7

LEGIONS OF THE OLD

Even though most people today get old, old age is no longer associated with the magic and mystique it used to be. Death used to have little to do with age, but in our times, age, illness, and death form a triad. The large population of old people has great implications for the demographic structure of society. While it used to resemble a pyramid, it now looks more like a skyscraper — with a temporary bulge representing the baby-boomers. The ratio between the working population and those under 20 years of age (the young-age dependency ratio), and that between the working population and those aged over 65 (the old-age dependency ratio), changes over time, but the total dependency ratio — that is, the ratio of economically active to inactive members of society — remains roughly the same. The old-age dependency ratio can be reduced by increasing the retirement age.

It’s New Year’s Eve, 1889. In Lochem, a village in the east of the Netherlands, not far from the German border, the municipal gravedigger, Jan Hendrik Lenderink, is drawing up his report on the year’s deaths. The next day, Lenderink has to present his list of the deceased to ‘the Right Honourable Mayor and Aldermen, Councillors, and other Residents of Lochem’. That year, 85 residents died. In his report, the gravedigger categorises them according to age. There have been six stillbirths, and 27 babies died below the age of one. Another six died before they could celebrate their third birthday. Almost half of the bodies he has buried this year were those of babies, infants, and toddlers. Lenderink thinks nothing of this; for him it is routine, business as usual. And it was not much different for his father, the municipal gravedigger before him. He told Jan Hendrik of the countless young lives he saw nipped in the bud. Just two days, two weeks, or six months of life — and then, all of a sudden, dead. Their parents were apparently unmoved by this state of affairs. Death was a part of life. If you had told father Lenderink and his son that parents in Africa do not name their children until their first birthday, they would have understood why.

THE GRAVEDIGGER

A municipal gravedigger was responsible for making sure the burial of the dead went without a hitch. In his shed, he always kept a stack of small coffins for the little bodies of dead children. They were buried with a simple but solemn service in a special section of the graveyard. How different this was from the great care and ceremony that went into the burial of youths, adults, and old people. Their bodies were first measured at their homes by Lenderink, so that he could build a coffin of the right size in his workshop. Young people died of polio; men perished from consumption, or were stabbed to death in an argument that got out of hand; proud women who had just become mothers were taken soon after childbirth. There was no predicting it. Of course, there were also men and women who died of cancer or dropsy; today, we would diagnose cases of dropsy as heart failure, but at the time it was not recognised as such. Finally, there was the rare individual, shrunken and senile, a phantom from the past, who slipped away quietly in her sleep. So, in his time, Lenderink experienced death in all age categories. Most of the people he buried had met an early end.

In the nineteen-thirties, unrest began to spread among gravediggers. Yes, it was during the Great Depression, but that was not it. The profession seemed to be changing. Some gravediggers spoke of a strange trend. They noticed that fewer and fewer children were dying, while the number of old people they were burying was increasing all the time. A veritable industrialisation of the coffin-making business seemed to have begun. One gravedigger announced that keeping a stock of these enormous coffins was now standard practice for him. Another told how a colleague had opened a shop to display the different kinds of casket that were now available. Some gravediggers were not the least bit surprised to see the children of the deceased perusing the range in the shop, choosing their parent’s coffin. But the rest listened in horror. They did not recognise any trend in this, and believed it was pure coincidence that more people were dying at a greater age. They were sure the situation would soon return to normal. They were proud of the fact that for generations they had provided simple coffins for the little ones and personal, bespoke caskets for the adults. They saw no need to change the way they did business, just because ‘getting old happens to be in fashion’.

Nobody in the village knows exactly when Lenderink the gravedigger gave up working. Was it just before the war, or just after? Anyway, it was inevitable, say the funeral directors who now organise burials in Lochem. Lenderink continued to build coffins to order, but even that ceased to be profitable at some point. Today, a carpentry workshop is no longer necessary. A showroom, however, is. Factory-made coffins come in all sorts of sizes and designs. Burying little children, once routine for a gravedigger, has become a rarity. These days, no one really thinks about the possibility of a child dying. And when it does happen, family and friends find it almost impossible to come to terms with. Who, these days, expects a child to die? A lot of care has to be taken in finding an appropriate way for the dead child’s loved ones to say goodbye. On the other hand, it has now become common for old people to arrange their own funerals.

