POPULATION AGING AND LONGEVITY: IMPLICATIONS FOR MEGACITIES

Victor G. Rodwin*


     The world's population is increasingly concentrated in urban areas. United Nations estimates indicate that 61 percent of the population will live in cities in 20251. There are now at least 20 "megacities" defined by the UN as cities of over 10 million people; in 2015, there will be 232. The fastest growing megacities are in developing nations and in 2015, with the exception of Tokyo and New York, the largest megacities will be in developing nations. Despite this trend, there are at least two reasons why wealthier nations must be concerned by the rise of megacities.

     First, what happens in megacities affects global health. Growth of air travel, migration, refugees, as well as the persistence of wars, famine and natural disasters have magnified their influence and vulnerability. Second, megacities are increasingly viewed as instruments of social and economic development3. They are strategic locations for transnational corporations, as well as for government and international organizations who seek to reduce the birth rate, generate economic growth and promote innovation4. With respect to these goals, it is important to track how megacities will cope with a world-wide demographic trend - population aging and longevity5. This trend is not limited to wealthier nations. By 2020, along with the United States, Japan and Russia, seven developing nations -- China, India, Brazil, Indonesia, Pakistan, Mexico and Bangladesh -- will be among the 10 countries with the largest older population6.

The World Cities Project

    As urbanization and population aging increases, we will need models of how to accommodate this population shift, as well as analyses of best practices. The World Cities Project (WCP), a joint venture of the International Longevity Center-USA and New York University's Wagner School of Public Service, examines the impact of population aging and longevity on New York, Paris, Tokyo and London -- the four largest urban agglomerations of the wealthy nations belonging to the Organization for Economic Cooperation and Development (OECD). These cities share in common an immense international traffic in the flow of trade, financial transactions, electronic communications, airline travel, and policy ideas. They often influence, significantly, the growing megacities of developing nations due to their relative wealth and dominance, their ties to the global economy, and their concentration of business, cultural and scientific activities. Since New York, Paris, Tokyo and London have all been affected by declining birth rates and the rise in the share of older persons, they already include neighborhoods in which the percentage of persons 65 years and over is close to 20 percent.

    The World Cities Project will compare, in its first phase, the health, quality of life, health and social services for persons 65 years and over, with special attention to frail older persons aged 80 years and over. In its second phase, WCP will examine these issues for children under 14 years, particularly young children under 5 years who are "at risk," either because their parents are poor or because they live under systems of foster care. WCP will document common characteristics and problems, as well as differences among the four cities. On the basis of quantitative data collection and case studies, WCP will organize working group meetings on specific themes, with the participation of city officials, policy analysts, and health and social service professionals. These meetings will be designed for knowledgeable experts to review research findings and to identify innovative and successful policy or program interventions. In the final stage of the project, designated areas of each city will serve as a kind of social laboratory in which to evaluate the effectiveness of alternative interventions.

    New York, Paris, Tokyo and London have been the subject of numerous studies in the field of architecture and urban planning. But there are no comparative studies of health and social services among these vulnerable giants. In addition to filling this knowledge gap, there is a methodological reason for focusing on world cities as a unit of analysis. Most comparative analyses of health systems focus on national averages that mask important variations within nations, between urban and rural areas, and between large and small cities. In contrast, WCP compares smaller and more similarly situated units, i.e., the inner core and outer rings of these world cities, which share in common more characteristics and problems, and therefore provide notable advantages for cross-national learning.

Initial Comparisons

    Consider the comparison of the inner core of New York City - Manhattan with its 1.5 million population - to the inner cores of the Paris metropolitan region, the Tokyo Prefecture and Greater London. For Paris, we examine the 20 arrondissements within the peripheral highway surrounding the old walls of the city (2.1 million). For Tokyo, we examine 11 inner Ku, an area mostly surrounded by the peripheral Yamanote subway line (2 million). For London, we examine the 14 boroughs known as "Inner London" (2.7 million). All four inner cores have economies based on services and information, which are closely tied to international transactions. They are also centers of culture, media, government and international organizations. And their resident populations include some of the wealthiest and poorest members of their respective nations.

    The inner cores of New York, Paris, Tokyo and London function as employment centers that attract large numbers of commuters from their outer rings - between 32 and 38 percent of their working populations. Their health care services are a significant export sector to their surrounding regions. For example, in Manhattan and Paris resident admissions to all hospitals represent approximately one-half of all hospital admissions. The density of physicians in Manhattan, Paris and Inner Tokyo is roughly the same - approximately 70 (per 10,000 population) which is more than twice that in their surrounding first rings. The density of hospital beds is also roughly the same in Manhattan and Paris (around 9 per 1000 population) and almost twice that in Inner Tokyo; and the ratio of inner core to first ring bed densities ranges from 2.5 in New York and Tokyo to 1.5 in Paris.

