 Can I start by thanking the Institute for inviting me. It's always particularly stimulating to go somewhere and be able to share your ideas with a very broad audience. I'm actually going to give something. I've been asked to give something which is a cross between a public lecture and an academic seminar. So it may be a little bit bumpy in parts as we shift backwards and forwards. But the main thing I want to try and do is to get us to rethink this whole idea of global ageing. I don't work on old people. I never have worked on old people. But I do work on something which I think is one of the huge challenges for the 21st century across the globe, as Ultron points out, which is the changing age composition of the world. And it is going to fundamentally change our economies, societies, politics, global migration, etc. And that's really what I want to talk about today. Population. I don't know if you're aware, but the Royal Society last week launched its population on the planet. I sat on that working group and, in fact, I was responsible for the demography of that. And we had a huge press interest that was vaguely positive. And we wanted to do two things. One, we wanted to put population demography back on the international agenda. It fell off in the 90s for a variety of reasons that we can discuss afterwards, but there isn't time to do now. And then also to talk about consumption, the changing consumption patterns of the world. And when we started this working group, there was very much a feeling that population was all about population expansion. And this is the old story. When people talk about population, it's about overpopulation. And how can this world sustain up to 24 billion people? And one of my jobs on that working party was to say, no, the population is going to change in some very complex ways. It is not just going to grow larger. It is going to change in terms of its density. We're all going to come far more urban. We currently have about 50% of the world population living in urban centres. That will rise to about 75% by the end of the century. It is going to change in its distribution. Not only are we becoming more mobile, but as I will talk about in the talk, that kind of migration pattern is going to change. And really importantly, it's going to change in its composition. These age structural changes are going to have a huge impact on our economies and our societies. And now, as I said, when I was teaching demography 20 years or so, the really big question was how can we stop the world population reaching 24 billion? Then we started to talk about, well, no, maximum world population will be about 12 billion. And now we think it will hit 10 billion by 2050 and then stabilise. And the reason for that is this, falling fertility. Nobody, I think, realised how quickly the total fertility rate, that's the number of children for women of child bearing age, would come down over the last 20 years. If we take replacement to be 2.1, then we can say that two-thirds of the world's countries are now at near or below replacement level. In terms of total fertility rate, we have countries like Thailand, which is now lower than the UK. We have Vietnam, which is lower than New Zealand, and about just a couple of points above the UK. We have the lowest total fertility rate in the world. Does anyone know which country has the lowest total fertility rate? Everyone always says exactly the same thing. It's actually Hong Kong, less than one child per woman. I recently said this at a lecture and someone put his hand up and said the Vatican, which I suppose is officially, but unofficially. And what that picture is, that fertility has come down as these countries have economically developed. And we know pretty well how to reduce total fertility rate. And it's a combination of improving child and maternal health, improving female education and family planning programmes. But this idea that we've got to worry now about dramatic growth in the world population has actually, if you like, by itself solved it as we've educated women and allowed them to choose the number of children that they have. And as a consequence, here we've mapped the total fertility rate. If you look at the yellow, these countries are below replacement now. And you can see that not only is it the OECD countries, but increasingly many countries in Asia and even in Latin America. And if you look at the beige, they are at or very near to below replacement. And indeed, you can see very, very clearly with the exception of here, these are the red, the African countries, predominantly African countries, where we still have over four children per reproductive woman that across the globe total fertility rate has come down naturally. Now I'm going to talk in a minute about China. People often go on about the one child policy. In fact, I was asked only last week whether India should have a one child policy. If you map the fall in total fertility rate in China and you put next to it the natural fall in total fertility rate that occurred in Southeast Asia, they actually map on to each other perfectly. In other words, China had to bring its total fertility rate down. But naturally those countries in Southeast Asia were beginning to do that themselves. So much so that we now have entered into what we call potentially the second demographic transition. And the second demographic transition basically says are we going to get trapped in what we call a low fertility trap? And countries such as Germany and China and Japan and even Singapore, Hong Kong, et cetera are beginning to question whether they will ever be able to raise their total fertility rate. And that argument is that if you have more than one generation that has a total fertility rate of below 1.5 then those societies adapt. And particularly the young reproductive population starts to adapt to the idea of just one child. And it isn't just that we're having individual women having one child we're having them delaying and delaying and delaying a third of the UK females age 35 have yet to have their first child and a considerable percentage of those will never have a child. Partly because of secondary infertility which means they were fertile but as they come up to their 40s they tend not to be. And