1. THE FUTURE OF LONGEVITY Michel POULAIN Senior Researcher Estonian Institute for Population Studies Tallinn University Emeritus Professor Université catholique de Louvain (Belgium) STATISTICS ESTONIA 95th Anniversary Tallinn, 25 April 2016

2. People around the world live longer and longer  In the middle of the XIX century, the life expectancy did not exceed 50 years, a level remaining fairly constant in past human history. Nowadays it peaks above 80 years and, in Europe, the life expectancy gained 10 years during the last 50 years. Currently every year brings three additional months to the expected duration of our life span.

3. In the EU and in Estonia…  In 2013, according the latest figures produced by Eurostat, the life expectancy in EU-28 was estimated as high as 83.3 years for women and 77.8 for men, slightly higher than observed in Estonia with 81.7 and 72.8 years respectively.  Nevertheless in Estonia the largest gains have been registered among all EU countries during the decade : + 6.4 years for women and + 4.5 for men.

4. The main reason for such improvement in longevity  Improvement is related to the progress in the medicine, for both preventive and curative areas, and despite evident worsening behaviours. Since the last decades of the past century, the trend toward longer life also concerned older ages with a substantial improvement of the quality of life of the oldest olds. That makes the improvement in longevity more visible.

5. The main contributors…  Improved nutrition and the control of infectious diseases reduced child and infant mortality since the beginning of the XX century.  The introduction of penicillin in the 50’s entailed adult mortality.  Around 1960, the so-called cardio-vascular revolution contributed to lower avoidable adult mortality in parallels to better living standards and health behaviours.

6. Comparing mortality rates  Mortality rates increase exponentially with age. The comparison of the Estonian figures with similar data from Japan and the neighbouring countries, Finland and Latvia, demonstrates the primacy of Japan especially for women. The Estonian mortality rates are somewhat lower than the ones of Latvian population.

7. Mortality rates 2013, Estonia, Japan, Finland and Latvia (Eurostat and WHO) MaleFemale

8. Males and females: the gender gap…  The analysis of the gender gap reveals a relatively worse situation of men in Estonia compared with Finland that is particularly evident between ages 55 and 70. The recent gains did not contribute to reduce enough the gender gap that remains the major negative trait for the Estonian population.

9. Mortality improvements from 2000 to 2013, for Estonia (left) and Finland (right)

10. Record female life expectancy from 1840 till present (Oepen & Vaupel 2002)

11. A strong challenger: South Korea (Vallin et al. 2016 )

12. M ortality risk above age 60 by gender Living with spouse versus living without spouse

13. Schematic possible evolutions of the survivorship curve: (a) rectangularisation

14. Schematic possible evolutions of the survivorship curve: (b) postponement

15. Schematic possible evolutions of the survivorship curve: (c) extension.

16. The future of longevity (1) As mortality rates are found to continue to decline at each age, it pleas in favour of non-existence of an absolute limit to the biological life span for humans. That mortality-reduction perspective is supported by Vaupel and colleagues (1998). Unexpectedly a deceleration of the exponential increase of these rates emerges around age 80, with a leveling off or even a decline after 110 years. Such possible mortality plateau at extreme ages is intriguing and supposed to be the result of heterogeneity and mortality selection.

17. The future of longevity (2) Another group of researchers are largely more optimistic as they believe in a fast approaching “biological revolution” that will allow people to significantly extend their lifespan. This extreme hypothesis proposed by De Grey (2010) is highly debatable and is not supported by scientific evidences. Conversely Olshansky and colleagues (2003) suggested that due to growing unhealthy behaviours and more specifically obesity, human longevity is most likely reaching a statistical limit. According to them the steadily increase in human life span is coming to an end in post-modern societies despite major medical advances.

18. Extreme longevity in Estonia In Estonia the number of centenarians increased by a factor of three between the 1979 and 1989 censuses and by a factor two between the 2000 and 2011 census. Among the 140 centenarians alive in 2014 the sex ratio is largely unbalanced with 10 female centenarians per male centenarian. The upper age ever reached by Estonians peaks at 107 years for men and 110 years for women.

19. Estimated number of centenarians by gender at successive censuses and in 2014

20. The consequences of improved longevity (1)  Living longer is a remarkable achievement of sciences, for every human being and for the humanity as a whole. Still it involves important consequences on both individual and society levels. At individual level, adding years to life is not an objective per se if no effort is done ‘to add life to years’. Healthy ageing is a key priority for our societies.  It has also strong socio-economic consequences for the society and the age of retirement and intergenerational relationships are not the least important.

21. The consequences of improved longevity (2)  Living longer means additional years as part of the post- active life. In terms of well-being these additional years of life could be lived in relatively good health with the possibility to realise some long-awaited personal achievements. Yet it could often mean years of dependency and bad health, years facing financial difficulties and probably years to live alone, especially for women.

22. The grey revolution is on the road..  … and the society should be prepared for its’ outcomes. The main paradox is that the society is proud of longevity improvements but at the same time tends excluding the oldest olds. Loneliness, supporting social network, residence and if needed palliative care and euthanasia should stay high-ranked in the priorities of policy-makers. National and local authorities should keep in mind that oldest olds within their population could be very disappointed of their living conditions.

23. Thanks for your attention and let’s prepare for the 100th anniversary of Eesti Statistika Aitähh!