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The impact of ageing on developed economies

A Note by the Director (Ditchley 2011/06)

12-14 May 2011

Ditchley last had a conference on ageing populations in 2002 and it was good to return to the topic now, as its implications for so many different areas of political, economic and social life were huge and becoming clearer. The scale of the issue is illustrated by the fact that three quarters of those who have ever reached the age of 65 are alive today. The discussion looked at the impact for the individual, the likely consequences for society, and the longer term geopolitical considerations. While the title of the conference was focussed on developed countries, in practice we extended our debate to all countries since ageing is rapidly becoming a global phenomenon, even if rates of change are different in different countries. We benefited from a great variety and distinction of expertise at the table, including gerontologists, sociologists, biologists, philosophers, healthcare professionals, civil servants and politicians.

The challenge was to analyse the causes of ageing societies, look at the impact across the board, and identify potential solutions to the problems produced by this continuing demographic shift. It was interesting that almost all participants thought that a reversal or prevention of the ageing trend was not worth discussing in any detail and that the discussion should concentrate on mitigation and adaptation. Most agreed that the trend would continue (some saying it would eventually bottom out at a relatively stable age profile of about 40% of the population above 50) and that policies to reverse the trend were impossible to design or implement, although it was interesting that fertility rates in some north European countries had turned up again recently. In any case we were not trying to solve a crisis, and should not present the issue in that negative light. People living longer should be celebrated as a success, and they should be seen as assets and opportunities, not as sources of problems. As one participant put it: ‘If living longer is seen as a problem, what message are we sending out?’ Rather we needed to find a new organising framework and new ways of thinking, for public sector, civil society and private sector alike, through which we could imagine and plan the 21st Century. We needed a transformation of society to fit the significant changes that had occurred and were continuing to take place, and a ‘place in our hearts for older people’.

What were the factors which had led to the current changes in the age structure in developed economies? There was little disagreement here. The basic causes were falling fertility, due mainly to the increase in female education rates and the availability of choice; and increasing life expectancy through improvements in diet and healthcare. This was not confined to the countries of the west by any means. Parts of East Asia for example now had extraordinarily low fertility rates, at an average of about 1.2, with Shanghai at a rate of 0.7. It was becoming acceptable to have one or no children. The world population as a whole was continuing to increase, and would peak at around 11-12 billion later in the century, but current youth bulges would soon be a thing of the past, except in a few mostly very poor countries in sub-Saharan Africa and some parts of Asia such as Afghanistan. Youth unemployment would give way to a desperate search for labour, with young workers at a premium. An eventual decrease in the global population, and decreases in some currently crowded countries, could be seen as a good thing, to help sustainability. But the real issue worrying everyone was the population or dependency ratio, in other words how many working adults there were within a society compared to the number of children and retired people being supported.  

Participants were keen to challenge some widespread assumptions. For instance, it was in fact those developed countries with the most working women who had the highest fertility rate – that factor in itself could not explain why women were not having so many babies. The availability of childcare and flexibility of the labour market were what made a difference. The evidence suggested that cash incentives to women did not work. Participants also challenged the ‘lump of labour fallacy’ which stated that older people staying in their jobs and retiring later reduced the number of jobs available for young people entering the labour force. This had been proven to be incorrect – there were not a fixed number of jobs in an economy – though it was a factor in any given closed community such as a single company or organisation. Just as economies had adapted to women entering the work force, so they would be able to adapt to older people retiring later in life. One interesting question was how far social attitudes could have a major impact on fertility rates. For example it was suggested that one reason rates were so much lower in Japan and similar societies was the unacceptability of children born out of wedlock, while this now represented up to 40% of births in some European countries.

What was clear was that life expectancy had been increasing linearly over at least 160 years, and that men were now catching up with women. This trend was likely to continue - no automatic limit to it had so far been identified. Similarly there was nothing which ruled out in principle medical and biological discoveries which could stop the ageing process altogether, although they did not seem imminent. The dramatic ethical and other issues raised by this prospect certainly needed to be looked at sooner rather than later. At the same time it was important to remember that life expectancy differed significantly between different groups within the same society, for example between those in poor and less developed cities and those in prosperous areas. What happened to people early in life economically and socially tended to determine what happened to them as they got older, which was another argument for reducing inequalities in society. In any case, everyone aged differently and policies and institutions needed to be adapted with this fact in mind. Too many generalisations should therefore be avoided.

