Page i

PREPARING FOR AN AGING WORLD

THE CASE FOR CROSS-NATIONAL RESEARCH

Panel on a Research Agenda and New Data for an Aging World
Committee on Population
and
Committee on National Statistics
Division of Behavioral and Social Sciences and Education
National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.



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Page i PREPARING FOR AN AGING WORLD THE CASE FOR CROSS-NATIONAL RESEARCH Panel on a Research Agenda and New Data for an Aging World Committee on Population and Committee on National Statistics Division of Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C.

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Page ii NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, DC 20418 Notice: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was funded primarily by NIH Contract No. N01-OD-4-2139 between the National Academy of Sciences and the National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services. Additional funding was provided by the Andrew W. Mellon Foundation and the Rockefeller Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Suggested citation: National Research Council (2001) Preparing for an Aging World: The Case for Cross-National Research, Panel on a Research Agenda and New Data for an Aging World, Committee on Population and Committee on National Statistics, Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press. Library of Congress Cataloging-in-Publication Data Preparing for an aging world : the case for cross-national research / Panel on a Research Agenda and New Data for an Aging World, Committee on Population and Committee on National Statistics, Division of Behavioral and Social Sciences and Education, National Research Council. p. cm. Includes bibliographical references and index. ISBN 0-309-07421-5 (pbk.) 1. Aging—Research. 2. Aged—Economic conditions. 3. Aged—Health and hygiene. I. National Research Council (U.S.). Panel on a Research Agenda and New Data for an Aging World. HQ1061 .D317 2001 305.23′072—dc21 2001002008 Additional copies of this report are available from the National Academy Press , 2101 Constitution Avenue, NW , Lockbox 285, Washington, DC 20055 ; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu Printed in the United States of America Copyright 2001 by the National Academy of Sciences . All rights reserved.

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Page iii THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Page iv

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Page v PANEL ON A RESEARCH AGENDA AND NEW DATA FOR AN AGING WORLD F. THOMAS JUSTER (Chair), Institute for Social Research, University of Michigan RICHARD BLUNDELL, Department of Economics, University College London, United Kingdom RICHARD V. BURKHAUSER, Department of Policy Analysis and Management, Cornell University GRAZIELLA CASELLI, Dipartimento di Scienze Demografiche, Università di Roma “La Sapienza,” Italy LINDA P. FRIED, Welch Center for Prevention, The Johns Hopkins University ALBERT I. HERMALIN, Institute for Social Research, University of Michigan ROBERT L. KAHN, Institute for Social Research, University of Michigan ARIE KAPTEYN, Center for Economic Research, Tilburg University, the Netherlands MICHAEL MARMOT, Department of Epidemiology and Public Health, University College, London, United Kingdom LINDA G. MARTIN, The Population Council, New York City DAVID MECHANIC, Institute for Health, Health Care Policy and Aging Research, Rutgers University JAMES P. SMITH, RAND, Santa Monica, California BETH J. SOLDO, Population Studies Center, University of Pennsylvania ROBERT WALLACE, Department of Preventive Medicine, University of Iowa ROBERT J. WILLIS, Institute for Social Research, University of Michigan DAVID WISE, John F. Kennedy School of Government, Harvard University, and National Bureau of Economic Research, Cambridge, Massachusetts ZENG YI, Center for Demographic Studies, Duke University, and Institute of Population Research, Peking University NIKOLAI BOTEV, Liaison, Population Activities Unit, United Nations Economic Commission for Europe, Geneva Staff KEVIN KINSELLA, Study Director ELIZABETH WALLACE, Project Assistant BRIAN TOBACHNICK, Project Assistant BARNEY COHEN, Director, Committee on Population

