­tributed and ne­ces­si­tat­ing a higher re­turn for their in­vest­ments. The prob­lem is com­pounded when pub­lic pen­sion plans in cer­tain na­tions ac­tu­ally en­courage work­ers to re­tire early, thus mak­ing re­tiree pay­outs more ex­pen­sive than ever be­fore.

Health-care sys­tem:

Another key eco­nomic im­pli­ca­tion of an ag­ing pop­u­la­tion is the in­crease in health care costs. As the pop­u­la­tion ages, health gen­er­ally de­clines with more med­i­cal at­ten­tion re­quired such as doc­tor vis­its, surgery, phys­i­cal ther­apy, hos­pi­tal stays, and pre­scrip­tion medicine.
There are also in­creased cases of can­cer, Alzheimer’s, and car­dio­vas­cu­lar prob­lems. All of this costs money and will in­crease not only due to ris­ing de­mand by an ag­ing pop­u­lace, but also be­cause of in­fla­tion. For ex­am­ple, in the United States, it is pro­jected that pub­lic health ex­pen­di­tures will rise from 6.7 per­cent of GDP in 2010 to 14.9 per­cent in the year 2050. This in­crease in health care costs will mean that na­tions must put more funds and hu­man re­sources into pro­vid­ing health care while also at­tend­ing to the needs of other seg­ments of their peo­ple.
With an in­creas­ing aged pop­u­la­tion, there will also be short­ages of skil­led la­bor trained to care for aged pa­tients. It is pro­jected that the reg­istered nurse work­force in the United States will see a de­cline of nearly 20 per­cent by 2020 which is be­low pro­jected re­quire­ments.

He con­cludes with the prob­lem aris­ing form a de­clin­ing global work­force:

With an ag­ing global pop­u­la­tion, eco­nomic growth will also be im­pacted. Most im­por­tantly, there will ul­ti­mately be less work­ers available for firms to make prod­ucts and provide ser­vices. This shrink­ing la­bor force will mean that fewer work­ers must sup­port greater num­bers of re­tirees since they must pay taxes for so­cial se­cu­rity, health care pro­grams, and pub­lic pen­sion benefits. The global work­force will shrink caus­ing policy and eco­nomic con­cerns. For ex­am­ple, In­dia is ex­pected to see a 46 per­cent in­crease in its work­ing-age pop­u­la­tion over the next quar­ter cen­tury, how­ever, there will be markedly slower eco­nomic growth of only 9 per­cent over the fol­low­ing 20 years. In or­der for In­dia to be­come a ma­jor player in the world econ­omy, it must have a grow­ing and vibrant work­force.
Na­tions, such as China and Mex­ico, are ex­pected to wit­ness de­clines in their work­force from the year 2030 to 2050. Other large economies such as Ja­pan are pro­jected to see a 19 per­cent de­crease in their worker pop­u­la­tion within the next 25 years fol­lowed by a 24 per­cent de­crease over the next 20 years. Europe is also ex­pected to see de­clin­ing num­bers in its work­force which will im­pact their chance to have a grow­ing, com­pet­i­tive econ­omy.
This de­cline in the global work­force will lead to an in­crease in the age de­pen­dency ra­tio which is the ra­tio of work­ing-age to old-age in­di­vi­d­u­als. Globally, the de­pen­dency ra­tio in 1970 was 10 work­ers for each in­di­vi­d­ual over age 64, but the ex­pected ra­tio in 2050 is four work­ers for each per­son over 64.

Ad­di­tional sources about the topic of this ar­ti­cle in­clude Statis­tics on health­care ex­pen­di­ture or­ganised by Our World in Data, The Life­time Distri­bu­tion of Health­care Costs, and The Health and Wealth of Na­tions, a land­mark pa­per about the pos­i­tive cause-effect re­la­tion­ship be­tween the health of a na­tion and its econ­omy.

Ther­a­pies tar­get­ing ag­ing could ame­lio­rate all of these prob­lems by pro­vid­ing true tech­nolog­i­cal solu­tions to ag­ing as op­posed to pro­long­ing ill health with­out treat­ing its causes. In the long run, the best-case sce­nario could be the en­tire pop­u­la­tion be­ing healthy enough to con­tribute to the econ­omy, with health­care ex­pen­di­tures re­duced only to treat­ments that di­rectly cure ill health (the elimi­na­tion of geri­atric medicine) with prices be­ing re­duced over time; a pen­sion sys­tem would also be un­nec­es­sary.

Th­ese benefits are the most ap­par­ent ones. There could be sub­tler ones not im­me­di­ately ob­vi­ous from cur­rent trends or data or which are just guesses for which con­clu­sive data is cur­rently lack­ing. Ex­am­ples (see this com­ment for more):

  • It’s pos­si­ble that longer lived peo­ple would care about longer term is­sues, like cli­mate change and ex­is­ten­tial risk.

  • Longer lifes­pans could mean more per­sonal ex­pe­rience and knowl­edge be­ing pre­served. This could help to make dis­cov­er­ies oth­er­wise not ac­cessible only with knowl­edge and in­sight gained in a nor­mal hu­man lifes­pan, but could also help ev­ery other hu­man ac­tivity, like par­ent­ing.

Im­pact on non-hu­man animals

All of the high-level con­sid­er­a­tions about LEV and avert­ing DALYs writ­ten in this post and in the pre­vi­ous ones also ap­ply to pets. It’s also pos­si­ble that effec­tive re­ju­ve­nat­ing ther­a­pies will ar­rive for cer­tain kinds of pets be­fore they ar­rive for hu­mans.

I ex­pect im­pact to be very large on this cat­e­gory, pos­si­bly ri­val­ing the one on hu­mans. Even if a small minor­ity of pet own­ers will be able to af­ford ther­a­pies for their pets at first, the frac­tion would likely in­crease as prices fall. It’s also wor­thy to note that the same proof I laid out in my pre­vi­ous post ap­plies: how a tech­nol­ogy spreads and how much time it takes to reach its max­i­mum share of us­age doesn’t im­pact cost-effec­tive­ness eval­u­a­tions if the source of im­pact is has­ten­ing the ar­rival of that tech­nol­ogy.

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Cross­posted to LessWrong