The Government Accountability Office (GAO), the watchdog arm of Congress, found recently that the United States lacks a strategy and coordinated agency efforts to analyze and prepare for a transformational worldwide phenomenon – global aging. In a Sept. 21 report on the implications of global population aging for U.S. security, economic, health, and humanitarian interests, the GAO found a handful of examples of U.S. government initiatives at the Departments of Defense, State, and Health and Human Services that are related to older populations in other countries. But the ultimate takeaway is stark: the United States doesn’t consider the overall impact of population aging in its planning nor understand what it means for a variety of U.S. interests.
Globally, the number of people over 60 is increasing, as is their proportion in populations. People are living longer thanks to improvements in public health, education, and poverty reduction. Declining fertility rates are shaping age structures in unprecedented ways. In less than 25 years, by 2050, the number of people over 60 will roughly double from 2020 levels and will make up more than 20 percent of the global population. The majority of older people already live in low- and middle-income countries; these nations are the least prepared for changes already underway.
U.S. partners and allies that are unprepared for such demographic change may face growing health and social spending as their populations age, leaving fewer resources for other priorities, including defense. Shrinking labor pools could slow economic growth (AI’s impacts in labor and aggregate productivity remain unclear.) And rising rates of chronic disease risk overwhelming health services. “Global aging abroad may contribute to changes in U.S. alliances, global stability, and conflicts,” the GAO wrote.
But population aging does not have to be a threat. Experts predict that longer lives can contribute to financial growth across many sectors, when adequate policies and systems are in place. When people can live longer in good health and contribute on equal terms, societies can reap dividends from an older population. Countries can prepare and respond better to crises and disasters. Those benefits extend beyond borders: thriving economies and stable nations make stronger trade and security partners for the United States.
Most Countries Lag in Adapting to Demographic Changes
However, most countries have yet to adapt their health, employment, long-term care, and other systems to ensure longer lives are healthy lives.
Around the world, older people face bias in employment, exclusion from civic life, and barriers to healthcare and services, as well as financial and physical exploitation and abuse. They are disproportionately impacted in disasters and humanitarian crises. Older women, who typically live longer than men, face multiple forms of discrimination, lower earnings, and greater caregiving duties over the course of their lives, leaving them more likely to live in poverty and poor health in later life.
These harms undermine both individual and societal well-being. A recent U.S. Census Bureau report, An Aging World 2025, makes an “urgent call” for countries to respond to the challenge of creating a society where the “older population is healthy, thriving, and engaged.” Global health investments should include primary healthcare systems that can provide a continuum of care across the life course, including to prevent and manage non-communicable diseases, the leading cause of death worldwide. Long-term care is also crucial, particularly high-quality care for older people who want to age at home. Home- and community-based systems of care not only support autonomy and choice, but are cost-effective and bring social dividends.
In addition, with the increasing frequency and severity of climate-related disasters and persistent conflict and displacement crises, national and global emergency preparedness and response must adjust to changing populations. Confronting agism, which persists in the workplace, social discourse, the media, healthcare, the legal system, and beyond, is also crucial to ensuring equal opportunities and quality of life for older people.
Seek and Use Input from Older People
To get the analysis right and plan for the future, policymakers should seek and utilize input from older people and the organizations that represent them. For example, in collaboration with my organization, HelpAge USA, the National Academy of Medicine sought input and insights from older people in seven countries on how to implement its ambitious 2022 Global Roadmap for Healthy Longevity. In addition, we work together with national partners to ensure that older people living in protracted conflicts and disasters in Ukraine, Ethiopia, Venezuela, and beyond actively participate in humanitarian response planning at the highest levels.
Demographic change is a complex, transnational phenomenon that will require not only a thorough assessment of its implications for U.S. interests, but also global leadership to ensure that countries find ways to collaborate and approach opportunities and challenges together. A worldwide phenomenon in an interconnected world will require coordination and cooperation across borders.
For starters, to enable coordination across the U.S. government and provide the necessary leadership for its outreach abroad, Congress should authorize an ambassador-at-large for global population aging and older people, and appropriate sufficient funds for the office to provide both cross-agency guidance and international diplomatic leadership. Effective and efficient use of U.S. foreign assistance also requires understanding and responding to new demographic realities. Humanitarian, food, health, and other foreign assistance should specifically take into account the requirements of older people.
Global population aging is inevitable. Congress should act on the GAO’s findings and authorize a dedicated leader so that the United States is prepared to capitalize on the opportunities ahead.