yes you can do all the IVF in the world but you're not actually going to have a huge impact on the demography of a country. You'll affect an individual but it really won't impact at the national level. And also their lifestyles have changed. Women are deciding not to have children. We have a huge group of young women throughout the world not just in Europe who are making their decision to be childless. And I think there's some wonderful evidence now coming out of China. It's very much anecdotal. We don't have the hard data. But in China we now have, if you think the one child policy was started in 1981 we now therefore have a whole cohort of young one children male and female who are now at primary productive age and they are choosing just to have one child. They're allowed to have more but they're choosing to have one because that's their common experience. So a lot of Europe and increasingly southeast Asia and you can see that flowing across the globe is talking about the second demographic transition and whether in fact we'll be stuck in a low fertility trap. And that obviously has huge implications when you understand the impact that that's happening on its demography. I think it's a good thing because as I say we're not going to go to 24 billion. We are likely to stabilise at about 10 billion if we can get Africa right and that's another conversation we can have afterwards. But it does mean that some countries are really having to rethink what's happening to their demography. As a consequence we are ageing our populations and we're not just ageing Europe. If you look at the green, the blue, the red and the orange let's just do green, red, let's just do green, blue and red that is those countries in the world which will have over a third, over a quarter and over 20% of their population what we now consider to be old age and we can talk about this later because of course that's very contested. 60 will mean increasingly very different things by the time we get to 2050 but that's basically how one can look at it unless you start changing policies and taking age 60 to be irrelevant which in health terms increasingly it should be otherwise that is the percentage of a population that you're going to have out of economic employment. I had some other graphs which I've just taken out because I don't have enough time which shows how this then replicates into the percentage of the workforce going forward across the globe. Now one of the things that I will argue and do argue is that this population ageing, this change in age structure we've looked at it in the wrong way. We've tended to concentrate on this kind of a figure and say oh my goodness we're going to have populations which will be increasingly elderly and that is the problem, pension, social security, long term care and instead of saying no there are two distinctive drivers here there's the one I've been talking about which is falling fertility which obviously is affecting the percentage of elderly going forward but there's also increasing longevity and falling mortality at the later ages and that's much more around healthcare and I'm going to divide the rest of the time that's left to me into these two very distinctive issues what happens to economies when we have falling fertility when we have increasing longevity. So let's look at this. Actually let's look back, if I can go back and talk you through it. So falling fertility, the argument around falling fertility is very simple that as you have falling fertility go through a population as you predict it going forwards or in fact obviously you can look back at those changing trends then the combination of particular age groups is going to impact upon your economies and your societies and for the economists that's a very very simple sort of life course economic idea that at certain times of our lives we tend to behave economically in different ways when we're younger we tend to produce we tend to consume and we tend to save and as we get older we reduce our production we reduce our consumption and we draw down on our investments and you can actually see these long term demographic trends in economies and I just want to show you one paper that I think illustrates this very well. This is a paper that came out of the States by Zeng and Spiegel and what they did was they took long term trends 1954 up to, in fact this is predicted to 2014 but we can stay here which is round about where we are at the moment and they showed that if you look at the US stock market okay we do have the cyclical fluctuations which are annual but the long trend was very much driven by the changing demography of the US in other words in 1981 all the members of that large post war birth cohort was in the labour market they were working, they were saving they were driving the US economy 2004 onwards they started to retire they stopped saving and they drew down their investments and a group of economists are now working not only looking at the US but looking at Japan, looking at Germany and saying we have to understand these long term demographic impacts and these of course are primarily driven by changes in the fertility rate these long term trends that come out very similar work has also been done by Bo Malberg's work in Scandinavia looking at housing build it works brilliantly in Sweden but they are also now doing it in other OECD countries exactly the same sharing how the changing demography of the population is changing the requirements in the housing market and the third area I want to talk about in this area is the impact on employment and the labour market and this is just very quickly to represent that what we've mapped here is OECD countries looking at the first three decades of this century and what we see very clearly here is if we look at the blue which if you like are the incoming cohorts into OECD labour markets how they are going to from about 2015 start to fall and the outgoing ones which are in the red they are going to increase and if I say that these projections take into account migration you can see why many OECD countries and particularly Europe are going to have difficulties because of their changing demography their age structural change is one older populations and decline and I think this