Population Aging: Global Challenges and Opportunities for ... · Population Aging: Global Challenges and Opportunities for the 21stCentury ... Global Challenges and Opportunities

Article from:

International Section News

March 2002 – Issue No. 27

S enator and former First Lady Hillary Clinton wrote a book based onthe premise that “it takes a villageto raise a child.” It also takes a

village—an increasingly global village—toaddress the challenges and opportunities ofan aging society. This concept will becomemore and more of a reality in the 21st

century as the impact of populationaging—the combination of low fertilityrates and the longevity revolution—is feltacross the globe.

The purpose of this paper is threefold.The first objective is to highlight the keytrends and projections that describe themagnitude and scope of the aging world inthe 21st century. The second is to identifysome of the key issues that countries in thedeveloped and developing world will haveto face as a consequence of population

NUMBER 27

INTERNATIONAL SECTION NEWSMARCH 2002

A s incoming chair, I’d liketo start off with a big“thank you” to our outgo-

ing Council members, Jim Toole,Mike Gabon, and Ronald Poon-Affat. These folks worked hard andmade incredible contributions tothe Section during their three-yearterms. Welcome to our newmembers, Rejean Besner, MichaelEnright, and Yiji Starr.

I feel very fortunate to start offmy term with all of the valuableinput from our survey. My onlyregret is that we did not hear frommore of you! Thank you to everyone

In This Issue

page

Chairperson’s Corner

by Lisa S. Kuklinski Ramirez . . .1

Population Aging: Global Challengesand Opportunities for the 21st Century

by Robyn I. Stone . . . . . . . . . . . . .1

Figure One . . . . . . . . . . . . . . . . .10

Figure Two . . . . . . . . . . . . . . . . .11

Figure Three . . . . . . . . . . . . . . .12

Figure Four . . . . . . . . . . . . . . . .13

Figure Five . . . . . . . . . . . . . . . .14

Figure Six . . . . . . . . . . . . . . . . .15

page

Editor’s Note

by Randy Makin . . . . . . . . . . . . .2

A Chicagoan in Hong Kong

by Martha Sikaras . . . . . . . . . .16

Table Manager Update

by Jim Toole . . . . . . . . . . . . . . . .17

International Section Breakfast,October 24, 2001 . . . . . . . . . . . . . . .18

Clearinghouse Scholarship Program

by Michael P. Enright . . . . . . . .19

International Health Seminar, SecondCommunique . . . . . . . . . . . . . . . . .20

page

Course One Seminar in Mexico City

by Jim Toole . . . . . . . . . . . . . . . .22

Actuarial Careers in the InternationalInsurance Business . . . . . . . . . . . .22

Meeting Minutes of theInternational Section CouncilMeeting, October 21, 2001 . . . . . .23

Korean Life Insurance Market: 1998-2000: years of Restructuring

by C. Hong & L. Zacheis . . . . . .24

ICA Meets in Cancun . . . . . . . . . . .30

Inernational Financial Reporting

by Jim Toole . . . . . . . . . . . . . . . .31

Population Aging:

Global Challenges andOpportunities for the 21 st Century

by Robyn I. Stone

Chair’s Corner:

Looking Ahead

by Lisa S. Kuklinski-Ramirez

continued on page 3, bottom continued on page 4

aging. The third objective is toemphasize the triumph and oppor-tunities of an aging world,providing a counterpoint to theprevailing notion that the aging ofsocieties is a catastrophe, leadingonly to undue burden on futuregenerations. It is important toembrace the aging of the world, toredefine aging in terms that areappropriate and useful for the 21st

century and to recognize the varia-tion and diversity of its impact.

By now we are all aware thatpopulation aging isan unprecedentedhistorical phenome-non; in 2020, morethan 700 million ofthe world’s inhabi-tants—or one in 10people—is expectedto be 65 or older (1).One in five people inthe developed coun-tries and 8% of thepopulation in thedeveloping world areprojected to beelderly (Figure 1).

But the timing,rapidity and effects of populationaging are and will continue to beexperienced in very different waysacross the globe—particularly asthese trends emerge in the devel-oped and developing countries. InFrance, for example, it took 115years (from 1865-1980) for theproportion of the elderly populationto more than double from sevenpercent to 17%; it is projected thatthe same doubling in China willtake 27 years (2000-2027), or fourtimes the rapidity. In developedcountries, population aging hasevolved gradually as a result ofimproved living standards over arelatively long period of time after

the industrial revolution. In devel-oping countries, this phenomenonhas occurred much more rapidly,mostly accounted for by medicalinterventions based on the use ofadvanced technology and drugs (2).

