《花旗銀行（Citi GPS）：2024年擁抱人口轉型：老齡化世界中的健康與財富研究報告（英文版）（70頁）.pdf》由會員分享，可在線閱讀，更多相關《花旗銀行（Citi GPS）：2024年擁抱人口轉型：老齡化世界中的健康與財富研究報告（英文版）（70頁）.pdf（70頁珍藏版）》請在三個皮匠報告上搜索。

1、Citi is one of the worlds largest financial institutions,operating in all major established and emerging markets.Across these world markets,our employees conduct an ongoing multi-disciplinary conversation accessing information,analyzing data,developing insights,and formulating advice.As our premier

2、thought leadership product,Citi GPS is designed to help our readers navigate the global economys most demanding challenges and to anticipate future themes and trends in a fast-changing and interconnected world.Citi GPS accesses the best elements of our global conversation and harvests the thought le

3、adership of a wide range of senior professionals across our firm.This is not a research report and does not constitute advice on investments or a solicitations to buy or sell any financial instruments.For more information on Citi GPS,please visit our website at GPS:Global Perspectives&Solutions July

4、 2024Embracing Demographic TransitionHealth and Wealth in an Aging World Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 Andrew Pitt Head of Global Insights and Content Citi Nathan Sheets Global Chief Economist Citi Research Alex Miller Head of Product Citi Global Insights Amy Thompson Soc

5、ial Economist Citi Global Insights Katsuhiko Aiba Japan Economist Citi Research Rob Garlick Head of Technology,Innovation,and the Future of Work Citi Global Insights Erika Irish Brown Chief Diversity,Equity and Inclusion Officer and Head of Talent Citi Chuck Cavanaugh Head of Financial Planning Citi

6、 Personal Wealth Management Adnan Memon Business Advisory Services Citi Global Insights Adam Spielman Head of Health and Consumer Citi Global Insights Diane Wehner Senior Portfolio Manager Citi Global Wealth Wendy Agnew Senior Portfolio Manager Citi Global Wealth Guest Contributors Professor Ian Gol

7、din Professor of Globalization and Development Oxford University Professor Carl Frey Associate Professor of AI and Work Oxford Internet Institute Dr Michael Devoy Chief Medical Officer Bayer Michael Hodin CEO Global Coalition on Ageing Melissa G.Mitchell Executive Director Global Coalition on Ageing

8、 With thanks to:Louise LaFortune,Andreas Theodoulou and Timandrah Brown July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 3 EMBRACING DEMOGRAPHIC TRANSITION Health and Wealth in an Aging World One of the most dramatic societal shifts of the 21st century will be the demographic

9、 transition to a population that is older than it ever has been.In the nineteenth century,no continent had a life expectancy of more than 40 years.By 2019,the average person could expect to live to 73 years old.Driven by declining childhood mortality and improved access to high-quality healthcare,th

10、ese gains in life expectancy are an extraordinary achievement of global development.Declining fertility compounds population aging,and it is driven by efforts in global development too.Rising rates of education and increased access to contraception have pushed down the number of children that famili

11、es have.Yet population aging has far-reaching consequences that governments,businesses,and wider society must reckon with.Economists have already sounded the alarm bells on some of these consequences:a ballooning older population will be dependent,they say,on a working-age population that is too sma

12、ll to support it.We argue that,while the trend towards a population that is older than it ever has been is intractable,the trend towards an increasingly dependent one need not be.In this report,we collate perspectives from across Citi and our global network to explore how our extra years of life exp

13、ectancy can be lived as social contributors rather than dependents.From these expert contributions,we find that supporting the health and wealth of an aging population are the levers to pull if our aim is to minimize the dependence of an aging population.We see four dimensions:Maximizing the economi

14、c contribution of older groups,including evolving labor markets in support of longer working lives.Supporting economic resilience in later life,through financial inclusion and incorporating longevity into financial planning.Preventing the onset of dependence by supporting healthy aging,including the

15、 shift to a more preventive healthcare system.Ensuring access to affordable healthcare for all,including boosting the supply of care work and joining up health and care systems.This demographic transition is not happening in a vacuum:some wider shifts already abate the potential economic consequence

16、s of population aging.For example,technologies like artificial intelligence which could prop up the productivity of a shrinking workforce are already being adopted.Other elements of the response require more action like joining up health and social care or increasing labor market flexibility.We ther

17、efore conclude the report with concrete recommendations for businesses to respond to the demographic transition,which we have co-produced with the Global Coalition on Aging.We hope this report helps to shift the discussion of population aging towards an optimistic vision in which we can spend our ex

18、tra years as healthy and active participants in flourishing,and merely numerically older,societies.After all,what good are longer lives if we cannot truly live them?Source:UN World Population Prospects(2022)2024 CitigroupEmbracing Demographic TransitionGlobal population is older than everThe“populat

19、ion pyramid”is changing shape.Increased life expectancy drives a widening at the top of the pyramid at the same time as declining fertility shrinks younger age groups at the bottom of it.85+80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-145-90-485+80-8475-7970-7465-6960-645

20、5-5950-5445-4940-4435-3930-3425-2920-2415-1910-145-90-42040 Europe and North America50,000Female50,000Male2000 Europe and North America50,000Male50,000FemaleSupporting economic resilienceThere are already concerns about the economic resilience of future retirees,especially those in lower socioeconom

21、ic groups.Source:World Bank,Global Findex Database(2021)USAEducation-Related Savings GapIncome-Related Savings GapJapanGreat BritainGermany80%70%60%50%40%30%20%10%0%Share of less educated groups saving for old age(%ages 15+)Share of more educated groups saving for old age(%ages 15+)Share of lower in

22、come groups saving for old age(%ages 15+)Share of higher income groups saving for old age(%ages 15+)Development drives agingDeclining fertility and increasing life expectancy have been among the aims of global development work for decades and they result in population aging.As development increases,

23、fertility trends downwards.876543210Total Fertility Rate(2015-2020)0.30.50.70.91.00.80.6Human Development Index(2019)0.4NigerYemenJapanNorwaySource:UN Human Development index(2024)and UN World Population Prospects(2022)Share of populationShare of health spendingFacilitating access to good healthAn i

24、ncreasing number of over 65s might risk driving up healthcare-related spending.100%80%60%40%20%0%Source:KFF analysis of 2021 Medical Expenditure Panel Survey data 0-18 19-34 35-44 45-54 55-64 65-84 85+36%Ages 65+34%Ages 45-6430%Ages 0-44Increasing Life Expectancy Access to HealthcareDeclining Childh

25、ood Mortality Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 6 Contents Foreword from Professor Ian Goldin 7 Chapter 1:The Demographic Story 9 Chapter 2 Minimizing the Dependence of an Older Population 26 Chapter 3 Perspectives on the Wealth of an Aging Population 30 Chapte

26、r 4 Perspectives on the Health of an Aging Population 49 Conclusion Responding to Population Aging 63 July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 7 Foreword from Professor Ian Goldin The combination of lower fertility and aging is having a dramatic demographic and econom

27、ic impact,and the world of business has an enormous role to play in shaping the societal response.Life expectancy has increased by about 2 years per decade over the post-war period and globally,its still increasing.At the same time,fertility is declining everywhere,and in over half the countries of

28、the world is below the replacement level of an average of 2.1 children per adult woman.A range of circumstances lead to changes in fertility rates and aging.These trends can be changed by disasters,wars,conflicts,pandemics,poverty,and economic crises but generally as countries get richer and more ur

29、banized,as women get rights and jobs,as girls get educated,and as contraception offers the potential to make choices,fertility declines.The decline in fertility is destiny and its universal,across countries with different cultures,religions,and political systems.The increased cost of living associat

30、ed with children which includes needing bigger homes and paying for the cost of raising a child is another factor.In rural communities,the benefits have also declined:children previously looked after the animals and helped with the harvest but fewer people now live in the countryside and young adult

31、s tend to leave home for the cities and are not around to care for their aging parents.The growing cost of children and the decline of family support systems is a global phenomenon,as is the progress,although much too slow,in women having more education,jobs and choice.The consequences of this trans

32、ition are manifold As a result of the combination of fertility declines and an aging population,the workforce will contract,and dependency ratios will increase.A shrinking workforce means a declining tax revenue base at the same time expenditure to care for the elderly is increasing.The consequences

33、 for social security and retirement are also significant.When social welfare packages were developed over fifty years ago,average life expectancy on retirement was about 7 years and real risk-adjusted returns were about 4%.Since then,average life expectancy has increased by over a decade,the age of

34、retirement has come down,and real risk-adjusted returns are barely positive.The result is that people need to save 50 to 100 times more now than when these packages were built.Key questions are where will this money come from,which asset classes will it go to,and who will manage these investments?Th

35、e consequences for consumption patterns are also significant:when elderly people spend down their savings,they will spend on different things to what they would have as young people.Increasingly,the elderly will hold onto their assets and the inter-generational wealth divide will get bigger.The grow

36、ing share of elderly people in the population also means that they will become increasingly significant politically.Aging will have to result in policy changes Labor forces are currently built on the idea that you enter at about age 18 and exit around age 65 or in some professions even earlier.This

37、assumes that you have a growing labor force that can provide for dependents both children and the elderly.Professor Ian Goldin Professor of Globalization and Development Oxford University Professor Goldin was the founding Director of the Oxford Martin School.During his decade as Director,the School

38、established 45 programmes of research,bringing together more than 500 academics from across Oxford,from over 100 disciplines,and becoming the worlds leading center for interdisciplinary research into critical global challenges.He is currently Oxford University Professor of Globalization and Developm

39、ent,Senior Fellow at the Oxford Martin School,a Professorial Fellow at the Universitys Balliol College and responsible for the Oxford Martin School Programmes on the Future of Work,Technological and Economic Change and Future of Development.He has published over 50 articles and 25 books,the most rec

40、ent of which are Age of the City and The Shortest History of Migration.Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 8 We need to shift expectations around retirement and pivot the labor market toward greater flexibility so that people can work well into their 70s,if they

