Baroness Camilla Cavendish, on Social Care and Longevity - Our Longevity Futures, with Chris Curwen

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Over the last 150 years, our life expectancy has grown, from 40 years in 1850 to over 90 years today in some countries. This can be attributed to advances in medical science, improvements in public health, and equitable access to healthcare, especially for maternal and infant care.

What will the future hold for our world? Will we be overwhelmed by a ‘silver tsunami’ of retirees with poor health, or will we use the latest research findings to rejuvenate the elderly and extend their lifespan?

Our Longevity Futures is a show where I, Chris Curwen, speak to scientists, engineers, entrepreneurs, doctors, politicians, and community activists who are giving the world the hope that we can all live longer and better, and improve our health.

In episode number 5 of ‘Our Longevity Futures’ we host Baroness Camilla Cavendish.

Camilla Cavendish is an award-winning writer and broadcaster, as well as a Senior Fellow at Harvard’s Kennedy School of Government. A regular columnist for the Financial Times, she is also the author of “Extra Time: Ten Lessons for an Ageing World”, published by HarperCollins in May 2019.

She has been Head of the Prime Minister’s Policy Unit under David Cameron, a Non-Executive Director of the Care Quality Commission, and she is best known for introducing the UK government’s sugar tax on sugary drinks in 2016 in a bid to curb obesity, and for her work on child protection.

In this discussion, Camilla eloquently and seamlessly bridges the gap between cold, hard statistics and story-telling to create a gripping and emotive account of the challenges and opportunities the science of longevity will present to society in the near future.

Camilla talks about her personal views on the nature of ageing and the journey that led her to writing Extra time, how the global changing population demographics will impact societal and political life in the future, and how current inequalities in wealth may soon manifest into inequalities of medical care and a growing biological divide.

Here are some of the highlights for my conversation with Camilla:

Chris: What is your personal definition of ageing?

Camilla: So I always think aging is a really loaded word, which I prefer not to use in a way, but I think if I have to, if you push me, I’ll say it’s a natural process that we shouldn’t be ashamed of. And actually that we can control more than we think.

Chris: How did you personally get interested in the issue of longevity, especially from looking at it from a biotechnology perspective?

Camilla: So I was researching this book partly from Harvard, where as you say, I have a fellowship and I was interested in a lot of aspects, but because I was sitting at Harvard, and with MIT next door, I was able to talk to some really fantastic biologists and geneticists. Including, in fact, Cynthia Kenyon who was on the West coast who famously isolated the Daf2 gene from C elegans worms.

What fascinated me was that there are decades of science now looking at ways in which genes can really prolong life quite substantially and not just prolong life, but also shorten the Twilight zone at the end. And for me, the most interesting thing is not just can we live forever or can we live longer, but how do we shorten those Twilight years?

Particularly of the ones, including dementia, which is what people most fear.

BY 2020, FOR THE first time in history, there will be more people on the planet over 65 than under 5.1 More grandparents than grandchildren.
Cavendish, Camilla. Extra Time: 10 Lessons for an Ageing World (p. 9). HarperCollins Publishers. Kindle Edition.

Chris: In the first chapter of your book, you talk about how global demographics are changing, becoming unsustainably, unbalanced by the, the ever-increasing elderly population, otherwise known as the ‘silver tsunami’. Do you think the UK government and governments around the globe are doing enough to prepare for these changes? And if not, what changes would you suggest that they might?

Camilla: Obviously I sat, as you said, in government which was engulfed by its own tsunami of health costs rising and pensions costs rising. I think governments have to reframe their view.

I think they’re far too pessimistic. I think they have to keep pushing up retirement ages. Not necessarily for everybody, because obviously what we’re also seeing is a huge divergence in how people age, but they have to get much more serious about those health inequalities. And actually, I think governments have been quite reluctant to intervene in preventative health to talk to people about lifestyles, but it’s becoming increasingly clear that if you’re rich and better off and you live in particular parts of a country, whether that’s the US or UK, you have a much better chance of having a much longer and healthier life than if you don’t.

I think has to become an issue that governments have to act on.