The remarkable demographictransition underway will result inthe old and the young represent-ing an equal share of the world’spopulation by mid-century (3).Globally the proportion of olderadults is expected to doublebetween 2000 and 2050, whereas

the proportion of chil-dren is projected todrop by a third. Incertain developed coun-tries and countries witheconomies in transition,the number of olderpersons already exceedsthe number of children,and birth rates havefallen below replace-ment levels. In somedeveloped countries, thenumber of older personswill be more than twicethat of children by2050.

Nearly two-thirds of the elderlywill be in the developing world by2020 (1); given the dramatic growthof the aged population in thesecountries over a relatively shortand compressed period of time, thedeveloping nations have not had thetime or the resources to establishthe infrastructure to address theneeds of such a population.

Therefore, the first importantmessage of this paper is the needfor policy makers, planners and thepublic to understand that whileaging is a global issue, the debatesand discussions related to the“graying of the world” must not bemonolithic. The issues of the future

of work, retirement, family relation-ships, quality of life, as a result ofpopulation aging, are not the sameacross the globe and must beaddressed in stages.

The second key message of thispaper is the importance of recog-nizing that the aging of the worldis primarily a female issue. Womenenjoy a near-universal advantageof longevity, even in developingcountries, although the gender gapis somewhat lower than in thedeveloped world (1). In most devel-oped countries, older womenaccount for more than 10% of thepopulation (Figure 2). By 2025, itis estimated that many nationalproportions will exceed 15%; inItaly and Japan, one in six peoplewill be an elderly female (4). Thenumber of widows is on the riseworldwide; while the proportion ofwidowed or never married femalesin the developed countries aredeclining, the absolute numberswill increase in the future (5).

Furthermore, because womenhave a higher life expectancy thanmen at age 65, the proportion ofdisability-free years of life in oldage for females is lower than formales (6). This means that acrossthe globe, women will be livinglonger, alone, and with a higherproportion experiencing chronicillness and disabilities.

The feminization of later life (7),characterized by both the highproportion of women among theworld’s elderly and the largeproportion of formal and informalcaregivers who are also female,poses a unique and important chal-lenge to policy makers and plannersin the developed and developingcountries.

The third message is a caution-ary note. While the aging of the

INTERNATIONAL SECTION NEWS4 MARCH 2002

Population Aging: Global Challenges & Opportunities for the 21 st Centurycontinued from page 1

world is an immutable phenome-non, the nature, magnitude andscope of these demographic changesremain uncertain. As we worshipedvoodoo economics in the 1980s, weneed to be careful not to becomeprey to voodoo demographics in the21st century. Who could havepredicted the AIDS epidemic that issweeping through Africa and Asia,creating a dilemma for aging grand-mothers left to care for the millionsof children orphaned by thisdisease? What will be the impact ofmedical breakthroughs and techno-logical advances that may create atrue fountain of youth but withunintended iatrogenic conse-quences? How long will the “birth

dearth” prevail? Given these uncer-tainties, the designers of policiesand programs to address the needsand preferences of an aging worldmust proceed cautiously, focusingon the shorter term (e.g., the next10 to 25 years) and avoiding thetemptation to extrapolate into thefar future.

The Status Of The Aging WorldThe elderly population (those 65 andolder) is the fastest growing segmentof the world population, expected toincrease 88 percent by 2020 com-pared with a 45% increase in theworking age population (8). As notedearlier, however, the magnitude ofthis phenomenon varies tremen-dously across regions. In the year2000, 14.8% of the European popula-tion will be 65 and over, comparedwith 5.8% of the population in South

America and 3.1% in Africa (Figure3). In 2020, older adults will com-prise 19.3% of the population ofEurope, compared with 9.1% inSouth America and only a marginalincrease in Africa (1).

The growth of the oldest old (75or 80 years and over depending onthe definition used) is expected toincrease dramatically as well,although the variation acrossnations is significant. The world’spopulation of oldest old is currentlyvery concentrated; more than 43%of those aged 75 years or older livedin just four countries in 1996—China, India, Japan and the UnitedStates (6). In 2020, the 80+ popula-tion is expected to be a little over

5% in Europe compared with 2% inSouth America and less than onepercent in Africa (1).

