A Stitch in Time

A measure of the steps Americans are taking to live long and well Tamara Sims, Steve Vernon and Jialu Streeter August/September 2017

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It’s been well documented that the populations of developed nations are aging, with many people living well into their 70s, 80s, 90s and beyond. As a result, the proportion of citizens living at older age groups is increasing significantly relative to the rest of the population in developed nations.¹

During the 20^th century, life expectancy at birth increased by roughly 30 years for many developed nations. This gift of longer life is one of humankind’s greatest achievements. It’s the result of many factors, including reliable and safe food and water, efficient and effective sanitation, vaccinations against formerly deadly infectious diseases, electricity, broad-based public education systems, and a reduction in warfare and violent deaths. These advantages typically are available to citizens of all walks of life in developed nations.

Looking at it from an evolutionary perspective, this increase in life expectancy occurred in the blink of an eye. As a result, our species isn’t truly prepared to live long, healthy lives.

As individuals, it just doesn’t come naturally to us to plan ahead for long periods of time, including saving for the distant future and protecting against chronic diseases that can result from many years of unhealthy behaviors. For example, a recent survey report by the Society of Actuaries (SOA) indicates that only 19 percent of retirees plan ahead for 20 years or more; and well over one-third (40 percent) either don’t plan ahead or report they haven’t thought about it.² Yet most retirees will live well beyond 20 years.

As a society, we haven’t redesigned institutions, systems or policies fast enough to keep up with this sudden shift in longevity. For example, working longer is a reasonable response to the challenge of financing longer lives, yet workforce participation among the 65+ age group is less than 20 percent (although this percentage has been increasing since 2000).³ This is a result of several factors, including resistance by older individuals to work longer and an inability for them to find work, and employers’ beliefs that older workers cost more and are less productive.

This significant achievement also generates new challenges. There’s much concern about the potential economic strain of supporting an aging population and the costs that will likely be incurred across the board by individuals, families and communities, and federal, state and local governments.⁴

One key outcome that has researchers interested in the life expectancy increase is that improvements in longevity and well-being within the past 50 years have been increasingly concentrated in the educated and affluent populations.^5,6,7,8 Of the many reasons attributed to this gap, the most common are higher prevalence of obesity and smoking, lower availability of healthy foods and quality health care, and exposure to harmful elements in lower-income jobs and communities.

How can more Americans from all walks of life live better and longer? What steps can we take collectively to help mitigate looming costs and realize the full potential of an aging society?

To help answer these questions, the Stanford Center on Longevity (SCL) initiated the Sightlines Project.⁹
The project identifies action steps that individuals can take to live long and live well, and measures the prevalence of Americans who are taking these steps. The goal of the project is to provide insight, stimulate conversation, motivate further research and generate ideas that promote wellness for all Americans in this age of human longevity.

Our aim is to help people arrive at their later years financially secure, physically healthy and socially engaged; and live well as long as possible. It’s best if they take action steps toward these goals as early as possible—not start thinking about them as they approach their retirement years.

As a result, it’s critical to make valuable social connections, engage in healthy behaviors and build financial security throughout adult life. How are Americans of all ages and all walks of life doing with these goals? Tracking is a critical first step, and that’s the mission of the SCL’s Sightlines Project.

Project Overview

SCL convened a group of scientists, researchers and experts from Stanford and elsewhere and asked them to identify variables that predict long and healthy lives. We spent two days together, debating evidence and identifying the best predictors of longevity and well-being.

We focused on action steps that are malleable—actions that people can feasibly take in their daily lives. We acknowledge that many of the action steps may be difficult for individuals to take on their own, without support from peers, technologies, organizations or communities.

Based on existing literature, we identified more than 100 behaviors and metrics with known links to longevity and well-being. This began an iterative process to narrow the list of indicators and seek large-scale, high-quality data sources that allowed us to compare how each present-day age cohort is doing relative to its same-aged counterparts from 15 to 20 years ago.

After reviewing the available data from multiyear studies of more than 1.2 million Americans completed over two decades, SCL identified seven nationally representative surveys to be analyzed. Ultimately, we distilled the findings to three overarching areas that are critical to well-being across the life span: financial security, healthy living and social engagement. Within each area, SCL pinpointed eight to nine specific action steps associated with longer, healthier lives.

Figure 1 summarizes these action steps and identifies acronyms of the U.S. surveys used for Sightlines (see the sidebar at the end of this article for a description of each acronym).

Taken together, these steps may be used as a checklist for people who want to increase their odds of living a long, healthy life.