Nevertheless it was suggested that as a general rule we should no longer think of people over 65 as ‘old’. This point was now more like 80. (The Beatles song should for example be retitled ‘When I’m 84’). Other participants took a different line: any chronological determinant of age and frailty was now arbitrary and meaningless. Age itself had become irrelevant to a person’s ability to work, participate in society and contribute to it, and should not be seen as the determining factor in how society or governments treated people. It was pointed out, however, that if age was no longer a proxy for frailty and disability then it should not be a valid criterion for access to public subsidy, i.e. state pensions, either. This gave participants some pause for thought.

What was in fact more important to track than length of life was length of healthy life. People naturally wanted to live longer, especially if everyone else was doing so. If a magic pill existed to enable them to do so, they would certainly want to buy it and be prepared to pay quite a lot for it. But they did not want to live longer in poor health, with no real quality of life. (We did not explore in this conference what the implications of this might be, for example the issue of choosing assisted death.) At the same time, whether someone was seen as having a disability very much depended on attitudes and perceptions within different societies. Moreover there was no agreement on whether longer life necessarily meant longer periods of frailty/disability – the evidence on this was mixed so far. Could life-style related problems like obesity and diabetes be successfully tackled, as smoking had been for many? Again, simplistic assumptions should be avoided.

 How then could this shift in the population age structure be addressed, given the many ways in which population ageing impacted on the individual, society and international relations. Particularly significant impacts were seen in the labour market, in the pattern of migration, in the demands on a country’s healthcare and social care systems, and in voter pressure for infrastructures and policies more in line with older people’s needs and desires. The things older people needed most – reliable health care, long-term care and pensions – were expensive and getting more so. Basic suggestions for solutions included calls for people to work longer, spend less, save more, be taxed more and consume less, as well as for migration to be managed effectively to fill labour gaps and for ageism to be combated by adapting communities physically and psychologically.

Other than health, the main area where an ageing population had a clear direct impact on budgetary pressures was public pensions. One basic answer to ageing was for people to work longer – the evidence suggested it was good for individuals as well as society, except where hard physical labour was concerned. Some stress was good for your cognitive function. The first notion to challenge was that older people needed to retire at a specific age in order to allow younger people to enter the workforce. Labour markets were adaptable and could readily adjust to the new age structure if allowed to do so. Specific changes proposed included a restructuring towards a higher overall labour force participation rate, and much more emphasis on life-long learning. As there was clearly a great heterogeneity in the ability to work at older age, mandatory retirement ages should be abolished, where they had not been already. Making it easier for women to work and raising participation at older ages would mitigate the problems caused by the ratio of workers to those needing support becoming too unbalanced. There was still a lot of visible ageism around, since many employers simply did not contemplate hiring older workers even though the advantages in terms of experience and reliability could be considerable, and physical strength was increasingly rarely a criterion. The retail sector was one area which was increasingly recognising this.

With respect to pensions themselves, specific challenges needed to be addressed. Many schemes were being effectively bankrupted by increased longevity, though heads were still in the sand in some places. The days of defined benefit schemes seemed inevitably numbered. Participants thought that auto-enrolment in private pension schemes – i.e. an opt-out rather than opt-in system – was one way forward. Discouraging people from opting out of pension schemes and removing incentives to draw pensions early were crucial. The basic requirement was to provide a safety net for the vulnerable, excluded and those on low incomes who had difficulty saving, as well as those who had had breaks in their contributions to pension schemes during their working lives.

The crisis of pensions itself needed to be addressed through a combination of policies, including:

  • Encouraging people to save, i.e. pay into a private pension scheme;
  • Creating incentives for people to retire later or at least draw down their pension from a later age, thereby increasing the years during which they contributed and reducing the years during which they needed pension payouts;
  • Creating different pathways into retirement, to allow people to choose between different options;
  • Making pensions internationally more portable.

All of this needed to happen against a backdrop of providing solid and adequate state provision for those in real need of support.

