Aging in America in the 21st CenturyDemographic Forecasts from the MacArthur Research Network on an Aging Society

Presented by S. Jay Olshansky, Ph.D.University of Illinois at Chicago

Due to a publication embargo, we are unable to provide the slides presented by Dr. Olshansky in November.

Aging, the Life-Course and Health Disparities: Exploring the

Intersections

Implications for an Aging Society

James S. Jackson Institute for Social Research

University of Michigan

R.I.C.E.R.I.C.E.

• Race

• Immigration

• Culture

• Ethnicity (and Gender, Age, and SES)

Evidence of Racial and Ethnic Evidence of Racial and Ethnic Disparities in Health and Disparities in Health and

HealthcareHealthcare

Disparities consistently found across a wide range of disease areas and clinical services

Disparities are found even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account

Disparities are found across a range of clinical settings, including public and private hospitals, teaching and non-teaching hospitals, etc.

Disparities in care are associated with higher mortality among minorities (e.g., Bach et al., 1999; Peterson et al., 1997; Bennett et al., 1995)

Age, Ancestry, and Timing of Immigration Matter for Black

Caribbeans

Lifetime Any Disorder for Black Caribbeans Over 55 Years of Age

50.6

7.7

11.58.8

43.3

0

10

20

30

40

50

R & ParentsU.S. Born

R U.S. Born, 1+ Parents

Not

R Came to U.S. >20 Yrs

Ago

R Came to U.S. 11-20 Yrs

Ago

R Came to U.S. 0-10 Yrs

Ago

Source: NSAL, National Survey of American Life, 2004.F-Statistics significant, p < .001*NSAL Whites living in areas with Black population of 10% or more.**Includes 7 disorders asked of all races: Major Depression, Dysthymia, Mania, Panic Disorder, Social Phobia, Generalized Anxiety Disorder, and Agoraphobia

31.5

20.822.6

0

10

20

30

40

50

Total

White

African American

Caribbean

Over 55 Years of Age at Time of Interview

Aging and Immigration

• Growth of aging populations worldwide creates demand for immigration of all ages, e.g. for young a way to gain opportunities, but also increasingly among the elderly for reasons of family reunification

• The attitudes of AIN populations are, for the most part, negative toward immigration, and while endorsing civil liberties for their own populations, tend to be less open to these liberties for immigrants

• Members of AINs, such as in Western Europe and the U.S., may be increasingly intolerant of increased immigration, especially as population aging takes place in these better-off receiving countries

Health Disparities by Age, Aging and the Life-Course: Health Disparities

Emerge in Middle-Age

There are links from childhood (infancy, neonatal, pregnancy, etc.) social conditions to race/ethnic disparities in adulthood and older age (e.g. Warner & Hayward, Massey, Geronimous, etc.)

Over the life course blacks more than any other group live the fewest years and a high proportion of these years is in poor health (e.g. Hayward & Heron)

Health, race, ethnicity and mobility (SES) are linked in complex ways across childhood, adolescence, adulthood, and old age (e.g. Hayward et al)

Disparities in Health Status, Health Services and Mental Health: Physical and Psychological

Inequalities

Large disparities in all cause and specific cause death rates exist among ethnic and racial groups – these differences are not due in any simple way to socioeconomic status

Infant mortality rates have declined but large difference exist between African Americans and whites

There are large disparities in health care utilization between African Americans and whites

Diabetes – Females 2004-2005

0

5

10

15

20

25

30

18-24 Years 25-44 Years 45-64 Years 65-74 Years 75-84 Years 85+ Years

Dia

bete

s P

revale

nce i

n F

em

ale

s (

%)

Black

White

Prevalence of Selected Chronic Conditions by Age, Sex, and Race/Ethnicity: United States,

1997-2005. National Health Interview Survey (NHIC05)

Hypertension – Males 2004-2005

0

10

20

30

40

50

60

70

18-24 Years 25-44 Years 45-64 Years 65-74 Years 75-84 Years 85+ Years

Hyp

ert

en

sio

n P

revale

nce i

n M

ale

s (

%)

Black

White

Prevalence of Selected Chronic Conditions by Age, Sex, and Race/Ethnicity: United States,

1997-2005. National Health Interview Survey (NHIC05)

Obesity – Females 2003-2004

0

10

20

30

40

50

60

70

2-5 Years 6-11 Years 12-19 Years 20-39 Years 40-59 Years ≥ 60 Years

Ob

es

ity

Pre

va

len

ce

(%

)

Black

White

Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight

and obesity in the United States, 1999-2004. JAMA 295:1549-1555. 2006.

