The global demographic transformation driven by increased longevity and falling fertility rates is reshaping societies at an unprecedented scale. By 2050, more than 2.1 billion people will be 60 or older, with those over 80 projected to quadruple. This shift is often framed as a crisis, with governments fearing unsustainable public expenditure on pensions, healthcare, and long-term care. However, evidence increasingly suggests that ageing, if met with the right strategies, is as much a lever for innovation as it is a policy challenge.

Fiscal Sustainability and the Ageing Population

The rise in the old-age dependency ratio (OADR) across OECD nations, exceeding 50% in Japan and expected to surpass 37% in Belgium by 2025, has generated concerns over fiscal sustainability. Yet, empirical analysis shows that rising interest charges on public debt have not, thus far, crowded out spending on ageing-related services. Instead, the capacity to finance pensions and healthcare depends more on intertemporal fiscal discipline and effective governance than on demographic destiny.

Importantly, not all ageing-related costs are unproductive. Many older adults remain economically active, contributing via formal employment, entrepreneurship, and informal care. In countries like Germany and Japan, policies supporting flexible retirement and knowledge transfer from retirees to younger cohorts are already mitigating the impacts of workforce ageing.

HADR and OADR by world region
Source: The Lancet

Health Impacts: From Treatment to Prevention

Ageing also brings rising prevalence of non-communicable diseases (NCDs), which are the leading contributors to lost healthy years among those aged 70 and above. Managing this disease burden requires a pivot from reactive treatment to preventative, person-centred care.

Long-term care (LTC) systems, especially in Asia, must adapt to shrinking family care networks due to urbanisation and smaller household sizes. Future-ready LTC systems include integrated financing, community-based delivery, and enabling technologies that support independent living. Countries like Japan and China have made significant progress in expanding coverage, though challenges remain in aligning systems with rapidly ageing populations in middle-income contexts.

Influences on the need and demand for Long-Term Care services for older people
Source: Semantic Scholar

Productive Ageing: Turning Longevity into a Dividend

In Europe, ageing has prompted a shift towards “productive ageing” models. These include phased retirement, later-life entrepreneurship, and investments in digital literacy. Studies show that with adequate policy support, older workers can sustain or even improve productivity, especially in knowledge-intensive sectors.

Encouraging later-life labour market engagement reduces fiscal pressure and enhances social cohesion and individual well-being. Ageing populations should not be reduced to a fiscal burden. When supported by health systems aligned with functional ability, labour markets designed for multi-generational inclusion, and policies prioritising dignity and independence, longevity becomes a demographic dividend.

Level of ageing-related public spending in 2019 and projected changes in 2070
Source: European Commission (2021 Ageing Report) and ECB calculations

Rethinking Ageing: From Burden to Catalyst

The challenge ahead is not ageing itself but our response to it. With clear policy direction grounded in equity, innovation, and integration, the global ageing phenomenon can improve the trajectory of human development.

At Orion Health, we believe in building future-ready health systems that support preventative care, integrated data, and person-centred services for all generations. Discover how our solutions are helping shape healthier, more connected communities.

Authored by Tom Varghese, Global Product Marketing & Growth Manager at Orion Health.


References

European Commission, Directorate‑General for Economic and Financial Affairs. (2021, May). The 2021 Ageing Report: Economic and budgetary projections for the EU Member States (2019–2070) (European Economy Institutional Paper 148). Publications Office of the European Union. https://doi.org/10.2765/84455

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Jayawardhana, Thaveesha, et al. “The Cost of Aging: Economic Growth Perspectives for Europe.” PLOS ONE 18, no. 6 (2023): e0287207. https://doi.org/10.1371/journal.pone.0287207

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