Currently, in response to last year’s Council invitation, the Commission is developing a set of key policy tools to assist Member States in navigating the impacts of an ageing population on Europe’s competitiveness and its society. These plans took the stage in a recent plenary debate in the European Parliament on healthy lifestyles and active ageing in the EU.
An important question in all of this: what are the factors that determine if we age healthily or not? We caught up with Aïda Solé-Auró, Associate Professor in the Department of Political and Social Science at Universitat Pompeu Fabra in Barcelona (Spain), and author of a STOA study on the socioeconomic determinants of healthy ageing in the EU.
During the Parliamentary debate in March 2024, Members of the European Parliament engaged in a lively discussion on the multifaceted factors influencing healthy ageing. What did your research on what elements determine healthy ageing unveil?
What are the primary drivers of unhealthy ageing?
Aïda Solé-Auró: Genetics accounts for about 10%-30% of longevity. The remainder is influenced by social and behavioural factors, along with some random chance. People who age slower typically abstain from smoking and drinking, exercise regularly, consume fruits and vegetables, and experience less stress.
Social factors such as occupation, education level, family status, social network and mental health also play significant roles. Notably, mental health issues tend to affect women more than men.
The Commission’s Green paper on ageing highlights extending working life and promoting lifelong learning as potential strategies to combat unhealthy ageing. What are your perspectives on this?
Aïda Solé-Auró: The retirement age continues to rise in Europe. The problem is not maintaining or increasing the retirement age. The problem is the quality of the jobs. Permanent quality jobs contribute more substantially to society and pensions than temporary or part-time positions.
Mandatory increases in retirement age could disproportionately impact those in physically and mentally demanding jobs. Flexibility is key: people should have the option to work until 70 if they choose, provided they are healthy and able to contribute to society, but it should not be obligatory. The focus should be on increasing work conditions to enhance competitiveness.
Are women more susceptible to unhealthy ageing?
Yes, we mainly observe differences by sex and educational levels. Women typically outlive men but spend more years in poorer health. They suffer from different causes, from which they experience physical limitations for more extended periods.
We have to see that longevity is a process shaped by events occurring over the entire lifespan. More boys are born than girls for genetic reasons. But we already observe differences in mortality rates from infancy, with men exhibiting higher mortality rates. Men engage in riskier behaviours, leading to more abrupt and violent deaths, such as road accidents and suicides, heart attacks. Additionally, there are variations between men and women in the prevalence of chronic diseases. For instance, men typically have more lethal cardiovascular diseases and tumours (e.g. prostate cancer), and overall, a higher percentage of diseases that are more lethal.
In women, while breast cancer is more prevalent, survival rates have improved over the last two decades. Women also experience higher rates of hypertension in most countries. Over the last 20 years, we have seen important changes in some countries, with women smoking more than men. These health disparities need targeted policies to address respiratory diseases and cardiovascular morbidity in women.
Parenthood
Childhood care is another factor influencing healthy ageing. Some studies show that life satisfaction varies depending on the family dynamics, with parenthood significantly impacting one’s trajectory. Women devote more hours to childhood care, increasing their mental load. In some studies, we see this as an effect of an immediate lower life satisfaction.
Then we see differences across countries and population groups at educational level. Despite increased female education levels globally, women in lower-educated groups are most susceptible to unhealthy ageing. Even though they are more educated, some women still suffer from the worst jobs in society, a finding persistent across different countries. One of the key societal challenges is to introduce specific policies that improve the quality of life of low-educated women. One recommendation is to avoid temporary or part-time jobs. Job insecurity leads to lower contributions to social security and pensions.
Investing in a robust healthcare system is also key, especially for vulnerable groups, such as low-educated women working in ‘bad’ jobs. Disparities across Member States underscore the importance of accessible, high-quality healthcare, contributing to longer life expectancy, as evident in Spain, where healthcare is free and of good-quality.
How are other vulnerable groups impacted?
Aïda Solé-Auró: My research delves into immigrants’ health. There is a so-called ‘healthy immigrant paradox’ that holds true across different European countries. We will soon publish papers on this, using Spanish and European data. The healthy immigrant paradox is that people who immigrate are healthier upon arrival than the native-born population in the destination country (taking similar demographic and socioeconomic profiles). This happens because of a selection effect in the country of origin of the ones who are willing to migrate to increase their social scale.