Most participants agreed that mandatory retirement ages were no longer sensible, particularly when ageing was occurring at such different speeds within age cohorts. State pension ages needed to be flexible, as certain people in manual jobs or too frail to continue their work needed access to state support from a relatively early age, but early draw-down of pensions should not be actively encouraged in general.

Healthcare also received a great deal of attention in two of the working groups. There was wide agreement that older populations posed particular challenges to healthcare systems, although old age should not just be defined in terms of healthcare, and many of the problems of old people with healthcare systems were generic issues which improving the systems as a whole would fix. Key health issues of old age were frailty, muscle wasting, dementia and cognitive decline, although as already noted there was some disagreement on whether years of disability at the end of life were rising in line with the rise in life expectancy, especially with the increasing frequency of obesity and diabetes. Some pointed out that other upward pressures on healthcare, including more expensive technologies and higher expectations of the level of provision, were in fact more important drivers of cost than ageing. It was also the last year of life that was the most expensive, regardless of when it occurred in terms of age. Old age was not a disease itself, although it was associated with increasing and sometimes simultaneous specific health problems. These should be treated on their merits, as for younger patients. Nevertheless, care for increasingly long periods of old age – particularly given the serious and widespread problem of dementia for which a cure was nowhere in sight – was without doubt having an effect on the overall costs of healthcare. Suggestions for how to mitigate the impact of ageing on healthcare costs included the refocusing of healthcare policies towards prevention, which would help reduce some of the common medical conditions now seen, and redefining what hospitals were used for. Too often they became a sort of dumping ground for elderly patients for whom there was no easy alternative, taking up bed space which could be more efficiently used for acute care. Moreover the evidence suggested that elderly patients often went downhill very fast once admitted to hospital, especially if they stayed there for any length of time. This was a social problem more than a health issue as such.

Healthcare provision as a whole needed to refocus to reflect the needs of an ageing population. Healthy ageing was the ultimate goal. This was described as ‘rectangulation’, in other words living long and well and dying fast. But it was not clear that this was what would happen. Meanwhile over-specialisation meant that it was more difficult to treat older people who suffered from a variety of medical ailments simultaneously. Elderly patients were therefore shuffled around from one doctor to another in an inefficient and confusing way, including within hospitals, with all the associated problems of record keeping and compatibility of treatments. Mainstreaming care for older people throughout health systems was crucial, rather than isolating or ghettoizing them. Other crucial steps were making the discipline of geriatrics more prestigious, and increasing spending on research into conditions associated with old age such as incontinence, dementia and Alzheimers.

Within healthcare systems we therefore needed:

  • A more integrated approach, reflecting the complex needs of older patients;
  • A clear strategy on what hospitals were to be used for – mainly for the treatment of acute conditions;
  • Mainstreaming of gerontology across the system, including in the training of all nurses;
  • Support for the central role of family practitioners in assessing and treating older patients.

The issue of social care for the elderly was intimately linked to the discussion on healthcare. For example if elderly patients were to be kept out of hospital or moved out of hospital faster, there had to be good alternatives readily available, either at home or in hospices of one kind or another, and an integrated approach, with budgets and budget incentives properly aligned. Informal carers should be given the respect, status and training due to them, including regular respite periods, especially as traditional family support mechanisms were disappearing. 80% of care was informal. Many carers were also themselves elderly eg the average age of a carer in Ireland was now 75. Social care could now be facilitated through the use of technology and this should be taken advantage of wherever possible, eg ‘telecare’ for those living alone: dispensing the correct medication at appropriate times of day, video coverage of key parts of the house, sending a warning when a cooker had not been turned off or a kettle not turned on, etc. This would allow people to live in their own homes for longer, which most people wanted, and allow them to participate in activities in the local community. Increasingly care in ageing developed economies was also provided by migrants, although this was not often officially recognised as it could be, for example by the provision of a special visa possibility for such carers. Too often they were operating unofficially, without insurance or decent working conditions.

