John Rowe, Dr. Lisa Berkman

A Society with Many More Seniors with Walkers than Youngsters in Strollers, Part IV

VTR Date: November 13, 2010

Dr. John Rowe and Dr. Lisa Berkman continue the discussion about our aging society.


GUESTS: Dr. John Rowe and Dr. Lisa Berkman
AIR DATE: 11/13/2010

I’m Richard Heffner, your host on The Open Mind.

And this is another in a series of programs that relate to our quickly and dramatically aging society.

Key to our conversation once again is the MacArthur Foundation’s “Research Network on An Aging Society”, which asks us to imagine a society with many more seniors with walkers than youngsters in strollers, when those over age sixty
clearly outnumber those under fifteen … and which asks us to consider realistically what Americans will have to do to accommodate these new demographic facts of life.

Here again today is the Chair of MacArthur’s “Aging Society Network”, Dr. John Rowe of Columbia University’s Mailman School of Public Health. Earlier Dr. Rowe led Harvard’s program in academic geriatrics, was President and CEO of Mount Sinai Hospital and Medical School in New York, then served as President and CEO of Aetna, the heath care organization.

With Dr. Rowe is another member of MacArthur’s “Aging Society Network” – Dr. Lisa Berkman, an internationally renowned social epidemiologist whose work focuses extensively on social and policy influences on health outcomes. Dr. Berkman is the Director of the Harvard Center for Population and Development Studies.

And I want to begin today by asking whether Dr. Berkman has earlier called “the health divide” between the United States and other developed countries…ranking us “in the bottom half of industrialized countries in life expectancy” … diminishes in any meaningful way the urgency we should feel about preparing for the needs of an older society. What’s the situation there?

BERKMAN: Thank you very much. Well, the situation is as you describe it … we sit at the bottom of OECD countries in terms of life expectancy. And that makes the problem solving venture even more critical.

And the amazing thing about life expectancy and our rankings is that we weren’t always like that. If we go back to 1950s or 1940s and we look at our ranking, we were doing really well about 1940s, 50s … we were fourth and fifth for men and women, respectively, in life expectancy.

So this drop in life expectancy has occurred over the last half century and as we start to think about what are the reasons that that’s happened … work pops up very prominently as one of the explanations.

HEFFNER: What do you mean “work”?

BERKMAN: So when we made work policies … many of them were made at around the time that Social Security came in, either before World War II or just after … and at that point, we were a very different, different society.

Very few women were in the work force … life expectancy for people in 1950 was only a few years after, after being 65.

So when you think about Social Security … Social Security was devised for people in the last couple of years of their life. And now we face a society that’s dramatically different. Dramatically, dramatically different.

Where women are in the workforce … most women have young children and they remain in the workforce and we have an aging society in which people live longer and longer and yet we haven’t adapted how we think about work to those kind of changing demographics circumstances.

ROWE: Oh, didn’t you say though … Linda … Lisa … that even though the United States has a relatively low life expectancy compared to other developed countries, it doesn’t mean we don’t have an aging society problem.


ROWE: What it means is we’re going to have an aging society problem later than these other countries.

So that Germany, with respect to it’s age distribution currently looks like the United States will look in 2030.

Because we had a Baby Boom and many of these other countries after World War II had a Baby Bust. And what that means is that we’re still going to have an aging society and everything that is entailed with that, and maybe we have something to learn from the fact that these other countries have gone through this transformation previous to our transformation …

HEFFNER: Of course which leads me to ask the question … have they gone through it well? Have they been wise in adapting their work policies and other policies to this fact?

ROWE: Well I would say that we’re currently seeing in France a conflict between policy makers who feel that the wise thing to do is to advance the retirement age and the preferences of some proportion of the population who are in the streets about it. Some of the Scandinavian countries have been smoother …


ROWE: … in this transition …


ROWE: But there’s been a cost in terms of taxes. And perhaps economic growth.