These metrics also can be used by policymakers; employers; educational and financial institutions; communities; and local, state and federal governments to assess how they might help their employees, students, customers and citizens realize these action steps and live longer, healthier lives.

How Well Are Americans Doing Today?

Overall, how well are Americans doing today in each of the three areas of concern? Figure 2 shows the average percentages of Americans who are taking the action steps in each domain.

It also shows how many Americans are engaging in each action step to a sufficient degree in each of the domains.

• Healthy behaviors: By 2011, fewer than two-thirds of Americans were taking these action steps—both in aggregate and across age groups.
• Financial security: In 2014, a little more than two-thirds (67 percent) of Americans age 65 to 74 were taking these action steps, whereas a little more than half (56 percent) of Americans age 25 to 34 were.
• Social engagement: The prevalence for most Americans who took these steps in 2012 hovered around 50 percent, with the exception of those ages 35 to 44, whose prevalence equaled 56 percent.

It’s useful to look at the overarching domains and understand whether different age groups are doing well in different aspects of well-being today. It is perhaps more important, however, to look back over time to see whether or not Americans are doing better considering an increased awareness of longer lives and knowledge of the importance of physical, financial and social health.

Healthy Living: Recent Gains Offset by Slippage

The eight action steps within this domain fall into two categories: healthy daily activities and risky behaviors. Most people are aware of these steps—getting around to actually doing them has proven to be much harder.

Healthy Daily Activities

• Exercise moderately (at least 150 minutes per week).
• Limit sedentary time (less than 320 minutes per day sitting).
• Maintain a healthy body mass index (BMI) that is below 30.
• Eat five servings of fruits and vegetables daily.
• Get sufficient sleep (between seven and nine hours per night).

Risky Behaviors to Avoid

• Tobacco and nicotine use
• Excessive alcohol consumption
• Illicit drug use

Figure 3 shows the change from 1999 to 2011, illustrating that not much has changed in overall prevalence since 1999. Gains in some areas, such as exercising more and smoking less, have unfortunately been offset by increases in sedentary behavior and obesity.

Here are some potential entry points for organizations and institutions encouraging Americans to improve their health:

• Expand exercise guidelines to include guidelines for sedentary behavior.
• Implement campaigns to promote less sitting and more light physical activities.
• Change employer norms to encourage standing or walking versus sitting during meetings and phone calls.
• Improve definitions of a healthy diet, and increase accessibility to fresh produce and decrease the cost.
• Modify wearables to include meaningful incentives (e.g., benefits that involve feeling happy or socially connected) to nudge healthy behaviors.

Financial Security: Trends are Ominous

The nine actions within this domain fall into three categories: cash flow, asset growth and protection. Compared to healthy living and social engagement, the financial security action steps can be the hardest for individuals to achieve on their own and are most likely to be improved through help and support from employers, financial institutions and public policy.

Cash Flow

• Earn income that’s more than 200 percent of the federal poverty level.
• Keep noncollateralized debt (credit card, student debt, payday loans) to manageable levels, at no more than 20 percent of household income.
• Be able to meet a $3,000 emergency.

Asset Growth

• Set aside funds for nonretirement goals.
• Save for retirement.
• Own a home.

Protection

• Get health insurance.
• Obtain long-term disability insurance and long-term care protection.
• Buy life insurance.

Figure 4 shows that all age groups under age 65 have shown troubling declines since 2000.

The foundation of financial security for most individuals is sufficient cash flow to meet current living needs and save for the future. SCL reviewed research that indicates increased odds of undesirable outcomes for individuals and families with incomes below 200 percent of the federal poverty level. These undesirable outcomes include increased mortality and morbidity rates, lower educational attainment, and increased chances of being a victim of crime and violence.

Figure 5 shows that more Americans are living at or near poverty in 2014 when comparing prevalence in the year 2000 to the figures today.

Figure 6 shows that asset-building activities, such as home ownership and participation in retirement plans, are down in 2014 for most age groups when compared to 2000.

Here are some potential entry points Americans can use to improve their financial security:

• Address student debt by reexamining college-specific, private, federal, state and local programs to limit initial debt and pay it off more efficiently.
• Institutionalize financial education programs to enhance financial planning abilities and offer post-secondary educational offerings to support a broader range of occupational aspirations at all life stages.
• Increase access and promote larger contributions to saving and retirement plans, especially among the growing number of workers not covered by employer-sponsored plans, such as automated and progressive defaults.
• Provide affordable health insurance programs for individuals who are not eligible for employer- or government-sponsored insurance.

