I have criticized the Longevity Dividend view on extending healthy life for a lack of ambition, for focusing on expensive and slow ways to obtain tiny gains in life expectancy through the manipulation of metabolism. Calorie restriction mimetic development and the forthcoming metformin clinical trial are representative of this school of thought. Here, however, is a view of what to do about aging that makes the Longevity Dividend seem radical. It is focused entirely on policy, provision of existing medical technology, and non-medical prevention strategies such as lifestyle choices to modestly reduce risk of age-related disease - as for the World Health Organization reports it derives from, it is a bureaucratic vision of doing something about aging without doing anything about aging. In this era of tremendous and transformative progress in biotechnology, it seems like burying one's head in the sand to talk at length about improving the state of aging without making medical research and development the primary focus.
Most countries of the world are emerging from the first or are in various stages of the second demographic transition. The first transition is from an agrarian society with high mortality and fertility rates to one where mortality, starting with child mortality, falls; this is followed by declines in fertility. As the "bulge" of children surviving ages into employability, the labor supply becomes greater than the dependent population of children, potentially creating economic growth. This results in what is called a first demographic dividend. This period is time limited. The stage that follows is one in which persisting declines in mortality lead to a population that is living longer. Combined with low fertility, the age structure changes with higher proportions of the population at older ages. Evidence indicates that longevity induces the accumulation of capital, including individual savings in anticipation of retirement. A country's wealth rises. This is termed the second demographic dividend. If policies are constructive and effective, the second dividend can lead to sustained positive economic outcomes.
Mounting evidence suggests that the second demographic dividend does not encompass, by itself, the full potential benefit that society could derive from a larger population of older and aging adults. Additional and sustainable benefits could arise if people arrive at old age healthy and if the large, unrealized social capital of older adults can be activated, conferring benefits both economically and in other measures of societal well-being.
To accomplish this would require a new frame of goal setting for successfully aging societies with investments needed in (a) education, (b) disease prevention and health promotion so that the people arrive at older age healthier and stay healthier longer, and (c) new social institutions and roles to enable paid work by older adults or new high impact generative roles, bringing new social capital to solve major unmet societal needs, while enhancing well-being for the older adults who are accomplishing this. Proposed here is the idea that such investments could lead to a third demographic dividend for aging societies, in addition to the increased wealth of the second demographic dividend.