BERKMAN: Right. I would say nobody’s done this well. Nobody’s done this well yet. Nobody has … no country has totally recognized the extent to which this kind of a demographic transition is likely to cause an upheaval in how people have to face work and family.

And so Scandinavian societies and a lot of the EU countries have been really conscious of work in terms of work/family balance.

But very few have adapted to issues of an aging society. It’s taking everybody by surprise.

HEFFNER: Well, of course, I was fascinated in recent times how the New York Times has picked up the issues that you are addressing yourselves to. Just the other day Natasha Singer writes about the financial time bomb of longer lives …

ROWE: Yes.

HEFFNER: … and says, “First the good news … we’re living longer, healthier lives than ever before. Now for the bad news … at this rate we can’t afford to live so long”.

ROWE: Right.

HEFFNER: What do we have to do in the workplace? What social policies …

ROWE: Right.

HEFFNER: … are you devising and hoping …


HEFFNER: … and hoping that will be adopted.

BERKMAN: So I think, I think they fall into three areas. We often focus on retirement as the obvious one. But actually retirement is only one and probably not even the central one that we have to think about.

So when we think about work re-design … about how we have to fundamentally re-organize how work is organized … we think about retirement, we think about workplace flexibility.

And I’ll talk about … a little bit about what we mean about “workplace flexibility” … not necessarily dramatic things, but things like vacation days or sick days or leave policies.

And third, I think we have to think about part-time work. So, if I take the last one first … part-time work is really rare in the United States. It turns out that, you know, Americans work more hours than any other country in the world and mostly we’re dual wage earners, so both members of the family are in the workforce.

Other countries do much better at defining times and throughout the life cycle, not just when we’re old, but there are lots of times throughout the life cycle where it would be really healthy for us to be able to work part-time.

HEFFNER: Well, why, why, why do we, as different from other countries work so hard. You say we in the United States work …


HEFFNER: … longer and harder than people …


HEFFNER: … do in other countries.


HEFFNER: Why is that?

BERKMAN: That’s the million dollar question.

HEFFNER: (Laugh)

BERKMAN: (Laugh) That IS the million dollar question.

HEFFNER: The trillion dollar question.

BERKMAN: The trillion dollar question. Because we don’t really know. I mean part of it is undoubtedly a work ethic that we have. That we just keep striving; part of it is about inequality and the amount of financial resources that we feel we need to have.

Lots of it is spread across very unequally, so people who are at the bottom need to work a huge number of hours and need both members of a family in the work force, just in order to survive in some ways.

But other countries seem to have understood that families are important, balance, times between work and family are important. And this is something that defines an aging society, but it turns out it’s good for everybody.

This isn’t only about old people, it’s about people with young children. It’s about people who are taking care of their partners. It’s about people who are taking care of their parents. It’s going to affect all of us in some way …

ROWE: But, but the paradox … the paradox is that on the one hand we say we work harder and longer than anyone else. On the other hand we say the solution to our problem is to work longer.

BERKMAN: Right. (Laughter)

ROWE: The solution to our problem is to keep people in the work force, keep them engaged, keep them productive and find ways to do that.

And one way to do that is to raise the retirement age from a policy point of view. And … but there are other ways to do it. And the other ways to do it are to “incent” people to stay in the workforce. Give them bonuses if they work to age 70. Have the employers not have to pay Social Security tax for their older workers. Have more flexibility.

When I was at Aetna we had a lot of workers who worked at home. And, in fact, I remember one year the Worker of the Year was a worker who worked at home.


ROWE: And so there are many more flexible approaches that we can have that try to help people adapt to maintaining some economic productivity.

HEFFNER: But what do you do … quite seriously … at a time when we have such high unemployment rates? When there are so many people, younger people, out of work … do you say …

ROWE: He’s falling into the trap, isn’t he?


BERKMAN: (Laughter)

HEFFNER: Okay, fine … go ahead … you were waiting for that.

BERKMAN: ????? and try it again. Go ahead. (Laugh)

HEFFNER: Answer.