The projected proportion ofpeople aged 80 or older in 2020varies tremendously with Japanleading the nations at 7.4% (9)(Figure 4). Among the Europeannations, Italy will have the largestproportion of oldest old (7.2%).Approximately 4.6% of Canadiansare projected to be at least 80 yearsold; the comparable estimate for theU.S. is 3.9%.

Among the South Americancountries the proportion rangesfrom 4.2% in Uruguay to 1.6% inBrazil. Less than one percent of theChinese population will be old old.

By the year 2025, 26 countrieswill have a life expectancy at birthof above 80 years; the highest isexpected in Iceland, Japan andSweden (82 years), contrasted with

an average life expectancy of 75years in China and 51 years inSierra Leone (8). The numericalgrowth and heterogeneity of theoldest old will be a challenge topolicy makers and social plannersbecause these are the people thatare likely to be living at or near thepoverty level at the same time thatthey are at highest risk for needingsubstantial health and long-termcare services.

Another important trend is thechange in the working age popula-tion. According to the UnitedNations 1998 medium variant fore-cast (10), the growth in the size ofthe population age 15 to 64 yearswill slow over the next half century,and older countries will experiencea significantly shrinking workforce.Consequently, the number of work-ers per retiree will fall everywhere.In Japan for example, the ratio ofthe working-age population to theretiree-age population is projectedto decline from 4.0 in 2000 to 2.2 in2025 and 1.7 in 2050. Similar esti-mates for the United States are 5.3,3.3, and 2.8. The change will beespecially dramatic in severaldeveloping countries. In Mexico, forexample the ratio will decline from13.2 in 2000 to 3.3 in 2050; simi-larly, the ratio in Brazil will shrinkfrom 12.9 to 3.6. In China, the ratioplunges from 10.0 in 2000 to 5.2 in2025 and 2.7 in 2050.

Aging Issues In TheDeveloping WorldAmong the oldest countries in theworld in 2000, Italy and Greeceheaded the list with 18.2% and17.9% respectively of their popula-tions aged 65 or over in 2000 (10)(Figure 5). In comparison, 12.6 %of the population in the UnitedStates was age 65 years or older in2000. By 2025, Japan will surpassItaly and Greece with 26.7% of itspopulation age 65 or oldercompared with 26.1% and 24.4%respectively. By 2050, one-third of

5MARCH 2002 INTERNATIONAL SECTION NEWS

continued on page 6

“By the year 2025, 26 countries will have alife expectancy at birth of above 80 years;the highest is expected in Iceland, Japan,and Sweden (82 years)....”

the populations of Japan, Italy,Greece, and Spain are projected tobe at least 65 years old.

As the world moves more andmore toward a global economy, it isimportant to understand that all isnot equalacross thedevelopednations. Arecent studycomparing theeconomicstatus of theelderly andother agegroups inSweden,Canada, the United States, and theUnited Kingdom, found significantintra-and intergroup differences(11). The United States, for exam-ple, reported the highest relativepoverty rates and Sweden thelowest among the age groups up toage 65. After age 65, elders in theUnited Kingdom had higherpoverty rates than in the UnitedStates. For the over−70 age group,Canada had a lower elderly povertyrate than Sweden. Among the fourcountries, the United States is themost frugal transferor of socialexpenditures via income transfers;Sweden is clearly the most gener-ous and “off the charts” for the 60-and-over population. Furthermore,the ratio of transfers to marketincome has risen dramatically inCanada and Sweden from age 55-59onward in recent years.

The irony of the success of popu-lation aging in the developed worldis that, as the countries have grownolder, the tendency toward earlyretirement has increased as well.Gruber & Wise (12) observeddeclines in labor force participationrates between 1960 and 1996 for

men aged 60-64 years in 11 devel-oped countries, but the magnitudeof this decline varies substantially.In the early 1960s, these rates wereabove 70% in all countries exceptItaly. By the mid 1990s, the rate

had fallen below20% in Belgium,France, and theNetherlands; to30% in Italy; to35% in Germany;and to 40% inSpain. The U.S.rate experienced arelatively modestdecline from 82%to 53%, with the

lowest decline observed in Japan,from 83% to 75%.

