The prospect of longer life should be a reason to celebrate but, increasingly, longevity is a source of great anxiety in countries across the world. Because, while many populations are living longer, a greater proportion of that time is now spent in ill health – and, consequently, a smaller proportion of that time is spent working.
This has profound implications for the global economy. Governments face low growth, falling tax receipts and rising welfare obligations – with stark implications for citizens’ standard of living, as well as leaders’ prospects for re-election.
Without action, the problem is predicted to worsen. By 2050, nearly one-third of Europe’s population will be 65 or over; East Asia and Pacific’s over-65 population will nearly double from 11.9 per cent to 23.7 per cent; and Africa’s over-65 population will grow from 3.5 per cent to 6 per cent, representing a quadrupling in absolute numbers.
There is a fix, but it will require purposeful and coordinated action. At a recent conference in Brussels, two organisations – the Tony Blair Institute for Global Change and the European Policy Centre, under the umbrella of the Coalition for Health, Ethics and Society – brought together leading policymakers and experts to address the longevity challenge. The message was clear: prevention of ill health will be critical to extending healthy life expectancy and unlocking new sources of productivity and economic vitality in later life. This commentary explores the key themes from the conference.
As South Africa prepares to assume the G20 presidency, there is an opportunity for this discussion to gain greater international prominence. Indeed, it can prompt global action that will transform the outlook for both health and wealth in the coming years.
The Politics of Demographic Change
Europe’s response to the longevity challenge demonstrates how coordinated policy can drive systemic change. The European Commission has established a dedicated demography portfolio, marking a fundamental shift in approaching demographic futures. The EU’s pioneering “demography toolbox” addresses four interconnected challenges: supporting families through enhanced child care and work-life balance initiatives; empowering young people through education and labour-market access; enabling older workers to remain productive through flexible work arrangements; and managing regular migration to address skill gaps.
This comprehensive framework represents a new political vision. Rather than treating an ageing population as a burden to be managed, it positions demographic change as an opportunity for societal renewal and economic growth. This approach requires creative solutions at both a national and supranational level, given that many relevant policy areas remain primarily within member states’ control.
A Global Health Transition
Building on this political vision, there is a need to transform health systems to realise the opportunity of longer and healthier lives. There has been a palpable evolution in how policymakers view demographic change, from initial scepticism to recognising longevity as one of our era’s greatest opportunities.
The scale of demographic change challenges traditional development narratives: life expectancy in Africa now surpasses 1950s European levels and is accelerating rapidly. Yet a critical gap remains between increasing lifespans and healthy life years, creating pressing challenges for health-care systems and societies worldwide.
The scale of this transition demands fundamental reform. Current health-care systems remain stuck in outdated models, with only 2 to 4 per cent of the Organisation for Economic Co-operation and Development’s health expenditure directed towards prevention prior to Covid-19. While spending on prevention doubled during the pandemic, much of this increase was due to temporary measures related to Covid-19 management, rather than long-term investments in population health. This imbalance is unsustainable as populations age, requiring a paradigm shift from treatment to prevention, from hospitals to communities, and from crisis response to sustained health promotion.
The Economic Imperative of Healthy Longevity
The economic case for addressing this challenge reinforces the political imperative for action; evidence increasingly challenges conventional assumptions about ageing societies. The employment rate of older workers (aged 55 to 64) in the European Union, for example, has shown a significant upwards trend over the past 15 years: it reached a record high of 63.9 per cent in December 2023, a substantial increase from 43.2 per cent in December 2009.
Health is becoming a first-order macroeconomic issue in ageing societies. Reducing non-communicable diseases through investment in prevention and effective interventions could significantly boost economic growth, preventing millions of premature deaths. It could also generate substantial GDP gains in low- and middle-income countries, driving both social and economic gains.
Prevention and Community Resilience
African approaches to preventative health care demonstrate how early investment can build system resilience. Across the continent, community health workers are transforming health-care delivery: Senegal has deployed about 25,000 workers to enhance preventative care and strengthen health infrastructure; Rwanda’s 45,000-strong community health workforce serves as the foundation of its health system; and Ethiopia’s community health-extension programme has deployed approximately 40,000 workers to provide essential health services at a community level. This emphasis on primary care and community engagement offers valuable lessons for societies worldwide that are facing the challenge of sustainable health-care delivery for ageing populations.
Technology and Community Integration
Singapore’s experience demonstrates how spaces can be redesigned to support active, healthy ageing while strengthening social bonds. The Health District @ Queenstown is a satellite town that has been turned into an area specifically designed for seniors, where they can take advantage of community initiatives such as volunteering, lifelong learning and paid work. It integrates the principles of Ibasho (a Japanese approach meaning “a place where you feel at home”) with community development; residents become active leaders in neighbourhood development, fostering social connections and driving positive change.
This people-centred approach transforms traditional senior centres into dynamic community hubs, where older residents mentor younger generations, lead local initiatives and contribute to neighbourhood planning. The result is not just better health outcomes but stronger and more resilient communities.
From Experimentation and Learning to Action
The longevity transition demands both experimentation and systematic reform. As South Africa prepares to lead the G20, there is a unique opportunity to forge sustainable international partnerships that move beyond crisis-driven collaboration. The EU’s experience in developing comprehensive policy frameworks, could be complemented by Africa’s approaches to community health and prevention (as demonstrated during the Covid-19 pandemic). Such a partnership would show how shared challenges can drive mutual learning and lasting cooperation.
Three fundamental shifts are needed to turn the longevity opportunity into reality.
Health systems must pivot from treatment to prevention. Current models, whereby only a fractional amount of health spending goes on prevention, are unsustainable. This change requires increased investment in preventative services and new delivery models that integrate technology with community care.
Care must move from hospitals to communities, which demands new approaches to primary care and community support. While some regions show how community health workers can build system resilience, others demonstrate how integrated care models and neighbourhood teams can strengthen community-based care.
Health systems must embrace digital transformation. While technology alone is not the answer, digital tools can enable both prevention and community-based care. Success requires combining technological innovation with strong community engagement.
The Path to an Evergreen Society
The demographic transition that the world faces is unprecedented in human history; never have societies aged at this scale or speed. Yet the diversity of approaches emerging globally – from European policy frameworks to African preventative strategies and Asian community integration – demonstrates how different regions are innovating to address this challenge.
The key insight is that longevity is not merely a challenge to be managed but an opportunity to be seized. Economic analysis shows that longer, healthier lives can drive productivity and growth. Realising this potential requires fundamental changes to health systems, social structures and economic models.
Success demands political will, sustained investment and international cooperation. While each region must develop solutions suited to its context, all can benefit from shared learning and coordinated action. The longevity transition offers a chance to create not just longer lives but better ones, driving societal progress through demographic change.
Acknowledgements
The authors acknowledge and thank the following experts for their contributions to the discussion that informed this commentary.
Awa Marie Coll Seck, chair, Galien Africa
Ines Hassan, director of health and economic policy, Ellison Institute of Technology Oxford
Elizabeth Kuiper, associate director, European Policy Centre
Peter Piot, professor of global health, London School of Hygiene and Tropical Medicine
Andrew Scott, macroeconomist, London Business School
Dubravka Šuica, vice-president for democracy and demography, European Commission
John Eu-Li Wong, executive director, Centre for Population Health, National University of Singapore