Mixed communities, with the elderly living alongside the rest of the population rather than in isolated areas, were seen as highly desirable, especially since in some societies different generations of families no longer lived together or interacted much. We were reminded that physical services to the elderly were often less important to their well-being and happiness than contact with others, especially their children and grandchildren. Many suggestions were made for how the built environment could be adapted to our ageing societies. These included retrofitting housing and transportation, adapting social services and creating liveable and integrated communities for all. Several concrete examples were given of successful community-level policies. In the United States, these included libraries serving meals for the elderly in which all users of the library joined, a scheme that recruited younger people to accompany older people to concerts and other events, with free admission for the young, and universities enabling older people to access their hospitals, libraries and facilities. In France, retired people were encouraged to sign up to local university courses, whether or not they planned to take a degree. Keeping physically and mentally active – and promoting continued training and learning – was seen as one of the most important ways of delaying the ageing process towards frailty and dependence. Communities needed to be redefined and adapted, age celebrated and wisdom and experience respected.

As well as being an issue of public policy, adapting to ageing populations was therefore clearly also an issue to be put front and centre on the civic agenda. The many practical solutions that could be implemented within communities relied in part on meeting the first challenge – to increase the visibility and participation of older people in communities. A degree of rebranding was seen as desirable – more positive portrayals of people at certain ages on TV and in films needed to be encouraged. Participants recognised that societies also had to respond more to growing ‘grey power’ i.e. consumer and voter pressure from older people for appropriate work, education, leisure facilities, housing and transport. The elderly tended to vote much more than the young, although political parties seemed slow to recognise this.

It should not be assumed either that the response to ageing issues was all about the public sector and public policy. The private sector could provide technological and other solutions in many areas, and the market was always a powerful driver of change and innovation, for example in sectors like telecare and longer term care. 95% of the formal provision of care of the elderly in Britain now came from the private sector. Solutions for the elderly could generate both wealth and jobs, especially if the incentives were properly aligned.  

A clear concern linked to ‘grey power’ was that pensions and healthcare spending would crowd out spending directed at the future, eg on education, defence or infrastructure, since funds were always going to be limited. This was a danger to be avoided by keeping spending in balance. There was a related fear of intergenerational conflict, for example if baby boomers took their resources with them into old age. It was no longer the case that the younger generation could automatically expect to be wealthier and live better than their parents. It was argued that a new ‘contract’ might be needed, and new ways of passing on wealth. However, most participants thought that an intergenerational rebalancing of resources would continue as before, one way or another, and that different age groups did not act in a unified way as the concept of conflict implied. Within families these issues could be understood, and successfully managed, and this read across into wider society. Wealth transfers were to a large extent circular, and the older often helped the younger within families. Older people also contributed to society in more ways than was generally recognised, as it was mainly older people who provided care and sustained families and communities through their volunteerism. It was certainly not a one-way street, as sometimes implied. On a more humorous note, one participant noted the battle of the bumper stickers in the US. From the mid-west: ‘Be nice to your kids – they will choose your nursing home.’ From Florida: ‘I’m spending your inheritance’.

The broader economic and geopolitical aspects of ageing in the world were discussed with great interest, since this was an aspect less often highlighted or debated, and with some passion. There were some who thought that an ageing population would mean less innovation, investment in the future, risk-taking and entrepreneurship, and would therefore diminish the dynamism of those countries where ageing of the population was most advanced. Others argued that, increasingly, people remained productive later in their lives than they once did and that the productivity potential of older workers was elastic and susceptible to policy and other forms of intervention. Evidence suggested that the older generations started more companies than the young, for example, although they might be less ambitious/risky in nature. In any case, whether or not a rapidly ageing population was likely to have a significant effect on GDP growth, the economic weight in the world of the currently developed economies was in inevitable relative decline because of the rapid growth of the emerging economies, especially those like China and India, with very large populations.

An interesting question was therefore what created influence in the world, and well-being for the populations of particular countries (the two were not necessarily the same, which complicated the debate). Was it size of population or economic prosperity (no doubt a combination of the two), and how far did size of population matter, compared to factors such as the physical size of a country? In the past, the ability to feed recruits into a large army had been important but this seemed less significant now, and some of the most successful countries such as Singapore or Denmark had small populations and relied on ingenuity and good policies to prosper in the world. As relative power in the world shifted away from the ‘west’, defined as the currently developed economies, and the proportion of the populations of these countries declined, how far should these countries worry about the potential consequences?