ROWE: One of the myths about aging that our MacArthur Network has, has been working on is … is the view that you have to get older workers out of the workforce to make room for the younger workers.

Certainly sounds intuitive. But you can’t prove that and in fact there are now studies in the United States by Weiss and his colleagues and studies in the European Union …


ROWE: … by Boersch-Supan and his colleagues that clearly show that when older age employment is up, younger age employment is up. That what it is … what you need is a strong economy and that getting unemployment in older age groups does not foster employment in younger age.


ROWE: Would you agree with that?

BERKMAN: I … exactly … I think that’s exactly the situation. Is that it’s hard to prove … it’s not, it’s not totally locked up that societies which have higher … like high retirement ages … actually have higher employment for younger people

So for instance when you look at France right now, it has high unemployment, it also has really early retirement. So it’s not like retirement is helping to find jobs for younger people. So it’s an anathema. But I think the issue of retirement has to be coupled with these issues of work place flexibility.

And the idea that there will be times in your life when you go in and out of the labor force without kind of completely losing ground. Right now we lose … if we drop out of the labor force, we never get back in. We never get back in where we are because the United States is so competitive and somewhat rigid in how it ranks people.

So if we were more flexible we could extend retirement, have more flexibility and allow people to kind of flow in and out at times in their lives when they needed that kind of help.

ROWE: A very interesting aspect of this issue of it … should it be young workers or old workers is the observation, again … this was by Boersch-Supan in Germany in a Mercedes Benz light truck assembly plant where they had young teams of workers and they had teams of older workers and they had mixed age teams.

And it was the mixed age teams that were really the best. They had a mix of speed and accuracy, experience and strength … whatever it was. And it would suggest that it’s really not one or the other, but both.

HEFFNER: Do you think you can get over the … that hurdle, the myth that you say that I, inadvertently …

ROWE: We trapped you. I think we trapped you.

HEFFNER: … fell into.

BERKMAN: (Laughter)

HEFFNER: Do you think we can do that?

ROWE: I think …

HEFFNER: You said it was “counter-intuitive”.

ROWE: I, I think that … as a former CEO of a major corporation, I think that CEOs are very evidence based. And that if we can articulate the facts, we should have evidence based policies that will come both out of local and state and federal governments … but also that corporations will develop their policies based on the evidence.

They want to be successful for themselves and their shareholders. And if we can show them the evidence, I think we can change the policies.

HEFFNER: What about the more human, less economic situation aspect of this? We older people … I’m not talking about you kids … we older people are so very concerned about what happens to us when we don’t work. Use it or lose it.

That sort of thing. Do you think there is much to the notion that one has to keep active …


HEFFNER: … to keep one’s marbles at least.

BERKMAN: Yes. Yes. The easy answer to that is Yes. That almost all the evidence that we have suggests that people who are socially engaged … whether it’s at work or in their lives, maintain their cognitive functioning more, maintain their physical functioning more and are able to both contribute to society and receive. And when we talk about social engagement among us, we’re not talking about social support, we’re not talking about what you get from people, it’s what you give to people. So, by being at work and socially engaged you are more likely to maintain your cognitive functioning.

And it’s because you create a … you have to … you’re constantly confronted with situations in which you have to problem solve. You know one of the things that people have done in the cognitive neuroscience field is try to improve memory.

And they’ve done a lot of tests to try to improve memory. And so far what they’ve said is that if you teach people to do cross word puzzles, they get better at cross word puzzles.

If you teach people to do Sudoku, they get better at Sudoku.

But they don’t get better at anything else. It’s doesn’t’ extend to their life. The thing about work that’s so important is that it seems to be able to generalize so that it extends to your life. It’s able … it makes you more able to problem solve and be creative in the rest of your life.

You’re not learning one little task, you’re learning a set of things that enable you to live in the world. Turns out to be really important.

HEFFNER: Why don’t the French? The workers in France understand that? They’re fighting against increasing the retirement age by, what, two years?

