In 21st-century America, millions of people are living longer. Between 1975 and 2015, life expectancy at birth for the total U.S. population increased by 6.2 years.
The Census Bureau projects that by 2030 more than 20 percent of U.S. residents will be over the age of 65. The fastest growing segment of the population are those age 80 and over. The number of people in this age group will nearly triple between 2010 and 2050 from 11 million to about 31 million.
The increase in longevity results mainly from advances in public health, such as improved hygiene and vaccines. Advances in medical science, including antibiotics, drug therapies for heart disease, hypertension, cancer, and diabetes have also led to improvements in longevity. However, life expectancy has increased more for some people than others. According to the Centers for Disease Control and Prevention, 65-year-old white men will live on average almost two years longer than 65-year-old black men. Further, the life expectancy for white women without a high school diploma has dropped by five years.
Another observed trend is that not only are most Americans living longer; they are also living longer with better physical functioning. Studies that track older Americans’ changes in disability over time (measured as difficulty in performing either activities of daily living or instrumental activities ofADLs or Activities of Daily Living are the basic tasks of everyday life, such as eating, bathing, dressing, toileting, and transferring. IADLs or Instrumental Activities of Daily Living are activities related to independent living and include preparing meals, managing money, shopping for… daily living) have shown a decline in the percentage of people reporting functional impairments. One study found that older people are living more disability-free years than they did previously and that the improvement has been greater for women than for men, with no difference by race. Another found that, between 1990 and 2010, healthy life expectancy (the number of years a person can expect to live in good health) for the U.S. rose from 65.8 years to 68.1 years.
Despite the positive trends in overall longevity, U.S. rankings on important indicators (including maternal mortality, life expectancy, healthy life-years, and reduction in disability rates) has fallen compared with 34 Organization for Economic Cooperation and Development countries between 1990 and 2010.
The leading risk factors accounting for these trends include poor diet, tobacco smoking, obesity, high blood pressure, high blood sugar, physical inactivity, and alcohol and other substance use. These risk factors can be addressed through behavioral modification.
While personal behaviors may affect longevity and disability, they are not the only determinants of healthy living and aging. Access to affordable, high-quality clinical preventive services and medical care is critical. Other factors outside the medical system also impact health and longevity. Socioeconomic factors like income, education, and occupation are some examples. Environmental conditions, neighborhood characteristics, cultural norms, and the historical legacy of discriminatory private- and public-sector practices also play a role. Policies and interventions aimed at improving health must address both personal behaviors and systemic factors. AARP’s health policies promote healthy living, so Americans not only live longer but also stay active and healthy to thrive while they age.
Health-promotion efforts should take place both inside and outside of the medical system as part of a holistic framework that includes lifestyles, social policies, and even the way communities are designed. Policies for housing, transportation, energy, and the environment should promote community engagement and good health for people of all ages.
One in three Americans is now age 50 or older. As America ages, policymakers must also focus on increasing the quality of years lived, not just the quantity. Nine in ten older Americans want to live independently in their homes and communities for as long as possible.
Maintaining and improving cognitive health—a top concern of older adults—is critical to increasing quality of life as people age. A 2015 Institute of Medicine report affirmed what emerging research has shown: While cognitive aging is not synonymous with cognitive disease, it is a public health issue that warrants action from many stakeholders. The report identifies action steps that the public, the health sector, nonprofit and professional associations, government agencies, and the private sector (particularly in transportation and financial services) can take to maintain and improve cognitive health throughout the lifespan. The right policies can help people improve and maintain cognitive functioning and that address the needs of people with dementia, their caregivers, and the communities in which they live.
The nation’s health care system is in critical need of reform. The U.S. spends more on medical care than any other industrialized nation, yet falls short with regard to access, efficiency, equity, and outcomes. Research has identified serious and pervasive problems with quality of care, as well as disparities in access and treatment. Despite an increase in the number (and percentage) of insured individuals since the enactment of the Affordable Care Act (ACA) in 2010, many people still lack coverage or have trouble affording it. Because reforming the health care system requires attention to many issues, implementing reform is a long-term endeavor that will require changes to the infrastructure; changes in expectations, behavior, and practices of all stakeholders and throughout the delivery system; ongoing research; and provider and consumer education.
However, the ACA lays the groundwork to create a framework for near-universal coverage. It expanded public coverage for poor adults who were previously ineligible for Medicaid, changed insurance rules to make private health insurance markets fairer and more accessible, and provided subsidies for those without access to employer-sponsored coverage who may have trouble affording insurance. The law also made several reforms to Medicare, including expanding prescription drug benefits and coverage of preventive services and encouraging adoption of health information technology, such as electronic health records. These and other aspects of the ACA are discussed later in this chapter.
AARP is committed to realizing the promise of the ACA despite national and state fiscal challenges to publicly funded health programs, as well as ongoing opposition to the law by some national and state leaders and business interests affected by the reforms. AARP is also committed to strengthening and improving the law.
Individuals and stakeholders in both the public and private sectors have a shared responsibility to protect and promote health throughout their lifespan.