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improvements in life expectancy have occurred much more rapidly in the developing world than was the case historically in Western Europe and North America. China, for example, had a life expectancy of 45 years in 1950 but today has a life expectancy of more than 72 years. In contrast, it took a century and a half for longevity to increase by that much in Western Europe and North America. Even in sub-Saharan Africa and Eastern Europe, where life expectancy at birth is declining in some countries, regional populations are expected to age over the next 25 years.

It is important to note that the greatest gains in life expectancy at birth in the past few decades have occurred because of increasing life expectancy above age 40 (Preston, 2005). Even countries with the highest life expectancy, such as Japan, are seeing rapid declines in mortality at the oldest ages (Kannisto et al., 1994). These major demographic trends raise important questions for policy makers concerned with reducing health inequalities: How will relatively larger number of older people affect the demand for health care services? How will having relatively fewer working adults affect a country’s ability to provide adequate health care and social security systems? Population aging also implies that the potential returns on efforts to reduce social disparities in health in later life may be greater than ever before. Furthermore, the spectacular increase in global per capita income and advances in scientific knowledge and technology provide new capabilities to address problems both old and new (Goldman et al., 2005).

Over the past 5-10 years, there has been considerable social science research on issues related to adult health and disability. Although this research is not the central focus of any of the Commission’s nine knowledge networks, it is nonetheless extremely important and can inform and strengthen the work of the Commission. For example, the Commission has not established a knowledge network that is focused specifically on the role of education as a determinant of health: yet the developing world has achieved dramatic progress in both school participation and attainment over the last several decades and studies on the determinants of social and economic differences in health and disability in later life have stressed the importance of compositional changes in older peoples’ educational attainment for explaining disability and mortality trends and differentials in later life (Elo and Preston, 1996; Freedman and Martin, 1999; Mirowsky and Ross, 2003; Minkler, Fuller-Thompson, and Guralnik, 2006). Although the exact pathway by which greater educational attainment produces better health and survivorship is unclear, the relationship has been observed persistently over time (Preston and Taubman, 1994).

More broadly, we recommend that the Commission consider population aging and elder issues in its work for several reasons. First, as we describe above, global population aging is an important factor that is shaping the ever-changing context in which the Commission must do its work. Second, at the societal level, social inequalities hinder the achievement of optimal longevity. Third, older people are often an invisible and vulnerable population that is missed by interventions to eliminate poverty or improve health. Finally, older people can be an underappreciated source of non-market contributions to family welfare, providing child care or other services that serve to prevent even greater health disparities than those that are currently observed.

Below we discuss five areas that the panel believe are promising for improving the health and quality of life of older persons through greater investment in interventions at the individual, community, or national level: (1) early life endowments; (2) social and



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