41、choose.This might involve facilitating part-time and remote working or otherwise changing the nature of work,including giving greater prestige to mentoring and charitable work.We need to think about education systems that prepare people for longer working lives.If technology continues to develop at

42、the rate that it is,relying on education only up to age 18 will be increasingly unfit for purpose.Continuous education will become more important.Tax systems will need to evolve from a work-based system toward both a more wealth-based approach and broader definitions of income,by including income fr

43、om property.We will not be able to balance the budget if our tax systems are based on income taxes and national insurance contributions from a diminishing workforce.We need to rethink retirement ages and packages.Defined benefit packages are extremely risky,as we have seen with the volatility of ret

44、urns.Combining them with improved life expectancy and declining workforces would be disastrous.Where they continue to exist,we need to move towards defined contribution packages.Healthy aging is also key.One of the challenges of aging is the risk of many elderly people who are not active and become

45、dependent.Addressing neurodegenerative diseases is particularly important:they are not being tacked as effectively as physical diseases.More people are living into their 80s and 90s who are physically well but mentally deteriorating.This poses growing care,cost and social burdens on families and eco

46、nomies.Businesses must respond to the demographic transition Businesses have responsibilities that impact on demography.These include maternity and paternity policies which allow people to have children and retirement policies that allow people flexibility as to when and how employees leave the work

47、 force.As the population ages,firms will need to explore how to allow people to work in different ways and to work for longer.The danger that older workers dominate executive positions needs to be mitigated by ensuring rotation out of senior positions into collaborative and ambassadorial roles.This

48、is necessary to prevent elderly people monopolizing leadership and blocking the promotion and career paths of younger people.Firms should shift towards a more circular approach to careers where more experienced workers can also choose to transition to other roles.The size of pension contributions an

49、d retirement packages will also become a growing preoccupation for employees given the inadequacy of projected savings relative to needs.Among the questions that business leaders need to consider is their attitudes to migration.The need for migrants is growing in many societies and yet the politics

50、is pushing in the opposite direction.Demography is too important to be left to demographers.The decline in fertility,aging of societies and the role of migration will play a vital role in shaping the opportunities and challenges facing businesses and economies around the world.This timely report off

51、ers insights which greatly enrich our understanding of questions which we all need to understand and address.July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 9 Chapter 1:The Demographic Story Shifts in the basic structure of the family are driving a demographic transition tha

52、t is one of the defining trends of our time.For generations,the family tree of living relatives was wide but not very deep:most people had many siblings as families had multiple children,but few generations were alive at the same time due to short life expectancies.Now family trees have gone vertica

53、l as families shift towards fewer children and an increasing number of generations lifetimes overlap.In the language of demographers,we have transitioned to low fertility and low mortality.The drivers of the demographic transition like longer lives,increased access to healthcare,and the ability to e

54、xercise choice over fertility are positive achievements and the outcomes of global development.However,aging has significant consequences:the most significant from an economic point of view include the risk of a higher level of economic and social dependence on an ever-shrinking workforce.But while

55、aging is inevitable,this increasing dependence is not.We therefore argue that population aging demands a response in the shape of supporting economic resilience and facilitating healthy aging rather than an attempt to reverse course.Businesses,governments,and financial institutions can unite to mini

56、mize dependence by supporting the health and wealth of an aging population.This is especially urgent in higher income countries which are advanced in their demographic transition,and we conclude with some practical recommendations for businesses in higher income countries.The global population is be

57、coming older The global population is becoming,in aggregate,older than it ever has been.Figure 1 shows that between 2000 and 2040,a 35%increase in the average age of the population is projected,from 25 in 2000 to 34 before mid-century.1 Figure 1.Median age 2000,2021,and 2040,by region Source:UN Popu

58、lation Prospects 1 Demographics can be forecasted with greater certainty than many other metrics.As the UN Population Division notes:“the size and age structure of the population over the next few decades are the result of demographic processes that have already taken place”.United Nations Departmen

59、t of Economic and Social Affairs,Population Division(2022).World Population Prospects 2022:Summary of Results,pp.4 2523212820191636343030273626221840373437334430272145420%10%20%30%40%50%60%70%01020304050WORLDLatin America and theCaribbeanCentral and Southern AsiaEastern and South-EasternAsiaNorthern

60、 Africa and WesternAsiaOceania(excluding Australiaand New Zealand)Sub-Saharan AfricaEurope and Northern AmericaAustralia/New ZealandPercentage Increase in Average Age 2000 to 2040Average Age,By Region,By YearAverage Age(2000)Average Age(2021)Average Age(2040)%Increase“The demographic future is not e

61、asy to manipulate,especially without violating human rights.Instead,we must plan for our demographic reality.”-Melanie Channon and Jasmine Fledderjohan Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 10 Variations exist between regions.The greatest projected age increases ar

62、e in Latin America and the Caribbean which expects a 60%increase between 2000 and 2040 and Central and Southern Asia,which expects a 56%increase.Expected gains are lower in Europe and North America,reflecting the already higher average age but the average person in Europe and North America will be o

63、ver 45 years old before the middle of this century.Clearly the demographic transition is not happening at the same pace in all places,but the trend is in one direction toward an older population globally.In Europe and North America,the demographic transition has already left its mark on the so-calle

64、d population pyramid,which charts the distribution of the population across age brackets.Figure 2 and Figure 3 compare the structure of the population in Europe and North America in 2000 and 2040.Two forces are acting on the population pyramid:1)increased life expectancy drives a widening at the top

65、 of the pyramid and 2)declining fertility shrinks younger age groups.The top of the pyramid has ballooned as the number of older people increases.At the turn of the millennium 14%of the population in Europe and North America was over 65;by 2040 it will be 25%.At the same time,the bottom of the pyram

66、id is now narrower than its middle:by 2040,there will be about as many over 65s as under 25s in Europe and North America.The consequence is a population that is older than ever before.Figure 2.Population pyramid for Europe and North America-2000 Figure 3.Population Pyramid for Europe and North Ameri

67、ca-2040 Source:UN Population Prospects Source:UN Population Prospects In this chapter,we characterize the nature of the demographic transition and examine these twin drivers in increased life expectancy and declining fertility.We argue that these are positive outcomes of global development marking t

68、he culmination of decades of(continuing)efforts.-50 000 50 0000-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+2000-Europe and North AmericaFemaleMale-50 000 50 0000-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+2040-Europe and N

69、orth AmericaFemaleMaleThe average person in Europe and North America will be over 45 years old before the middle of this century.At the turn of the millennium,14%of the population in Europe and North America was over 65;by 2040,it will be 25%.July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions

70、 2024 Citigroup 11 Increasing life expectancy drives population aging Gains in life expectancy have contributed to population aging.2 While there have been periods of decline e.g.,during pandemics and conflicts the global trend over centuries is toward increasing life expectancy.In the 19th century,

71、no continent had a life expectancy of more than 40.3 By 2019,the average life expectancy globally was 73.By 2040,life expectancy is expected to rise modestly again to 76,driven by increases in areas that currently have the lowest life expectancy.This trend is more advanced in high income countries w

72、hich have substantially higher life expectancies.Children born in 2019 in high income countries could expect to live to more than 80 years of age.A dent has been made in regional inequalities over the last century.Figure 4 shows that the greatest gains between 1950 and 2040 were on the Asian contine

73、nt,where life expectancy was lowest at the beginning of that period and is expected to have almost doubled.As a result,the global population can be expected to age in coming decades,albeit at different rates.Figure 4.Life expectancy at birth in 1950,2019 and 2040,by region Source:UN World Population

74、 Prospects(2022)Increasing life expectancy is a long-desired outcome of global development.In recent decades it has been driven by 1)declining childhood mortality and 2)improved management of noncommunicable diseases.Both are targets under the third UN Sustainable Development Goal.4 2 United Nations

75、 Department of Economic and Social Affairs,Population Division(2022).World Population Prospects 2022:Summary of Results,pp.4 3 Saloni Dattani et al.2023,Life Expectancy published online at OurWorldInData.org.Accessible here.4 Targets 3.2(Neonatal and child mortality)and 3.4(Noncommunicable diseases)

76、0%10%20%30%40%50%60%70%80%90%100%0102030405060708090100Eastern and South-EasternAsiaNorthern Africa and WesternAsiaCentral and Southern AsiaSub-Saharan AfricaOceania(excluding Australiaand New Zealand)Latin America and theCaribbeanEurope and NorthernAmericaAustralia/New ZealandPercentage Change in L

77、ife Expectancy(1950 to 2040)Life expecancy 1950Life expectancy 2019Medium variant projected life expectancy 2040%Change(1950 to 2040)In the 19th century,no continent had a life expectancy of more than 40.By 2019,the average life expectancy globally was 73.Citi GPS:Citi GPS:Global Perspectives&Soluti

78、ons July 2024 2024 Citigroup 12 Declining childhood mortality supports gains in life expectancy The first driver of increased life expectancy is declining childhood mortality.One estimate finds that even in the mid-19th century,up to 50%of children could expect to die before reaching the age of 15.5

79、 Figure 5 illustrates the declining share of children who die before the age of five on a much reduced,30-year time horizon.Marking an extraordinary achievement,in 2020,4%of children died before their fifth birthday globally;in high-income countries,the figure is less than 1%.Figure 5.Chance of deat

80、h before age five has declined globally Source:UN Inter-Agency Group for Childhood Mortality Medical and social factors have combined to drive this progress.6 Medical factors like access to ante-and post-natal healthcare,sanitation and infection control,and vaccination coverage,have all contributed.