ROWE: Maybe because they’re French?

HEFFNER: (Laugh) No, you can’t say that …

BERKMAN: No, no, no.

HEFFNER: … on The Open Mind.

ROWE: No, no.

BERKMAN: Two serious things about France. So, French people live longer than almost anybody; they have the secret, as far as I’m concerned … (laugh) to longevity. It is actually a very healthy balance between work and the rest of their life.

They stay engaged across a number of fields, so when French people drop out of the workforce, when they retire, they remain quite socially engaged.

But I think there are two things going on in France right now. One is very short sighted. I mean they just are very centered on preserving privileges and rights that they, that they worked hard for. So unions argue against that … and they’re just resisting. There’s no logic to it. Of course, retirement should change in France.

But the other thing that’s more complicated, which I’ve heard and, and is not necessarily proven, is that a lot of people are worried about job security in France. And so their years between 60 and 62 may not be filled with their jobs as they see them right now. They may be filled with unemployment. And they were …

HEFFNER: You’re not going to fall into the trap, too, are you?

BERKMAN: … unemployed. Well, they don’t know. So what they see themselves as guarding against is unemployment, not two more years of working life.

They see themselves as potentially guarding themselves against being unemployed.

ROWE: Uncompensated … uncompensated unemployment. I think one of the other aspects of the United States … that people feel if they’re not working, they’re “out of it”, you know … that things are over. Is that we don’t, in this country, value activities that are not monetized.

If you’re working in the economy and you have a paycheck and you’re producing something, that’s part of the ideal. But if you’re … as we’ve spoken in previous shows, if you’re volunteering in the community and you can be doing so with full engagement and very substantial productivity, but it’s not monetized, it’s not counted in dollars. And until we find a way to measure those activities and, and add them to financially productive activities as a true measure of someone’s productivity … we’re not really going to give full weight to those activities.

HEFFNER: You think we have a chance to do that?

ROWE: Well, I think we do. We think that, in our group, we’re working on new approaches rather than the GDP, you know, new approaches to measure productivity of a society beyond just the financial productivity. And we think that those kinds of measures can be important supplement to GDP.

HEFFNER: Well, look … I know that as a physician you’re a totally enlightened person and so I suspect …

ROWE: (Laugh)

HEFFNER: And so I suspect that as a businessman … as chairman of a great health insurance company that you were, too, and you talk about your policies there as CEO of Aetna … what role, however, has got to be played by government, has got to be played by enlightened industry in bringing about the policy changes that you think are so important in the work place?

BERKMAN: Ahmm, well we should both take a crack at this. I think in terms of changing policy, there have to be government … sort of policies that promote a long life and a healthy workforce.

At the same time I think, increasingly, there are companies in the private sector who recognize that this could be a win-win. So maybe I could give you two examples of that.

We’re doing a study now in a long term care company … very, very large, long term care company. And we’re trying to increase workplace flexibility and increase work/family balance for people.

The company sees this as important because they think it’s going to be better for their bottom line. They think they’re going to reduce turnover, they’re going to reduce sickness absence because right now … especially in a mostly female labor force they see the biggest threats to their company surviving being related to work/family issues. So people call out all of a sudden because they’ve got to take care of somebody. Or they quit because they can’t stay in that workforce. So they constantly lose the most talented people, alright, they constantly lose the most talented people.

So they’re hoping that a kind of an initiative which increases flexibility will be good for the bottom line and good for the health of their employees and families. So that’s a, that’s a private sector …


BERKMAN: … initiative that could be really important. On the public side, the United States, again, is one of the only countries in the world that does not have parental leave.

Now you may not think this is related to aging … I actually think it’s just the flip side. It’s … we just don’t imagine how we’re going to incorporate times at work where people need to be out and other places … there’s a very, very famous study in South Africa where they gave older people pension plans … turnout to spill over to younger people.

So I think as a government we could think of policies that are win-win. And they’re win-win for younger people and they’re win-win for middle aged people in the workforce and they’re win-win for older people. And that’s the kind of creative approach that we need to be thinking.

