1. How can healthy and active ageing policies be promoted from an early age and throughout the life span for everyone? How can children and young people be better equipped for the prospect of a longer life expectancy? What kind of support can the EU provide to the Member States?

The most effective, and cost-effective, way of promoting health and active ageing from an early age is through prevention. Currently, poor health is one of the main barriers to people working, spending and engaging in their communities as they age. In 2017 alone, 27.1 million years were lived in poor health as a result of a number of largely preventable diseases – and this is set to increase by 17% over the next 25 years if governments fail to prioritise preventative health interventions across the life course (1).

We know that it’s never too early to prevent ill health, but it is also never too late. Investing in prevention across the life course is therefore vital when planning for an ageing society in the long term and building back out of the post-pandemic recovery in the short term.

Not only can investing in prevention support the long-term sustainability of health systems, but it also has powerful economic implications. People in better health are more likely to be in work, they are also likely to spend more and volunteer more often (2). We also found higher rates of employment among older people in countries that spend more on health as a proportion of GDP (2).

The case for prevention is clear, but to deliver it in an ageing world, EU Member States need to:

• Address health inequalities and democratise access to prevention for people of all ages.
• Inspire and engage policymakers, healthcare professionals and individuals to invest, promote and take action on prevention.
• Effectively utilise technology to improve access to health care, improve uptake rates, reduce barriers and empower patients.

The EU should act as a source of best practice in this space, sharing examples from across Member States of what works in delivering prevention to help promote investment in and uptake of preventative health interventions, from vaccines to screenings to better management of disease, across Europe.

(1) Never too late: Prevention in an ageing world
(2) Health equals wealth: The global longevity dividend

2. What are the most significant obstacles to life-long learning across the life-cycle? At what stage in life could addressing those obstacles make most difference? How should this be tackled specifically in rural and remote areas?

Across the G20, older people make up a significant, and growing, share of the workforce – with one in three workers aged 50 or above (1). But this proportion could be greater if older workers were equipped with the skills they needed to adapt to an ever-changing workplace.

Ageism in the workplace is a big barrier to equipping workers with the right skills and competencies they may need throughout their working lives, with many employers less likely to offer training to older workers than younger workers (2).

But employers are not the only source of ageist stereotypes. Research has found that older workers are less likely to take part in training than their younger counterparts (2). This internalised ageism – that is, when older workers themselves modify their labour market behaviour because of their own assumptions and stereotypes related to age – also acts as a barrier to lifelong learning. Often, this form of ageism is based on the idea of the inevitable link between age and cognitive as well as physical decline. In this way, ageism and ableism in the workplace are intertwined and as a result, many older workers believe they are too old to be trained.

To make the most of an ageing and increasingly diverse workforce, it will be vital for employers to offer training and development opportunities at all stages of people’s working lives. But simply offering more training opportunities will not enable life-long learning for many older workers because of their own internalised ageism. Employers need to proactively promote policies that stimulate an inclusive work environment where age and ability are seen positively.

(1) Health equals wealth: The global longevity dividend
(2) Older workers’ outdated skills and resistance to retraining

3. What innovative policy measures to improve participation in the labour market, in particular by older workers, should be considered more closely?

According to ILC research, if EU Member States enabled older people to work at the rates seen in Iceland, they could see an average GDP gain of around 11% – or an aggregate GDP boost of EUR 2 trillion (1). To unlock this potential, the EU should support and empower all generations to have fulfilling and longer working lives through removing regulatory barriers (such as mandatory retirement ages) and supporting people to work for longer through making flexible working the default for all employers.

Employers should also invest in opportunities for lifelong learning, and incentivise adoption by encouraging people to move towards a ‘multi-stage life’. Finally, EU Member States should incentivise employers and technology providers to redesign working life – in particular through incentivising technology innovation that support productivity, rather than displacing older workers.

(1) Health equals wealth: The global longevity dividend

6. How could volunteering by older people and intergenerational learning be better supported, including across borders, to foster knowledge sharing and civic engagement? What role could a digital platform or other initiatives at EU level play and to whom should such initiatives be addressed? How could volunteering by young people together with and towards older people be combined into cross-generational initiatives?