works leads very much into a sort of policy discussion which is around things like the recent world bank report that showed that in fact Europe is not going to be able to attract the skills it requires in an upcoming world of a shortage of skills and one of the reasons they suggest links into some recent work by MANPA which has looked at what is happening in China and China is the only country in the world that has mapped its occupational structure by age and it knows what year it's going to have a downturn in each occupational group and MANPA suggests that they have geared up to actually start cherry picking the world skills and one of the areas I do a lot of work in is Southeast Asia and the governments of Southeast Asia, Malaysia, Singapore even Indonesia are becoming very concerned about China cherry picking the best that we have in Europe, we cherry picked the best for the last 50 years or so and they suggest that the brain drain will eventually by about 2030 flip from the US over to China so if you're a bright young graduate I normally say from Oxford but let's just say from Trinity you won't go and work for first Boston in New York for five years you'll go and work for the bank in Shanghai and I think the demographic, the demography of the labour market is something that internationally is going to really have an impact particularly on things like global migration trends because one of the ways that the old countries old rich countries of the northern hemisphere we've propped up our economies by exporting economic capital to the south and importing human capital and that kind of north south migration is going to be significantly disrupted at the first half of the 21st century I'm going to very, very quickly move on now because I know I have quite a tight schedule to get through all of this but to go on to the other one, the other side and we can talk about it later in the questions we've looked at some of the impacts that falling fertility is going to have on national and global economies let's look at the other side falling mortality rates, late life mortality rates and increases in longevity and I'm going to illustrate this this actually is English data because England has fantastic data going back England and Sweden have some of the best historical demographic data in the world just to try and understand the way that we really have altered longevity and this is looking at the survival curves and this is the rectangularisation of that survival curve and if you look at 1851 in England you can see this is the age along the bottom and this is the proportion surviving we had deaths across the life course death across the life course was common and we pushed back that death so that by 2011 it's not quite rectangular but that is very much how we've managed to push it so much so that in 1851 less than half the population reached 46 and currently we have half our population in England at 85 and of course if you want to talk about the impact on pensions then when the first national pension in the UK in 1908 was introduced you can see that in actual fact 72 was the age at which half the population had died and if we're going to extrapolate that we should have a state pension age of about 80 and if we want to extrapolate what was happening in 1800s when Bismarck introduced his European pension then the pension age we should be looking at in order to keep it in line with the Bismarckian calculations is an English pension age of 103 so we really have changed in the last 150 years or so the structure of our population quite considerably what I want to do is actually take you through this bit let's take 1911 to 2011 people often say how did this happen we can say basically that in this part of the graph a lot of it was public health, increased nutrition, increased sanitation but from about 1911 onwards we started to get medical and scientific advances coming in and I just want to show you this what we've done here is take UK male mortality last century we've divided it into four main the four main killers of men during that time and you can see very clearly how those killers have changed across the century the exception of the yellow which is cancer where we actually interestingly enough have not made that many inroads and the interesting thing about cancer is that incidence is increasing and death is declining and that means that probably due to environmental factors we're increasing incidences but medical effects mean that we're reducing deaths but if we took for example respiratory obviously here we have the flu epidemic so this is green this respiratory you can see basically that's been downward and if you look at the others which are here circulatory is blue and infections red they also have steadily come downwards and a lot of this particular here onwards is going around medicine and science the really interesting thing of course is what's going to happen here are we going to see a continued decline those people who work on infectious diseases has a big debate at the moment I'm sure you've all heard about antibiotic resistant bacteria and whether or not we're going to have an increase in infectious diseases the general view of my colleagues at Oxford is no because of things like the new genetics we understand the DNA of pathogens we'll be able always to be ahead of the game in terms of the pharma, of the drug therapy but it will come at a cost and that's something we can come back to and the other big thing obviously is this which is the circulatory, the blue and that tells a wonderful wonderful public health story what happened in the UK around about the 1970s a lot of this came out of Richard Peter's work was the understanding of the impact of smoking on late life deaths particularly for men there was a huge public health drive and men basically gave up smoking women didn't men dramatically decreased their smoking and as a consequence deaths from cardiovascular disease stroke and lung cancer in the male population just dropped dramatically and you can see that here this is more ONS figures this is heart disease deaths this is the male cohort coming through into later life and you can see the dramatic reduction we've had in deaths from heart disease in England and Wales over the last 20 years