Views were sharply divided, with Americans and Europeans tending to be on different sides of the argument. Some felt that the world remained a dangerous place, where hard power was not irrelevant, and relative decline meant increased vulnerability. In particular, if the relative weight and population of the developed countries declined too far, this meant also, as things stood, that the relative influence of those in favour of liberal democracy and open markets would decline markedly. With a diminishing population, the developed world’s ability to steer the global world order would be reduced and countries in the developing world would acquire, through their population size coupled with rapidly increasing economic growth, the ability to shift the world order. Unfortunately, many of them espoused authoritarianism. Meanwhile ageing democracies would not have the same degree of political will to act internationally or to give aid – or the same financial wherewithal as younger societies to do so. Others were not convinced that the equation was so simple, or that the threats were so great, and believed that the newly rising countries were likely increasingly to espouse universal liberal values, as India already arguably did. In any case it was not clear that we could do much about current trends, although there was a good case for using international aid to mitigate the risks of instability in young population countries, especially those with plenty of weapons.

An important aspect of the geopolitical discussion was obviously the place of migration. Again this was controversial. It had the potential to be the answer to some of the problems discussed during the conference, as we have already seen in the case of care of the elderly. While all societies were likely to suffer from ageing in the future, for the time being there was an obvious complementarity between those countries with rapidly ageing populations needing workers, especially young ones, and countries with youth bulges and few economic or other outlets for them. This could clearly not be a long term solution as migrants themselves would for the most part stay in the country to which they went and themselves grow old, with fertility rates which rapidly matched those of the host country. Circular migration was not realistic. But for now ageing was driving migration from both directions – increasingly, developed countries were opening up their labour markets to migrants and, increasingly, governments and individuals in developing countries were seeing emigration as a solution to excess labour supply and protracted poverty. There was agreement that migration could be a partial solution to some of the challenges faced by ageing populations for the time being if it could be sensibly managed. But for the moment much migration was illegal, which undermined people’s belief in the ability of their governments to control and manage it.

Good management included the successful control of flows, selection of migrants with the right skills, and an ability of recipient societies to integrate incoming migrants. Without successful integration, the economic and social objectives would not be met – immigrants would not find the jobs they were brought in to perform, immigrant investors would leave the country with their money, and the host country’s reputation as hostile to immigrants would diminish its recruitment ability. Immigrants often took on jobs left unfilled by the local labour market – migration could occur alongside persistent unemployment. Participants looked at ways in which migration could be managed effectively for the benefit of both sending and recipient countries, and at relatively successful examples such as the US, Australia and Canada. Bilateral agreements could be one way forward. China’s investment and general interest in sub-Saharan Africa was also seen by several participants as a clear example of a demographic relationship being built for the future – with China’s population shrinking and fertility rates in Sub-Saharan Africa still very high. International contractual agreements could be used to manage migration and multilateral institutions might in the future be encouraged to mediate relations between older and younger societies. Globalisation was crucial in matching jobs to workers and savers to investment opportunities.

However there was a major question mark over ageing countries’ willingness to contemplate more inward migration. For now popular attitudes were increasingly hostile, for example in much of Europe, driven by fears of irrevocable change to the nature of societies, and exacerbated by the economic crisis and the perception (whatever the reality) that jobs which could go to nationals were going instead to migrants. This situation could change, as the effects of ageing became clearer, but for the present the prospects of sensible management of migration for mutual benefit did not look good. European governments needed to lift their eyes a little and be aware that Asia might soon become a rival for migrant labour, and could appear more attractive to many. The ability to attract and manage migration might in the future be a key determinant in a country’s economic success.

Both these factors, ie the relative decline of the developed countries and the migration issue, fed into a wider discussion about whether ageing was likely to lead to an increased risk of conflict in the world, even a clash of civilisations. The optimists argued that ageing, rather than bringing about a potential for a clash of visions for the world order, would see a convergence towards a “geriatric peace”. The assumption was that all societies were ageing and that the differential rates of this process were of little ultimate consequence since the inevitable end state would be a world with fewer young people, who were more likely to engage in conflict, and more older people, who were less testosterone-fuelled and more likely to look for compromises and mutually advantageous arrangements, including over migration. Although there was as yet no firm evidence that countries became more peaceful as they got older, there was wide agreement that the Arab spring could be at least partly explained by huge ‘youth bulges’ present in those countries and that a lot of the instability and internal conflict in sub-Saharan African countries was due to their high ratio of young people to old. Youthful societies were generally more unstable than older societies.