Chris: Yeah. You mentioned, in your previous writing, that the wealthiest 10% of the population is likely to live 18 years longer than the poorest. Creating this, not only inequality of wealth, but also a biological divide between the rich and the poor. So how would you actually propose we resolve this issue?

Camilla: There is no one silver bullet. And if you talk to people like Michael Marmot, he will talk about the whole life course and poverty housing pollution, the whole set of stress, all set of things that bear on this.

Obviously, one of the things I’m known for is having introduced the sugar tax on fizzy drinks, when I worked in the government, which was something people feel very strongly about. It was a tiny move to try and start to tackle obesity. I do think that obesity is an epidemic. I do think it’s reducing the life chances of many of the poorest people in our society, and I think there is quite a lot that governments can do about that. But I think it’s also empowering and encouraging doctors to take preventative health seriously. And as I say in the book, 9 out of 10 doctors in the US and 8 out of 10 GPs in the UK said that they’re very reluctant to talk to people about their weight at all. And we ought to make it like smoking and ought to be absolutely axiomatic that you talk to patients about it, and you try weight loss programs and you support people through it.

Chris: So we face several ethical challenges when caring for a growing population that is aging. So how do we address these in a way that is positive, positively affects the whole society.

Camilla: Do you want to tell me more about what you, which ethical challenges you’re thinking of?

Chris: So in supporting an elderly population, in regards to economics, it’s going to be a massive challenge for the working population to support the growing elderly. How will do we mitigate that?

Camilla: In the UK, we’ve recently passed the point where actually the average pension household is now better off than the average working household. And that is a result of the policy put in place about 10 years ago, which was designed to make pensioners better off, but actually has slightly overactive because it was paid to various different indicators.

The real issue is, as I say again, it’s between the rich and poor. So if you look at analysis in the US, a really interesting analysis, been done by the Academy of sciences, which suggests that even if you wrap up all the disability benefits that go to poor people, if rich people are living so much longer, they’re going to start taking a bigger share of the welfare budget than anybody ever meant them to take.

So I think I’m afraid there are some really tough decisions to be made about that, but they’re not just going to be based on age. They’re going to be based on characteristics, which is of course. Much harder to do. So you’ve got to have the two things in tandem. I think you’ve got to tackle the health inequalities, and you’ve got to make the welfare budgets much more nuanced.

You might want, for example, to be increasing disability budgets while you’re cutting social security benefits for richer people.

Chris: Technology is evolving faster than social policy at the moment. And it’s critical to not fall behind because that would involve various challenges. The most prominent example of this is the fast paced development of modern biotech vaccines for COVID. What way can these technologies be used to improve public policy and population health?

Camilla: So that’s a brilliant, but huge question. I think we need a much better understanding. So it’s the old sort of CS Lewis dynamic, isn’t it? We clearly need policymakers to have a much better understanding of the science. And if you look at the whole debate around CRISPR and the germline edited I think there needs to be in that particular case, the ethical challenges are so serious.

Once you take it to the germline, there probably needs to be more of an informed public debate. I think data plays a huge part in this, and historically people have been very reluctant to give away their medical data or medical information, and that has actually stymied quite a few attempts to introduce technology or do bigger trials.

I actually think COVID is a huge opportunity to change that perception, because people have seen the rapidity of the vaccine rollout in the development of the science. And there’s a kind of moment where politicians, I think, need to level with people and become a bit. Bolder about saying actually sharing your data, particularly in, in the UK where we have a universal health service.

We could be making much better use of the data than we are.

Chris: As a regular columnist for the financial times, you claim that longevity will impact many aspects of our lives more than just healthcare and what we need to keep a firm grasp on the future with regard to regulation, to education, workforce development, if we want to avoid major economic shocks. So what is the future of longevity, especially for aging people and the general population?

Camilla: I think that the combination of people living longer and plummeting birth rates is what’s bringing about this kind of cataclysm, and that is what is making governments across the world so scared they’re trying to bribe people into having children.

I think what that does, is it actually starts to challenge notions of family itself. So you have to start thinking differently about support networks. Women all over the world who are deciding not to have children for a whole series of reasons that I write about in the book. We’ve actually seen that this year under COVID that the lockdown baby boom has not happened. And the China one child policy, which has been revised, but has had no impact on the Chinese population. It’s actually being replicated in all sorts of other places without government intervention. And that’s completely fascinating, but it doesn’t have to be all doom and gloom.

