New interventions into the aging process have already prolonged the life span of nematodes, fruit flies, mice, and most recently even of primates. What has been successful in laboratory animals may be applied to human aging in the long run as well. At the same time, the almost universal trend of population aging raises concerns that health care costs will rise significantly and that this trend will threaten universal and equal access to health-related services. Therefore, it is crucial to assess the potential impact of new age-related biomedical interventions on health care systems in order to predict who will have access to these interventions and how this will affect existing health inequities in old age. This would at first require data on the cost-effectiveness of new age-related interventions. However, such data are not yet available. Nevertheless, a discussion on the potential impact of this technological development in such an early stage has one big advantage: possible undesirable outcomes may still be prevented by timely regulatory action. Therefore, instead of trying to answer the question of the possible consequences for publicly and privately financed health care based on data concerning cost-effectiveness, we will try to anticipate which groups will presumably have access to these interventions into the aging process. We will also suggest a social justice framework to evaluate unequal access, based on a conception of health-related equality of opportunity. As a starting point for this projection, we will compare different biodemographic scenarios. According to our analysis, access to age-related interventions will be limited to certain population groups and this will further increase already existing health inequities among the elderly, which should be avoided from a social justice perspective. We suggest that the most promising strategy to prevent such a development would be to set priorities in publicly funded age-related research. An analysis of the development of NIA-funding and the current NIA strategy will examine to which extent starting points for such an ethically justified priority setting already exist and how it could basically be conceived.
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Following the terminology of the WHO commission on social determinants of health, by health inequities we mean “avoidable health inequalities” (Commission on Social Determinants of Health 2008: 25-35).
Cf. http://www.who.int/whosis/database/life_tables/life_tables.cfm (accessed 28.2.09). In the EU nevertheless substantial inequalities in healthy life years exist: See Jagger et al. 2008.
Source: WHO Life Tables for member states, http://apps.who.int/whosis/database/life_tables/life_tables.cfm, accessed 18.7.2009.
Statistics available at: www.statistics.gov.uk/statbase/Product.asp?vlnk=14466, accessed 18.7.2009.
The following information if not available directly from the NIA as indicated is based on an informative article by Robert Binstock (Binstock 2004).
National Institute on Aging 2007: 12. Of course the NIA outlines all age-related health problems as a general target of its work. This is not only Alzheimer’s disease, but also CVD, cancer and diabetes, decline in sensory functions, age-related problems of the musculoskeletal system and psychological disorders.
See http://www.share-project.org/ (accessed 28.2.2009).
See ERA-AGE Newsletter 11, available at http://era-age.group.shef.ac.uk/newsletters/25/eraage-newsletter-issue-11 (accessed 6.3.2009).
Alzheimer’s Association. 2008. Alzheimer’s disease facts and figures. http://www.alz.org/national/documents/report_alzfactsfigures2008.pdf. Accessed 27 Feb 2009.
Binstock, R.H. 2004. Anti-aging medicine: The history anti-aging medicine and research: A realm of conflict and profound societal implications. Journals of Gerontology Series A: Biological and Medical Sciences 59: 523–533.
Bone, M.R., A. Bebbington, C. Jagger, et al. 1995. Health expectancy and its uses. London: HMSO.
Centers for Disease Control and Prevention and the Merck Company Foundation. 2007. The state of aging and health in America 2007. Whitehouse Station, NJ: The Merck Company Foundation. http://www.cdc.gov/aging. Accessed 27 Feb 2009.
Commission on the Social Determinants of Health. 2008. Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: World Health Organisation.
Crimmins, E.M., and Y. Saito. 2001. Trends in healthy life expectancy in the United States, 1970–1990: gender, racial, and educational differences. Social Science Medicine 52: 1629–1641.
Ehni, H., and G. Marckmann. 2008. The normative dimensions of extending the human lifespan by age-related biomedical innovations. Rejuvenation Research 11: 965–969.
Fukuyama, Francis. 2002. Our posthuman future. New York: Farrar, Straus, & Giroux.
Fries, James F. 1980. Aging, natural death, and the compression of morbidity. The New England Journal of Medicine 303: 130–135.
Graham, Patrick., Tony Blakely, Peter Davis, et al. 2004. Compression, expansion, or dynamic equilibrium? The evolution of health expectancy in New Zealand. Journal of Epidemiology and Community Health 58: 659–666.
de Grey, A.D.N.J. 2005. