Europe is steadily ageing – by 2100, one in three Europeans will be over the age of 65. Many Europeans may be living longer lives but might not be living healthier lives or working for as long as they would like. In his blog Patrick Swain, ILC’s Research and Development Manager, highlights how addressing the challenges of demographic change through positive and productive ways is crucial.

In October, the ILC Europe Network hosted a webinar, Healthy Ageing and Prevention in Europe: How do European countries compare? where we explored the current state of healthy ageing across the continent.

Using the ILC-UK’s Healthy Ageing and Prevention Index, we examined how European countries compare when it comes to living healthier for longer. We heard from experts in Austria, Czech Republic, France, Israel, Romania, and the UK, who shared insights on what population ageing looks like in their country.

The Healthy Ageing and Prevention Index ranks 121 countries in six healthy ageing metrics: life span, health span, work span, income, environmental performance, and happiness. This lets us know the extent to which governments have invested in longevity.

How does Europe compare?

Europeans are living longer, but they’re not necessarily working longer

What was made clear during the discussion was that Europe is ageing rapidly. And the figures back this up: by 2100, more than 30% of the EU’s population is set to be aged 65 and over, while Europe’s old-age dependency ratio is set to rise from 32 to 57.[1] This means current pressures associated with an ageing workforce across the continent are only going to increase.

And while the EU performs well on a range of healthy ageing metrics, it performs badly on work span (that is, the average number of years someone is able to work between the ages of 15-65). Out of nine country blocs measured on the Index, the EU ranks last for work span (with an average of just 28.6 years spent working).

Our panellists highlighted the challenges faced by their countries in terms of working life expectancy. For instance, France ranks 19th globally on the Index, yet it falls to 84th out of 121 countries in terms of work span. Despite its high ranking in healthy life expectancy (7th), France’s work span score presents a dilemma: while France can’t fiscally sustain such an early retirement age, attempts to raise the state pension age from 62 to 64 have been met by strong opposition. Even with this two-year increase, it would remain one of the lowest retirement ages in Europe. As outlined by Sophie Schmitt:

“We are behind on work span…with the retirement age at 62 and soon to be 64, we are trying to improve this score. However, this is a big challenge for France as we’re ageing quickly.” Sophie Schmitt, Director, General, Seniosphère Conseil

Despite the French government’s best efforts, Seniosphère Conseil’s research suggests that the desire to work for longer isn’t appealing to older French adults. According to findings from their 2015 Observatory for Aging Well, 20% of French adults (over 50) suggested that the ability to continue working in later life was “Very important”, yet this score dropped to just 7% in 2023.[2] A similar sentiment was felt in the Czech Republic:

“The average work span in the Czech Republic is 30.3 years. The retirement age is quite low – around 64 years for men, and a little bit lower for women depending on the number of raised children. However, the retirement age is slowly increasing each year which it’s not very popular.” Dr Kateřina Macháčová, Director, ILC-Czech Republic

In Israel, the challenges of a lower working life expectancy are also being mitigated through changes to the state pension, but older people are also finding working for longer more challenging today as the labour market continues to shift technologically:

“The state pension age is relatively high: 67 for men and 62 women, but soon it’ll go up to 67 for women as well. But there is a cohort effect in that older people today have a low education attainment, and although that will change as the high-tech economy attracts younger people, older people looking for work now are at a disadvantage.” Prof A. Mark Clarfield, President, ILC-Israel

From our discussions, there doesn’t appear to be an appetite from older European adults to work for longer. But given that the average EU citizen spends just over a decade in poor health, the ability to continue working into later life may be compounded by poor health. Although the EU ranks 2nd for both life span (life expectancy of 81.2 years) and health span (healthy life expectancy of 70.7 years), the gap between these two figures suggests that an average of 10.5 years is spent in poor health, making the need to close this gap and improve healthy life expectancy critical. Moreover, we know that shorter working lives is likely contributing to the skills shortages currently affecting the region.

Poor health is limiting Europeans’ ability to live active and better-quality lives, and there are distinct regional inequalities that highlight this

Across Europe, there are clear inequalities between Eastern and Western European countries in terms of healthy life expectancy. For example, on the Index Sweden is the best performing country in the EU and ranks 4th globally, while Bulgaria ranks the lowest in 56th. Swedes can expect to live 5.6 more years in good health than Bulgarians, as well as being able to work an average of 3.9 more years.

Life expectancy is lower in Eastern Europe than in Western Europe

These inequalities highlight an imbalance across the EU, with Eastern European countries fairing much worse with healthy ageing.

“What we find is life expectancy is lower in East Europe than it is in West Europe…the top performing country being Sweden and the worst-performing country being Bulgaria. Generally, across Western Europe, life expectancy is relatively stable.” Arunima Himawan, Senior Health Research Lead, ILC-UK

This was reflected in our discussion too, with Romania seen as another example of an Eastern European country that falls behind. Radu Ganescu, President of the Coalition of Patients’ Organizations with Chronic Diseases in Romania (COPAC), suggested that a lack of investment and healthcare expenditure means countries in Eastern Europe perform worse:

“Looking at our [Index] ranking, it’s not something that surprises me…Eastern European countries haven’t invested well in the health system, in prevention or vaccination programmes…we see Romania and Bulgaria lower down on the list…there is a big difference between Western and Eastern European countries.” Radu Ganescu, President, COPAC

When it comes to preventative health interventions such as influenza vaccination, there is also a clear correlation between uptake and the position of Eastern and Western European countries on the Index.