81、Social factors,like access to nutrition and reductions in conflict,have also played a part in these extraordinary reductions in childhood mortality.Further reductions likely lie ahead and will power reductions in remaining regional inequalities in life expectancy.7 Treatments for chronic conditions

82、support life expectancy at older ages Life expectancy at older ages has also increased.A 45-year-old in 1950 could expect to live 24 years more while someone who turned 45 in 2019 could expect to live another 34 years.Declines in childhood mortality do not fully explain the global increase in life e

83、xpectancy:in countries with a life expectancy of more than 75,5 Max Roser,2023.Mortality in the past:Every second child died,published online at OurWorldInData.org.Accessible here 6 Despite this progress,we are not on track to achieve the target of 60)Japanese find work via this public-private SHRC.

84、Technology props up productivity of a shrinking workforce Technology can also contribute to resisting the consequences of population aging in a second dimension by propping up the productivity of a shrinking workforce.Productivity has been falling for the last two decades:Figure 28 illustrates the t

85、rend in the UK.While factors like Brexit exacerbate this trend,the same slowdown can be seen in most developed economies.An economic lifeboat is now capturing imaginations AI.Generative AI is still early but a series of studies suggest it offers transformative productivity opportunities,from 50%in c

86、oding43 to 37%in writing,44 14%in call centers and more.45 43 Github.Quantifying Github Copilots Impact on Developers Productivity and Happiness September 2022.Accessible here 44 Noy and Zhang,Experimental evidence on the productivity effects of generative artificial intelligence,Science 381(2023)Ac

87、cessible here 45 Brynjolfsson et al.Generative AI at Work April 2023.Accessible here Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 36 Figure 28.UK Labor Productivity Source:Bank of England,Office for National Statistics There is also a significant derivative point this is

88、not discussed enough.The productivity opportunities of a more positively engaged workforce are currently estimated to be double that from GenAI.46 This does not need to be either or.We can have both,if worker anxiety about GenAI is used as a catalyst to have robust conversation and action on how to

89、create better jobs.This was a key conclusion from our recent report AI Doom or Boom for Jobs.But there are risks for inequality However,almost all digitizing markets in the last 30 years have led to concentrating market shares due to economies of scale.This can exacerbate inequity and increase monop

90、sony power over workers.Given AI thrives on data,the same could be true ahead unless AI anxiety leads to a tech-backlash.We may have seen the start of this in 2023 with the strikes in Hollywood.Humans can vote for the future they want.There is however a different trend worth highlighting.Andy Haldan

91、e has argued that longer working lives could provide a“new endowment for the charitable sector”.As well as providing meaning,societal contribution and social interaction,volunteering can help retraining.So,while technology could indeed extend inequality and hollow out the labor market,there is a pos

92、itive opportunity to direct surplus hours towards improving human-to-human contribution.46 Clifton and Harter,2023.Culture Shock July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 37 Flexibility and Technology for Longer Working Lives:An Interview with Professor Carl Frey Is te

93、chnology a blessing or a curse for the demographic transition?The long period of income stagnation that dominated nearly all of human history can be attributed to the so-called Malthusian trap,where any technological advancements that initially increase income levels lead to population expansions th

94、at eventually strain resources,causing living standards to revert to basic subsistence levels.However,over time,population growth itself spurred technological advancement,as the increase in population size contributed to a greater number of inventors and a higher rate of successful technological inn

95、ovations.As the pace of technological development picked up,societies reached a critical juncture where parents understood that their children needed education and skills to flourish,a realization that necessitated substantial investment in childrens development and thus led to deliberate fertility

96、control.Consequently,population growth decoupled from technological progress,allowing for a significant rise in living standards.This is the essence of Oded Galors“Unified Growth Theory”,which highlights the role of technology in the demographic transition.How might technology help older workers to

97、stay in the labor force?A broader impact of technological change has been to allow people to work longer by shifting the bulk of the workforce from farms to factories,to airconditioned offices.Before electricity,for example,the multitude of belts,gears,and shafts were frequent culprits in factory mi

98、shaps,threatening the safety of workers limbs and lives.The transition to individual electric motors did away with the hazardous tangle of mechanical parts and the related risks.Moreover,electric machinery produced less airborne dust,leading to cleaner air and healthier work environments.The replace

99、ment of gas lighting with electric illumination also contributed to better air quality by reducing humidity and eliminating harmful acid vapors.And automation further eased the physical demands of work.As one factory worker at Henry Fords River Rouge plant marveled in 1955,“Automation has saved me.I

100、f I had to lug those heavy blocks into position like I used to I could not last till I was 65.Now I expect to be working till I am 80.”His main concern was having put on thirty-three pounds since being aided by advanced machinery.How might technology prop up the productivity of a shrinking workforce

101、?Technology can enhance the productivity of a shrinking workforce by promoting greater automation,particularly in response to an aging population that results in a scarcity of middle-aged workers who typically perform manual production tasks.Indeed,empirical evidence suggest that as demographics shi

102、ft towards older age profiles,countries and regions are more likely to adopt robots and other forms of automation.We see this across nations with varying rates of aging as well as across cities.Work by Daron Acemoglu and Pascual Restrepo,for example,shows that Innovation in automation is notably mor

103、e intense in countries experiencing steady aging.Their research underlines that technological advancement,Professor Carl Frey Associate Professor of AI and Work Oxford Internet Institute Professor Carl-Benedikt Frey is the Dieter Schwarz Associate Professor of AI&Work at the Oxford Internet Institut

104、e and a Fellow of Mansfield College,University of Oxford.He is also a Director of the Future of Work Programme and Oxford Martin Citi Fellow at the Oxford Martin School.His most recent book,The Technology Trap:Capital,Labor,and Power in the Age of Automation,was selected a Financial Times Best Books

105、 of the Year in 2019.Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 38 particularly in automation,can counterbalance the effects of a diminishing workforce due to demographic changes.What might be needed beyond technology to support an older workforce?Supporting an older wo

106、rkforce requires a number of things that encompasses lifelong learning and training to keep skills updated,flexible working arrangements,and robust health plans for physical well-being.Ergonomic adjustments to the work environment are also essential to minimize strain,while anti-discrimination polic

107、ies and training aim to foster an inclusive atmosphere that values experience over age.What does technology mean for inequalities and the“hollowing out”of the labor market?A decade ago,our study“The Future of Employment”was released,spotlighting the expansion of artificial intelligence(AI)capabiliti

108、es and its implications for automating a wider range of tasks.At that time,the dominant belief was that we were moving past the era of the“average”worker,with automation increasingly taking over routine and administrative roles done by the middle class.This shift seemed to predominantly favor highly

109、 skilled professionals,who benefited from enhanced productivity through computer assistance and the global marketability of their skills.However,ten years later,the advent of whats now known as generative AI is challenging these notions.The advent of Copilot in software development,for example,has b

110、een a game-changer,significantly reducing project completion times.Interestingly,the greatest productivity gains have been seen not among seasoned programmers,but among those new to coding.And this is not an isolated example.Similarly,ChatGPT has notably improved efficiency in writing tasks,particul

111、arly for individuals with weaker writing skills.Moreover,in customer service,research by Erik Brynjolfsson and colleagues demonstrates that AI assistants enhance productivity by automating mundane tasks and aiding human agents,with novices and those with less skill deriving the most benefit in terms

112、 of productivity.These developments are overturning the traditional view that automation primarily advantages highly skilled workers,suggesting instead that technology can level the playing field in content-driven sectors like legal,education,news,and entertainment.However,this democratization of ac

113、cess also implies more competition and potentially lower earnings for those already established in these fields.The situation mirrors the impact of Uber on the taxi industry.With GPS technology,intimate knowledge of city streets became less critical,allowing drivers unfamiliar with their cities to s

114、ucceed.This increased competition led to lower earnings for traditional taxi drivers.My own work with Thor Berger and Chinchih Chen reveals that Ubers entry into a new city typically resulted in a 10%decrease in hourly earnings for drivers.July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 20

115、24 Citigroup 39 Supporting longer working lives requires more than the technology revolution that is underway:it requires flexibility like part-time and hybrid work schedules,opportunities for phased retirement and ending ageism which the World Health Organization defines as“using age to categorize

116、and divide people in ways that lead to harm,disadvantage and injustice and erode solidarity across generations”.47 Policy plays some role,but employers must also support evolving the labor market to facilitate longer working lives and in many cases,they can lead.One way to address this is for divers

117、ity and inclusion initiatives to include older workers and to balance the competing demands of a multi-generational workforce.Research suggests that older people experience ageism both at work and elsewhere,which curtails their income and makes them more likely to retire early.48 1 in 3 report havin

118、g experienced some sort of ageism in Europe.Yet,data from a survey of UK-based companies shows that age lags other aspects of diversity in terms of the actions being taken by leaders.(Figure 29)Moreover,age-related Employee Resource Groups(ERGs)lag ERGs on other aspects of diversity,like gender and

119、race.(Figure 30)Figure 29.UK companies are less likely to report that action is being taken on age-related inclusion Figure 30.Across Europe,Japan and the U.S.,age-related employee resource groups are less common than other diversity characteristics Source:Chartered Management Institute Source:Denom

120、inator Given the economic benefits that could be derived from boosting the supply of older workers,there is reason for employers to support longer working lives.To explore what a diversity and inclusion strategy for older workers could look like,we turn to the expertise of Citis Chief Diversity,Equi

121、ty and Inclusion Officer,Erika Irish Brown.Like Professor Carl Frey and Rob Garlick,she highlights the importance of flexibility and,pointing towards the second half of this chapter,the need to support healthy aging and health at work to allow workers to extend the duration of their careers.47 WHO,2

122、021.Global Report on Ageism.Accessible here Last accessed 3rd April 2024 48 WHO,2021.Global Report on Ageism.Accessible here Last accessed 3rd April 2024 0%10%20%30%40%50%60%70%80%90%100%Organisation is inclusive regardless of.Action is being taken on.00.10.20.30.40.50.60.70.8EuropeJapanUSLGBTQ+ERGR

123、ace ERGAge ERGMulti-cultural ERGDisability ERGOne in three report having experienced some sort of ageism in Europe.Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 40 Beyond Technology:An Interview with Erika Irish Brown How can employers support older workers to remain at wo