    Despite their common characteristics, there are, of course, many significant differences among these cities. To begin with, their population densities are much higher in Manhattan and Paris than in Inner Tokyo and Inner London7. Manhattan is characterized by the highest level of inequality in the distribution of income. For example, intra-city variation in average household income varies from a ratio of 2.1 in Inner Tokyo, 3.0 in Paris, and 5.7 in Manhattan8. The percentage of single-parent families is also much higher in Manhattan (22.8%) than in Paris (14.7%), Inner London (9.8%) or Inner Tokyo (9.0%). Birth rates are roughly the same in Manhattan and Paris (around 48 per 1000 females aged 15-45), highest in Inner London (64.6) and lowest in Inner Tokyo (30.2). The percentage of persons aged 65 years and over is highest in Inner Tokyo (15.4%) in comparison to Paris (14.8%), Manhattan (13.3%) and Inner London (11.5%); and population projections for 2015 indicate that Inner Tokyo will have the highest percentage of persons 60 years old and over (35%) in comparison to Paris (20%) and Manhattan (18%). At the present time, however, Paris has almost twice the percentage of older persons 85 years and over (2.5%) as Manhattan, Inner London and Inner Tokyo.

    Most of these differences -- poverty rates, birth rates and family structure -- reflect national patterns and policies with regard to income maintenance and immigration. Other differences -- population density and percentage of the older old -- are distinctive urban characteristics. Still other contrasts, about which we are attempting to collect comparable data, involve societal and institutional responses to the growing need for long-term care services. We know, e.g., that Inner Tokyo has the lowest rate of persons 85 years and older living alone (18%) in comparison to Manhattan (61%) and Paris (65%). Also, Inner Tokyo has the highest rates of labor force participation for men aged 60-64 years (78.2%) in comparison to Manhattan (59%) and Paris (47%)9. Which city delivers the most long-term care services for homebound frail older persons? Which city has the highest rate of institutionalization for frail older persons? Which city relies the most on family caregivers?

    The population census indicates that the percent of the institutionalized population 75 years and over is higher in Manhattan (5.0%) than in Paris (3.8%). Likewise, the number of nursing home beds is higher in Manhattan (33.3 per 1000 population aged 65 years and over) than in Paris (22.8). These data are consistent with the best available indications of mobility limitations among older Manhattanites and Parisians. They are also consistent with data indicating a higher percentage of older persons receiving home nursing care in Manhattan than in Paris. What is more, they support evidence that the health of Parisians is better than that of Manhattanites. Whether one examines life expectancy at birth or at 65 years, it is lower in Manhattan than in Paris.

    It is too early in our research to present robust findings across all four cities. One hypothesis guiding this inquiry is that higher levels of poverty and greater income inequality result in greater mobility limitations, greater reliance on nursing homes as well as home care services, and lower health status indicators. Another hypothesis is that cultural traditions and the size of the informal sector will strongly affect institutional responses to the growing need for long-term care services for frail older persons in all four cities.


    *Victor G. Rodwin is Professor of Health Policy and Management, Wagner School of Public Service, New York University, and Director of WCP at the International Longevity Center - USA, an independent, not-for-profit, non-partisan organization affiliated with the Mt. Sinai School of Medicine and founded by Dr. Robert N. Butler, M.D., its President and CEO.

NOTES
  1. UN projections cited by E. Linden, "The Exploding Cities of the Developing World," Foreign Affairs (75)1, 1996.
  2. World Urbanization Prospects: 1999 Revision. United Nations Population Division.
  3. G. Bugliarello, "Megacities and the Developing World," The Bridge (29)4, Winter 1999.
  4. S. Sassen, The Global City: New York, London, Tokyo. Princeton: Princeton U. Press, 1991; R. Kaplan, "Could This be the New World?" New York Times, Dec. 1999
  5. R. Butler and C. Jasmin, eds. Longevity and Quality of Life: Opportunities and Challenges. New York: ILC-USA, April 2000.
  6. C. Muller and M. Honig, Charting the Productivity and Independence of Older Persons. New York: ILC-USA, April 2000.
  7. Population densities range from 66,390 persons per sq. mile in Manhattan, 53,041 in Paris, 30,000 in Inner Tokyo and 21,599 in Inner London.
  8. The poverty level (measured as the percentage of households below half of the median income) was twice as high in Manhattan (28.5%) as in Paris(12.8%) in 1994.
  9. For women of this age cohort, the Manhattan rate (51%) exceeds the rate for Inner Tokyo (49%) and Paris (34%).