Now, the risk of dying before the age of 50 is small. Almost everybody these days dies later than that, though almost everyone dies before the age of 100. The average age of death now stands at around 85 years. Death has been tamed, from an ageless monster to an almost predictable fate for older people. In 1889, no one could be sure whether they would still be alive in a year’s time. Under the conditions at the time, old age was a desirable commodity, and old people provided a glimpse of the mystery of holding on to life, long into old age. Nowadays, so many people reach old age that it has lost the magic and mystique of yesteryear. Gone are the days when a grey beard was associated with wisdom and valuable life experience. Today, old age, illness, and death form a close triad. There is little interest in the lessons learned by old people over their long life, or in their capacity for reflection and their powers of empathy.

FROM PYRAMID TO SKYSCRAPER

To understand the consequences of this new lifespan, it is a good idea to imagine what life was like around the year 1900 — before this revolution took place. That’s no easy task. Of course, we have paintings and photos from that era, but they provide a distorted picture. They are mostly images of celebrations and parties, made for people with a lot of money, as a way of capturing highpoints in the life of their families. But images of ordinary life, of the normal scene on the streets, are much rarer. I imagine it to look a little bit like the markets you still find in north-eastern Ghana today. It is a crowded scene; everybody has come in from the surrounding villages to sell their wares and to buy things themselves. Children swarm about, some of the older ones with a toddler on their back. There are crowds of youths standing round carts, mothers with babes-in-arms, men selling cloth. And here and there, sitting in the corner, you can see a single, toothless old person.

This is nothing like the scene at the street markets in our modern cities. There are droves of older people, out doing their shopping. They are grey-haired, but their mouths are full of shiny white teeth. Middle-aged couples stroll past the market stalls, pushing their grandchildren along in buggies. A few young fathers and mothers do some last-minute shopping in a rush. Very occasionally, you see a group of youths hanging about.

This common street scene reflects not only our affluence and culture, but also the structure of our population. The market scene in north-eastern Ghana is a typical example of the population pyramid. Such a structure develops whenever death is able to strike mercilessly and unchecked right from birth. As the years pass, almost no one is left alive. But the West has made short work of that. Soon after the end of the Second World War, the World Health Organisation was set up to tackle major medical and social problems. In the second half of the twentieth century, a large number of ‘mother and child care’ programmes were introduced — all sorts of initiatives to reduce mortality associated with childbirth, to give newborn babies a realistic chance of a future in regions where that was not already the case, as well as sanitation and hygiene programmes, obstetric care, nutritional advice, and vaccination drives. Where these programmes have been successful, and child mortality is reduced to a minimum, and death takes its toll only in old age, the demographic pyramid takes on the form of a skyscraper. Generation upon generation, storey upon storey, are filled with people, (almost) all of whom will stay alive and reach an ever-increasing age. This change from pyramid to skyscraper is called the ‘demographic transition’ — that is, the change in the age structure of the population.

The demographic transition is more than just a change in the composition of the population. Before the transition took place, women commonly had six to seven children, of whom two to three reached adulthood. When mortality figures fall, and babies, infants, toddlers, and young adults stay alive, the population increases in size. The number of births surpasses the number of deaths, in what we call a ‘birth surplus’. This phenomenon occurred in the twentieth century in almost every country. It explains how, from 1900 to 2010, the number of people in the world exploded from 1.5 to 7 billion.