However, over time, their health tends to decline and converge with the host population. We see this effect with immigrants coming from both inside and outside EU Member States. That said, disentangling differences between immigrant groups is challenging due to limited data sample sizes (only about 10-15% of the population migrate to another country).
The European Parliament’s resolution of 2021 underscored disparities in healthy ageing between urban and rural areas. What have you observed?
Aïda Solé-Auró: Rural areas often lack adequate public services, rendering residents more vulnerable as they must travel to urban centres for essential services. Depopulation exacerbates this issue, driven by migration from rural to urban areas in search of employment.
Initially, more women than men migrated to cities, seeking improved quality of life and access to education. This trend has led to an imbalance in marital status, with more men remaining in rural areas. Consequently, they face challenges in finding partners and establishing families, contributing to increased isolation among men. These dynamics persist in less-populated regions, exacerbating social and demographic imbalances.
Your research shows that Spain and Italy have higher longevity rates compared to Nordic countries, but exhibit more unhealthy ageing. Why is this the case?
Aïda Solé-Auró: Southern European countries tend to have higher life expectancies but poorer health outcomes compared to Nordic counterparts. The reasons for are manifold and need further investigation. For instance, there are higher suicide rates in some central, Nordic and Eastern regions compared to the South.
How does Europe fare on the global stage regarding healthy ageing?
Aïda Solé-Auró: While life expectancy is increasing globally, significant disparities in healthy ageing persist among countries.
Vulnerable groups, including racialised individuals and women, often face disproportionate health burdens.
How do you approach the study of healthy ageing?
We primarily use survey data, combining subjective and objective health measures, which include mobility, limitations, disabilities, behaviours (e.g. smoking, drinking, obesity), and various chronic health conditions (e.g. diabetes, hypertension, cardiovascular diseases, respiratory diseases, arthritis and mental health disorders).
Public databases collecting health histories of individuals have emerged and gained popularity. Northern European countries were pioneers in using them to analyse population health. Catalonia now also has a population-based health registry, which includes medical diagnosis, health status and risky health behaviours. But it can be difficult to acquire access to this data from the administration. Using self-reported data also has some limitations: since self-reported data is subjective data, we need to ensure that survey questions are comparable across countries and regions.
What novel aspects does your research bring compared to previous work?
Aïda Solé-Auró: We have more data now. The Survey of Health, Ageing and Retirement in Europe, SHARE, started in 2004. With 20 years of data, we can now explore multi-morbidity trends over time comprehensively. In the US, the same data set already exists since 1994, so they are able to see multimorbidity trends for a longer period of time and conduct detailed analyses of age, gender, social structures and regional differences, offering valuable insights into healthy ageing.
Was there a personal motivation driving your focus on healthy ageing research?
Aïda Solé-Auró: My great grandfather lived until the age of 103 years old. He was a very hardworking farmer living in a pleasant rural area, who worked until he was 85. He smoked, but not a lot and stopped smoking in his fifties; he had a balanced diet, with no access to fast-food products. When I was young, I was fascinated by this. And everyone kept asking me how my great grandfather was in such good shape. So, I decided to study longevity and aging for my PhD. I was particularly interested in its social aspect.
Is there a particular insight from your research journey that has surprised you?
Aïda Solé-Auró: I was shocked that there are such huge differences between people. While genetics play a role, social factors, including healthy habits and social support, significantly influence healthy ageing. For instance, my family has a history of longevity and healthy ageing. People from my great grandparent’s generation suffered a lot, they lived through a century that saw two World Wars and Franco’s dictatorship. And yet they survived all of this. These life circumstances were very interesting to me.
Ultimately, having a healthy age successfully involves a combination of things. I think there is a big component of resilience, of saying: “OK, this should not affect me. I have to keep going, and I have to keep going”. The key is that when you experience obstacles in life, you need to keep going. This is the example of my grandmother, she always says: “If there is a problem, you have to talk about it, but you have to keep going”. And this is resilience…