ROWE: I would just underline the last comment. It’s really not just about the elderly, it’s about our society, it’s about all the age groups, and we need a comprehensive set of public and private policies across the life course.

And if we can change the life course in terms of education throughout mid-life and opportunities for flexibility in the workforce then we’re going to be delivering to late life a, a fitter, a better educated, more prepared workforce that can more easily continue until later in life. So we really need to think about the society …

BERKMAN: And it will be good for young people, too.

ROWE: And it’s good for young people and its good for middle aged people and its good for the elderly. It’s not just a fix on the elderly, changing that frame of reference is very tough.

HEFFNER: Well, I wonder whether it isn’t even tougher today as we look at a political situation in which the notion of getting government out … and that’s why I asked the question of …


HEFFNER: … what government’s involvement must be … we’re talking about an industry based change … I guess that’s not that impossible. But I would think you would feel up against a stone wall.

ROWE: Yes and no. I, I think that there are things going on in the economy and in the political debates that, that might make it harder then to introduce these changes.

On the other hand, as you pointed out … the media is now replete with articles about the aging society …


ROWE: … and here we are on your show and doing several segments … we’ve been pushing this rock up, up the hill a long time …


ROWE: … it’s taken us years to become an overnight sensation here in terms of people’s interest.

HEFFNER: Well, I, I really wonder then why we are laggards in this. Why we Americans are so far behind the line?

ROWE: Because we’re aging later.

HEFFNER: You mean that’s good or bad?

ROWE: The point you made in the introduction about an aging society is more people over sixty than under 15 … Germany was there in 1981 … we’re going to be there in 2013. The Baby Boom generation diluted the elderly in our society. It was all about youth, it was all about that generation. And we really haven’t had to face these problems as early as those other countries, that’s why we’re laggards … because we’re laggards from the demographic transformation.

HEFFNER: That’s a very interesting point to make. Does it make you more hopeful now? You’re saying we’re going to run up against this problem.

ROWE: And we, we’ve learned what works and what doesn’t work in some of these other developed countries and that’s got to be helpful.

HEFFNER: In, in the two minutes that we have remaining … and I’m sorry that there’s so little time … what do you think is the most important reform that’s needed here, the most important social policy change?

BERKMAN: So, from my perspective, I think the most important … policy change we could do would be to re-think work. Both in terms of retirement, in terms of workplace flexibility and in terms of part-time work. It’s gotta be an orientation to work that’s not a single arrow, but really thinking about how we can work and live to be 90 and have children and take care of people. It’s got to be all of those things sort of put together in a policy that’s, that’s oriented towards taking care of families as well as maximizing our engagement throughout an entire life cycle.

HEFFNER: Do you find that the importance of the computer and of the possibility of working at home, via the computer, has changed this picture …


HEFFNER: … in any way?

BERKMAN: … I think that, that flexibility policies that allow people to work at home or in the hours they want to is a clear, clear bonus. The only downside of that is lots of people don’t have those kinds of jobs.

Lots of people who are working at manual jobs or face jobs … all of healthcare … our, our intervention for healthcare … all of those people have to be there, there’s nothing they can do at home. It’s a face-time job. So only some of our jobs are going to be like that. But for the people who have them, terrific.

ROWE: I think the skeptics about the computer aspect of, of this point to the digital divide … that a very small proportion of older households are connected to the Internet compared to younger households. We think that’s what’s called a cohort effect … as, as the population ages … the current middle age and, and young/old individuals who are wired will continue to be wired and continue to participate.

HEFFNER: Well, of course, I’m wired and the wire tells me that we’ve run out of time …

BERKMAN: (Laughter)

HEFFNER: … but thank you so very much Dr. Berkman …

BERKMAN: Thank you.

HEFFNER: … and Dr. Rowe for joining me again. Appreciate it.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. Meanwhile, as an old friend used to say, “Good night and good luck.”

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.