In 21st-century America, millions of people are living longer. The US Census Bureau projects that by 2030 more than 20 percent of US residents will be over the age of 65. The Census Bureau also projects that the number of adults age 85 and older will grow to 8.9 million in 2030, from 5.9 million in 2012. AARP’s health policies promote healthy living so Americans not only live longer, but also stay active and healthy to thrive while they age.
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 almost two years longer, on average, than 65-year-old black men. Further, the life expectancy for white women without a high school diploma has actually 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 livingActivities of daily living (ADLs) include: bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating. or instrumental activities ofIADLs include preparing meals, managing money, shopping for groceries or personal items, performing light or heavy housework, and using a telephone. 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 US rose from 65.8 years to 68.1 years.
Despite the positive trends, compared with 34 Organisation for Economic Co-operation and Development (OECD) countries, the US fell in ranking when measured on gains in life expectancy, gains in healthy life-years, and reduction in disability rates between 1990 and 2010. According to the study, the leading risk factors related to overall disease burden for the US have been dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use.
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 are critical. In addition, systemic factors outside of the medical system impact health and longevity. These include socioeconomic determinants of health such as income, education, and occupation. They also include environmental challenges, neighborhood characteristics, cultural norms, and the historical legacy of discriminatory private- and public-sector practices. Policies and interventions aimed at changing personal behaviors must recognize and address these systemic factors.
Put simply, 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 and the fastest-growing segment of the population is people age 80 and 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 achieving that goal. 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. AARP supports policies that 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.
AARP believes that the nation’s health care system is in critical need of reform. According to the OECD, the US 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 the system’s quality of care, as well as disparities in access and treatment. Despite a decrease in the number of uninsured people since the enactment of the Patient Protection and Affordable Care Act (ACA) in 2010, many people still either lack coverage or are underinsured due to uncovered services, high deductibles, and other cost-sharing. 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.
The ACA lays the groundwork for progress in this endeavor by creating 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 now provides 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 law 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.
AARP believes that individuals and stakeholders in both the public and private sectors have a shared responsibility in promoting and protecting health from infancy onward in clinical, community, work, and home-based settings. These priorities become more urgent as our nation’s population gets older.