To illustrate the magnitude ofthe retirement phenomenon evenfurther, it is important to point outthat at age 50, approximately 90%of men are in the labor force in allof the 11 industrialized countries.By age 65, fewer than 5% are work-ing in Belgium, and in all but threecountries, fewer than 20% are inthe labor force. Evidence fromseveral studies (12,13) indicatesthat old age pension policiesdiscourage people from staying inthe labor force. In many countries,the combined effect of pensions,disability benefits, and unemploy-ment benefits impose an implicittax on those who work past theminimum retirement age.

Researchers (12) cited an exam-ple where the effect of an olderGerman male remaining in theworkforce for an extra five yearswould reduce the present value ofhis benefits by almost 18%.

The major issue related to popu-lation aging for most of theindustrialized, developed world ishow to take advantage of the

triumph of population aging byencouraging the productivity of theelderly. It is difficult, if not unten-able, to comprehend a world in the21st century where so many peopleliving well into their 80s and 90sare experiencing 30 to 40 years ofretirement. Recent data point todecreases in the rate of disabilityamong the elderly in the UnitedStates (14) and several other coun-tries (8) and successes in both theprevention of and treatment forchronic diseases. These trendssuggest the possibility that theelderly of tomorrow living in thedeveloped world will have greatercapacity than today’s elderly cohortto contribute productively to society.Researchers assessing the impact ofdemographic changes on theeconomic situation in severalemerging Asian countries (15)examined the relative effects ofgrowing young dependent andelderly dependent populations onthe economic growth in this region.

The study authors reported thata one percentage point increase inthe growth of the under age 15population is associated with adecrease in the GDP per capitagrowth of about 0.4 percentagepoints. In contrast, a positive(although statistically insignificant)coefficient emerged for the elderlypopulation. The authors speculatethat since the elderly continue tomake important economic contribu-tions by working part-time,caregiving, doing other volunteerwork, and continuing to save, theyare not a drag on the economy;rather, they contribute to economicgrowth in old age.

The longevity revolution in theindustrialized world, coupled withlow birth rates that have contrib-uted to the mushrooming of the



elderly population, has triggeredthe need for a new paradigm ofaging. The chronological bench-marks (i.e., 60 or 65 years) havelived out their usefulness, for bothpublic and private sector policies.How can we talk about raising theretirement age another two years,when a large proportion of theelderly will be spending a third oftheir lives in that status? The majorchallenge and opportunity for thedeveloped countries is to figure outhow to redefine the institutionsthat we hold so dear—work, family,education, leisure—in the face ofthis demographic imperative.

We must experiment with newforms of work that incorporateopportunities for all social classes tocreatively combine successfulemployment with ongoing educa-tion and leisure activities over alifetime. We must reinvigorate andstrengthen the intergenerationalcontracts that have been so impor-tant for families and societies overthe centuries. This will be particu-larly important as the five-generation family becomes thenorm, and as alternative familystructures (e.g., single-headedhouseholds, stepparents and chil-dren from divorce and remarriage,same-sex marriages) provide newopportunities for establishingcontracts across the generations.

We must also get beyond ourrelatively narrow, budget-drivenpolicy debates about the future ofhealth care and income securityprograms. Some have argued thatthey are red herrings; that thecrises have been invented or atleast exacerbated by politicianslooking toward re-election. Whetherreal or invented, it is clear thatthese debates have engenderedundue and unwarranted intergener-ational conflict. To use thesomewhat hackneyed expression,“We are all in this together!” Thedeveloped world can and shouldtake advantage of population aging

to create a new and exciting 21st

century.

Aging Issues In TheDeveloping WorldThe issues for the developing coun-tries are “worlds apart” from theirdeveloped counterparts. The rapid-ity and compressed time frame

within which these changes areoccurring makes the graying of thedeveloping world a particularlychallenging phenomenon. The aver-age annual growth rate in the 65+population between 1996 and 2020for the developing world is pro-jected to be 3.3% compared withonly 1.5% in the developed coun-tries (Figure 6).