Health Disparities by Age, Aging and the Life-Course

There are links from childhood (infancy, neonatal, pregnancy, etc.) social conditions to race/ethnic disparities in adulthood and older age (e.g. Warner & Hayward, 2003)

Over the life course blacks more than any other group live the fewest years and a high proportion of these years is in poor health (e.g. Hayward & Heron, 2002)

Health, race, ethnicity and mobility (SES) are linked in complex ways across childhood, adolescence, adulthood, and old age (e.g. Hayward et al, 2003; Whitfield & Hayward, 2003; Crimmins et al, 2000; Crimmins & Saito, 2001)

Pregnancy to Death

Blacks May be More Highly Selected for Positive Health Than Whites Early in Life

Infant, Fetal, & Perinatal Mortality Rates - 2002

Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System: Hoyert DL, Heron M, Murphy SL, Kung HC. Deaths: Final data for 2003. National vital statistics reports. Vol 54. Hyattsville, Maryland.

National Center for Health Statistics. 2006; and unpublished numbers.

0

2

4

6

8

10

12

14

16

Mo

rtality

Rate

s

Black motherWhite mother

Endocrine, Nutritional, and Metabolic Diseases – 1999-2004

0

0.5

1

1.5

2

2.5

3

< 1 Year 1-4 Years 5-9 Years 10-14Years

15-19Years

20-24Years

25-34Years

35-44Years

45-54Years

55-64Years

65-74Years

75-84Years

85+Years

Bla

ck

:Wh

ite

Ra

tio

Females

Poly. (Females)

Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2004. CDC WONDER On-line Database, compiled

from Compressed Mortality File 1999-2004 Series 20 No. 2J, 2007.

Stressors

Physical health and psychiatric disorder disparities are not reducible in any simplistic way to differences in social and economic statuses among groups (Report of the Surgeon General, 2001)

Complex, multi-faceted -- racial, ethnic, culturally, environmentally, gendered, and life-course, influenced

Conclusions

Conclusion

Poor Neighborhoods and Housing as Root Causes

Selection Effects May Account for Low Incidence of Health Disparities in Early Years

Implications for Life-Course Community Interventions and Treatments in an Aging Society

Thank YouThank You

Intergenerational Relationsin Our Aging Society:

Political and Policy Perspectives

presented byRobert H. Binstock

Professor of Aging, Health, and SocietyCase Western Reserve University

for the

MacArthur FoundationResearch Network on an Aging Society

November 21, 2008National Harbor, MD

Over 25 Years, Many Harbingers of Intergenerational Political Conflict

• “Greedy Geezers”

• Tradeoffs between children and the elderly

• Perhaps most explicit regarding intergenerational conflict in the aging society have been investment banker Peter Peterson and MIT economist, Lester Thurow

Lester Thurow

• “Universal suffrage is going to meet the ultimate test in the elderly. If democratic governments cannot cut benefits that go to a majority of their voters, then they have no long-term future…In the years ahead, class warfare is apt to be redefined as the young against the old, rather than the poor against the rich.”

Figure 1Persons Aged 65 and Older As Percentage of All Persons of Voting Age In U.S. Presidential Elections, 1968-2008,

and As Projected for Selected Years, 2010-2050

0

5

10

15

20

25

30

68 72 76 80 84 88 92 96 0 4 10 15 20 25 30 35 40 45 50

Source: author’s calculations from data in U.S. Census Bureau, Current Population Reports, Series P20 and Series P25 (Middle Series Projections).

27%

Year

Per

cen

tage

17%

Undergirding the Intergenerational Conflict Scenario..

