As the World’s Older Population Increases, Can Cities Handle the Influx?

New York Harbor. JOHN PENNEY
A rare moment of solitude in New York Harbor. The city has made strides in offering more amenities to older people, recognizing the economic benefits of doing so.  JOHN PENNEY

A trio of megatrends that could radically change the makeup of cities around the world is about to converge.

“You have two very powerful trends,” says John Wilmoth, director of the United Nations Population Division. “There’s aging of population and there’s an urbanization that’s taking place. It’s not only movement to cities, but it’s the growth to cities relative to the rural areas. From 1950 to 2050, it’s a change from one-third urban and two-thirds rural. A hundred years later it has flipped.”

The facts are clear: More than half the world’s population lives in cities, the aging population — those 60 and over — will be increasingly dominated by women and Europe and North America will soon have the highest population of older people globally. Some countries, like Germany, may be better prepared for the influx of aging citizens than others.

The United States, falling in the cohort of rich countries with an increasing aging population, is not gearing up on a large scale for this arrival at the federal level, despite a gradually aging baby boomer population. Instead, cities themselves are taking the initiatives, like New York and Portland, Ore., in carrying out new policies.

Moreover, ballooning aging populations are mainly affecting cities in developed countries in the near future. Developing countries will have to contend with large aging populations eventually, as longevity increases and fertility rates remain high in places like sub-Saharan Africa and South Asia. At the very least, current bare-bones public services in the developing world will need to be enhanced.

The UN estimates that the number of people age 60 and over will double in 10 years, from 600 million now to 1.2 billion by 2025, and to 2 billion by 2050. From 2000 to 2050, the proportion of the world’s population over 60 years old will double to 22 percent.

By 2050, 66 percent of the world’s population will live in urban areas, up from 54 percent in 2014, UN data shows. The highest growth will occur in China, India and Nigeria, according to the 2014 revision of the World Urbanization Prospects by the UN Population Division, reinforcing the need for developing countries to begin addressing infrastructure and provision of social services soon.

Large cities will not be the only metropolises affected. Wilmoth says that urban growth includes small and medium-size cities with populations from 250,000 to 500,000. This expansion has resulted in a “shift in the private and public sector to create systems to provide for the needs of older people,” he adds, noting the long-term care industry.

Aging and urbanization is in many respects an evergreen issue. Nearly two decades ago, in 1998, UN-Habitat, a program that promotes optimum urban development, held a conference titled “Aging and Urbanization: Challenges and Opportunities,” ahead of the 1999 UN International Year for Older Persons.

But as the world inches further into the 21st century, the trends are becoming more pronounced, demanding fuller attention and faster solutions. Cities need to be prepared for the requirements of an older population, which involves a lengthy checklist ranging from transportation to health care. In 2016, UN-Habitat will hold a conference looking at these issues through urbanization and sustainability themes.


 

 

Despite the continuing fears, are cities even beginning to prepare for the intersecting trends? Take, for example, the US and its fast-aging baby boomers. The US is not in the top 10 aging nations, as reported by PassBlue, because of its young immigrant population, but it falls into the top 20 countries, where the growing number of aging people is perceived to be a major concern by its own citizens, according to a 2013 Pew Research Center survey.

In the US, the population of people 60 years old and over will leap to 112 million in 2050, nearly double from 56.9 million in 2010, says the US Department of Health and Human Services’ Administration for Community Living.

Women Predominating in the US

In 2050, the number of women age 60 and over in the US is projected to be 54.2 percent, compared with 45.8 percent for men, as women generally outlive men.

In the US, a woman’s life expectancy is 81 years old, compared with 76 for men. Women are expected to be in better physical shape than men, says a report, “Older Americans 2012: Key Indicators of Well Being,” published by the Federal Interagency Forum on Aging-Related Statistics, an entity established in 1986 by the National Institute on Aging, the National Center for Health Statistics and the Census Bureau to connect government agencies focused on relevant data.

Women in the US have become more financially independent, which means that they have more say on how they want to spend their time as they grow older, says William Frey, a demographer with the Brookings Institution.

Yet many older women will be struggling financially, says Lisa Warth, coordinator of the World Health Organization’s Global Network of Age-Friendly Cities and Communities. “Women often outlive their husbands and face their oldest age as widows,” she says. “Women often have a lower income in old age than men and are more likely than men to be affected by poverty. Living alone, they are at a higher risk of social isolation and loneliness.”

Warth adds that “Tackling women’s needs in old age starts with ensuring that women have equal opportunities in education and employment and that the unpaid care they provide in the family is recognized in pension systems to improve their financial situation in old age. Access to quality health, care and social services is important as well as the opportunity to continue to contribute in a meaningful way and to engage with others.”