124、rk for longer?There is immense value in a multigenerational workforce.Earlier generations such as Baby Boomers bring a wealth of experience and historical knowledge that add value to any workplace.We take a holistic approach to supporting the well-being of colleagues of any generation and encourage

125、other employers to do the same.One way to support is through inclusive healthcare benefits,including virtual telehealth options.At Citi,we offer mental health resources such as manager training and free counseling,in all our geographies,and many of our largest locations feature onsite medical clinic

126、s,fitness centers and annual health screenings.In addition,we have leave policies that provide the opportunity to recharge or step away from work,which we believe can boost job productivity and morale.Another method is offering colleagues flexibility in how they work.We remain committed to our hybri

127、d work model which gives colleagues the flexibility to work at least three days per week in the office and up to two days per week remotely.This supports better work-life integration while realizing the advantages of being together in person.A third recommendation is to build community through Emplo

128、yee Resource Groups.Our“Inclusion Networks”enable executive leaders to partner with colleagues to build an organization that understands,appreciates,and leverages the unique perspectives of our global workforce.We provide multigenerational colleagues with localized networking,mentoring and career de

129、velopment programming,supporting talent of all tenures and levels in the workforce.How can employers manage a multigenerational workforce?Fostering a culture of inclusivity and belonging is key.At Citi,transparency and accountability are key to our success as a diverse,equitable and inclusive compan

130、y.Every generation brings unique skills,perspectives,and experiences to the table,and as employers,it is up to us to ensure our colleagues understand the benefits of a multigenerational workforce.How we communicate and collaborate,what programming and benefits we offer,and how we promote this interg

131、enerational knowledge exchange are all key components to delivering for our colleagues.Leaders and managers play a crucial role in fostering an inclusive environment where every team member feels valued and empowered to contribute.By recognizing the strengths of different generations,leaders can cul

132、tivate high-performing teams that capitalize on a range of skills and perspectives.Encouraging mentoring and apprenticeship programs facilitates the exchange of knowledge between generations,ensuring that valuable expertise is shared while also fostering a culture of continuous learning and developm

133、ent.Additionally,creating a psychologically safe space where all employees feel comfortable proposing ideas encourages innovation and collaboration across generational lines.Ultimately,leaders and managers serve as culture carriers,guiding their teams towards embracing diversity and leveraging it as

134、 a competitive advantage in todays dynamic workplace landscape.By embracing diversity and leveraging the strengths of each generation,employers can create a dynamic and innovative workplace where every employee can contribute and grow,ultimately leading to increased productivity,employee satisfactio

135、n and organizational success.Erika Irish Brown Chief Diversity,Equity and Inclusion Officer and Head of Talent Citi Erika Irish Brown is Citis Chief Diversity,Equity and Inclusion Officer and Head of Talent,responsible for developing global diversity,equity and inclusion strategy and driving Citis a

136、genda on talent planning,succession planning and leadership development.Before joining Citi,Erika was Chief Diversity Officer at Goldman Sachs from 2018 to 2021 and Global Head of Diversity and Inclusion at Bloomberg from 2015 to 2018.Prior to this,she led executive and diversity hiring efforts at B

137、ank of America and Lehman Brothers.July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 41 How can employers support colleagues with care-giving responsibilities?As our workers enter new stages of life,they often have new work,family,and caregiving responsibilities.At Citi,we cel

138、ebrate the important role families play for our colleagues as well as recognize the joys and challenges of integrating workplace responsibilities as a parent,child,grandparent,or caregiver.Employers can support colleagues with family or caregiving responsibilities by implementing flexible work arran

139、gements to accommodate their personal duties while maintaining productivity.Offering inclusive paid family leave and caregiving benefits can provide employees with the time and financial support to attend to their responsibilities without worrying about job security or financial strain.Providing acc

140、ess to caregiving support services,such as legal support,eldercare assistance programs or childcare assistance,can alleviate the stress and burden on employees integrating work and caregiving responsibilities.We also recommend building community through Employee Resource Groups,like our Families Mat

141、ter Inclusion Networks.Recognition,appreciation,and opportunities for career advancement can foster loyalty and engagement among employees with caregiving responsibilities.By prioritizing the well-being and needs of employees with caregiving responsibilities,employers can cultivate a compassionate a

142、nd inclusive workplace that promotes work-life integration and supports the needs of an aging workforce.Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 42 Staying attached to the labor market for longer is one thing,but it is unlikely that anyone will either choose or be abl

143、e to work for their entire life.At some point,retirement and savings will need to come into play even if the 20th century notion of retiring at a certain age“to the golf course or a rocking chair”,as Chuck Cavanaugh,Head of Financial Planning at Citi Personal Wealth Management,puts it in his intervi

144、ew,is revolutionized.This is the second pillar of supporting economic resilience that we set out at the beginning of this chapter:evolving financial planning and boosting inclusion to support economic independence into older age.There are concerns about the economic resilience of future retirees bec

145、ause the share of the adult population that report saving for old age each year is far from 100%even in the most economically inclusive societies.For example,Sweden had the highest share of workers saving for old age in 2021 but even there more than 20%of the adult population reported not saving for

146、 old age.49 Likewise,we drew attention to Japan earlier as a country that is well advanced in its transition:even here,over a third of adults in the workforce did not save for their old age in 2021.Automatic enrolment,which sees employees automatically enrolled in pension schemes unless they opt out

147、,is one policy tool that can boost the share of people saving for retirement.50 These policies have spread across developed economies in the last two decades and have boosted the share of the population saving for retirement,but questions about saving enough for a longer retirement remain.Figure 31.

148、Inequalities in rate of saving for old age Source:World Bank,Global FIndex Database(2021)Moreover,financial preparation for retirement is in some places inflected along the lines of traditional inequalities.Figure 31 shows that in some countries there are inequalities in savings rates by education a

149、nd income level.This ignores questions about how much each group is saving and only considers whether they saved for old age in the year 2021-22 or not.For example,in the U.S.,60%of those who had completed secondary education or more saved for old age vs.34%of those who had not.Likewise,of those in

150、the richest 60%by income,72%saved for retirement vs.40%in the lowest earning 40%of the population.The same trend shows up in other places(albeit to a lesser 49 World Bank,The Global Findex Database 2021 50 European Commission,Best practices and performance of auto-enrolment mechanisms for pension sa

151、vings:Final Report November 2021.Accessible here Last accessed April 16th,2024 0%10%20%30%40%50%60%70%80%USAGBRJPNDEUSaved for old age,primary education or less(%ages 15+)Saved for old age,secondary education or more(%ages 15+)Saved for old age,income,poorest 40%(%ages 15+)Saved for old age,income,r

152、ichest 60%(%ages 15+)Education-RelatedSavings GapIncome-RelatedSavings GapThe share of the adult population that report saving for old age each year is far from 100%,even in the most economically inclusive societies July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 43 extent)l

153、ike in the UK and Japan,but it is not a global trend as Germany shows in Figure 31.Health inequalities and the sorts of job that those with fewer years of education or lower incomes tend to have compound difficulties in saving to produce stark inequalities.Evidence suggests that there is a gap in li

154、fe expectancy between the richest 1%and poorest 1%which runs to 15 years for men and 10 years for women.51 Likewise,socio-economic status is a risk factor for many chronic diseases which have a bearing on capacity to work into later life.52 Those with less education or lower incomes therefore stand

155、to live for fewer years and to be in worse health.Those with worse health are also less likely to be economically resilient in later life because they are less likely to have saved for retirement even before we ask whether they have adequate savings.In other words,those who most need to retire due t

156、o ill health are less likely to be able to.Moreover,some evidence suggests that it is not universally true that there are non-economic benefits associated with longer working lives:the benefits of remaining in work“are most likely to be for males,those reducing to part-time working,and those employe

157、es who are in jobs which are not low quality or low reward”.53 The need to continue working for financial reasons is instead potentially negative for health outcomes,rather than underlining the economic reasons to stay in the labor market.This is a significant economic concern:if some are unable to

158、retire on their own economic resources and are unable to continue working due to ill health or increase their ill health by attempting to remain in the work force,they will become economically dependent whether on social security or on family members.Financial planning,then,remains a key support to

159、economic resilience in the context of longevity and there is a need to expand access to it.We turn here to one of Citis experts on financial planning for U.S.individuals,Chuck Cavanaugh,Head of Financial Planning at Citi Personal Wealth Management,who explains how financial plans must evolve to acco

160、unt for increased life expectancy.Approaches to retirement saving and social security in later life vary globally,and the insights that follow arise from the U.S.context.51 World Economic Forum.2020.Global Social Mobility Index:why economic benefit from fixing inequality.Accessible here Last accesse

161、d April 9th,2024 52 For example,on diabetes:Kyrou et al.2020.Low socioeconomic status can significantly increase the risk for prediabetes and T2DM,but is often overlooked.Accessible here And on cardiovascular disease:Schultz et al.2018.SES has a measurable and significant impact on cardiovascular he

162、alth.Individuals of low SES carry a substantial burden of CVD and are more likely to experience increased event rates and poorer outcomes.Accessible here Last accessed April 9th,2024 53 Susan Baxter et al.Is working in later life good for your health?A systematic review of health outcomes resulting

163、from extended working lives,BMC Public Health(2021)Gap in life expectancy between the richest 1%and poorest 1%runs to 15 years for men and 10 years for women Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 44 Financial Planning for Longevity:An Interview with Chuck Cavanaugh

164、,Head of Financial Planning,Citi Personal Wealth Management What are the economic costs to the individual associated with aging?One of the most important costs to consider is healthcare:older individuals require more medications,visits to the doctor,and unfortunately hospitalizations.They often have

165、 increased medical expenses and the health insurance industry is adjusting in response,resulting in higher deductibles and higher premiums.All of this can significantly strain individual budgets,especially for those with lower or medium incomes.Related to this are long-term care expenses for support