and similarly exactly the same cancer and stroke related deaths have gone down so the really really big question that we have to tackle is this the new lifestyle disease of the 21st century is obesity now will obesity have the same kind of decline that we saw in the public health and the lifestyle disease of the 20th century smoking and I don't have time to show you this data but I'll just talk you through it we recently done some very or drawn upon some very interesting work that has been done assessing two particular meta studies and one of them looked at the data around obesity from 1979 across to 1996 storing on OEC data the second one looks at data from 1996 across to 2006 and the reason I was interested in that actually came out in states because those of you who are familiar with this will know that the United States has a far lower life expectancy than one would presume given its position economically within the OECD it is below the OEC average and one of the arguments is the impact of obesity we now have up to a third of some states with obese individuals and that obesity is in some way reducing life expectancy in the same way that smoking reduced male life expectancy at the end of last century and what they are suggesting is that when you look at these two studies although rates of obesity have gone up dramatically significantly over those two time periods between the 80s and 90s and the 90s and 2000 it looks as if its impact on life expectancy has actually gone down so people are beginning to argue why is that and one of the reasons may be because of drug therapy in other words people are not changing their lifestyles as they did with smoking they are continuing to over consume calories to eat and to drink to become obese because they can pop a pill a statin or a lipid reduction or a hypertension which reduces the long term effects of diabetes symptoms of cancer and cardiovascular disease and if that is the case then we are moving into a world where some people will say fine science is solving a lifestyle problem but at again a cost and one of the things we can talk about maybe afterwards is some research that we have done which looks at the difference for example in the US and Japan in terms of how they are treating these lifestyle diseases I have five minutes is that correct ten if you want I just want to highlight some other work we have done because as you saw we are dramatically increasing life expectancy in OECD countries in most countries outside Africa life expectancy is going up and because of that we have governments who are saying as I inferred when we were talking about the pension ages that as we are living longer so we should be pushing back state pension ages people should be working longer and actually you should be able to work as long as you want to I am very much pro getting rid of any kind of age discrimination I can't see why you can't have race discrimination and gender discrimination but you can still have age discrimination but that's another conversation but I think we must be careful that we don't look at the national figures and ignore the huge variation that we see and I want to illustrate that with just a small piece of work that we have done in the UK to detail some of these national figures and this is looking at inequality in mortality we have access to a very large UK data set nearly 2 million pension records these are occupational pension records so we are picking up those people who are sufficiently well educated to be in an occupation where you have an occupational pension so if you like we have already sliced off that bottom group and what we are able to do those of you who know about the Whitehall study in the UK which showed differential in late life mortality we can answer some of those questions but with far more power because we have nearly 2 million half a million of these people are already dead so we can actually these are actual mortalities we are looking at and what we did was we divided our groups into two sort of outlying groups we are just going to show you men here and we have what we call our low group they are the low income ill health retiree who had an unhealthy lifestyle and our high income normal health retiree and a healthy lifestyle and you can see that if you are 65 if you are in the low group you have got 12 years of life expectancy left if you are in the high group you have got up to 23 that is an 11 year difference and if we look at this schematically this is the proportion of 65 year old men expected to survive to each older age the ages along the bottom the probability on the Y axis and we are comparing the green unhealthy low income group with the blue healthy group and you can see particularly when you get into your ages huge difference in life expectancies now what we were also able to do was actually to tease out because we got quite a lot of power in this study tease out the impact of different facts on longevity and these are independent because many of you are going to sit there and say oh yes this is all related these are actually independent so if we took our manual employee poor unhealthy lifestyle ill health retiree as you saw he had only 12 years of life expectancy if he had returned in normal health he could have added a 1.8 years on if he had a healthy lifestyle 4.6 if he had a high income 4 and interestingly enough if he had done a non manual job only 0.7 so the impact of occupation was much much less than we thought but look here healthy lifestyle actually adds on more than anything else and so I think we are beginning to really really understand the role of healthy lifestyle across the life course and the role that public health can really make if you like in reducing that late life burden of ill health and dependency that we see at the end of lives so if we put these these two drivers together then we can see very clearly that falling fertility is actually having particular effects on our economies and societies increasing longevity is having a very different set of effects and a lot of those are going to be around health if we are going to have a third of our population aged over 60 and they are going to have health profiles that are disability and frailty and they are going to be alive for 30 