Wilmoth of the UN Population Division agrees that it is important to focus on antidiscrimination rules against women, who may not have access to pension and full-time work, including women who never married.

At the grassroots level, initiatives to generate discussion on these issues have been underway for years. In 2007, for example, Marianne Kilkenny started Women for Living in Community, which encourages sharing housing among single women as they get older.


 

 

“Wellbeing is more than healthcare; it’s emotional care, and that kind of care comes from being surrounded by people we know, love and trust, not just by nurses and planned activities,” Kilkenny, who lives in Asheville, N.C., writes on her website.

These and other gender-specific aging problems will need concerted focus in cities, where the majority of the aging female population is settling.

Ha'penny Bridge
Dublin’s Ha’penny Bridge: the combination of old infrastructure and high population density is taxing many cities in Europe. JOHN PENNEY

A Matter of Avoidance?

Yet cities generally have far to go in confronting the needs of aging populations, Warth of Global Network says. Some key necessities include creating barrier-free and accessible urban environments, combating ageism by raising retirement age or abolishing compulsory retirement and promoting volunteering through such organizations as AARP’s Experience Corps, where people 50 years old and above work with children on literacy.

The World Health Organization, for one, has been paying attention to the trends converging on cities: a report in 2007, “Global Age-Friendly Cities: A Guide,” detailing information culled by focus groups who met in 33 cities in developed and developing countries to discuss an array of topics, including housing and infrastructure.

The list of services and improvements that the groups compiled included more outdoor seating areas, green spaces, buildings with more escalators and elevators and nonslip pavements. The groups also suggested some “Do Nots”: like eliminating cross-walk lights timed for “Olympic runners.”

Some participating cities have responded to the wish list. Germany has built multigeneration houses (Mehrgenerationenhauser) in more than 450 cities and communities nationwide. The houses act as hubs for all generations, with services from child care to elder care as well as offering opportunities for older people to volunteer, say, as storytellers to children.

In Geneva, restaurants provide subsidized lunches for older people and volunteers help those with limited mobility to join a group meal to have company.

The World Health Organization recently introduced a website, www.agefriendlyworld.org, with information on other helpful initiatives, like Akita, Japan’s bus-coin project, in which people age 68 and over ride buses free or are provided free alternative transportation. The website includes online tools and guides for cities and communities. (Japan has the world’s largest population over age 60.)

New York, Portland and Other US Spots


 

 

How are American cities prepping for the converging trends? The country has the wealthiest population based on gross domestic product, but interviews with aging experts and demographers reveal that many cities have been slow in making their environments more amenable.

New York City is one major exception: it has been making headway on being more responsive to older people’s needs, recognizing the economic value of attracting this population to its neighborhoods.

Lisbon rail
Lisbon’s rail line: many cities need to upgrade their transportation services.

Bethany Brown, the policy director of HelpAge USA, a Washington D.C.-based nonprofit group focused on the livelihood and rights of senior citizens, points out that certain cities on WHO’s list of age-friendly ‘partner cities’ have added traffic islands and increased the number of seconds to traverse crosswalks. (New York became the first member of a separate list: WHO’s Global Network of Age-Friendly Cities and Communities in 2010, but it did not participate in the focus groups project.)

In 2009, under Mayor Michael Bloomberg, as many as 59 initiatives to make New York more comfortable emerged from a review by his office and the New York City Council. These included safer streets and cultural guides for older people.

On the other side of the US, in Portland, Ore., which participated in the WHO focus group project, carried out an action plan in 2013, including engendering “respect and social inclusion.” (The number of people 65 and older in Portland is forecasted to jump to 882 million in 2030 from 533 million in 2010.)

Other Portland initiatives have featured certifications to businesses catering to older people and  promoting less ageist language, like dropping “senior citizens” and “the elderly,” for “older adults” and “elders.”

While Portland was the only American city participating in the WHO project, other organizations like AARP have created age-friendly certifications. AARP’s Network of Age-Friendly Communities is run under WHO and involves committing to a five-year program based on “8 Domains of Livability” — like social and civic participation, employment, communication and information and community support and health services.

Making the list of AARP certified cities are Denver, San Francisco and Washington as well as smaller cities like Des Moines, Ithaca, N.Y., and Lexington, Ky.

Quality of life is critical as cities undergo makeovers, rehabilitating decades-old infrastructure and improving other public services to prevent, say, flooding as climate change problems ensue. The Rockefeller Foundation’s City Resilience Framework report says that a resilient city “values ecosystem services and has in place robust environmental policies to protect ecosystems in situ.”