One major cross-cutting issue in all our debates was the crucial importance of accurate and comprehensive data. There were repeated calls for more collaborative and comparative research agendas to be developed. A lot of comparative data was currently missing for developing countries and, although this should not be a cause for paralysis, good data was crucial for effective policy development. Several examples of good data sources, for instance the OECD and the EU, were named, although their member state-based nature meant that these sources would never be able to provide a complete picture. Having a solid evidence base helped prevent practitioners and policy-makers from accepting their own views too easily and challenged their assumptions – comprehensive data mining programmes should therefore be developed internationally to provide such an evidence base. For instance, current projections on ageing relied on the assumption of continued constant fertility behaviour and life expectancy increase – it was important to support or challenge these assumptions with concrete facts and calculable observations.

We also had a wider discussion on the many areas of life that were affected by changing demographics. There were many practical suggestions for how the most challenging effects of an ageing society could be managed through adaptation and transformation of our attitudes, budgets, systems, infrastructures and policy planning. The challenge in dealing with this issue came in the diversity of disciplines which needed to be involved in successfully addressing it and the diversity of the audience that needed to be educated in new ways of working. One crucial but too often missing element was to consult older people themselves about what they needed and wanted, and involve them in decision-making. Ageing was not only a physical but also a social phenomenon and it could not be addressed in the same way across the world – each country’s culture was different, for example the extent to which older people were integrated into and looked after by families. But countries could still learn best practice from each other, and avoid each others’ mistakes. And there was still an urgent need to move the issue up the public policy pecking order, and take it as seriously as it deserved. Although there was a lot more awareness of it now than ten years ago, the time horizons of most democratic politicians did not fit well with the long term thinking and policy-making required. More pressure at the UN and elsewhere for new normative documents on age-related issues, and support for international research into non-communicable diseases such as dementia, on the lines of the effort put into HIV in the past, would also help. Age issues should for example be included in the successors to the current Millennium Development Goals. If the issues were not tackled urgently, the dangers of demagogic solutions gaining popularity were considerable.

The wise and expert guidance of our Chair helped us pull together the disparate strands as our discussions concluded. Participants agreed that the ultimate aim should be to make age irrelevant, rather than a cause for special treatment. What was most relevant was whether someone was poor, cold, frail, disabled or neglected – not what age they were. Fostering intergenerational solidarity and ultimately eroding the perceived division between generations would go a long way towards reducing the impact of ageing on developed and developing economies alike. Meanwhile it might be better to relabel the issue ‘demographic change’, rather than ageing, not least to increase its attractiveness as an issue, including for the young.

This Note reflects the Director’s personal impressions of the conference.  No participant is in any way committed to its content or expression.

PARTICIPANTS
Chair :  Baroness Greengross of Notting Hill OBE (UK) 
Crossbench Member (Independent), House of Lords (2000-); Chair, All-Party Parliamentary Groups: Dementia, Corporate Social Responsibility, Intergenerational Futures and Continence Care; Vice-Chair, All-Party Parliamentary Group on Ageing and Older People; Treasurer, All-Party Parliamentary Group on Equalities; Chief Executive, International Longevity Centre - UK; Commissioner, Equality and Human Rights Commission (2006-); Chair, Advisory Groups for the English Longitudinal Study on Ageing (ELSA) and the New Dynamics of Ageing (NDA); President, Pensions Policy Institute;Honorary Vice President, Royal Society for the Promotion of Health.  Formerly: Director General, Age Concern England (1987-2000); Joint Chair, Age Concern Institute of Gerontology, Kings College London; Secretary General, Eurolink Age.

CANADA
Professor François Béland PhD 
Professor, Health Administration Department, School of Public Health, Faculty of Medicine, University of Montreal; Associate Professor, Division of Geriatric Medicine, Faculty of Medicine, McGill University.

Mr Mel Cappe OC 
Professor, School of Public Policy and Governance, University of Toronto.  Formerly: President, Institute for Research on Public Policy; High Commissioner for Canada to the United Kingdom (2002-06);  A Member of the Program Advisory Committee, The Canadian Ditchley Foundation.