We just have to revise our notion of what is the support network you’re looking for when you’re older and crucially, I think. Longevity means we have to think about meaning, it might sound a bit hokey, but we need to think about purpose and meaning. We’ve still got this cliff engine for retirement and I’ve interviewed so many people who’ve fallen over that cliff edge.

Quite often, they’ve rushed over the cliff edge, delighted by the thought that they’re going to have many more years on the golf course and then become seriously disillusioned with it all, maybe, financially threatened by it. But I just think we have to change our assumptions and we’re remarkably traditional and unconventional in the way we think.

I give a lot of talks to big companies about the future of work. Now it’s astonishing that so many big companies still retire people at 60. They have a really conventional notion and we all have it in our heads. We have a career timetable in our heads of actually at what age are we going to do what. Now funnily enough, I haven’t had a very unconventional career. I’ve fallen into interesting things when they come along. But I’m very unusual and I meet people continually who have got to their fifties and suddenly think ‘Oh my God, what am I going to do next?’, we shouldn’t be like that.

There’s been a suggestion of a mid career M.O.T, which I think is a great idea. Sit people down, talk to them about their future, give them some hope. We just don’t realise as a culture, how conventionally we think about this stuff.

MY 19-YEAR-OLD GODDAUGHTER IS looking over my shoulder as I write. Will she be reading this again in 2150, when she will be 150?
Cavendish, Camilla. Extra Time: 10 Lessons for an Ageing World (p. 27). HarperCollins Publishers. Kindle Edition.

Chris: Now you’ve mentioned your goddaughter in the book. And, she might grow up in a wildly different world from ourselves in regards to the actual definition of ageing. So in what ways should we educate our children differently to prepare them for a future where longevity and long life is much more common?

Camilla: That’s great you noticed. I was writing about the bet that was made between Jay Olshansky and Steve Austad.

Chris: She was actually the first time I’ve heard of it. So that was a really fascinating,

Camilla: They’re two wonderful professors and they made this bet that there would be a 150 year old human by, I think it was 2150. There are interesting views on either side of that, but fundamentally it definitely points to something that my 19 year old goddaughter for the time has to think about, which is, I think that you’re asking, what her school should be telling her. Her school should have been saying, you’re going to live a hell of a lot longer than you expect. At the moment, if you ask the actuaries, they say that about two thirds of people seriously underestimate how long they have to live.

One reason I wrote the book was because my beloved father, to whom this book is dedicated, seriously underestimated how long you’d have to live and also how healthy and able he would be. And as a result, his life comes shrank before it should have done. So I think there’s an awful lot we can do to say to people ‘look, have you thought about it?’. It’s wonderful, we’re going to have all these different careers and possibilities.

The other thing we’re seeing is that adolescence is extending longer. I think in the UK and Australia, and I think the US, the average age of leaving home is now 24.

There were parents tearing their hair out all over the country at the being the bank of Mum and Dad. Things are changing and we have to recognize that.

Chris: The books wonderfully entwine the statistics around this matter as well as storytelling is really a fascinating read. And you must have had so many interesting chats with fascinating individuals. So my final question is that something: a conversation, a piece of technology, a word of wisdom, an idea, which resonated with you that you would like to share to finish off this interview.

Camilla: Okay. What I would love to share with you is a nursing home in Holland that I visited where university students live in an exchange for doing 30 hours a week with the old people. As you can imagine, it is the most heartwarming and it’s very much a two way experience. But what I’d like to quote for you is what the manager of that home said to me, which is it used to be that when residents came, they had to fill out a hundred questions on the form.

Now they only ask you three questions, and the questions are: who are you? Who were you? And who are you going to be? And when you think that the average age of residents in that care home is more than 85, that gives you a sense of the possibility and the philosophy that we should apply to agents.

We really appreciate Camilla taking the time out of her busy schedule to come and talk to us. So a massive thank you from Chris and everyone on the Gowing life team.

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