Vectoring Community Resilience – Take a Centenarian to Lunch!

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This blog originally posted on the Community & Regional Resilience Institute 

One of the keys to becoming more resilient is to anticipate change. That we live in a kaleidoscopically changing world is obvious; the trick is to recognize the forces driving change and the directions they might take us. We can’t simply look at these forces one at a time either. The changes our communities will experience will be driven by the sum of these forces to produce an overall “Vector of Change.” This “Vector” will reflect abrupt changes – such as natural disasters – superimposed on long-term trends, many of which are often unrecognized.

The impacts of this Vector will depend not only on the external driving forces but also on the makeup of each community itself – its structure (economic, social, physical), its location, its deomgraphics, its strengths, its weaknesses and its leadership. In the next few posts, I’ll focus on some of the extremely important long-term trends that are likely to impact our communities for at least the next decade. These are based on my rather Catholic choices in reading material and really don’t reflect much in the way of original thought (So what else is new?). I’d love to hear what each of you would add – or delete – and why.

I’ll start with health care. I know, I know – we’re all sick to death of the debates around Obamacare. Well, the dirty secret about Obamacare is that it means little to nothing in terms of health; its primary focus is on who pays the bills for health care. The ACA will continue to disrupt our economy in ways good and bad. However, there are two other health trends underway that will have huge impacts on our communities.

• Stem cells and other new treatments. Having just been operated on for a torn meniscus (arthroscopy is our friend), I am very interested in what my knee’s future might be. Last weekend I read a report about scientists who have succeeded in inducing stem cells to grow as cartilage (=no future knee replacement?!?). As well, the decreasing cost of genetic profiling is leading to “Personalized Medicine” that will mean much more effective treatments for diseases such as cancer even without the advent of new drugs. And the field of biologics is blooming with the promise of entirely new classes of drug and therapies.
• “Smarter” regulation. Not well recognized is that our FDA can be considered responsible for millions of deaths each year. Its “CYA” regulatory regime (esp. Phase 2 and 3 trials) lengthens the time before new drugs and treatments can be legally used in the US. That extra time (sometimes up to a decade) means that lives are lost that otherwise could be saved and that the cost of developing new drugs is perhaps an order of magnitude higher than it needs to be (costs that are recouped from the patient). Several countries (foremost among them Japan) no longer require Phase 2 and 3 trials and have seen no ill effects.
• Smarter regulation is coming, just in time to get new treatments into use faster. That will mean much longer lifespans and million(s) of centenarians instead of the 70,000 or so we have today in the US. This aging population will have huge impacts on community resilience (For those who are interested in going into this in more detail, there is an excellent – albeit somewhat dated – report from the US Department of Health and Human Services Why Population Aging Matters: A Global Perspective). In the following, I’ll briefly touch on a few reasons, primarily from a US perspective. However, most if not all of them should resonate with you wherever you live.
• In most of the developed world, there are as many 65 and older as there are children under 5. And the ratio will continue to tilt further and further to the elderly until the 2040s. While it is generally recognized that birth rates are tumbling in the developed world (and most of the developing world as well), no one seems to be answering the question (few are even asking!) “Who’s going to take care of the increasing numbers of the elderly?” Fewer children, fewer siblings and fewer spouses – in the US about one in five couples are childless, and half of our marriages end in divorce – indicates a growing demand for community social services for the elderly. And if the present gender differences persist among the “oldest old” (women with fewer financial resources, men with weaker – or no – social networks) and there are more of them, how will they cope in times of stress?  How will communities be asked to step in to help?
• Throughout the developed world, we are seeing a huge growth of institutionalized care – who’s going to pay for that? When do the young balk and say enough is enough? The elderly will demand municipal services (e.g., parks and recreation, public transportation) but won’t be paying much in the way of taxes.
• Pensions will place an even bigger strain on communities’ financial resources. Current actuarial calculations reflect past trends; thus, even pension funds that are financially sound based on current calculations are likely to be significantly underfunded in reality. That means that even the most prudent communities are going to have contribute more than expected to keep their pension funds sound.
• In the US, the Baby Boomers – the world’s largest and wealthiest generation in all of history – are just beginning to slouch into retirement. We know that people tend to become politically more conservative with age EXCEPT when it comes to the demand for their “entitlements.”  This is likely to strain the social compact between the retired and those still working, and make it difficult to get our social safety net into a more sustainable condition.
• In the US, the Boomers were the only generation who did not see a significant downturn in employment during the Great Recession. Conversely, younger workers felt a disproportionate impact (I’ll discuss this in a later post in this series.). What will this mean in terms of productivity when we Boomers finally do retire? How much “corporate wisdom” will be lost?  How much should be lost, due to changes in circumstances?
• And what about the changing spectrum of “age-related diseases” as we retire and are healthier? According to the Centers for Medicare and Medicaid Services, STDs have reached almost epidemic proportions among the Medicare set:  as many are applying for screenings for STDs as are getting colonoscopies or pap smears, and the numbers are growing (Probably should have been expected of the generation that invented the “Sexual Revolution.”).

In the next posts in this series, I’m going to look at economic and demographic trends. Taken together, all of these trends will provide the context for community resilience over the next decades.

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