Social Engagement: Traditional Methods Waning

Throughout the past few decades, the benefits of this domain have been less obvious than those that come with improved financial security and health. Research demonstrates, however, that social engagement contributes significant benefits to physical and mental health and longevity. Many are surprised to learn that socially isolated people have mortality rates comparable to smokers, and twice the mortality risk of the obese.

The eight action steps listed here fall into two categories: meaningful relationships and group involvement.

Meaningful Relationships

• Have deep interactions with a spouse or partner.
• Seek out frequent interactions with family.
• Get social support from family.
• Have frequent interactions with friends.
• Get social support from friends.

Group Involvement

• Converse with your neighbors.
• Volunteer.
• Participate in the workforce.

Figure 7 shows that little has changed since 1999, with one exception: Today’s 55- to 64-year-olds are less likely to be socially engaged than their predecessors.

Here are some potential areas where Americans can nurture their social portfolios:

• Rethink the potential of enhancing social interactions and fostering social support in the workplace, particularly when demands at home are high, such as starting a family or caring for a sick loved one.
• Design organizational and community environments to support more proximate social interaction among neighbors and active civic engagement.
• Don’t just encourage, but normalize volunteerism, particularly among 55- to 64-year-olds who are approaching retirement and will have the flexibility to give back to their communities.
• Increase accessibility and fine-tune social technology to optimally supplement interpersonal interactions, particularly among groups vulnerable to social isolation.

The Proper Perspective

Of course, taking all of these steps won’t guarantee a long, comfortable, healthy life. Many people take every one of these steps and don’t live long, healthy lives; many others have lived a long time in spite of not engaging in most of these healthy behaviors.

In addition, other actions not captured during this initial phase of the Sightlines Project are also beneficial to long-term well-being. However, substantial scientific evidence indicates that living long and well is more realistic for people who take the specific action steps identified in Sightlines. In addition, if most citizens adopt more of these steps, there’s a very good chance that the long-term costs and challenges associated with aging will be mitigated.

“There is a great deal that people can do to ensure long and satisfying lives,” says Laura Carstensen, psychology professor and founding director of the SCL. “We hope that examining trends among factors known to influence longevity will help to inform national debate and stimulate entrepreneurial innovation.”

The challenge of optimizing an aging society is a nice problem to have, given the alternative: navigating the plights of shorter lives, such as widespread famine and plagues that were prevalent just a few generations ago. SCL’s Sightlines report provides valuable insights and is highly relevant to stakeholders across the board, including you.

Four key takeaways for individuals to consider

1. Anticipate living into your 80s and 90s, and raise your children to be centenarians.
2. Think about health broadly as physical, financial and social wellness.
3. Continue learning new ways to be healthy, make good financial choices and connect to others throughout your life in formal or informal settings.
4. Explore ways to be actively engaged in paid or unpaid work for most of your life.

Four key topics for stakeholders aiming to make a large-scale impact

1. Develop policies targeted at diverse populations that not only focus on goals to prevent risky and unhealthy behaviors, but focus on goals to promote living well.
2. Identify appropriate change agents. Effectiveness of policies will vary depending on whether they are implemented by federal, state, local or other private institutions. National interventions might be better suited for indirect behavioral interventions, such as default or opt-out policies. Local interventions can focus on the built environment and direct supportive services. At all levels, it is likely most fruitful to appeal to groups that are meaningful to people, such as those with whom they identify strongly, want to belong or feel they can make a difference.
3. There is no one-size-fits-all approach. Identify the most vulnerable demographic subgroups and target interventions accordingly. Who is vulnerable depends on many individual characteristics (e.g., age group, ethnicity, gender, educational status) and which aspect of health is at most risk (i.e., physical, financial, social).
4. Across the board, policy and decision makers need to acknowledge and adjust for this era of longevity. The first step is to recognize that people in their 60s, 70s and 80s are an invaluable resource that should be tapped into, not only for older adults’ well-being, but for the benefit of children and young adults, who can learn so much from them.

Next Steps and More Details

The Sightlines Project¹⁰ website hosts a wealth of information, including the percentage of Americans doing well in each action step by age, gender, marital status, income, education and ethnicity. These findings are steering the project toward more in-depth reporting on who is most successful and who is most vulnerable to better inform interventions, policies and decision-making. The website also acts as a repository for the latest research on these action steps, expert interviews and commentaries, and ongoing Sightlines projects. More than a website, it serves as a constant resource for those aiming to gain insights and ideas for reshaping the culture of long-lived societies.

Acknowledgment

SCL is grateful to the SOA for the financial support and for providing SOA volunteers to develop the inaugural report of the Sightlines Project. In particular, Anna Rappaport and Sam Gutterman volunteered many hours to the project.