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Page vi Consultants ROB ALESSIE, Department of Economics, Free University of Amsterdam JAMES BANKS, Institute for Fiscal Studies, London AXEL BÖRSCH-SUPAN, Department of Economics, University of Mannheim, Germany DAVID CUTLER, Department of Economics, Harvard University TULLIO JAPPELLI, University of Salerno, Italy YUKINOBU KITAMURA, Institute of Economic Research, Hitotsubashi University, Tokyo FRANCO PERACCHI, Tor Vergata University, Rome LUIGI PISTAFERRI, Stanford University NORIYUKI TAKAYAMA, Institute of Economic Research, Hitotsubashi University, Tokyo SARAH TANNER, Institute for Fiscal Studies, London ELIANA VIVIANO, Bank of Italy, Milan

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Page vii COMMITTEE ON POPULATION JANE MENKEN (Chair), Institute of Behavioral Sciences, University of Colorado, Boulder CAROLINE H. BLEDSOE, * Department of Anthropology, Northwestern University JOHN BONGAARTS, The Population Council, New York City ELLEN BRENNAN-GALVIN, Population Division, United Nations, New York City JOHN N. HOBCRAFT, Population Investigation Committee, London School of Economics F. THOMAS JUSTER, Institute for Social Research, University of Michigan, Ann Arbor CHARLES B. KEELY, Department of Demography, Georgetown University DAVID I. KERTZER, Department of Anthropology, Brown University DAVID A. LAM, Population Studies Center, University of Michigan, Ann Arbor LINDA G. MARTIN, * The Population Council, New York City MARK R. MONTGOMERY, * The Population Council, New York City, and Department of Economics, State University of New York, Stony Brook W. HENRY MOSLEY, Department of Population and Family Health Sciences, Johns Hopkins University ALBERTO PALLONI, Center for Demography and Ecology, University of Wisconsin, Madison JAMES P. SMITH, RAND, Santa Monica, California BETH J. SOLDO, * Population Studies Center, University of Pennsylvania JAMES W. VAUPEL, Max Planck Institute for Demographic Research KENNETH W. WACHTER, Department of Demography, University of California, Berkeley LINDA J. WAITE, Population Research Center, University of Chicago BARNEY COHEN, Director *Through October 1999.

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Page viii COMMITTEE ON NATIONAL STATISTICS 2000-2001 JOHN E. ROLPH (Chair), Marshall School of Business, University of Southern California JOSEPH G. ALTONJI, Institute of Policy Research, Northwestern University LAWRENCE D. BROWN, Department of Statistics, University of Pennsylvania JULIE DAVANZO, RAND, Santa Monica, California WILLIAM F. EDDY, Department of Statistics, Carnegie Mellon University ROBERT M. GROVES, University of Michigan and Joint Program in Survey Methodology, University of Maryland HERMANN HABERMANN, Statistics Division, United Nations, New York JOEL HOROWITZ, Department of Economics, The University of Iowa WILLIAM KALSBEEK, Department of Biostatistics, University of North Carolina RODERICK J.A. LITTLE, School of Public Health, University of Michigan THOMAS A. LOUIS, RAND, Washington, D.C. CHARLES F. MANSKI, Department of Economics, Northwestern University EDWARD B. PERRIN, Department of Health Services, University of Washington DARYL PREGIBON, AT&T Laboratories-Research, Florham Park, New Jersey FRANCISCO J. SAMANIEGO, Division of Statistics, University of California, Davis RICHARD L. SCHMALENSEE, Sloan School of Management, Massachusetts Institute of Technology MATTHEW D. SHAPIRO, Department of Economics, University of Michigan ANDREW A. WHITE, Director

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Page ix Preface Nearly two decades have elapsed since the United Nations convened the First World Assembly on Aging (Vienna, 1982). During that period, researchers have made enormous progress toward understanding various dimensions of the human aging process, from the molecular level upwards to the global population level. As our knowledge has expanded, we have come to better appreciate the dynamic nature of the aging process and to recognize the many unanswered questions that urgently need attention. On the eve of the Second World Assembly on Aging (Madrid, 2002), we hope this volume helps focus ongoing and future research in several important arenas. I would like to thank, first and foremost, my fellow panelists. Drawn from a variety of academic disciplines, most have studied one or more aspects of aging for the bulk of their careers. Each member contributed to the study by providing background readings, leading discussions, making presentations, and critically commenting on the various report drafts. The different perspectives that members brought to the table were instrumental in synthesizing ideas and forging agreement on overarching recommendations. Drafting the final report was a uniquely collaborative enterprise. The panel divided itself into five working groups, corresponding to the major substantive content areas—labor force participation; income, wealth and saving; family structure and intergenerational transfers; health and disability; and subjective well being. Each of the panel members made sig-

