The point of departure for discussions at this ASL session was an acknowledgement that the gradual but inexorable process of population aging is having profound effects on the demographic and economic structure of societies. In this regard, the participants pointed to forecast trends that speak volumes: in all developed countries, and especially in Italy, Japan and Germany, the proportion of elderly people relative to the total population will continue to rise substantially. In Italy, for example, where life expectancy has reached 82 years of age (compared to 65 in 1950), over-65s represent 20% of the overall population (compared to a European average of 15%), with this set to rise to around a third of the population within twenty years. Meanwhile, the 20- to 54-year-old contingent will shrink from almost 50% to 38% by 2060. The main problem, however, is not simply the fact that there are proportionally less working-age young people and more post-working-age older persons, but also the state of health expected to be experienced in older age. In particular, the forecasts indicate that, within 30 years, one out of every ten Italians will not be self-sufficient due to the increasing incidence of chronic diseases – a situation which poses compelling challenges to the sustainability of the welfare state.
While figures were cited showing that welfare spending in Italy is currently in line with that of the European Union (around 30% of GDP), it was judged to be poorly allocated given that 60% is spent on the elderly population compared to 45% in the rest of the EU. Moreover, only 4.6% is directed towards families, maternity and childhood as compared with the European average of 8%, and only 3% is spent on the unemployed compared to 6% in Europe. It was felt that the solution lies not so much in postponing the retirement age (a step already taken through a series of successive reforms in Italy in recent years that have succeeded in financially restabilizing the system), but rather in improving the workforce participation rate among the aged as well as the state of health of this age group. As meeting this challenge involves building a welfare and production system in which it is possible, desirable and cost-effective for people to continue working for longer, the participants moved on to explore strategies for achieving this goal.
It was suggested that a good starting point would be a change in perception of the elderly, who should be viewed as a resource rather than a problem, and as a treasure-house of life experience and knowledge rather than a cost. To this end, it is necessary to ensure that people reach old age in good health, which in turn makes the lifestyles choices adopted throughout life crucial. Promoting healthy lifestyles both in schools and at all stages of people’s lives was therefore seen as imperative, as was investment in health prevention – not just in terms of awareness raising but also research.
As well as having an increasingly more preventative focus, medicine was perceived as becoming more and more personalized, including through a greater emphasis on community-based homecare. In a healthcare system like that prevailing in Italy, which continues to hinge on a universalistic model, care of the elderly and the non-self-sufficient is largely entrusted to the public sector, with the roles of various levels of government (from central to local) being intermingled. The participants consequently stressed the importance of communication and coordination between these different administrative levels in order to ensure a more effective division of roles and responsibilities between central and regional authorities, both in terms of health care and monitoring. It was observed that the public system should be complemented by an accountable private system, based not just on volunteer and philanthropic efforts, but also on corporate social commitment. Although current legislation provides for the deductibility of corporate welfare expenditure incurred for purposes of providing employees with health and social care, it was felt that the role of the private sector could be further boosted by entrusting firms with responsibility for health awareness training. In a world of increasingly scarce public resources and rampant sovereign debt, it would seem increasingly vital not just to improve the efficiency of the welfare state, but also for social solidarity efforts to be intra-generational alongside inter-generational.
Extending people’s working lives was also deemed critical to addressing the insecurities characteristically faced by the elderly, both in terms of their role in society and their financial stability. It was suggested that a step in this direction would be to introduce more flexible work contracts (to accommodate potential mentoring roles, thereby enabling knowledge to be handed on to younger employees by their older colleagues), more flexible wages in the later stages of people’s work lives, and customizable paths to retirement. Those in attendance were conscious of the key role that technology can play in empowering the elderly, thus necessitating efforts to make it easily accessible by promoting a sense of participation in and belonging to social networks. Also cited was the need for a renewed emphasis on relational goods and on balancing the role of technology with that of the individual. This was seen as the only way of effectively tackling one of the basic fears of the elderly, namely, loneliness, and the psychological distress that this causes.
The participants highlighted that, at the same time, the demographic revolution taking place presents a number of opportunities for firms capable of coming up with new products and services tailored for aging customers. The pharmaceutical sector, in particular, which accounts for 67% of Italian exports and employs 63,500 employees, could direct its energies towards not only discovering new drugs, but also designing new personalized care services, integrated therapeutic solutions, and community care options. Opportunities were seen as arising not only for sectors of the health industry, but also for all those connected with the concept of wellbeing in a broader sense, such as the food industry, the tourism sector (with Italy potentially becoming the Florida of Europe), as well as the architectural and town-planning professions, which should take on the task of redesigning cities to make them more senior-friendly.
In concluding, the participants emphasized that a demographic shift is already underway, and that it is now no longer possible to put off formulating a series of effective and farsighted policies. Any such approach must however take into account relational, health and financial aspects, and should aim to achieve a successful mix of prevention, education, treatment and improved health. Only then will the elderly of tomorrow feel healthier, wiser and more active.