Dr Howard Duncan 
Executive Head, International Metropolis Project, Ottawa; Chair, Metropolis International Steering Committee.  Formerly: Professor of Philosophy, University of Western Ontario, University of Ottawa.

Ms Kate Smolina 
DPhil Candidate in Public Health, Unit of Healthcare Epidemiology and British Heart Foundation Research Group, Department of Public Health, University of Oxford.

DENMARK
Mr Mark Pelle Noppen 
Head of Section, Aging Policy Unit, Ministry of Social Affairs of Denmark.

Professor Suresh Rattan
Professor and Editor-in-Chief, Biogerontology, Department of Molecular Biology, Aarhus University; Secretary, Biological Section, Association of Gerontology (Europe) (2007-11); Scientific Advisor, Life Extension Foundation, Russia (2009-).

EUROPEAN COMMISSION/NETHERLANDS
Mr Julius op de Beke
Senior Administrator, Demography, Migration, Social Innovation and Civil Dialogue Unit, Directorate General for Employment, Social Affairs and Inclusion, The European Commission, Brussels.

EUROPEAN COMMISSION/SWEDEN
Mr Per Eckefeldt 
Deputy Head of Unit, Sustainability of Public Finances, Directorate General for Economic and Financial Affairs, The European Commission, Brussels.

INDIA
Mr Ram Belavadi 
Director, International Longevity Centre - India, Pune.  Formerly: Deputy Director, Social Welfare Department, Government of Maharashtra; Director, Post-Graduate School of Social Work, University of Pune, Pune City.

IRELAND
Dr Roger O'Sullivan 
Director, Centre for Ageing Research and Development in Ireland, Belfast/Dublin.  Formerly: Queen's University Belfast; Rural Community Network.

ITALY
Ms Claudia Villosio 
Researcher, Economics of Ageing, LABORatorio Riccardo Revelli Centre for Employment Studies, Collegio Carlo Alberto, Moncalieri.

JAPAN
Professor Noriyuki Takayama 
Director, Project on Intergenerational Equity; The JRI Pension Research Chair Professor, Hitotsubashi University; Distinguished Scholar, Research Institute for Policies on Pension and Aging. 

NETHERLANDS
Dr Kieke Okma 
Adjunct Associate Professor, Wagner School of Public Service, New York University (2006-); Editorial Board, Journal of Health Services Research and Policy (1998-) and Health Policy (2003-); Member, National Academy of Social Insurance, Washington DC (2010-).

Ms Marieke van der Waal 
Director, International Longevity Centre - Netherlands (2010-); Director, Leyden Academy on Vitality and Ageing (2010-); Member, Supervisory Board, Welfare Foundation Lelystad (2010-). 

OECD/UK
Mr Edward Whitehouse 
Head of Pension Policy Analysis, Social Policy Division, OECD, Paris.  Formerly: Co-Editor, World Bank Pension Reform Primer; Director, Axia Economics; Leader Writer and Social Affairs Correspondent, Financial Times. 

SLOVENIA
Mr Marko Mrsnik 
Director, Standard & Poor's Sovereign Ratings Europe, Madrid (2007-).   Formerly: Economist, European Commission, Directorate General for Economic and Financial Affairs, Brussels (2003-07).

SWEDEN
Professor Bo Malmberg 
Chair, Ageing Research Center, Karolinska Institutet, Stockholm; Board Member, Stockholm Student Housing Foundation; Member, Steering Commitee, Linneaus Project: Social Policy and Family Dynamics in Europe, Stockholm University.

UK
Professor David Coleman 
Professor of Demography, Department of Social Policy, University of Oxford; Fellow, St John's College.  Formerly: Special Adviser, Home Office and Department of the Environment.

Ms Gillian Crosby
Director, Centre for Policy on Ageing, London; Member, UK Advisory Forum on Ageing; Trustee, In Control; Member, Department of Health Advisory Group on Age Discrimination; Member, Editorial Boards, Ageing and Society and Working for Older People.

Dr Robert Dalziel
Research Fellow, The Institute of Local Government Studies, School of Government and Society, University of Birmingham.

Mr Henry Elphick
Managing Director and Head of International Healthcare, Healthcare Investment Banking Group, Jefferies International Ltd, London (2009-).  Formerly: Managing Director, UBS Investment Bank (1999-2009).