Eastern European countries perform poorly on influenza vaccination

Despite the benefits of vaccination, particularly in terms of protection against disease and preventing subsequent ill health across the life course, lower uptake is significant across Eastern Europe, and not just for influenza. ILC-UK’s Shifting the narrative project has explored the barriers to life course immunisation in Eastern Europe and what needs to be done to increase vaccine confidence in the region. Our key recommendations to improve life course immunisation in the region include:

• Investing in systems designed for prevention – better public information and training for HCPs on vaccination is needed across different countries.
• Actions to inspire and engage – communication materials and government messaging on vaccination needs to encourage people to take up vaccines.
• Actions to democratise access to prevention – better infrastructure and more robust vaccination programmes are needed to ensure that everyone has good access to vaccines.
• Actions to support the effective use of technology – technological innovations can improve uptake and confidence by supporting all the above objectives.

Responding the difficulties associated with poor healthy ageing is crucial, and despite the unique challenges facing each European country, there are examples of good practice that can be shared and adopted throughout the continent.

Good practice on healthy ageing exists across Europe and should be championed

Although there are clear and fundamental issues facing Europe’s ageing population, our webinar highlighted positive ways of addressing these challenges. In the Czech Republic, for example, there are programmes that include older adults visiting children in early education settings to read them stories. This is one way of fostering intergenerational connections and allows older people to have greater social interaction:

“There is a programme in the Czech Republic called the “Grandmas and Grandpa fairy tale reading club”. Older people go to the kindergartens, and they read a fairy tale after lunch before nap time. It’s very popular, and I think it’s very nice to connect older and younger generations…it’s a very important way for older people to remain active in wider society.” Dr Kateřina Macháčová, Director, ILC-Czech Republic

These case studies have the potential to be replicated across Europe and used as a means of instilling better connections between different generations. What works well for one country has the potential to benefit another, too.

Attitudes on ageing are also starting to shift, suggesting that older European adults are taking more notice of the need to age well for longer

In France, it was also highlighted that older adults are starting to recognise the importance of “ageing well” (interestingly, there is no term in French for “healthy ageing”, so “ageing well” is seen as the phrase with the closest resemblance):

“Ageing well is definitely a strong and growing expectation. And this expectation has increased over the past five years: people who consider ageing well to be “Very important” has increased from 39% in 2018 to 60% in 2023.[3] So, this is a big issue.” Sophie Schmitt, Director, General, Seniosphère Conseil

And in Austria, data suggests that people are expected to live well for longer, and potentially be able to work for a bit longer too:

“Cognitive life expectancy – that is those who are expected to live with good health cognition – has seen an increase, which gives us some hope. Also, when it comes to healthy life years, and looking at the working life expectancy, for men, we can already see a big increase…and a small increase for women.” Dr Daniela Weber, Research Scholar, International Institute for Applied Systems Analysis Vienna

So, it’s not all doom in gloom. However, there are still many challenges ahead that need to be addressed.

What happens next?

The ILC Europe Network will continue to address the issues with population ageing in positive and productive ways. Our network has 92 members across more than 60 organisations in 18 European countries. We’ll be hosting our inaugural in-person event in Brussels next year ahead of the European Parliament elections in June, where we will be focusing on three topic areas:

• Prevention in an ageing Europe: How can we use preventative health interventions to live longer lives?
• The European longevity dividend: Maximising the economic opportunities of longevity.
• Bridging the intergenerational gap: How can we bring different generations across Europe together?

We want to use this event as an opportunity to establish a set of key priorities and policy recommendations for the 2024-29 EU Parliament and Commission. As we move forward into a critical policy year for the EU and wider Europe, we want to seize the chance to have the greatest impact at a European level. More information about this event can be found on our website. To express an interest in attending or speaking at this event, please email PatrickSwain@ilcuk.org.uk.

What happens next will define us for a generation, and we want to ensure the Europe of tomorrow is healthier, happier, and more prosperous than it is today.

About the ILC Europe Network

The ILC Europe Network was launched in December 2021 to address longevity and population ageing in Europe.

The Network is represented by academics, practitioners, civil society representatives and business leaders with a focus on helping societies address longevity and population ageing in positive and productive ways. The Network works together to organise policy and research events, share good practice, and engage with policymakers across the continent. It currently has 92 members from more than 60 organisations across 18 countries.

ILC-UK is a founding member and of the ILC Europe Network and helps to coordinate its activities. The Network operates under the auspices of the International Longevity Centre Global Alliance.

To join the ILC Europe Network, sign up here. Follow the Network on X (formerly Twitter): @ILC_Europe

[1] World Economic Forum, Here’s what the EU population could look like by 2100

[2] Seniosphère Conseil, Observatory for Aging Well

[3] Seniosphère Conseil, Observatory for Aging Well

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