寿命延长将带来深刻社会变化
2024-05-19 05:41阅读：
1965年在英国，死亡的最常见年龄是出生第一年。如今，辞世的最常见年龄是87岁。
这一惊人的统计数据出自伦敦商学院教授安德鲁·斯科特的新书《长寿势在必行》。世界各地，人的寿命都在延长：现在全球女性预期寿命是76岁，男性是71岁。
这是人类最伟大的成就。然而，我们的主要反应是担心“老龄化”社会的成本。
是的，我们生活的新世界带来挑战，但它也创造机会。作为个人和社会，我们需要重新思考老龄问题。我们绝不能让我们社会的很大一部分人成为没有生产力和不健康的“老年人”。无论是个人还是社会，我们都能够、而且必须做得更好。这是斯科特所说的“势在必行”。除非发生灾难，否则高龄老人将变得更多：1990年，世界上有95000名百岁以上老人；如今，这一数字已超过50万，且还在上升。
一大问题是，人们将如何变老。他们会享受充满活力的晚年、然后突然死去，还是会在“没有视力、没有牙齿甚至没有一切”的状态下度过无助、无望的漫漫岁月？斯科特设想了四种情况。第一种是乔纳森·斯威夫特笔下的不死族人，他们长生不死，却永远在衰老；第二种是奥斯卡·王尔德笔下的多里安·格雷，他活得年轻，却突然老死；第三种是彼得·潘，他永远年轻；第四种是漫威漫画公司创造的超级英雄金刚狼，他能获得重生。
我们可以认为第一种情况很糟糕。然而，这似乎就是我们的现状：如果我们活得足够长，往往会慢慢崩溃。但是，改善饮食、增加锻炼和医学进步三者相结合，没准可能带来其他可能性。斯科特认为，这是我们现在应该努力的方向：不应是治疗或只管理老年疾病，而应寻求预防老年疾病。这不仅需要医学进步。高度不平等不仅是一个社会经济问题，也是一种健康危害。
目前，中国女性预期寿命为82岁，男性为76岁。值得注意的是，这与美国的情况大致相同。对于这样一个
富裕国家来说，美国的预期寿命低得惊人。这是由于巨大的卫生不平等。据斯科特说：“在美国，1%最富有人口与1%最贫穷人口之间的预期寿命差距，男性为15岁，女性为10岁。”
然而，我们不仅需要改变我们变老的方式，还要改变我们对年龄的看法。
多里安·格雷的世界虽然理想，但似乎不太可能。而一个只有不死族人、或只有彼得·潘的世界将是可怕的。只有不死族人的世界确实是可怕的，因为我们大多数人都不希望在衰老中结束生命，这不可避免给社会年轻成员带来巨大负担。只有彼得·潘的世界也是可怕的，因为很少有人愿意与他们的高祖父母住在一起。长生不死不适合我们。
同样明确的是，我们需要彻底反思一个大多数人可能活到90多岁、许多人甚至活得更久的世界。接受25年左右的教育、工作35年、然后退休35年，这种想法对个人和社会来说都是不可行的。这当然是负担不起的。它还可能导致大量人口老年空虚。
有必要延长工作时间就成了理所当然的事。这也需要一个人在一生时间里对职业生涯做一些改变。人们不再是一段时间受教育、一段时间工作和一段时间退休，而是把三者混合在一起，这样将是合理的。人们可以反复地回过头来学习，反复地休整，反复地改变自己所从事的工作。这是让长寿可负担、可承受（这点同样重要）的途径。
要让这样一个世界运转起来，我们必须对教育、就业、养老金、福利国家和卫生系统进行调整。例如，人们将不再只是在青壮年时期上大学或接受培训。上大学或接受培训将是终生的活动。同样，强制性或标准退休年龄将毫无意义。在人生的不同阶段，人们必须有工作和不工作的选项。仅仅全面提高退休年龄既效率低下又不公平，因为预期寿命分布非常不均衡。养老金缴费比例也需要改变，现在的养老金缴费比例普遍过低。卫生系统还必须把公共卫生充分纳入进来，因为随着社会老龄化，公共卫生将变得越来越重要。
Increased longevity will bring profound social
change
People will have to work longer and pension systems will need to be
transformed
MARTIN WOLF
In the UK in 1965, the most common age of death was in the first
year of life. Today the most common age to die is 87 years old.