People have been worrying about the rapid increase in the global population for a long time now. As early as 1972, the Club of Rome reported that the situation was ‘unsustainable’. The paper predicted that we would not be able to feed the ever-increasing number of mouths. At that time, the world population stood at around 4 billion, and a veritable Malthusian scenario was expected. This prompted a call for intervention policies, and massive birth-control programmes were instigated. Such programmes had very varied rates of success. One of the few countries that managed to curb its birth surplus early was China, with its one-child policy. But despite the explosive growth in the world’s population, mass starvation has not occurred. Just like Malthus in his time, the Club of Rome hugely underestimated our capacity for innovation. At the beginning of the twenty-first century, we produce enough food for approximately 12 billion people. About one-third of that goes to waste. Today, starvation is principally a problem of distribution. Political conflicts, economic decisions, and acts of war are responsible for people not getting enough calories and/or nutrients.

It is noteworthy that family size decreases naturally when a country goes through a demographic transition. Parents simply start having fewer children. We saw this happen in our study area in north-eastern Ghana, where a large fall in mortality rates was accompanied by a parallel reduction in birth rates. When we began our study there in 2003, women gave birth to an average of six children each. Ten years later, that number had fallen to two or three, and there was no interventionist population policy behind that development. It was as if parents sensed that the circumstances in which they were living and starting families had improved greatly. They no longer had to invest in having six children, since they felt that two or three were now enough to ensure the next generation.

The reproductive behaviour of parents in the Netherlands was no different. In 1900, women gave birth to more than four children on average. That number decreased steadily to a level of 2.5 in the 1940s. After 1968, a sharp decline began, and the average number of children per woman reached 1.5. The reasons for this included not only the introduction of the contraceptive pill, but also increasing prosperity, emancipation, secularisation, and individualisation of society. This was also the period when the standard life trajectory — marry early and have children — gave way to a more flexible pattern. Change in the composition of the population due to a fall in mortality is called the ‘first demographic transition’; the population change due to rearranging our family lives is known as the ‘second demographic transition’. The number of children per family in the Netherlands has now risen slightly, to 1.8, but that is still well below the minimum of 2.1 necessary to maintain a stable population over time. The minimum number is larger than 2.0 because a small proportion of each generation will die before adulthood, or will be infertile.

The population explosion in the twentieth century has its origins particularly in the imbalance between the number of births and the number of deaths. However, since the number of births is currently falling in almost every country, global population growth is now levelling off.

Almost every country has to deal with a baby boom that originated from a period when births and deaths were temporarily not in equilibrium. This explains why the population makeup in many nations does not take the straight-sided form of a skyscraper, but has a bulge somewhere in it. A prime example is the wave of births after World War II. Especially in developed countries, the number of newborns surged, only to decline more than a decade later. The Dutch saw a huge wave of births. The United Kingdom faced a short baby boom immediately after the war, peaking in 1946, and a second baby boom with a peak in births in 1964. In the US and Australia, servicemen and servicewomen returned to their homes and resumed family life after several years of wartime conflict. In all cases, this had a major impact on the population structure, the imprint clearly being visible in the population ‘pyramid’. These baby boomers are now ageing, leaving the labour force and entering their senior years. This is a frightening prospect for economists and politicians alike. It will make the populations grow older, with a peak set to occur around 2040. After that, however, the populations will become younger again.

YOUNG AND OLD-AGE DEPENDENCY RATIOS

We can see a number of socio-political consequences of changes in the structure of the population. If it is shaped like a pyramid, a relatively large proportion of public finances must be invested in children. They need to be brought up and educated. Whenever there is a wave of births, the consequences for society are easy to predict. It is no coincidence that the sixties and seventies were a time of many important educational reforms in the Netherlands. The 1968 Education Act was introduced as an attempt to provide the growing numbers of young people with the best education possible. The status of middle and secondary modern schools was raised, and they were merged with classical grammar schools to create large school complexes. Existing school buildings were surrounded by countless temporary structures to house the large numbers of pupils. Not everyone in the Netherlands has fond memories of those huge schools, sometimes with two to three thousand students.