The 80+ population is expected totriple in the developing nationsduring the next 25 years, comparedwith just a 70% increase in thedeveloped world (16). By 2020,seven developing countries will beamong the 10 countries with thelargest elderly populations in theworld: China (231 million), India(145 million), Brazil (30 million),Indonesia (29 million), Pakistan (18million), Mexico (15 million), andBangladesh (14 million) (2). Amongthe developing nations, China iscertain to experience the most rapidaging because fertility rates havealready declined dramatically, from5.4 in 1970 to the current 2.0 level(2). Within less than four decades,China’s old age dependency ratiowill be higher than North America’s

and about the same as that ofWestern Europe today (17).

The growth and pace of agingwithin the developing world variestremendously (10). Asia and LatinAmerica are aging most rapidly, andwill reach 20−25% of older personsby 2050. Sub-Saharan Africa, whichcontinues to struggle with the

HIV/AIDS pandemic in associationwith economic and social hardship,will reach half that level. Areasaffected by very high levels ofmortality of young adults due toHIV/AIDS may, however, also expe-rience a relative increase in theproportion of older persons.

Latin America and theCaribbean is the next region of theworld to experience the significanteffects of population aging.Uruguay, for example, currently hasa higher percentage of people aged60 or older than does its northernneighbors, Canada and the UnitedStates. Outside of Europe andNorth America, the Caribbean isthe oldest region of the world, with10% of its aggregate populationaged 60 years and over (1).

Even though by the year 2020many of the developing nations willhave age structures approaching(and in some cases, exceeding) thatof the developed world today, theresources and infrastructureneeded to provide for rapidly agingsocieties will not be in place. By2020, it is estimated that three-


continued on page 8

“Even though by the year 2020 many of thedeveloping nations will have age structuresapproaching that of the developed worldtoday, the resources and infrastructureneeded to provide for rapidly aging societieswill not be in place.”

quarters of all deaths in developingcountries will be aging-related andcaused by non-communicablediseases such as diseases of thecirculatory system, cancers, hyper-tension and diabetes (2). As lifeexpectancy increases, the olderpopulation in this region will likelyexperience more chronic diseaseand disability, placing unduedemand on health and long-termcare systems that are minimal ornonexistent. In the majority ofthese countries, poverty, lack ofsocial security schemes, continuingurbanization, and the growingparticipation of women in the work-force all contribute to the erosion oftraditional forms of care for elderlypeople.

In 1992 the World Bankprojected that GNP per capita insub-Saharan Africa would remainat the presentvery low levelsof US$300 forthe next 40years, andwould onlyreach US$4000in NorthAfrica. Theprojections arealmost as bleakfor LatinAmerica wherethe estimatedfigure is US$6000 (18). Clearly,there are no real prospects of savingfor old age in these countries, andeven in nations with higherincomes, savings may not be secureover the long term or even remainin the country with increasinginternational capital transfers.

While the developed world strug-gles with the future of its socialsecurity, private pension and healthcare systems, these issues are not

relevant to most of the developingcountries. As Julia Alvarez, spokes-person for the United Nation’sInternational Year of the Elderly,noted: “Social Security income or aprivate pension is not an option inmy country. People work until theydrop!” This observation is born outby statistics revealing that theproportion of economically activeelders in the developing world issignificantly higher than those inthe developed countries.

A recent World HealthOrganization report (19) of life inthe 21st century emphasized theneed for intergenerational relation-ships that are based on equity,solidarity, and social justice.However, as noted in another brief-ing paper by WHO’s aging andhealth program (18), the intergen-erational relationships in

industrializednations arebuilt on alevel ofadequateresources forboth youngerand oldergenerations,and oneconomictransfersthroughpublic or

private sector initiatives. In thedeveloping countries, there is likelyto be a widening social andeconomic gap between the genera-tions, with the younger generationlacking the material resources toprovide any support to the oldergeneration.

Although this discussion wouldlead one to believe that populationaging will be a catastrophe for thedeveloping world, I believe that the

triumph of this demographicphenomenon should be viewed asan opportunity for creative socialplanning. The first step is for policymakers to understand the impor-tance and immediacy of thesechanges and the implications forsocieties across the developingworld. It has been difficult to keepthe concerns of an aging society onthe priority list in the developednations; it will be even more diffi-cult to place these issues on theradar screen of decision-makers inthe developing world, where theconcerns of poverty, communicablediseases and basic economic devel-opment still prevail. On the otherhand, it is essential that policymakers in these regions understandthe connections between populationaging and economic growth andthat initiatives designed to addressthe changing demographics willhave an impact on the overalleconomic well being of their respec-tive countries.

