BUS604: Innovation and Sustainability

The major demographic changes that are occurring globally are resulting in a rapid increase of elderly people in virtually every society: by 2050, 20 per cent of the global population will be over the age of 60 and the number of people over the age of 80 will have tripled compared to 2010. Overall, this shift is related to increased life expectancy, as a consequence of improved hygiene, better nutrition, and better medical care, but it is also a consequence of declining birth rates.

Specific regions may be particularly affected because of additional emigration of the young for economic reasons and/or socio-economic and political trends in society. The topic "Healthy Aging" is therefore broadly recognised as one of the greatest societal challenges affecting most countries in every continent over the next decades. Indeed, the consequences of aging societies are manifold and will affect individuals, communities, and economies.

Aging is the leading risk factor for nearly all major chronic diseases, such as type 2 diabetes, neurodegenerative diseases, cardiovascular diseases and dementia, and also for cancer. These chronic diseases constitute an increasing cause of morbidity and hence a major driver of healthcare costs now and increasingly so in the near future.

Conceptually, it is important to emphasize that healthy aging is not only about elderly people: in fact, healthy aging starts in the womb and at various stages in early life. For instance, nutritional status or exposure to pollutants can have a strong impact on health outcomes later in life due to "metabolic programming". Programmes aimed at promoting healthy aging should therefore address the entire course of life in all its aspects. The goal is to promote healthspan rather than lifespan (see Figure 1).

Healthspan is defined as the years lived without chronic age-related conditions that allow people to live an active life and hence to contribute to society. Lifespan refers only to life expectancy.

Yet our understanding of the biological mechanisms that influence human aging and its relation to disease development remains limited. This knowledge is essential to define strategies that extend healthspan. The societal impact of ongoing demographic changes is also evident from "the 10 facts on aging and the lifecourse" as defined by the World Health Organization (WHO). In short and modified form:

1. The world population is rapidly aging.
2. The number of people aged 80 and older will quadruple in the period 2000 to 2050.
3. By 2050, 80 per cent of older people will live in low- and middle-income countries.
4. The main health burdens for older people are from non-communicable diseases.
5. Older people from low- and middle-income countries carry a greater disease burden than those in the rich world.
6. The need for long-term care is rising.
7. Effective, community-level primary health care for older people is crucial.
8. Supportive "age-friendly" environments allow older people to live fuller lives and maximize the contribution they make.
9. Healthy aging starts with healthy behaviors in earlier stages of life.
10. We need to reinvent our assumptions of old age.

It is evident that, in the end, a meaningful extension of healthspan for all citizens around the globe will take an enormous effort in the fields of life sciences and (bio)medical sciences, as well as of social sciences, nutritional sciences, economics, and spatial sciences. With respect to the latter, it is becoming increasingly clear that the built environment has a strong impact on the course of an individual's life, not only with respect to the indoor environment of houses and public buildings (air quality, light, etc.), but also the surrounding infrastructure, (playgrounds, bicycle lanes, meeting points, etc) and local availability of healthcare facilities.

It is also evident that economic and cultural differences between countries will have to be taken into account as an additional layer of complexity. The maintenance of a healthy lifestyle from birth onwards (or even prior to birth) is key, but it has proven to be difficult to achieve a focus on primary prevention and it will require increasing health literacy in all communities.

This process, in turn, will be strongly influenced by socio-economic and cultural differences between communities. In addition, early detection of markers of disease, preferably of biomarkers for a group of age-related diseases rather than for each one separately, is necessary for early and effective treatment (secondary prevention). Application of novel consumer-tailored eHealth tools can be of great value in this respect.

Finally, improved treatment strategies for most of the chronic, age-related diseases are still in urgent need of the recognition that each patient should be considered as an individual that requires a personalized, individualized, or "precision medicine" approach.

Novel technologies in genetics, analytical chemistry, imaging, and bioinformatics provide, in theory, the tools for personalized medicine but full application of Big Data in public health and clinical care is still in its infancy. Consequently, more research into these issues, as well as harmonization of data and applications, is urgently needed.

At the same time, however, an awareness is needed that medical professionals and caregivers should be educated:
It is important that healthcare professionals of the future are aware of and contribute to societal initiatives to increase health literacy of citizens; and to maintain a healthy workforce in view of increasing retirement ages.