Demographically speaking, there was an enormously high ‘young-age dependency ratio’. This is a statistical measure expressing the ratio between the number of people below the age of 20 and the size of the working population. In the Netherlands, the latter group is officially defined by Statistics Netherlands as people between 20 and 65 years of age. From 1960 to 1970, the young-age dependency ratio in the Netherlands stood at around 70 per cent. This means that every ten working people were socially responsible for raising seven newborn babies to adulthood — no easy task.

The decline in the number of births means that this pressure has decreased; in 2010, the young-age dependency ratio in the Netherlands stood at 40 per cent. This means there were ten working people to organise and finance the upbringing and schooling of every four newborn babies. This has allowed the scaling back of investments in mother and child welfare, vaccination programmes, schools, and other public- and private-sector investments.

Now that our responsibilities for young lives have become less, the increase in the number of older people poses new challenges. There is an increasing demand for care from older people who suffer from chronic illnesses, have become frail, and require help, as a result of the ageing process. In other words, the old-age dependency ratio is increasing.

Some politicians and policymakers, but also ordinary citizens, are seriously concerned about the increasing number of older people who will become dependent on the working population. The old-age dependency ratio in the Netherlands is set to double from 20 to 40 per cent by 2025, and to rise to 50 per cent by 2040, at the height of the ageing population phenomenon. In other words, while every ten workers used to have to bear the public responsibility for two older persons, that number will rise to four or five in the future. There is much debate about whether that represents a large number, and many people wonder whether it is even possible to manage an old-age dependency ratio of that size at all.

A glance at the situation in other countries helps put the situation in the Netherlands in perspective. In Japan, the old-age dependency ratio has already risen to between 40 and 50 per cent; and in Europe, countries such as Italy and Germany have moved much further in that direction than the Netherlands. What is more, the birth rate in those countries is even lower than in the Netherlands, and their populations are shrinking. The population in the Netherlands is still growing slightly due to immigration, and that also curbs the increase in the old-age dependency ratio. China’s profile is almost identical to that of the Netherlands, which is unexpected, given its one-child policy and the sharp drop in mortality as a result of the country’s rapid economic development. The explanation is that China will be able to fall back on large numbers of workers for a long time to come, since its strict family-planning policy was only introduced in 1979. If we look at the United States, we see that there is no increase in the old-age dependency ratio on the horizon. Although women in the US are also having fewer than two children on average, the country has a huge number of immigrants who will keep the working population at the necessary level.

Fear of the consequences of this development in the old-age dependency ratio has fuelled recent calls for interventionist population policies. These calls are principally based on advocating ways to persuade young parents to have more children. Apart from the moral question about whether it is the place of governments to interfere with family planning, it is very questionable whether it would even be of help in the long term. First of all, the young-age dependency ratio would rise. The average cost to parents and society of caring for a child from birth to employment age in Europe is estimated around 200,000 euros, but estimates vary widely between countries and socio-economic class. Researchers from the University of Canberra have found that it costs a middle-income family in Australia as much as $812,000 to raise two children, while the estimates are $474,000 for lower-income families and $1,097,000 for higher-income families. The greatest expenses are for food, transport, and education; however, the latter very much depends on whether children are sent to private or predominantly state-funded schools.

In the years that follow, the individual has to pay back that ‘debt’ to society. A person only begins to profit society from the age of 40. The fact that it takes 40 years before a person is ‘quits’ with society is in accordance with the fact that the minimum average life expectancy necessary for a stable population size is 40 years. This also means that all the years that we continue to benefit society, both tangibly and intangibly, beyond the age of 40 can be seen as that part of the gross national income that is free spending money. Conversely, it also explains why countries fail to ‘progress’ when life expectancy lags far behind, as is the case in areas heavily affected by HIV.

Another argument against the call for people to have more children is that it leads to an inevitable increase in the size of the population. This may not be an important objection in sparsely populated countries, but it is very doubtful whether it is really what the Netherlands or any developed nation should be striving for. There is general agreement that it would be better if there were fewer people living on Earth. Issues around environmental policy, renewable energy, and biodiversity are at the top of the list of ‘major challenges facing society’.