In addition, it is important forthe developing countries to learnfrom the failures as well as thesuccesses of the developed world. Tocite one example in the long-termcare arena, most of the industrial-ized nations have encouraged thedevelopment of hospitals, nursinghomes and other institutions tomeet the needs of chronicallydisabled elderly. These institutionshave required significant capitalinvestments over the years, andwhile they may have taken advan-tage of economies of scale, theyhave not created environmentsconducive to optimal independenceand quality of life for frail elders ortheir families. Furthermore, theyare now the driving forces behindmost of the health care budgets inthese countries.



Ironically, because of the lack ofinfrastructure, the developing worldhas the opportunity to create alter-native long-term care systems thatuse as their base the local commu-nities in which people live. They canexperiment with new and creativemodels of home care and commu-nity residences that take advantageof the indigenous cultures and thatcreate nurturing environments atlower costs than would be requiredto invest in elaborate institutionalstructures.

This may include traininghealthy, non-disabled elders tobecome home care workers in theirneighborhoods where they alreadyhave established ties. To do so,policy makers and planners in thedeveloping world must resist thetemptation to equate “bigger with

better” and believe that an edifice isthe best solution to long-term caresystem design. This may be difficultas investors and developers fromthe industrialized world who arelooking for new, fertile marketsbarrage developing countries.

Finally, as the population of thedeveloping world ages, issues ofchronic illness and disability willbecome a major public healthconcern. It is imperative that policymakers and planners developprimary and secondary disabilityprevention programs that help miti-gate the potential negative effectsof extended longevity.

Here, again, there is much tolearn from the developed world with

respect to successful interventions(e.g., exercise, nutritional counseling,environmental modifications).

Some ConcludingThoughtsPopulation aging is one of the mostexciting and challenging trends inthe history of the world. We mustembrace this triumph, recognizingthat the world is, in fact, a globalvillage, and that we all have aresponsibility to take advantage ofthe opportunities emerging fromthese demographic changes. Whiledeveloped and developing nationsare at different stages of experienc-ing this phenomenon, several issuesare relevant across the globe. Thefirst is the need to develop a newparadigm of aging, which redefineswhat it means to be old and which

recognizes that all of our sacredinstitutions need to change withthis demographic shift. The secondis the need to establish new inter-generational contracts thatrecognize the “give and take” ofwisdom, energy and resourcesacross the age groups at the indi-vidual and societal levels. Finally,we need to move the discussion ofpopulation aging from “doom andgloom” to one which is realisticabout the challenges but which alsorecognizes the range of possibilitiesfor the next century and the newmillennium.

The International Strategy forAction on Aging, developed inpreparation for the Second WorldAssembly on Aging to be held in the

Summer of 2002, advocates changesin several areas to ensure that theenormous potential of aging in the21st century is fulfilled (3). Theseinclude change in attitudes, innational and international policies,and in community, corporate andother organizational practices. Theaim of the Strategy for Action is toensure that people everywhere willbe enabled to age with security anddignity, and continue to participatein their societies as citizens withfull rights. The report recommendsthree priority directions: develop-ment for an aging world, advancinghealth and well being into old age,and ensuring enabling and support-ive environments. The authors ofthe report also argue that main-streaming aging into globalagendas is essential. To achieve thisgoal, a concerted effort will berequired to move toward a wide andequitable approach to policy inte-gration that links aging to otherframeworks for social and economicdevelopment.

Please look at the upcomingpages as they will have all thecharts that I was referring toearlier.

Dr. Robyn Stone is Executive Director,Institute for the Future of AgingServices, American Association of Homesand Services for the Aging 2519 Connecticut Avenue, N.W.Washington, D.C. 20008

Grants andAcknowledgementsThis paper is based on a keynoteaddress delivered by Dr. Stone at theWorld Health OrganizationInternational Symposium entitled.“Aging and Health: A Global Challengefor the 21st Century,” in Kobe, Japan,November 10, 1998.

References(see page 32)


“It is imperative that policymakers and planners develop primary and secondarydisability prevention programs that help mitigate the potential negative effects ofextended longevity.”

continued on page 10












Documents

Population Aging: Global Challenges and Opportunities for ... · Population Aging: Global Challenges and Opportunities for the 21stCentury ... Global Challenges and Opportunities