Henry McKinnell: Making the most of old age

For citizens to enjoy longer lives, says Henry McKinnell, governments should invest in the latest and most effective medicines –

In the summer of 1890, a girl was born in Smilde, the Netherlands. Six months later, 5,000km away, a boy was born in Syracuse, New York. The boy was healthy, but the girl struggled for several months before her family was reassured that she would survive.

The births didn’t attract much attention beyond the immediate families. But people might have taken note if they had had a crystal ball. Last year, Hendrikje Van Andel-Schipper and Fred Hale both turned 114, thus sharing the distinction of being the oldest documented people on the planet.

How did they do it? Fred Hale attributes his longevity to the teaspoonful of bee pollen and beeswax he eats each day – along with a nip of whiskey.

While it’s no longer unusual to hear of people living to advanced ages, both Fred and Hendrikje symbolize something far greater than their individual longevity. They embody one of the great success stories of the 20th century. The past 100 years have seen dramatic revolutions – in politics, ideology and technology. But we’ve been slow to acknowledge a quieter but equally epoch-making revolution: longer life.

In 1890, when Hendrikje and Fred were born, average life expectancy worldwide was about 30 years – in the United States and Europe, about 45. Now it’s 66 for the world, and about 77 in the United States and Europe.

This dramatic extension of life expectancy has been one of the great advances in human history, and one that cannot be measured by numbers alone. It means that millions of people can continue to work productively, go to a grandchild’s or even a great-grandchild’s birthday party, pursue hobbies, enjoy the companionship of loved ones, or simply pursue favourite pastimes like driving in the country (as Fred Hale did until he was 108), or following a favourite soccer team (as Hendrikje has done since 1924).

The gift of longer life

This gift of longer life was made possible by a combination of economic development, scientific discoveries, improved agricultural methods, and better sanitation and hygiene.

It’s also the legacy of such innovators as Jonas Salk, who developed the polio vaccine; of Alexander Fleming, who discovered penicillin; and of the countless scientists who have discovered and developed new medicines to lower cholesterol, fight depression, manage HIV/AIDS, and combat virtually every major disease.

The widespread availability of these and other innovative medicines has saved, extended and enriched countless lives. Researchers expect this impressive record of prolonging human life to continue over the next 50 years, with average life spans rising six years in Europe, five years in the United States, and six and a half years in Japan.

Longer lives, together with falling birth rates in many industrialized countries, signal a major shift in the demographic balance. The share of Europe’s population that is under 15 years of age is 23 percentage points smaller than it was in 1970; Japan’s is 25 points smaller. Today 61 countries have fertility rates below replacement rate, including every country in Europe except Albania.

Just 35 years from now, four of every 10 people in Italy and Japan are likely to be older than 60. By mid-century, some European countries could have more citizens over 80 than under 20.

This convergence of demographic trends – rising longevity and declining fertility – carries enormous economic and social implications. As people live longer, they consume more medicines, have more operations, see the doctor more often and spend more time in hospital. Increased demand for healthcare has already put intense financial pressures on national health and pension systems. These pressures are likely to become unsustainable in future decades – unless we meet the challenges and opportunities of ageing in a dramatically new way.

The way forward

How can governments better manage the fiscal challenges posed by ageing populations? And how can our growing ranks of seniors be helped to enjoy healthy and productive old age without short-changing younger generations?

Many solutions have been proposed, but few are politically palatable. Should we raise the retirement age? Increase worker and employer contributions to pension systems? Reduce pension benefits? Encourage immigration?

I’m convinced that we can accommodate the “gift of longer life” without imposing harsh penalties that victimize workers, taxpayers or pensioners. But we must move now. And we must work together.

We can start by answering four important questions. What are our goals? What are the obstacles? What are our most effective solutions? Finally, what will it take to bring them about?

Clearly, people want to remain active, engaged members of society throughout their entire lives. Healthy ageing is about making the right health choices at all ages. To help make this possible, governments and other stakeholders need to focus more on prevention, education, information and encouraging healthy habits. Just as important, they should create a policy environment that encourages biomedical discovery. Innovative medicines play an indispensable role in making a healthier future possible for people at all stages of life – and in contributing to the economic prosperity of society as a whole.

Unfortunately, governments in Europe and elsewhere have responded to budget pressure by enacting short-sighted policies that deny patients rapid access to the most innovative and effective medicines. This arbitrary approach, which really amounts to a form of rationing, treats new medicines as a cost to be managed, rather than a long-term investment in public health and economic growth.

Innovation is key

Pharmaceutical cost-containment policies don’t just make it harder for patients to obtain the most up-to-date medicines – though they certainly do that. They also tend to discourage investment in future pharmaceutical innovation. It’s no coincidence that just five of the world’s current 20 top-selling medicines were discovered by companies based in Europe or Japan, where governments tightly control spending on new medicines and show less commitment to fostering an active and robust science base. The other 15 emerged from America, which offers a more welcoming climate for pharmaceutical investment in research.