166、 with the activities of daily living.This is very expensive;it can quickly deplete personal savings and retirement funds.Modifying housing like installing ramps for wheelchairs or grab bars in bathrooms also has a cost attached.Transport costs also change,like needing to take a taxi home because old

167、er individuals might not be comfortable driving at night.At the same time older individuals often see a significant decrease in income.When we create financial plans,were trying to keep people at a standard of living that theyre comfortable with but often it is very difficult because they have much

168、less money coming in.We talk about saving earlier,saving more,and retiring later because we do see people retiring with an income that will not sustain even a facsimile of their prior standard of living.Some people think they will just work for longer,but ill health often gets in the way.Even when i

169、t doesnt,age discrimination is still prevalent:its still difficult for older individuals to find or keep employment.Those who have planned and those who are in better health will be better prepared.Are current generations prepared for their financial needs in later life?The situation is different fo

170、r each generation.The Baby Boomers were working during a fairly strong economy which allowed them to accumulate wealth and buy their own homes.They also had access to a robust social security program in the early stages of their retirement and some had the benefit of pensions.They are now in retirem

171、ent and are dealing with rising healthcare costs and the potential demise of social security in its current form which they probably did not plan for because its a relatively new phenomenon.Gen X witnessed some of the financial challenges on Baby Boomers experienced,so they have more awareness of th

172、e need for a financial plan.But many entered the workforce during a recessionary period which impacted their earning potential and retirement savings.This was also one of the first generations to have student loan debt and some of them still have it because they couldnt pay it off.Millennials had mo

173、re access to financial planning resources than other generations,but they still have the challenge of student loan debt.Theyre also dealing with rising costs of living and many of them entered the workforce during the Great Recession which has impacted their ability to accumulate wealth in the early

174、 years of their career.Gen Z are planning their finances earlier than other generations time will tell how they fare financially over the course of their careers.How does financial planning need to change for longer lives?One of the biggest challenges is longer retirements.Because people are living

175、longer than before,retirement savings need to last for a longer period of time.Its possible that you might be retired for 30 years and that might be the same amount of time that you were working.The model used to be that at a certain age you would retire to the golf course or a rocking chair.This wi

176、ll not be sustainable for most Chuck Cavanaugh Head of Financial Planning Citi Personal Wealth Management Chuck is the Head of Financial Planning for Citi U.S.Consumer Wealth Management,where he is responsible for leading the financial planning team.The team works with clients to develop and impleme

177、nt financial plans,including estate&trust planning,charitable giving,intergenerational planning,business succession,secured retirement income,risk mitigation and wealth protection.With over 30 years of experience,Chuck is a seasoned wealth management strategist who has spent most of his career suppo

178、rting wealth advisors in helping clients achieve their financial goals.He has also been a guest speaker throughout the United States on retirement income strategies,financial planning,and estate planning.July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 45 people.Expectations

179、will need to shift toward working longer,working part-time or freelancing and phasing into retirement gradually.Even if these expectations do shift,planning will still have to factor in the possibility of people being retired for longer.This will necessitate conversations about saving more and savin

180、g earlier which can be challenging when young people want a standard of living similar to what their parents had that allows them to buy a home and have children.Investment strategies will need to shift.Generally,you have a more aggressive strategy while youre younger and when you get older,you shif

181、t into more fixed income because its more secure.Longer lives mean staying somewhat invested in equities for longer to keep up with inflation and balancing a growth-oriented portfolio with income generating assets like bonds.Risk tolerance in later life will need to be revised upwards to drive this.

182、This complexity in financial planning for longer lives really requires a professional.They can also do what-if scenarios in the planning process,to explore what happens if social security falls to only 80%of what it is now,or you need medical assistance and long-term care.Everyone should have not on

183、ly a financial plan but a financial professional to coach them on the complexities of longer lives.What wider support is needed to support effective financial planning for a longer life?The first piece is education.In some places financial literacy is taught in school.You shouldnt be learning about

184、that in your thirties because by then you have already missed a decade of potential earning time.But public awareness campaigns must be balanced:if scare tactics are used,some people cant handle reality and as the idiom goes,“bury their heads in the sand.”Governments play a role in supporting awaren

185、ess or expanding incentives to save for retirement especially for lower-and middle-income groups.Another area is in long-term care insurance.20 years ago,there were over one hundred companies in the U.S.providing long-term care insurance.Now,I think that number will be in the dozens.Products werent

186、priced correctly and so some insurance companies couldnt sustain their unprofitable long-term care insurance portfolios.But exploring tax advantaged accounts that cover long term care expenses or building more public-private sector partnerships that provide a degree of asset protection against long-

187、term care expenses would be helpful.There will always be a role for social security.It provides financial protection for retirement,disability,and survivor&family benefits.We need to improve its sustainability by implementing gradual adjustments,like raising the retirement age or modifying the benef

188、its it offers.This requires transparency to make sure public expectations match what social security will offer.For example,if people are expecting to live solely on social security benefits in retirement,they need to be made aware that these benefits may be reduced in the future.There is also more

189、to be done on workplace flexibility to encourage employers to hire older workers this isnt only economically important;staying in work can have a positive psychological impact.Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 46 As financial planning evolves to account for hig

190、her life expectancies,the investment management industry stands to be impacted.The industry has already responded to managing the shift in members and assets arising from the shift from Defined Benefit(DB)to Defined Contribution(DC)plans.Our Business Advisory Services colleagues set out five scenari

191、os for these decumulating DB plans in their 2023 TrendWatch report,How Investors Demand for Scale and Transparency Could Re-Shape Investment Management.Adnan Memon highlights in his contribution to this report that the impact of population aging might evolve in three dimensions:1.Increasing demand f

192、or customization of investment products to reflect heterogeneous experiences of aging and retirement.2.Changing demands on pension funds from consumers and perhaps regulators as products come closer to retail investment products by targeting individuals.3.Stickier relationships between retiree and i

193、nvestment manager as retirement becomes more flexible and financing needs evolve around a multi-stage career of phased retirement.Shifting retirement patterns stand to impact the investment management industry Why might the status quo be disrupted by existing trends?As Defined Benefit(DB)pension pla

194、ns distribute their assets to the retirees,there are fewer large institutional pools of capital remaining for the industry,so the industry becomes more linked to the needs of individual investors.The drive for transparency and consolidation of assets may increase in the coming years and pensions may

195、 not be immune.In the UK,the governments progress towards launching a mandatory Pensions Dashboard could make it easier for individuals to compare fund performance across ones pension portfolio in a single place,regardless of whether the funds are from workplace or private pension savings.In theory,

196、this development isnt entirely novel,with commercial aggregators and dashboards already available,but the attention it is gaining right now is changing the likelihood of adoption and so the consideration of risk and return on a portfolio basis,rather than on a fund basis.The logical next step would

197、be to pool other savings into that same dashboard so that assets and risks can be assessed more holistically which we discuss in greater depth in our recent TrendWatch paper.The growth of multi-asset class solutions globally and retail separate accounts in the U.S.in particular(and also to a lesser

198、extent elsewhere)are some of the manifestations of this drive to customization.That process is underway but still has a long way to go.The main limitation is the data on the future retirees,but some firms are taking steps to address this gap.How might the demographic transition combine and accelerat

199、e these trends?Portfolios are becoming more customized and,as explained above,are likely to become even more so.Pension dashboards could highlight the shortcomings of existing approaches to targeting a return linked to government bonds instead of generating the maximum possible risk-adjusted retirem

200、ent income.If those assets need to last thirty years rather than ten,we could potentially apply much of the Adnan Memon Business Advisory Services Citi Global Insights July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 47 same financial models as were used to build those assets

201、 up over the previous thirty years,but without the,now unnecessary,desire to divert assets from equities to bonds upon retirement.From a product perspective,asset managers may evolve their offerings further to help retirees with their financial needs.In many cases,the goal has been to get people to

202、retirement and then to hand them off to retirement specialists who can offer annuities.That may have worked previously and could continue to serve many well,but with the increasing longevity pressures on those pools of assets,we may no longer treat retirement as a binary moment that switches from sa

203、vings to retirement income.Instead,we could see ongoing management of those assets linked to investor needs and goals and,in doing so,create stickier relationships between retirees and their investment management partners.It merits noting that some face challenges to saving anything.Across OECD-11 c

204、ountries,more than 60%of adults say that they have a financial cushion to last them no more than six months.54 Figure 32 shows that a significant share of the population even in High Income Countries face challenges to coming up with emergency funds in 30 days if they needed them.These figures are f

205、rom 2021,i.e.,before post-pandemic inflation impacted personal finances in many places.Figure 32.Share of the population facing difficulties finding emergency funds in 30 days Source:World Bank,Global Findex Database(2021)Economic resilience is therefore not only about access to the tools of financi

206、al planning:low pay and barriers to wealth accumulation are additional risks to economic resilience in later life.Some studies of the U.S.suggest that millennials(born between the early 1980s and late 1990s)are earning less than their parents generation did and that their level of asset accumulation

207、 and home ownership is both lower55 and beset with risks.56 This has consequences for future generations of retirees,which will not be solved by financial planning.54 World Economic Forum,2024.Longevity Economy Principles:The Foundation for a Financially Resilient Future,pp.7.OECD-11 countries inclu

208、ded in their analysis are:Austria,Colombia,Czech Republic,Estonia,Germany,Hungary,Italy,Korea,Poland,Portugal and Slovenia.55 Young Invincibles,2017.Financial Health of Young America:Measuring Generational Declines between Baby Boomers and Millennials 56 For discussion,see:Gale,W.G.et al.2019.How Wi

209、ll Retirement Saving Change by 2050?Prospects for the Millennial Generation Brookings Institution.0%2%4%6%8%10%12%14%16%18%20%GermanyUKJapanUSHigh IncomeComing up with Emergency Funds in 30 Days is.Not possibleVery difficultLow pay and barriers to wealth accumulation are additional risks to economic