This startling statistic comes from a remarkable new book, The
Longevity Imperative, by Andrew Scott of the London Business
School. He notes, too, that a newborn girl in Japan has a 96 per
cent chance of making it to 60, while Japanese women have a life
expectancy of nearly 88. Japan is exceptional. But we are living
longer everywhere: global life expectancy is now 76 for women and
71 for men (clearly, the weaker sex).
This new world has been created by the collapse in death rates of
the young. Back in 1841, 35 per cent of male children were dead
before they reached 20 in the UK and 77 per cent did not survive to
70. By 2020, these figures had fallen to 0.7 and 21 per cent,
respectively. We have largely defeated the causes of early death,
by means of cleaner food and water, vaccination and antibiotics. I
remember when polio was a great threat. It is almost entirely gone,
as is the once vastly greater peril of smallpox.
This is humanity’s greatest achievement. Yet our main reaction is
to fret over the costs of an “ageing” society. Would young and
middle-aged adults prefer to know that they and, worse, their
children might die at any moment? We know the answer to this
question.
Yes, the new world we live in creates challenges. But the crucial
point Scott makes is that it also creates opportunities. We need to
rethink old age, as individuals and societies. We must not shuffle
a huge proportion of our society into unproductive and unhealthy
“old age”. We can and must do far better, both individually and
socially. This is his “imperative”. Barring a disaster, there are
going to be far more very old people: in 1990, there were only
95,000 people over 100 years old in the world. Today, there are
over half a million, and rising.
A big question is how people will age. Will they enjoy a vigorous
old age and then drop dead suddenly or will we live on “sans eyes,
sans teeth, sans everything” for many helpless, hopeless years?
Scott imagines four scenarios. The first is Jonathan Swift’s
Struldbruggs, immortal but ageing, eternally. The second is Oscar
Wilde’s Dorian Gray, who lives young and then suddenly dies old.
The third is Peter Pan, who is forever young. The fourth is Marvel
Comics’ Wolverine, who is able to regenerate.
We can agree that the first is awful. Yet it seems to be where we
are: if we live long enough, we tend to fall slowly apart. But,
maybe, the mixture of better diet, more exercise and medical
advances might deliver other possibilities. This, Scott argues, is
where effort should now go, not to treating or, worse, merely
managing the ailments of old age, but to seeking to prevent them.
This requires not just medical advances. High inequality is not
only a social and economic issue, but a health hazard.
China’s life expectancy is now 82 for women and 76 for men.
Remarkably, that is much the same as in the US. Life expectancy in
the latter is strikingly low for such a wealthy country. This is
due to huge health inequalities. According to Scott: “In the US the
gap in life expectancy between the richest 1 per cent and the
poorest 1 per cent is fifteen years for men and ten years for
women.”
Yet we need to change not only how we age, but how we think about
age.
The Dorian Gray world, while ideal, seems unlikely. But a world of
either Struldbruggs or Peter Pans would be horrible. This is true
of the former, because most of us do not wish to end our lives in
decrepitude, inevitably also imposing a huge burden on the younger
members of society. It is also true of the latter, because few will
want to live alongside their great, great, great grandparents.
Immortality is not for us.
Equally clearly, a world in which most are likely to live into
their 90s, many even longer, needs to be thoroughly rethought. The
idea of 25 or so years of education, 35 years of work and then,
say, 35 years of retirement is impossible, for both individuals and
society. It is certainly unaffordable. It is also likely to produce
an empty old age for vast proportions of the population.
It is going to be necessary to work longer as a matter of course.
This is also going to require several changes in one’s career over
a lifetime. Instead of one period of education, one of work and one
of retirement, it will make sense for people to mix the three up.
People will go back to study, repeatedly. They will take breaks,
repeatedly. They will change what they do, repeatedly. This is the
way to make longevity affordable and, as important, bearable.
To make such a world work, we will have to reorganise education,
work, pensions, welfare states and health systems. People will no
longer, for example, go to university or receive training only as
young adults. This will be a lifetime activity. Again, mandatory or
standard retirement ages will be senseless. People must be given
options to work and not to do so at various stages of their lives.
Just raising retirement ages all round is both inefficient and
inequitable since life expectancy is so unevenly distributed.
Contribution rates to pensions will also need to be changed. Today
they are generally too low. Health systems must also fully
incorporate public health, which will become ever more important as
society ages.
We are moving into a new, old world. This is the fruit of a huge
success. Yet there is also a realistic danger of a Struldbrugg
future for individuals and society. If so, we must rethink our view
on the priority of preserving life.