One inevitable result of this disparity is a steady migration of scientific expertise and investment to the United States. Since the mid-1990s, four research-based pharmaceutical companies – Novartis, Aventis, GlaxoSmithKline and Pharmacia – have all moved their research operations or headquarters from Europe to the United States.

This “brain drain” has European governments deeply worried – and rightly so. They know that Europe’s future economic growth and competitiveness depend on attracting – and retaining – high-tech investment and scientific expertise.

Prescription for a healthy future

One of the most pressing challenges of the 21st century, then, will be to create a global climate that fosters research, innovation and access to the most effective medicines – and ensures a healthy future for the growing ranks of the elderly and for future generations.

Here are three suggestions that could aid in overcoming the global healthcare challenge: Listen to the people. Public opinion surveys in Europe show that many people are dissatisfied with the quality of their healthcare. They hold governments largely responsible, and expect them to spend a larger share of the national budget on health. There is also widespread concern in Europe about the loss of biomedical investment and expertise, with people fearing that it will degrade the quality of their healthcare.

Surveys of doctors in Europe, Canada, and parts of Africa and the Middle East reveal similar concerns. Medical professionals are worried about pressure on healthcare budgets, about bureaucratic interference in doctors’ choices of medicines and treatments, and about limits on patient access and reimbursement for the latest and most effective medicines.

Expand access to information. Good health depends on patients of all ages becoming more informed about – and involved in – their own healthcare. To do this, they need full information about the causes of disease, means of prevention and available therapies.

Forge new healthcare partnerships. I’m not the first to point out that there is no “i” in “team”. Expanding access to high quality healthcare is a shared responsibility of governments, doctors, hospitals, academic institutions, healthcare companies and patients themselves.

Various advocacy and research organizations are doing excellent work in promoting healthy ageing – especially through educational and monitoring programmes that help people maintain good health.

On example is the Alliance for Health & the Future, a partnership between the International Longevity Center and Pfizer. This non-profit organization conducts research and educates scholars and thought leaders on how to maintain wellbeing and productivity throughout life. It helps individual patients, health professionals and government officials become more knowledgeable about healthy living.

Another noteworthy programme is The Hearts at Work Initiative, through which Pfizer Canada and the British Columbia Healthy Heart Society are working to reduce cardiovascular disease in the province of British Columbia through patient education initiatives and cholesterol screening.

Yet another initiative is “Team Health”, a pilot partnership formed by the British National Health Service and Pfizer UK that focuses on heart failure, heart disease and diabetes. By helping patients become more directly involved in managing their own healthcare, this scheme seeks to reduce unnecessary hospital admissions and inadequate health outcomes, while improving patients’ satisfaction with their healthcare. The programme is now being piloted at the Haringey Teaching Primary Care Trust in London.

Health and wealth – a virtuous circle

At Pfizer, we view the phenomenon of ageing as a great opportunity to rethink how our societies view the entire range of health issues. We are engaging with policy-makers in the European Union and national governments to emphasize the link between health and wealth. Each strengthens the other – provided that patients have access to information and the most effective medicines, and that research-based companies have a conducive climate in which to discover and develop tomorrow’s cures and treatments.

As David Byrne, former EU health commissioner and now a special envoy with the World Health Organization, has pointed out, “In a knowledge-driven society, to add economic value, you must first add years of healthy living. In an ageing Europe, a healthy, active workforce will be a key determinant of sustainable productivity.”

As we try to map out what lies ahead, it helps to look back to when Fred Hale and Hendrikje Van Andel-Schipper first saw the light of day. In 1890, people had few defences against childhood diseases that today are routinely managed with widely available shots and pills. But that same year, Paul Ehrlich joined with Emil van Behring to standardize an anti-toxin that could cure one of the world’s great scourges – diphtheria.

It was Ehrlich who coined the term “magic bullet” to describe molecules that could selectively target harmful bacteria for destruction. And today, when we bring our children in for their DPT shots – diphtheria, pertussis and tetanus – we should say a silent word of thanks to Ehrlich and his fellow biomedical pioneers. But many other innovators deserve our gratitude as well. When Fred and Hendrikje were three years old, a Dane, Niels Finsen discovered the first treatment for lupus. When they turned five, German physicist Wilhelm Roentgen discovered the X-ray. When they were 11, an Austrian, Karl Landsteiner, identified blood types. The story of longevity is the story of men and women all over the world, making false starts, occasionally hitting dead ends, but discovering, one by one, the innovations that today help us stay healthy throughout life.

I’m convinced that in future decades we can continue to make significant progress in raising global health standards. The sheer scale of the ageing phenomenon will require significant and daring changes in public policy. By working together and building productive alliances and partnerships to achieve shared goals, we will someday view people like Fred Hale and Hendrikje Van Andel-Schipper not as geriatric marvels, but as ordinary human beings with normal life spans – extended just a bit, perhaps, by beeswax and a nip of whiskey.

Henry McKinnell
Henry A McKinnell is chairman and CEO of Pfizer, a research-based global pharmaceutical company. He is a member of the World Economic Forum’s Foundation Board.