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Page xnificant contributions to the report in at least one of these areas, and many contributed comments in a number of areas. This report reflects the efforts of many organizations and individuals beyond those represented on the panel. The panel itself was established under the auspices of the Committee on Population, directed by Barney Cohen, and the Committee on National Statistics, currently directed by Andy White. Both directors were instrumental in developing and guiding the study. The impetus and funding for this project came primarily from the Behavioral and Social Research Program of the U.S. National Institute on Aging, and we are grateful to Richard Suzman for his motivation and suggestions. We also are grateful to the Andrew W. Mellon Foundation and the Rockefeller Foundation for additional project funding. A set of papers was commissioned to survey extant data and knowledge in several areas and to assist the panel in its deliberations. We benefited greatly from the work of these consultants: by Rob Alessie and Arie Kapteyn on wealth and savings in the Netherlands; by James Banks and Sarah Tanner on household wealth in the United Kingdom; by Richard Blundell and Sarah Tanner on work and retirement in the United Kingdom; by Axel Börsch-Supan on savings and retirement in Germany; by David Cutler on data needs for studying health care systems; by Tullio Jappelli and Luigi Pistaferri on household wealth accumulation in Italy; by Yukinobu Kitamura and Noriyuki Takayama on household wealth in Japan; and by Franco Peracchi and Eliana Viviano on work and retirement in Italy. The panel met six times over the course of 16 months. To ensure that the panel was attuned to the latest information on key topics covered in this volume, one meeting was arranged in London in September of 1999 to bring together researchers from countries other than the U.S. as well as from international organizations involved with aging research and policy. For their presentations and/or insightful comments, we are indebted to Gary Andrews (Center for Ageing Studies, Flinders University, Australia), Arpo Aromaa (National Public Health Institute, Helsinki, Finland), Alessandro Cigno (Dipartimento di Studi sullo Stato, University of Firenze, Italy), J. Edward Dowd (Ageing and Health Program, World Health Organization, Geneva), Catherine Fallon (Directorate of Employment and Social Affairs, European Commission, Brussels), Luigi Ferrucci (Istituto Ortopedico Toscano, Firenze, Italy), Emily Grundy (Centre for Population Studies, London School of Hygiene and Tropical Medicine), Gunhild Hagestad (Northwestern University), Peter Hicks (Social Policy Division, Organization for Economic Co-Operation and Development, Paris), Felicia Huppert (Department of Psychiatry, University of Cambridge), Stephane Jacobzone (Social Policy Division, Organization for Economic Co-Operation and Development, Paris), Alan Lopez (Epidemi-

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Page xiology and Burden of Disease Program, World Health Organization, Geneva), James Nazroo (Department of Epidemiology and Public Health, University College London), Jean-Marie Robine (INSERM Demography and Health, Montpellier, France), Richard Wall (Cambridge Group for the History of Population Social Structure, University of Cambridge), Mary Beth Weinberger (Population Division, United Nations, New York), and several of the commissioned paper authors mentioned above. This report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council (NRC). The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their participation in the review of this report: Joseph G. Altonji, Institute for Research on Poverty and Department of Economics, Northwestern University; Gary Andrews, Center for Ageing Studies, Flinders University, Australia; Arpo Aromaa, National Public Health Institute, Helsinki, Finland; Axel Borsch-Supan, Department of Economics, University of Mannheim, Germany; Jonathan Gruber, Department of Economics, Massachusetts Institute of Technology; Michael Hurd, Center for the Study of Aging, RAND, Santa Monica, California; James H. Schulz, Florence Heller Graduate School, Brandeis University (emeritus); and Linda Waite, Center on Aging, National Opinion Research Center, University of Chicago. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by T. Paul Schultz, Department of Economics, Yale University. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring panel and the institution. Lastly, we must acknowledge the efforts of two individuals as well as the staff of the NRC's Committee on Population and the National Academy Press. Julia Hum, University College, provided valuable assistance with the logistical aspects of the panel meeting in London. Heather Hewett, research secretary at the Institute of Social Research, University of Michigan, expertly facilitated communication and the transfer of data,