The third argument is the most compelling reason to reject such demographic intervention. Every wave of births will eventually lead to a wave of old people, since children get older as time goes on. In other words, trying to relieve the pressure of the old-age dependency ratio with an intervention that will increase the old-age dependency ratio in the future results in a vicious circle, and saddles future generations with a burden.

There is one way to curb the rise in the old-age dependency ratio effectively, and that is to raise the dividing line between working and not working, between productivity and dependency, from 65 to a greater age. This increases the size of the working population, and simultaneously reduces the number of people who are dependent on others. Such a move would greatly reduce the old-age dependency ratio, and is more than just an accounting trick to deal with the greatest challenge facing society in our times. There is something foolhardy about our stubborn adherence to 65 as the pensionable age, as if it had some kind of biological basis. The number has come to be seen as a dividing line in people’s lives between a period of giving and a period of taking. But, in fact, this delimitation is based on nothing but a political compromise that was reached in the nineteenth century. I return to this point in Chapter 13.

The question is whether the problem of the ageing society in developed countries really is as great as people believe. If we limit our view to the increasing pressure of the old-age dependency ratio, then the clouds on the horizon really do look black. But what people often forget is that the pressure from the young-age dependency ratio has relaxed. This means that the overall dependency ratio, between the working and non-working sections of the population, has not increased significantly. To compare: in the Netherlands, the total ratio in the sixties and seventies stood at 90 per cent, comprising 70 per cent young-age dependency and 20 per cent old-age dependency, with almost equal figures in the UK. The overall dependency ratio in Australia and the US were even higher, as their populations were relatively young when compared to the European continent. At the end of the twentieth century, the total ratio was lower, because that was when the post-war baby-boomers were adults, actively contributing to the labour market, and had not yet grown old.

However, we expect that the overall ratio in the Netherlands will also stand at 90 per cent in 2040: 40 per cent young-age dependency and 50 per cent old-age dependency, and that it will be similar again in the UK. Overall dependency rates in Australia and the US will be in the same range, but with 10 per cent more youngsters and 10 per cent fewer elders. To put it another way: every individual will have to share the responsibility for one other person during their working life, and that is just as true of the future as it was in the past. While our principal responsibility used to be raising the young to adulthood, in the future it will mainly be older people who require our care and support. Most people prefer the idea of wiping babies’ bottoms to that of wiping old people’s bottoms, but that is a different matter. From an economic point of view, it is far from being a doomsday scenario.

Although the old-age dependency ratio is manageable at the national level, it can increase drastically at the local level due to migration. The population in the north and south of the Netherlands, for example, is shrinking, because young people in particular are moving away. This results in an ageing regional population, although not because birth rates are falling or because people are suddenly growing old. Local population ageing can become a serious problem without it showing up in the national statistics. There appears to be no problem on the level of the national budget, and the old-age dependency ratio can be managed financially. But this does not take into consideration the fact that the local population is increasingly out of kilter. The problem then is not a lack of money, but a lack of people to keep society running. Who will manage the local supermarket? Who will staff the library? Who will help old people with their everyday tasks, like housekeeping and washing?

The phenomenon of local population ageing is eternal and ubiquitous. The famine in nineteenth-century Ireland was caused to a large degree by the depopulation of rural areas. The Industrial Revolution attracted workers to the cities. The very young, the old, and the needy remained behind. In today’s China, young adults are moving to the cities, because that is where careers are to be forged. The older generation stays behind in the countryside, often left looking after their grandchildren.

All over the world, lively communities are turning into ghost villages. Sometimes, a picturesque hamlet is bought up wholesale and turned into a hotel resort. Norway is trying to turn the tide by offering residence permits to skilled professionals from abroad, on the condition that they settle and work in a local community. The appearance and disappearance of communities is comparable to the appearance and disappearance of species. It is a never-ending cycle.