210、 resilience in later life Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 48 Key Actions for Supporting Economic Resilience The first lever to minimize the level of economic and social dependence that an aging population imposes is to support economic resilience.In this chap

211、ter,we have set out two aspects:1.Maximize the economic contribution of older groups by supporting longer working lives through the adoption of technology,inclusion efforts,and labor market flexibility.2.Support economic self-reliance in later life through financial inclusion,including access to the

212、 tools of financial planning and wealth accumulation.Both aspects minimize the dependence in the population.The first delays the effects of aging at the individual level,by redefining what it means to be a particular chronological age in terms of attachment to the labor market.The second takes serio

213、usly the consequences of population aging,that there will be an increased number of people relying on their retirement savings and asks how economic resilience can be boosted in that context.These are not incompatible;they work in tandem to first reduce the impact of chronological population aging a

214、nd then respond to its effects.For now,these are high-level principles for a response to population aging.In the Conclusion,together with the Global Coalition on Aging,we highlight concrete examples of how private sector actors can contribute to each of these principles.July 2024 Citi GPS:Citi GPS:G

215、lobal Perspectives&Solutions 2024 Citigroup 49 Chapter 4 Perspectives on the Health of an Aging Population In the previous chapter,we explored how we might collectively reimagine work to facilitate longer working lives.An unanswered question lurks behind this discussion:will todays older population,

216、and indeed tomorrows,be healthy enough to extend their working lives as far as they might need?57 Health is the second dimension in which the level of dependence in an aging population must be minimized.It is relevant to this discussion beyond being a precondition of longer working lives.First,maxim

217、izing healthy life expectancy is valuable on a human level:increased life expectancy will be of little value to individuals if they are not able to enjoy those years.Second,part of the economic worry surrounding the demographic transition is the concern that healthcare costs will spiral out of contr

218、ol as the older population grows.Indeed,a report on public spending among EU member states finds that the total cost of aging58 in 2019 stood at 24%of GDP,and this is forecast to rise by 1.9 ppts by 2070 driven primarily by increases in long-term care and healthcare spending.59 The thesis is that ov

219、er 65s account for an outsize share of medical spending compared with their share of the population(Figure 33),so an increasing number of over 65s in the global population will drive up healthcare-related spending at the population level.Figure 33.Over 65s account for a higher share of healthcare re

220、lated spending,U.S.only Source:KFF analysis of 2021 Medical Expenditure Panel Survey data Responding to the demographic transition in this dimension requires two things:57 For discussion of this objection to lengthening working lives,see:Scott,A.J.The Longevity Economy,Lancet Healthy Longevity(2021)

221、,pp.828-835 58 This includes pensions(the costs of which are projected to decline on account of prior policy reforms),healthcare,long-term care and education.59 European Commission,The 2021 Aging Report:Economic and Budgetary Projections for EU Member States(2019-2070),pp.7-8 Over 65s account for an

222、 outsize share of medical spending compared with their share of the population Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 50 1.Supporting healthy aging or minimizing the level of ill health in the population as it ages and maximizing the years of additional life expecta

223、ncy that are lived in good health.2.Strengthening and innovating the provision of healthcare and long-term care to ensure access to high quality care for all in later life.Begin with the first of those.There is some evidence that gains in healthy life expectancy have not kept pace with gains in life

224、 expectancy:in other words,although we live for longer,we do not live all our additional years in good health.A systematic review of international trends in health expectancies between 1970 and 2017 revealed that“in most countries,gains in healthy and disability-free life expectancy do not match the

225、 growth in total life expectancy”.60 A more recent study of the UK quantified expected gains in life expectancy and healthy-working-life-expectancy,defined as the number of years individuals are expected to spend in good health and in paid employment after age 50,between 2015 and 2035.Over this peri

226、od,life expectancy at age 50 was projected to increase by 0.2 years and 0.12 years per calendar year for men and women respectively.The years spent in good health and paid work was expected to increase substantially less,at 0.02 years for men and 0.05 years for women per calendar year.In other words

227、,we can expect to spend our additional years of life expectancy in ill health and out of the work force.Figure 34.Gains in healthy working life expectancy fail to keep pace with gains in life expectancy Note:Data is for men.A similar trend,but with less levelling off in HWLE,can be seen for women.So

228、urce:Lynch et al.2022 But the health of tomorrows aging population is not immutable.Just as it is in our gift to increase economic resilience,for example by lengthening working lives,so we have an opportunity to improve how healthy our older population can be.The idea that age 65 marks a threshold a

229、t which one requires more healthcare spending 60 Gemma Spiers et al.Trends in health expectancies:a systematic review of international evidence,BMJ Open 11(2021),doi:10.1136/bmjopen-2020-045567 29303132333435891020152020202520302035Projected LEProjected HWLEWe do not live all our additional years in

230、 good health We have an opportunity to improve how healthy our older population can be July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 51 can be both questioned in theory and altered in practice.The first salient question is,then,what is needed to support healthy aging?We ag

231、ain collate insights from experts across Citi and our global network,from which we observe two key levers to support healthy aging:1.A preventive approach to healthcare,like encouraging healthier lifestyles from a young age,could help to maximize the years lived in good health.This requires the coll

232、aboration of healthcare systems,pharmaceutical companies,civil society,and governments.Both Citis Adam Spielman and Bayers Mike Devoy highlight in their contributions to this report the importance of testing and early detection to boost preventive approaches to healthy aging.2.Innovation for disease

233、s associated with older age must continue.As the UKs Chief Medical Officer,Chris Whitty,noted in his 2022 lecture for Gresham College,“there are diseases of old age which we do not have a good treatment for yet,such as the major dementias”.61 While healthy aging can minimize the number of people aff

234、ected by these conditions,innovation is a second lever to minimize the potential negative impacts of population aging.Aligning market incentives with the economic impact of these innovations will be key.However,even if the health of an aging population can be improved,it is likely that demand for ca

235、re will still increase.Currently,demand for formal care is projected to increase by almost 50%between 2020 and 2035.62 Meeting this demand is a significant question in its own right.In this chapter,we only articulate the economic motivation for enhancing care provision and explore some recent innova

236、tions that might contribute to increasing care provision a)by joining the dots between health and long-term care and b)the specific example of“dementia villages”.Although we have examined them separately,the health and wealth of an aging population are closely linked.First,aging in good health is cr

237、itical to enabling longer working lives.Second,in some healthcare systems,medical and care-related expenses are one of the most significant financial worries that adults report.63 In some places,this worry is not unfounded:Charles Cavanaugh notes in his interview for this report that in his context

238、of the United States,“one of the most important costs for individuals to consider is healthcare”.The healthcare industry is clearly key to supporting the health of an aging population.We therefore begin by highlighting the perspectives of a healthcare company and a healthcare investor on what aging

239、means for the industry.61 Whitty,C.The Future of Health Globally,A lecture to Gresham College.18 May 2022.Accessible here Last accessed 10th April 2024 62 Bureau of Health Workforce,Long-Term Services and Support:Demand Projections,2020-2035 63 World Bank,Global Findex Database 2021 Citi GPS:Citi GP

240、S:Global Perspectives&Solutions July 2024 2024 Citigroup 52 Collaborating to Maximize Healthy Life Expectancy:An Interview with Mike Devoy,Chief Medical Officer,Bayer What is needed to maximize healthy life expectancy?For healthcare,it requires emphasizing preventive health,promoting a healthy lifes

241、tyle,and ensuring access to quality healthcare.First,a preventive approach could stop people moving into the more serious stages of many diseases linked to aging.A good example is chronic kidney disease(CKD).If CKD reaches its end stages,its a devastating disease which brings an enormous individual

242、burden and huge costs to healthcare systems.If hypertension and metabolic diseases are treated early,we can reduce the risk.So,how can we start to detect these things earlier and intervene earlier?Second,simple steps towards healthier lifestyles like smoking cessation,dental hygiene,and even hearing

243、 tests have significant benefits in preventing some of the diseases related to aging,including cognitive decline.Healthy lifestyles can therefore have a major impact at both the individual and public health levels.So,how can we encourage people in all age groups,not just those who are already older,

244、to take ownership over their health as they age?Third,we need to combat ageism.There are societal assumptions about how we should live as we age.Many of these are built on outdated notions that are no longer relevant because people can have very healthy lives for many more decades than in previous g

245、enerations.Have we made progress on maximizing healthy life expectancy?I am optimistic.The UNs Decade of Healthy Aging is mobilizing a variety of stakeholders that must be engaged to improve the healthy life expectancy and the living conditions of older people,their families,and the communities in w

246、hich they live.The UN Sustainable Development Goals also speak to some of these initiatives around awareness and access to quality healthcare.Political decision makers and communities are beginning to recognize the need to support healthy aging.For example,New York City has defined itself as an age

247、friendly city by committing to ensuring that its urban environment,policies,and services are designed to accommodate and support the needs of residents of all ages,particularly older adults.What is the role of the pharmaceutical industry in contributing to healthy aging for all?The primary role is t

248、o bring innovative medicines,new technologies and digital advancements to diseases that,if left untreated,can lead to a significantly less healthy old age.We have seen a renaissance in the study of Alzheimers disease.For some years this had been set aside as too hard to tackle.There is still a long

249、way to go but now there is more optimism that innovations from the pharmaceutical industry and the wider scientific community will address it.Cell therapies and gene therapies are another example as they start to be used to address degenerative conditions such as Parkinsons disease.As technologies o

250、f gene editing come onstream,perhaps we will be able to edit cells in a way that Dr Michael Devoy Chief Medical Officer Bayer Dr Michael Devoy is the Executive Vice President for Medical Affairs and Pharmacovigilance for the Pharmaceuticals Division at Bayer AG.He is also the Chief Medical Officer o

251、f Bayer AG.Dr Devoy joined the former Schering AG in 2005 as Senior Vice President of Global Medical Development and was appointed to his current position in 2014.July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 53 interferes with the aging process.That is not a short-term in