Dr Paul Flather 
Secretary-General, The Europaeum; Fellow, Mansfield College, Oxford.  Formerly: Founding CEO, Central European University; Journalist, BBC and Times newspapers.

Mr Mark Gorman MBE
HelpAge International (1988-); Director of Strategic Development (2007-).  Formerly: Director of Policy Development (1997-2007); Director of Policy and Programmes (1992-97).

Professor Sarah Harper
Professor of Gerontology, University of Oxford; Director, Oxford Institute of Population Ageing, University of Oxford; Director, Clore Programme on Population-Environment Change; Member, Royal Society Working Group on Population Change: People and the Planet.

Mr Andrew Harrop
Director of Policy and Public Affairs, Age UK; extensive work on age discrimination, social care and employment in later life and regular speaker/writer on older people's issues. 

Ms Elizabeth Padmore 
Board Member, Facilitator and Mentor; Director, National Australia Group Europe Ltd and Clydesdale Bank plc; Chairman, Basingstoke and North Hampshire NHS Foundation Trust; Fellow, Royal Society for the Encouragement of Arts, Manufactures & Commerce.  A Governor and Member of the Council of Management and the Finance and General Purposes Committee, The Ditchley Foundation.

Professor Naina Patel OBE 
Founder and Executive Director, PRIAE Policy Research Institute on Ageing and Ethnicity; Professor of Ageing and Ethnicity, School of Health, University of Central Lancashire.

Mrs Noreen Siba
Managing Director, International Longevity Centre - UK, London (2006-). Formerly: Director, Alzheimers UK; Director, Contact A Family; Training and Management Consultant, International Alzheimer's Association.

The Rt Hon David Willetts MP
Member of Parliament, Conservative, Havant (1992-); Minister of State (Universities and Science), Department for Business, Innovation and Skills (2010-).  A Governor, The Ditchley Foundation.

UK/USA
Lady Judge CBE 
(Formerly The Hon Barbara Thomas) Director, NV Bekaert SA (Brussels); Director, Statoil (Norway); Director, Magna International (Canada), among others; Chairman Emeritus, United Kingdom Atomic Energy Authority (2004-10); Chairman, UK Pension Protection Fund (2010-).  A Governor and Member of the Council of Management, The Ditchley Foundation.

USA
Dr Gloria Gutman OBC 
President, International Network for Prevention of Elder Abuse (2010- ); Member, Expert Advisory Panel on Ageing and Health, World Health Organization. Professor/Director Emerita, Gerontology Department and Gerontology Research Centre, Simon Fraser University.

Dr Michael Hodin
Executive Director, Global Coalition on Aging, New York; Adjunct Senior Fellow, Council on Foreign Relations; Regent, Harris Manchester College, Oxford.

Dr Michael Hurd  
Senior Principal Researcher and Director, Center for the Study of Aging, RAND Corporation, Santa Monica; Research Professor, Mannheim Research Institute for the Economics of Aging; Research Associate, National Bureau of Economic Research.

Dr Richard Jackson
Director and Senior Fellow, Global Aging Initiative, Center for Strategic and International Studies, Washington DC; Senior Adviser, Concord Coalition.

Professor Theodore Marmor 
Professor of Public Policy and Management, School of Organisation and Management, and Professor of Political Science, Yale University. Author.  A Member of the Board of Directors, The American Ditchley Foundation.

Mr Robert McNulty
Founder (1975), President and CEO, Partners for Livable Communities, Washington DC; Writer, Editor and Contributor on Urban Strategies; Civic Strategist. 

Dr Susan Reinhard
Senior Vice President and Director for Public Policy, and Chief Strategist, Center to Champion Nursing in America, AARP, Washington, DC.  Formerly: Professor and Co-Director, Rutgers Center for State Health Policy.

Dr Richard M Suzman 
Director, Division of Behavioural and Social Research, National Institute on Aging (NIA), National Institutes of Health, Bethesda, Maryland (1988-). 

Professor Larry Temkin 
Professor II (formerly Professor, 2000-07), Rutgers, The State University of New Jersey (2007-).  Formerly: Visiting Scholar, Australian National University (2008).