The contributions of older people extend far beyond their formal economic contributions. Across the EU and Turkey, productive non-market activities, like caring and volunteering, by people aged 50 and over were worth 1.4% of GDP in 2010 – more than what the EU spends on defence (1).

To make the most of these contributions and better support them in an ageing Europe, the EU should regularly measure unpaid contributions made by older people, and calculate their social and economic benefits.

The EU should take this impact into account when making decisions about investing in supporting volunteering (such as cost-benefit analysis models) and develop strategies to support and incentivise volunteering, including removing barriers to participation.

(1) Health equals wealth: The global longevity dividend

7. Which services and enabling environment would need to be put in place or improved in order to ensure the autonomy, independence and rights of older people and enable their participation in society?

To enable older people to participate in society as fully as they wish, products and places must be designed more inclusively. Retailers and city planners have largely failed to adapt public spaces to meet the needs of an ageing demographic. For example, public toilets have been closed; cafes and shops blare loud music; and public spaces and shops rarely have anywhere to sit (1). City planners must therefore explore how more inclusive public spaces could better support increasing numbers of older people to participate in society.

Furthermore, we must encourage universal design for all, rather than creating special products for different groups. As accepting that we’re getting older isn’t always easy, products specifically marketed for older people won’t sell to those who don’t see themselves that way.

Also, products designed specifically for older people or those with disabilities are often unattractive, as the person buying the product often isn’t the one that will use it (it could be their children or their local authority) and so aesthetics aren’t at the top of the priority in these decisions. Therefore, the EU must encourage designers and manufacturers to focus on universal design that will be appealing to people of all ages. Aesthetics must be considered as another inclusive feature in this, and those buying on a large scale (like local authorities) should be encouraged to attach a value to choosing attractive products, along with all other considerations.

(1) Lockdown not shutdown: Unlocking the longevity dividend post-pandemic

10. How can the risks of poverty in old age be reduced and addressed?

The reduction in poverty in old age has been one of the greatest achievements of the past few decades. However, there is still a long way to go. And in many European countries, changes to pension systems mean that future generations might struggle to reach adequate retirement incomes.

ILC research has found that the average amount that someone entering the workforce today will have to save to enjoy the same retirement income adequacy as current retirees is around 12.6% of earnings every month (1). But many aren’t saving enough. This intergenerational gap is as high as 26% in France (1). The EU should encourage Member States to promote saving throughout the life course by introducing “nudges”, as per the UK’s auto-enrolment system.

Saving can also be supported by improving access to financial advice. According to ILC research, people who take advice in the UK are on average over £47,000 better off in retirement, and that this is especially the case for less affluent people (2). Moreover, financial advice significantly improves financial literacy, boosts confidence, gives people greater control of their finances, offers greater reassurance, and provides greater peace of mind and security (3). The EU should therefore improve access to advice that is affordable and accessible, including through investing in technology such as “robo advice”.

Many people may also rely on working for longer to make up for inadequate savings in retirement. Making work more flexible is an effective approach to enabling longer working lives. ILC research has found that in Europe, 78% of older workers cited a lack of gradual retirement opportunities as an important reason to leave the workforce early (4). Making all jobs flexible by default – i.e. offered on a flexible basis unless there is a strong reason not to – can have enormous potential to enable more people to flex their work around their health needs, caring responsibilities and other priorities in later life.

(1) The Global Savings Gap
(2) What it’s worth – Revisiting the value of financial advice
(3) Peace of mind: Understanding the non-financial value of financial advice
(4) Health equals wealth: The global longevity dividend

11. How can we ensure adequate pensions for those (mainly women) who spend large periods of their working life in unremunerated work (often care provision)?

One way to ensure adequate pensions for women who spend large periods of their working life in unremunerated work is to require all employers to make all jobs flexible by default. ILC research has found that a lack of flexible work opportunities is a key factor in prompting people with adult or child care responsibilities to leave the workforce (1). Beyond this, greater flexibility is not only valued by those with caring responsibilities, but can also boost employee satisfaction more broadly and is significantly valued by employees (1).