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Page xiiand test files between myself, the panel members, and the NRC staff. Within the NRC, we are indebted to Elizabeth Wallace and Brian Tobachnick, project assistants, for providing the essential infrastructure that facilitates such a project. Elizabeth skillfully and cheerfully handled a plethora of administrative matters during most of the panel's tenure, and Brian later took the reins and assured the orderly and efficient completion of the report and its subsequent preparation for publication. Special thanks go to Rona Briere, who edited the volume and made numerous suggestions for its improvement, and to Alisa Decatur for implementing the editorial changes. Kevin Kinsella, the NRC study director, not only helped to manage the overall work of the panel, along with Barney Cohen, Director of the Committee on Population, but also played a major role in drafting the panel report. Kevin wrote most of Chapter 2 (the demographic background of the problem), the initial draft of Chapter 1 (Introduction), and played a major role in the drafting of Chapter 5 (Intergenerational Transfers). F. Thomas Juster, Chair Panel on a Research Agenda and New Data for an Aging World

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Page xiii Contents EXECUTIVE SUMMARY 1 1     INTRODUCTION 15     Is There a “Crisis of Aging”?, 17     The Value and Challenges of Cross-National Research, 18     Charge to the Panel, 22     Study Approach and Scope, 22     Cross-Cutting Issues, 23     Organization of This Report, 26     References, 28 2     OUR AGING WORLD 30     Numbers and Proportions of Elderly, 31     Growth of the Oldest Old, 35     Metrics of Aging, 37     Dynamics of Population Aging, 41     Reliability of Demographic Projections of the Elderly, 57     References, 61 3     WORK, RETIREMENT, AND PENSIONS 66     Patterns of Work and Retirement Around the World, 68     Retirement Incentives and Pension Arrangements, 77     Key Data Requirements, 91

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Page xiv     Recommendations, 97     References, 98 4     PRIVATE WEALTH AND INCOME SECURITY: INTERNATIONAL COMPARISONS 102     Wealth Accumulation: Research Framework and Key Questions, 104     Data Sources, 112     Patterns of Household Wealth Accumulation, 131     Recommendations, 150     References, 151 5     INTERGENERATIONAL TRANSFERS 155     Policy Considerations, 158     Intergenerational Transfers, Economic Welfare, and Transfer Institutions, 159     Collection of Data on Intergenerational Transfers, 171     Assessing Family Dynamics and Their Implications for Future Transfer Patterns, 180     Research Gaps and Implications for Data Collection, 187     Recommendations, 192     References, 193 6     THE HEALTH OF AGING POPULATIONS 200     Key Issues, 202     Conceptual Model of the Determinants of Health Status, 204     Measuring Health Status, 205     Characterizing Health Care Systems, 207     Existing Health Data on Older Persons: Types, Availability, and Quality, 212     Overcoming Obstacles to Cross-National Research on the Health Status of the Elderly, 217     Recommendations, 219     Annex 6-1.     The Role of Social Inequality in the Health of Elders, 221     Annex 6-2.     Commonly Used Measures of Health Status, 225     References, 244 7     WELL-BEING: CONCEPTS AND MEASURES 250     The Measurement of Well-Being, 252     Findings on Well-Being Among the Elderly, 270     Recommendations, 272     References, 274

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Page xv 8     CONCLUSION AND MAJOR RECOMMENDATIONS 276 APPENDIX A:     LEARNING FROM CROSS-NATIONAL RESEARCH 283 BIOGRAPHICAL SKETCHES 289 INDEX 295

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Page xvi

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Page xvii PREPARING FOR AN AGING WORLD

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Page xviii