COVID-19 will change how we address equity and aging. Here are three lessons we need to learn so we never return to “normal”

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This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.

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Our population—in the United States and around the world—is aging.

With life expectancies on the rise and fertility rates declining in most of the world, the growth of the older population is steadily outpacing that of younger generations. In just 30 years, the number of people around the world over age 65 is expected to more than double, reaching 1.6 billion—or 17% of the world’s population. Demographers predict that, in countries where people are aging well, more than half of children born today will live to 100. In fact, some researchers believe that the first person who will live to 150 has already been born. This is all news worth celebrating: longer lives are a triumph of medicine, public health, technology and international development.

However, in the last nine months, our world has been turned upside down. As the COVID-19 crisis rages around the world, more than 16 million Americans have been infected and more than 300,000 people have died at the time of writing this article.  Worse, these deaths have not been spread equally across our population. The COVID-19 pandemic has caused immeasurable suffering and death, especially among older adults and communities of colour in the United States.

As we approach the recovery as a reset, we must rebuild our health and social systems to be more equitable than ever before. We need to reject the status quo and envision a more evolved future that is prosperous, sustainable and rooted in the principles of global collaboration and equity. Here are three lessons we need to learn to address the systematic disparities that inhibit our ability to live longer, healthier and more productive lives: 

More on the Forum Network: An Alarming Trend: The toll of COVID-19 on older adults by Debra Whitman, Executive Vice President and Chief Public Policy Officer, AARP

Lesson 1: COVID-19 revealed challenges and vulnerabilities facing nursing homes and other long-term care facilities

This pandemic has exposed the systemic and underling challenges facing our long-term care system and the millions of family caregivers who support them. While less than 1% of the United States’ population resides in nursing homes and other long-term care facilities, over 40% of all COVID-related deaths have occurred there. Globally, the World Health Organization found that, in many countries, more than 40% of COVID-related deaths have been in long-term care facilities, with figures being as high as 80% in some high-income countries.

But the long-term care crisis is not new; COVID-19 did not create these challenges. It has only exacerbated what have been longstanding and structural issues, such as lack of integration between health and social service systems, lack of investments in alternative options to nursing homes or the lack of meaningful benefits for direct care workers or support for family caregivers. According to AARP’s Nursing Home COVID-19 Dashboard, more than 100,000 nursing home residents and staff have died of causes related COVID-19. Nursing home staff are more likely to be women, people of colour and immigrants. Recent data from the Kaiser Family Foundation shows that nursing homes with a relatively high share of Black or Hispanic residents were more likely to report COVID-19 related deaths than those with lower shares.

This pandemic has offered us an opportunity to look through an equity lens to spark new solutions, develop models and create systems that are aligned with the realities and preferences of an aging population. This is the opportunity to reform our system to design a “person- and family-centred” delivery system and support individuals in need of services, as well as the families who make it possible for them to remain in their homes and communities for as long as possible.

We can’t talk about COVID-19 without discussing racial and socioeconomic disparities.

Lesson 2: Addressing the societal and structural issues of ageism means a better world for all of us

Whether it’s age discrimination in the provision of medical care, scaling back clinical and social services due to local shutdowns or underlying conditions that put them at greater risk of infection, older adults around the world are in the bullseye of COVID-19’s arrow.

But long before COVID, older people—and especially older people of colour—were marginalised, devalued and discriminated against because of their age. A recent report found that age discrimination against workers 50 and older cost the economy USD 850 billion in 2018. The potential economic contribution of the older population could increase by USD 3.9 trillion every year in a no-age-bias economy, which would mean a contribution of USD 32.1 trillion to GDP by 2050. The Organisation for Economic Co-operation and Development (OECD) confirms these findings, calculating that eliminating factors such as discrimination and ageism would raise the GDP per capita in OECD countries by 19% over the next 30 years.

Lesson 3: We need to address growing inequality to prevent a future fallout

We can’t talk about COVID-19 without discussing racial and socioeconomic disparities.

The COVID-19 pandemic has put a spotlight on the equality and economic crisis that disproportionately impacts women, communities of colour and older generations. Communities of colour continue to feel the double whammy of the pandemic, both in terms of their health and their wallets.

Read more articles on a new societal contract for the recovery in our Dedicated Room

On the health side, Blacks, Latinos and American Indian/Alaska Natives are being hospitalised and dying at higher rates due to COVID-19. On the economic side, of the millions of Americans out of work Latino and Black communities have been hit disproportionally, with lower-wage workers age 50 and over being the most vulnerable.

Sadly, these disparities are not random. They reflect a long history of inequality wherein social, economic and political opportunities were extended to some at the expense of others. People of colour disproportionately live, work and play in unhealthy communities. They also face significant structural barriers to healthcare access, living in communities with inadequate healthcare resources, dealing with racial bias in encounters with healthcare providers, receiving poorer quality care in nursing homes and more. They are more likely to be excluded and isolated from mainstream resources necessary for economic mobility, such as good schools, good jobs and access to banks and capital for business development. 

However, the end result is clear. Preserving these disparities, which have only been exacerbated by COVID-19, stifles economic growth in the United States. The Kellogg Foundation reports that closing the disparities gap would generate an additional USD 8 trillion to GDP by 2050, an increase in additional federal tax revenues by USD 450 billion and state and local tax revenues by USD 100 billion annually. As we start to recover, we need to ensure that everyone has the opportunity to live a longer, healthier and more productive life. This is not just a moral imperative: it’s also an economic necessity.

Any desire to get back to a level of “normal” must be accompanied by the recognition that normal excluded many in our pre-COVID world, and disparities and inequality were common practice. It is time to reimagine and build a future that is more equitable, and where race and other sociodemographic factors do not determine health and economic outcomes. Equity will enable not only greater prosperity, but also the means to withstand, hold steady and come out strong in future crises.

It doesn’t matter what generation you fall into—if you’re lucky, you’ll be an older adult someday. As we imagine our post-COVID world, we need to remember that if we want a better world tomorrow, we need to speed the pace of progress against inequality today.

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Jean Accius II

Senior Vice President of Global Thought Leadership, AARP

Dr. Jean Accius is a passionate champion and catalyst for changing how the world sees and values aging. He is an internationally recognized thought leader on aging, longevity, equity, health systems transformation and modernizing the delivery and financing of long-term care. Dr. Accius is the Senior Vice President of Global Thought Leadership at AARP where he leads a team in positioning AARP as a global thought leader in identifying emerging trends around the world, cultivating and elevating new ideas, forging global strategic alliances and sparking bold solutions to change systems and improve the lives of all as they age.