Population ageing: the timebomb that isn't?

Population ageing is a concern in all developed countries. For the first time, there are now more people over the age of 65 in the United Kingdom than there are children under 15 years. Over the past century, the proportion of over 65s has grown from about one in 20 to around one in six. Although declining birth rates and infant mortality formed the basis for this growth from the end of the 19th century until the second world war, since the 1970s increasing life expectancy has been an additional driving force (fig 1⇓). This population ageing has worried policy makers because for every worker paying tax and national insurance there are more older citizens, who make greater demands on social insurance, health, and welfare systems and have increasing morbidity and disability. The standard indicator of population ageing is the old age dependency ratio. It takes the number of people who have reached the state pension age and divides it by the number of working age (16-64 years) adults in order to estimate the proportion of older people relative to those who pay for them. Although the phased raising of the state pension age (from 65 for men and 60 for women) to 68 for both sexes, which will keep 3.5 million people in the working age, will initially cause the ratio to decline from today’s 31% in England and Wales, by 2035 it will have risen to 37%. However, the old age dependency ratio is a poor measure of the burden of an ageing population. It counts neither the number of dependent older people nor the number who sustain them. It merely takes a cut-off point (the state pension age) and assigns adults to the two sides of the ratio accordingly. This might be a useful rule of thumb if the relative size of these two age groups tracked the volume of old age dependency, but it does not. We propose an alternative measure that gives a more accurate and very different picture and consider the implications of our results for health policy. Counting dependent older people