252、tervention,but it shows how scientific advances might support healthy aging.New scientific research and digital advances hold promise for dealing with some conditions associated with aging.A good example is the use of artificial intelligence and precision medicine to deliver the treatments that are

253、best for individual people in a more targeted way.Beyond innovation,the pharmaceutical industry,along with other stakeholders,also has a role in preventive health,aiming to assist individuals in avoiding hospitalization and the need for advanced medical interventions.While we cannot accomplish this

254、alone,our goal is to promote longer-lasting health and prevent illness.One contribution would be raising awareness.Bringing it back to the example of CKD the pharmaceutical industry can raise awareness that if patients are living with a disease like hypertension or diabetes,they should be getting re

255、gular testing for kidney function or for protein in their urine.This could help reduce the rate of declining kidney function.What would support the industry to make a bigger contribution?More active collaborations with civil society,academia,healthcare systems,governments,and super-governmental agen

256、cies such as the World Health Organization would support the industry to make a bigger contribution.Together,we must employ creativity in finding ways to collaborate to unlock the scientific aspirations for healthy aging.At Bayer we have been working hard to find public-private partnerships to help

257、us bring forward innovations related to aging.Our new Berlin Center for Gene and Cell Therapies,a joint project of Bayer and Charit Berlin,will be substantially funded and supported by Germanys Federal Government as well as the State of Berlin.It aims to bring groundbreaking cell and gene technologi

258、es to patients more quickly while creating a leading biotech ecosystem for innovative therapies in Berlin.Next-generation technology is costly but offers a huge potential value to improving the lives of patients.Healthcare systems need to understand and acknowledge the importance of investing in the

259、se new breakthrough areas of medicine,and match the degree of innovation or risk taken by companies.At the same time public resources are limited and face competing priorities.What are some of the latest innovations in addressing age-related and chronic conditions?The innovations in personalized med

260、icine and gene therapy that I talked about previously are significant.These are already in the clinic,and we might see gene therapies for neurodegenerative conditions this decade.Gene editing and addressing aging as a condition at the cellular level is another area of innovation that might emerge ov

261、er the longer term.Another example is treating the symptoms of menopause.Vasomotor symptoms,commonly associated with menopause,can have a debilitating impact and risks of conditions like osteoporosis and cardiovascular disease increase at that stage of life.Its essential to enhance awareness of thes

262、e issues and advance therapies due to the substantial unmet need in this area.Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 54 How is longevity science evolving?We now talk of the“100-year life”will it get longer?I believe life expectancy will continue increasing.There are

263、 two camps in the aging and longevity world:there are super-optimists who think theres no limit to our lifespan and life expectancies might continue increasing beyond what we can now conceive.Others think there is some limit.There are already humans living well beyond 100 years some to 115 or 120 an

264、d we have seen a steady increase in longevity over the last century.I dont think we have reached the limit of human life span yet.It remains to be seen where that limit will be,but I think we can look to a much larger proportion of our society living healthier,longer lives over the next decades.July

265、 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 55 An Investor Perspective on Aging:In Conversation with Diane Wehner and Wendy Agnew,Senior Portfolio Managers,Citi Global Wealth What are the implications of population aging from an investor perspective?This question goes far an

266、d wide.From a healthcare perspective,we know that as we age we use more healthcare products and services.64 The cost on society is ever-increasing with healthcare spending already representing 18%of GDP in the U.S.,around 12%in the rest of the developed world,and single digits(and rising)in emerging

267、 economies where a growing middle class expects and has the means to access better health care.The growing demand for healthcare along with the rising costs of treating seniors are at the core of what drives the attractiveness of the healthcare sector where innovation is taking place with the dual o

268、bjective of delivering better health outcomes at a lower overall cost of care.What are the most exciting innovations to support healthy aging?Healthcare investing overall inherently leverages the theme of an aging global population.Studies show(and it intuitively makes sense)that as people age,they

269、use healthcare services more often.Healthcare companies prioritize the advancement of science with the objective of keeping people healthy,and extending health spans which for an aging population translates into increased vitality and longer independence.The shift taking place in the U.S.towards val

270、ue-based care(outcomes-based care)away from fee-for-service is particularly relevant for seniors who may require more assistance with compliance and preventative care.Though gradual,this shift is most evident in the services space where managed care organizations and other healthcare service provide

271、rs focused on Medicare Advantage provide a full suite of preventative services to Medicare recipients aimed at keeping them healthy.These services include for example,home health visits,transportation to doctors appointments or medical procedures,and assistance with drug compliance.Aging is often ac

272、companied by the increasing incidence of chronic illnesses including type 2 diabetes,cardiovascular disease,osteoarthritis,Alzheimers Disease and cancer.Some biopharmaceutical companies are innovating to address chronic conditions like these,for example:1.After nearly two decades of failed attempts

273、at effective treatments for Alzheimers Disease,the FDA recently approved novel drugs shown to slow the progression of the disease in early-stage Alzheimers Disease patients.2.GLP-1 drugs are demonstrating effectiveness in managing type 2 diabetes while also addressing obesity and overweight conditio

274、ns.In clinical trials,the incidence of diseases related to excess weight is also being reduced with the use of GLP-1 treatment,such as cardiovascular disease,osteo-arthritis,and obstructive sleep apnea.64 For discussion,see our article For investors,healthcare innovation is on sale,in Wealth Outlook

275、 2024 Diane Wehner Senior Portfolio Manager Citi Global Wealth Wendy Agnew Senior Portfolio Manager Citi Global Wealth Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 56 3.Advancements in cancer treatment utilizing biologics-based drug development platforms such as cell and

276、gene therapies,immunotherapy,mRNA,and antibody drug conjugates are leading to new and more effective treatments for cancer and other diseases,oftentimes with less toxicity.4.Life science tools companies that provide equipment and services that support the drug development process by partnering with

277、biopharma to move drugs through clinical trials also play a role in this focus on chronic illness and the emergence of new biologic drug development platforms.Medical device companies that address these chronic diseases with innovative devices that are either implanted in the body or worn on the bod

278、y also contribute to supporting healthy aging.For example:1.Companies that develop externally-worn devices to monitor vital statistics such as heart rate,blood pressure,blood glucose levels(continuous glucose monitors)are helping patients prevent or manage various diseases.2.Minimally invasive proce

279、dures both manual and robotic are allowing older patients to benefit from implantable devices to address heart disease such as aortic stenosis or mitral regurgitation(leaky heart valve)as these procedures are less invasive and result in better surgical outcomes and faster recovery.3.A more active se

280、nior population can also result in increased incidence of injury think pickleball,tennis and golf and with that increased activity,the need for orthopedic repairs such as rotator cuff repair or hip and knee replacements correspondingly increases.4.Diagnostic testing to identify diseases early is a k

281、ey factor in preventative care.Companies that offer genomic screening for colon cancer or blood tests to monitor the recurrence of cancer in patients in remission can lead to early intervention and better outcomes for patients.Areas outside of the healthcare sector that address an aging population i

282、nclude industrial and technology companies that are focused on innovation in transportation and smart cities that are designed with a focus on urbanites health and well-being.July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 57 The healthcare sector is not the only contributor

283、 to healthy aging.Collaboration is key,as Mike Devoy told us:“maximizing healthy life expectancy requires the collaboration of healthcare systems,pharmaceutical companies,and wider society.No one group can achieve this independently.”The World Health Organization has articulated the need for a publi

284、c health approach to aging.65 Evolving the design of public spaces to both enable healthy lives and support older residents is one dimension.We have described in other reports how cities could be designed to support healthy lifestyles,by enabling“active transport”(i.e.,cycling or walking)or by facil

285、itating access to green spaces in urban areas.66 Catering to older individuals is different it involves increasing accessibility in housing,healthcare,and public spaces.67 For example,New York is now part of the WHOs“Age Friendly Cities”network,and initiatives have included increasing the availabili

286、ty of public seating for those who might need to rest.68 More than 1500 cities across 51 countries are now designated“age-friendly”.However,Figure 35 shows high variation in the share of the older population living in age-friendly cities in a selection of high-income countries,indicating that there

287、is more to be done in making public spaces accessible.Figure 35.Proportion of older people living in age-friendly cities and communities in 2023 Source:WHO Dr.Louise Lafortune from Cambridge University also highlighted to us the role that age-friendly communities and micro-towns,like dementia villag

288、es,will play in supporting the health needs of an older population.69 To illustrate,reporting on a 65 World Economic Forum,2024.Longevity Economy Principles,pp.19 66 Citi GPS,2018,Sustainable Cities:Beacons of Light Against the Shadow of Unplanned Urbanization,pp.107-9 67 World Health Organization,2

289、007.Global Age-Friendly Cities:A Guide Accessible here Last accessed April 24th,2024 They define eight domains of age-friendly cities.68 https:/extranet.who.int/agefriendlyworld/afp/citybench-program/69 For discussion,see:ADI,2020.World Alzheimer Report 2020:Dignity,Design and Dementia Dementia-Rela

290、ted Design and the Built Environment,Accessible here Last accessed April 24th,2024 0102030405060708090IrelandChileUruguay CanadaU.S.UKFranceFinland DenmarkGermany Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 58 French dementia village has described shops that dont require

291、 payment upon purchasing groceries and appointments that run with no set times.70 In other places,there are efforts to bring the local community into these communities,so that they dont just look and feel like villages they actually are villages and towns.71 This is a more radical redesign of public

292、 spaces,which might become increasingly common as the population ages.Public health approaches to healthy aging also include evolving health systems to reduce the prevalence of chronic disease,as Adam Spielman describes.70 Sophie Hutchinson,2023.Landais Alzheimer the village where everyone has demen

293、tia.Accessible here Last accessed April 24th,2024 71 Joann Plockova,As cases soar,Dementia Villages look like the future of home care,New York Times.July 3,2023 Accessible here.Last accessed April 24th,2024 July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 59 Healthcare System