The foundation and the global consulting firm Arup introduced a 100 Resilient Cities project in 2013, identifying what makes cities thrive.


 

 

Rankings that examine what cities are doing specifically on aging are surfacing more. The Milken Institute’s biannual ranking of best cities for successful aging factors in 84 data indicators. The index included rankings for 352 US metropolitan areas. Important indicators look at community engagement, for example.

In 2014, the top large metropolitan area was Madison, Wis., and the small metropolitan city was Iowa City.

Smarter cities that cater to an aging population can generate a domino effect, strengthening their economy and attracting more tourists. This phenomenon could become a worldwide trend, experts proclaim, especially in the Asia Pacific region, where the majority of aging populations are located in Japan and in South Korea.

Struggling Countries

While industrialized countries grapple with policies on urbanization and making cities more adaptable, developing countries — which are also experiencing rapid urbanization — face a greater challenge in providing such basics necessities as water and sanitation. A 2015 report from the Save the Children Foundation, “The Urban Disadvantage,” highlighted the large disparities between the rich and the poor in cities in developing countries, especially related to children.

Ethiopia provides a snapshot of a poor nation, often stricken with drought and other natural calamities, that has a relatively small but growing population of people 60 years old and older. In this case, it’s about 5 percent of the total population, as life expectancy is now 64 years old, reflecting a steady rise over decades.

The country, however, is hardly prepared for an influx of older people moving to its capital and main city, Addis Ababa. A survey noted in a 2011 report by the United Nations Population Fund found that most of the older people already living in the city did not have enough to eat, suffered chronic health problems and lacked proper plumbing and any family support.

The Importance of Suburbs 

William Frey of Brookings points out that while most policymaking may be zeroing in on how cities must prepare to manage fast-increasing aging populations, it is important not to neglect areas just outside cities. Suburbs traditionally attract young families, but some couples stay after their children are grown.

Chairs
More public seating areas are needed for older people in cities.

“I focus on the suburbs because I think that’s an area most likely to feel the change as they aren’t suited to older people,” Frey says. “In a lot of suburbs, you are dependent on your car; all issues that will affect the suburbs are more significant than downtowns because the infrastructure [in suburbs] has really been geared to younger people.”


 

 

Aging experts like Lori Simon-Rusinowitz, a professor at the University of Maryland’s School of Public Health, says that the movement to make cities more conducive to an older population should start in communities. “The age-friendly communities can be urban, they can be suburban,” Simon-Rusinowitz says.

She noted, for example, Maryland’s Communities for a Lifetime Act, a “comprehensive, strategic state plan” to address challenges for aging, like employment.

A separate initiative, she notes, is the “villages” — community-run, volunteer-led organizations making neighborhoods more useful, peppered throughout the US. Capitol Hill Village in Silver Spring, Md., for example, offers programs like cooking clubs. Beacon Hill Village in Boston is another “village” shaped by members.

Yet Bethany Brown of HelpAge USA contends that big cities offer the most perks for an older population.

“There’s easier access to services like health services, or even things we take for granted, like easier access to employment and easier access to stores and to public transportation,” she says. Moreover, cities can often combat social isolation.

Raising Comfort Levels

Government, city planners, architects and designers have ample room to create better environments for older people.

Nithin Umapathi, an economist at the World Bank, says that one important aspect for cities is to make them more affordable for older residents. Big cities like New York can be expensive for many folks, especially those living on fixed incomes.

Moreover, a rich marketplace beckons in design and aesthetics. A Japanese designer, Emi Kiyota, founded Ibasho, a charity whose motto is “Creating Socially Integrated and Sustainable Communities That Value Their Elders.” Kiyota, an environmental gerontologist, works closely with communities worldwide in designing homes or senior citizen centers in the pre-design, or brainstorming phase.

The buildings she helps to develop are inspired by certain realities: It is no longer a given, for example, that taking care of aging parents will be a generational or a family affair, in Japan or elsewhere. One such project involved Ibasho collaborating with Hokkaido University in Japan and a team of architects and local consultants to renovate a “locally significant building,” Ibasho’s website says, in Sri Lanka. The building was donated by a retired professor and turned into homes for elderly people who have no immediate family members; it also offers a community center for all villagers to congregate in.


 

 

Another project, La Maison du Père, was set up as a community for retired priests in a village in Ivory Coast that has enabled them to interact with the local residents through teaching in a variety of ways.

Aging experts, demographers and designers emphasize that modernizing cities and communities for a rising older population benefits society overall.

As Brown of HelpAge put it, “The way I would like it to be framed is, how can they [cities] be sure that they are serving all of their citizens?”

 

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