A second way in which to support women who spend large periods of their working life in unremunerated is to introduce paid carer’s leave.

A third measure would be to provide some financial support to workers with adult caring responsibilities to help pay for the care for someone else they would otherwise need to care for could also be hugely beneficial. While in many EU countries, free childcare and tax-free childcare is given to parents, the same support is often not offered to those with adult caring responsibilities.

This is not the case for all EU countries however, such as France and Belgium, where service vouchers are given to individuals to pay for help in the household. The EU could encourage all Member States to introduce similar financial support for workers with adult caring responsibilities.

Some people with caring responsibilities, however, may still need or want to take a career-break regardless of any changes to policy. One way to still support the pensions of this group is to allow individuals to share their annual allowance for pension contributions with another person who is unable to contribute to their own pension, due to caring responsibilities. This could help to incentivise, for instance, a carer’s spouse or family member to contribute to their pension to help them build up a pension in their name whilst they are unable to work.

(1) The Missing Million

13. How can the EU support Member States’ efforts to reconcile adequate and affordable healthcare and long-term care coverage with fiscal and financial sustainability?

Government spending on promoting and protecting the health of its citizens should be treated not as a cost, but as in investment. In particular, investing in prevention not only boosts the sustainability of a country’s health systems, but also enhances their fiscal and financial sustainability.

We estimate that the yearly productivity loss across the G20 as a result of non-communicable diseases is 659 billion USD (1). We have also found that, while healthy life expectancy has increased in all G20 countries, it has risen most in countries where the state pays for a greater share of health spending (2). In fact, across the G20, increasing preventative health spend by just 0.1 percentage points can unlock a 9% increase in annual spending by people aged 60+ and an additional 10 hours of volunteering per year (3).

There therefore need not be a trade-off between health and wealth. Instead the goals of promoting population health whilst ensuring fiscal and financial sustainability can be achieved in unison.

The EU should therefore encourage a shift in mindset among Member States from viewing spending on health as a cost towards viewing it as an investment that will benefit not only their populations, but their pockets too.

(1) Never too late: Prevention in an ageing world
(2) Health matters: Why we must commit to delivering prevention in an ageing world
(3) Health equals wealth: The global longevity dividend

15. How can older people reap the benefits of the digitalisation of mobility and health services? How can the accessibility, availability, affordability and safety of public transport options for older persons, notably in rural and remote areas, be improved?

The world has seen huge technological advances over the last decades, from wearable technologies to artificial intelligence. We know these advancements have the potential to support the health and mobility of European citizens by:

• Improving population health
• Supporting healthcare delivery
• Connecting individuals to preventative healthcare
• Empowering individuals

But the reality is that high-tech solutions have often over-promised and under-delivered. The problem isn’t a lack of innovation, but the challenges that come with implementing these solutions and ensuring that they benefit everyone equally.

Too often, only a privileged few benefit from technological interventions. If we are not careful, these technologies could increase, rather than reduce, inequalities through causing digital exclusion for those in remote areas and for the less digitally literate.

Technology should therefore not be treated as a silver bullet or as a solution in its own right, but instead as an enabler for greater participation in society, greater connectedness of services and a tool to target interventions to those who need them most. The EU should therefore focus its investment in technologies that are usable and accessible to all, rather than on complex or highly advanced interventions that require high levels of digital literacy and infrastructure.

Big data has a vital role in driving technological innovation, through for example helping to develop targeted preventative healthcare strategies (1) as well as powering driverless vehicles that improve the mobility of older people who may not have access to a private car (1). We also know that digitising the healthcare system and sharing data can help healthcare professionals to deliver better, more integrated and more efficient preventative care throughout people’s lives and help individuals become more health literate (1).

It is therefore vital that the EU also invests in data infrastructure to enable the interoperability of electronic health record systems. To address data privacy issues, the EU should also embed individual ownership of data into this approach to engage with, rather than ignore, privacy issues, through listening and responding to individual concerns.

(1) Delivering prevention in an ageing world: Using technology effectively – Consultation paper
(2) The future of transport in an ageing society