294、s and Healthy Aging Healthcare systems in developed economies are already coming under increasing pressure and absorbing an ever-higher percentage of GDP as the population ages,so its easy to imagine the problems will become ever-harder to deal with.One example comes from the U.S.:Healthcare for ove

295、r-65s is provided by Medicare,but the Medicare Board of Trustees says the fund for hospital spending will be run short of money by 2031.72 A substantial majority of healthcare spending is on chronic diseases things like dementia and diabetes that are managed,not solved.Almost every chronic disease i

296、s made significantly worse by being over-weight,and(historic)trends in obesity look very poor as Figure 36 shows.The best way to reduce the burden of aging on the health system and indeed on society as whole would be to reduce the prevalence of chronic diseases.Figure 36.Obesity rate in selected cou

297、ntries,1990 to 2016 Source:Global Health Observatory,via OWID There are a number of technologies on the(near)horizon,which we believe will do exactly that:GLP-1s and reduced obesity:For the first time,there is a really effective class of medicines to reduce peoples weight:the GLP-1 drugs.One example

298、 is semaglutide sold as Ozempic and Wegovy.In a clinical trial,overweight people taking the drug lost about 15-17%of their body weight after 68 weeks,vs 2-3%for those taking a placebo.73 As capacity increases and more GLP-1s get approval,we are confident that a substantial proportion of the populati

299、on will use them,resulting in a decline in the proportion of the population that is overweight.72 2023 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.Accessible here Last accessed 10th April 2024 73 This was the STEP1

300、 trial,which included almost 2000 participants.Wilding,J.P.H.et al.Once-Weekly Semaglutide in Adults with Overweight or Obesity,New England Journal of Medicine 384(2021)Accessible here Last accessed April 10th 2024 01020304019901992199419961998200020022004200620082010201220142016USUKGermanyJapanChin

301、aWorldEgyptMexico Adam Spielman Head of Health Citi Global Insights Adam Spielman is Head of Health and Consumer at Citi Global Insights.In the health area,his overarching thesis is that in time,healthcare will become more preventative,more personalized and more convenient,thanks to the convergence

302、of the health,tech and consumer industries.In the consumer area,he focuses on the Future of Food.Citi GPS:Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 60 This in turn should help reduce the incidence of many chronic diseases,in particular diabetes,chronic kidney disease and cardio

303、vascular disease.Early detection and prevention:Techniques are being developed in several areas to detect diseases earlier,before the symptoms become problematic,and when they are much easier to treat.For example new tests are being developed to detect type 2 diabetes and chronic kidney disease befo

304、re people become symptomatic,allowing them to be addressed early enough to prevent these diseases becoming so burdensome.(For more details see our recent GPS report,Future of Healthcare:The Oxford Prescription)If we are right,and more people can remain healthy for more years,that will resolve many o

305、f the difficulties associated with aging societies.But maximizing the years of life spent in good health is one thing,but there will always come a point in our lifespan when we need care.As the population ages,the demand for formal care is projected to increase by almost 50%between 2020 and 2035.74

306、We believe it will be possible to re-organize healthcare in order to look after older adults more effectively.In theory healthcare is distinct from other types of care because all treatments need to be approved by agencies like the FDA,after they have been shown,rigorously,to be safe and effective.G

307、enerally,healthcare and insurance-works best for acute issues.An individual has a problem maybe a disease,maybe an injury they go to a doctor,who perhaps sends them to a hospital,and the system fixes the problem as best it can,and the individual goes home.However many older people,struggle with the

308、ADLs the activities of daily living,and therefore the assumption that these individuals can simply go home and look after themselves breaks down.At this point,healthcare blurs with social care,and the traditional distinction goes away.As the proportion of the population that struggles with the ADLs

309、grows,it is likely that the traditional structural separation between healthcare and other types of care will erode,allowing joined up solutions that work more effectively for older adults.Case study:NHS England The National Health Service in England provides a good example of how healthcare systems

310、 are likely to adapt.In 2022 NHS England was restructured with the aim to simultaneously improve healthcare performance and efficiency and to collaborate effectively with local providers,so health and social care are joined up effectively.In the short term both health-and social-care are under extre

311、me pressure in England due to limited national and local government funding.However,we believe that in the long-term,this type of integration between health-and social-care is likely to provide a template of how care can be provided for older adults most effectively.74 Bureau of Health Workforce,Lon

312、g-Term Services and Support:Demand Projections,2020-2035.Accessible here.Last accessed April 10th,2024 July 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 61 Formal or paid care work is not the whole story when it comes to an aging population.Most care work is carried out by fam

313、ily members and friends.To illustrate:14%of the U.S.population aged over 15 was engaged in providing unpaid care in 2021-22.75 At a global level,women(the primary providers of care)spend an average of more than four hours undertaking unpaid care work every day.76 If the supply of formal care cannot

314、be brought to match demand,informal carers will likely fill the gap and the share of people engaged in unpaid care work will likely increase.Formal care is not uniformly preferable to unpaid care work,77 but reliance on it has economic consequences.Unpaid care work makes a significant economic contr

315、ibution.One estimate found that if unpaid care work was paid at the rate of other caregiving,it would be valued at between$2.5 and$3.5 trillion.78 Care work is hugely economically valuable,but providing it is a leading reason that women are out of the paid workforce:647 million working-age adults,of

316、 which 606 million are women,are out of the labor force due to a responsibility to provide care79(Figure 37)and crucially,data suggests that many would prefer to be in formal paid work.80 For women who stay at work while providing unpaid care,their caregiver status often results in less rewarding wo

317、rk compared with men.81 75 US Bureau of Labor Statistics.Accessible here Last accessed April 10th 2024 76 ILO.2018 Care work and care jobs for the future of decent work.Accessible here.Last accessed April 11th,2024 77 ILO.2018 Care work and care jobs for the future of decent work.Pp.288.Accessible h

318、ere.Last accessed April 11th,2024 78 BCG.Solving the$290 billion Care Crisis November 15,2022.Accessible here Last accessed April 11th,2024 79 ILO.2018 Care work and care jobs for the future of decent work.Accessible here.Last accessed April 11th,2024 80 Gallup.2017.Towards a better future for women

319、 and work:Voices of Men and Women.Accessible here Last accessed April 11th,2024 81 ILO.2018 Care work and care jobs for the future of decent work.Pp.287.Accessible here.Last accessed April 11th,2024 Many unpaid care workers would prefer to be in formal paid work Citi GPS:Citi GPS:Global Perspectives

320、&Solutions July 2024 2024 Citigroup 62 Figure 37.Share of economically inactive people,by sex and reason for inactivity Source:ILO(2018)Key Actions for Supporting Healthy Aging Access to good health is the second dimension in minimizing the level of economic and social dependence that an aging popul

321、ation brings.We have again articulated two high-level principles:1.Prevent the onset of dependence by supporting healthy aging,for example by preventing ill health and innovating for the conditions of old age 2.Prepare for a higher level of dependence by ensuring affordable access to healthcare for

322、all,including boosting the supply of care work,joining up health and social care systems,and supporting unpaid carers These combine to address increasing dependence in the population.The first minimizes the effects of population aging,by redefining what it means to be a particular chronological age

323、in terms of how healthy an individual is.The second prepares for a higher level of dependence in the population by ensuring access to high quality care for all.We again provide concrete examples of how to put these high-level principles into action in the Conclusion to this report.0%10%20%30%40%50%6

324、0%70%80%90%100%WomenMenWomenMenWomenMenWomenMenUnpaid careEducation,sick,disabledOther sources of incomeLabor market reasonsOtherWORLDHIGH-INCOMEMIDDLE-INCOMELOW-INCOMEJuly 2024 Citi GPS:Citi GPS:Global Perspectives&Solutions 2024 Citigroup 63 Conclusion Responding to Population Aging We said in Cha

325、pter 1 that population aging is a mega-trend that demands a response rather than attempts to reverse its course.This is necessary to address not only our longevity but also the shift to a society with more older people than younger people.We then argued in Chapter 2 that the most pressing challenge

326、posed by the demographic transition is that of increasing dependence or the idea that a growing older population will lead to an unsustainably shrinking workforce with economic and social implications.However,we suggested that while the trend towards a population that is older than it ever has been

327、is intractable,dependence is not it can be altered by focusing on the health and wealth of our aging population.Steps to minimize the level of dependence in the global population will be wide-ranging.From the contributions collated in Chapters 3 and 4,from experts at Citi and across our global netwo

328、rk,some high-level recommendations arise.Supporting economic resilience and good health,including earlier and more effective access to appropriate care,can help minimize the dependence of an aging population.Economic resilience and good health can be decomposed into an attempt to maximize the length

329、 of time in which individuals are contributors rather than dependents first,followed by a second intervention which prepares for increased social and economic dependence.Under the first banner,we include facilitating longer working lives and healthy aging;under the second,boosting financial inclusio

330、n and access to healthcare and support services.The contributions collated in the previous two chapters also make these high-level recommendations more concrete by providing specific examples and actions that could form part of a response to population aging.The table below collates some of these co

331、ncrete recommendations into a tear sheet,co-produced with the Global Coalition on Aging(GCOA)and drawing upon their work on demographic change.In structuring these recommendations,we build on the series of guiding questions that have been previously published by the GCOA.82 Private sector actors can

332、 use the following tear sheet to understand what might constitute answers to GCOAs guiding questions.82 GCOA,Decade of Healthy Aging Demystified July 2022.Last accessed 19th March 2024 Michael Hodin CEO Global Coalition on Aging Melissa Mitchell Executive Director Global Coalition on Aging Citi GPS:

333、Citi GPS:Global Perspectives&Solutions July 2024 2024 Citigroup 64 Figure 38.Supporting the Health and Wealth of an Aging Population Supporting Economic Resilience Addressing the Impact of Declining Health Minimizing Dependence and Supporting Contribution Longer Working Lives Listen to all generations of workers to understand and respond to their needs as they evolve across their working lives.Dep