years in increasing frailty societies are going to have massive public health bills to deal with long term care, social care etc if however we can push back disability and frailty and we can keep healthy life expectancy so healthy life expectancy keeps up with life expectancy then it's a very very different situation because we have these individuals staying in our workforces and particularly in OECD countries we need that because we are going to have to compete with Southeast Asia and Asian Growth centres for our skills so we need people to stay in the labour market more we know that they are experienced and we know that current cohorts coming through are very well educated far more than the cohorts coming through before but if we are not careful we are going to have a situation where we are pushing pension ages back to 75 I stuck my neck out about 3 years ago and said I thought state pension would hit 70 in my lifetime and then David Cameron last month I think or earlier in the year announced that there was something that the government was potentially looking at we are going to have huge numbers of people falling into disability benefits and staggering along for a few years until they can get their pension so it is a complex story but you can see that the two drivers are having two very different impacts on our economy finally just to conclude I want to just show you how really where we are going with this life expectancy a lot of work has recently done on centenarians one of my demographers recently at the end of last year did some predictions on the percentage of centenarians in the UK population across the century and this is because there is a new group called biodemography we are working on this the Max Planck Institute Joe Shansky in Chicago and what these biodemographers are trying to do is to look at the new science stem cell research nanotechnology the new genetics and say how is this going to impact upon future longevity and my colleague produced some statistics and we said you are mad sorry this cannot be the case and then about three weeks later the ONS which is a rather sort of boring group of statisticians they are not wacky statisticians at all they produced this for the UK this is a projected number of centenarians in the UK and it was higher than the work that we had done we can't have about 12,000 centenarians they are predicting that we will be approaching 400,000 nearly half a million centenarians by the middle of the century and a million heading for a million centenarians by the end of the 21st century there are 8 we have 8 million people who are currently alive in the UK they say we will reach 100 1.6 million of those are already over 60 3 million in the under 16 year olds but it fits in with what other demographers are saying Val Pearl out of the Max Planck Institute he is predicting that half the baby girls born at the end of last century will live into three centuries so my daughter who was born in 1996 has a really good chance of making it into the 22nd century they are also suggesting that the 2007 birth cohort if you do this kind of analysis has a life expectancy of 103 so we really really are pushing back the boundaries we are not having babies we are all living longer and it is going to have a profound impact on our society and I am just going to put up I think it is three pictures so that we can discuss it because I think we need also to look at some of the social and conceptual implications number one is generational succession we live in a society where our societies, communities families, workplaces are used to the idea that you pass down assets, wealth and status in a particular regular time, what happens when we don't inherit from our parents till we're 80 or from our grandparents till we're 80 how are we going to adjust our workplaces to these very very long possibly potentially healthy lives what is going to happen to the life course this is a black fire station it's the seven ages of man if ever you go through a black fire station I think it's the most interesting thing or the most interesting reason if we are going to be living 120, 130, 140 years say we are, I think we will have larger numbers of people living over 115 I may not stretch it beyond that this century but still, are we going to have 12 ages of man or are we going to start stretching out our life courses it's crazy that we're in education then work and then we've got 50 years of retirement ahead of us how is society going to adjust to that I recently talked to the City of London boys school and I thought they were going to be sixth formers and they turned out to be between 12 and 18 and I thought how do I talk to young boys so I split them into two groups and I said you're going to live till you're 50 you're going to live till you're 150 and bearing in mind when you're a 12 year old 50 is so dear on the pale I thought this may not work and a little boy sitting over there said if I'm going to live till I'm 150 I'm not going to start having kids till I'm 80 but actually that was the way of thinking and then finally is this the generational contract what's going to happen to the generational contract and just to conclude and it says that parents bring up children and in return children care for parents as they get older in Asia it happens within the family still in Europe it happens within the public system because we contribute taxes and those taxes produce pensions and welfare payments but there are a whole group including one of my philosophers in my institute and they are beginning to say given the success of current cohorts reducing their fertility and their mortality and they've benefited from that they've had less dependent children so they can benefit and they're going to live longer because their mortality rate is going down should they not be bearing more responsibility for their old age and I think it really does raise quite an interesting question about this generational contract and how we're really going to negotiate it because this is happening very very quickly I think that's the other thing, the speed at which these life expectancy increases the fact that these life expectancy falls are happening is quite extraordinary and that's just a picture of Oxford a picture thank you