• View of “the elderly” as a self-interested political monolith, voting to maximize old-age-benefit programs

• A doubling of number of older voters because of aging of boomers

• But assumptions that older persons vote as a benefits bloc are wrong – up to now

• In past national elections they have voted for the winner, regardless of old-age policy issues

Figure 1Percent of All Voters and Voters Aged 60+ Voting for

Republican Presidential Candidates, 1980-2008

0

10

20

30

40

50

60

70

1980

1984

1988

1992

1996

2000

2004

2008

all voters

voters 60+

Source: Connelly, M. (2004). How Americans voted: A political portrait. New York Times, Nov. 7, 4wk., and Edison/Mitofsky poll (2008).

51%

47%

Year

Per

cen

tage

Figure 2Percent Voting for Republican U.S. Presidential

Candidates, by Age Groups, 1976-2008

0

10

20

30

40

50

60

70

1976 1980 1984 1988 1992 1996 2000 2004 2008

18-29

30-44

45-59

60+

Year

Pe

rce

nta

ge

31%

51%

Why Were Older People the Only Age Group Favoring McCain?

• Old-age benefits weren’t on the radar screen• The Eisenhower cohort was a major factor• These are voters who were socialized to

politics during the heart of the Eisenhower presidency, but before the Kennedy presidency

• Cohort of voters 65-69 -- 36% of those 65+

Table 1Nationwide Votes for U.S. President, 2008,

by Selected Older Age Groups

Source: Edison/Mitofsky Exit Poll (2004c); Lenski, (2005).

Obama McCain

all ages 53% 47%

ages 65+ 45 53

ages 60+ 47 51

ages 60-64 50 48

ages 65-69 44 53

ages 70-74 46 50

ages 75+ 46 51

Race as Another Factor?

• Hypothesis: with Black candidate, White older voters will show signs of cohort and period effects

• The era in which they grew up was substantially different in terms of structural and cultural aspects of race relations

• Especially in the South

Table 2Voters Aged 60 and Older, by Region, 2008

Obama McCain

South 36% 62%

East 54% 45%

Midwest 52% 46%

West 50% 47%

Figure 3Percent Voting for McCain, 2008,by Race/Ethnic and Age groups

0102030405060708090

100

18-29 30-44 45-64 65+

BlackLatinoWhite

6%4%

30%

19%

58%

44%

56%57%

Summary of Voting Behavior• For now, the elderly are diverse in politics as

they are in most every other social sphere

• They have not been voting as an old-age-benefits bloc, either in U.S. or in Europe

• Boomer cohorts voted 49% vs. 49% in this election

• But all this could change if the policy and political environments change – and they may do so given the new fiscal environment

• Intergenerational political conflict might well emerge

Also, A Possible Crosscutting Racial Dimension to Age Group Politics

• During next several decades, the workforce will be increasingly composed of minorities

• Indicators (e.g., education) that they will be working in relatively low-paying jobs

• Elderly boomers will be 75% White

• Will low-wage young minority workers want to pay payroll taxes to support entitlements for a predominantly White older generation?

As Recent Fiscal Events Underscore, Intergenerational Politics in an

Aging Society Will Ultimately Be Shaped By…

• 1. Whether there is enough national wealth available to redistribute to older people

• 2. Whether there is the political will to do so, or considerable political resistance

• In other words, whether the prevailing ideology supports a politics of collectively insuring against social and economic risks in old age

Reframing the Public’s Understanding of the Social

Contract…

• Could strengthen that political will

• And might moderate the risks of intergenerational political tensions

Reframing:• Older people are not hermetically sealed

from their families, communities, & society

• Old-age policies need to be better understood as family policies, which, in many ways, is what they are

• In fact, many successful modern pension reforms in European aging societies were built on redefining policy goals in terms of widely-shared social values (Kohli, 2007)

Without Our Old-Age Policies…

• Far more elders could be financially dependent on their families and local communities, or in institutions

• Because of financial necessity, we might see return of 3- & 4-generation households (3.6 million “move-ins” last year)

• Many adult children could be financially devastated by paying the costs of health care and long-term care for their parents

• And that, in turn, could limit their resources for their own children

Most of Us, of All Ages, Have a Stake in Old-Age Policies

• Social Security, Medicare, and Medicaid are not “luxurious” government benefits for a group of Americans that are presently depicted in public rhetoric as if they were a separate, selfish tribe of “the elderly.”

• I personally hope that the MacArthur initiative can help to reframe public understanding of the intergenerational social contract in multigenerational terms