Not long ago, I spoke with Dr. David Reuben, a colleague who heads a top-ranked geriatrics program. After touching on current healthcare dilemmas, our conversation moved to the future. Specifically, how to cope as baby boomers sail past birthdays that their grandparents never dreamed of reaching.
"What lies ahead when the age wave really hits?" I asked him. "You know, when every state looks like Florida?"
"Another Hurricane Katrina," he shot back. "But by then, will we have working dams and dikes? Or levees that overflow?"
Ted C. Fishman — business reporter, mercantile trader and author — may have a different day job than my colleague, but the two are kindred spirits. The key message in "Shock of Gray," Fishman's sprawling, fact-filled preview of a "historically enormous older population," is this: We are ill-prepared for the coming storm. Oh, and one more thing: Most of us barely grasp how much the world has already changed.
Granted, many may know about China's looming elder glut (fueled by 30 years of a one-child policy) and centenarian-steeped Japan's population slide, but what about modern Spain, which leads the European Union in longevity? As Fishman states, the irony of Spain and several of its Mediterranean neighbors is that "the youngest and most fecund countries in Europe became the oldest and least willing to have children." Once immigrants stoked Spain's growth, the modern boom state couldn't function without them.
More recently, Fishman notes, Spanish seniors' nest eggs have cracked as their children retire young (spelling longer reliance on unearned funds) and their university-educated grandchildren go jobless. Some Spanish families are still bankrolling their heirs, he adds, but the support comes at a price — namely, emotional and monetary payback as future generations age. Minus that, Spain will soon resemble Britain, where 30% of people older than 65 now live below the poverty line.
Despite China's different trajectory (still growing, educating and transforming), Fishman's portrait of the country is equally stark, if not downright chilling. With backing from the state, a fresh generation of strivers has already displaced 70 million midlife workers while grandparents provide 24/7 childcare. What filial piety will remain in 40 years' time, at which point some estimate six elderly dependents per each working Chinese? It's anyone's guess. The elderly should head to the big city, Fishman suggests, where social networks and other services are a necessary lifeline. Already, according to the author, the rate of suicide among China's rural seniors is five times the world's average.
Or perhaps China will one day resemble Japan, where robot dogs comfort lone-dwelling elders and movement-detecting rugs allow family members to monitor their loved ones. As it turns out, the Japanese envy Scandinavians' quality of life in later decades. "Here, we assume our families will be the ones around," one Fishman source states, "but in reality there is often no family to be there. In Europe, people expect to have a network of friends they can count on. In Japan, men are reluctant even to visit the sick."
Despite "Shock of Gray's" doomsday tone and dizzying pace (including various local stops at luxe retirement villages in Florida and spontaneous, intentional communities in other U.S. locales), readers should consider its messages and economic implications. What do we really want for ourselves, as individuals and a nation, as we age? A return to multi-generational families? More government-planned living, healthcare and pension support? Continued reliance on immigrant caretakers?
Don't expect neat prescriptions. The true mission of "Shock of Gray" is a big, messy call to confront the demographic drama now unfolding in many middle- and high-income countries, not to proffer solutions.
Still, if I could choose one book this year as required reading for medical students and colleagues, this would be it. No, I take that back. Add undergrads to the list. They might as well get ready too. Fasten your seatbelts, kids. It's going to be a bumpy ride.
Dunavan is a professor of medicine, infectious diseases and global health at UCLA.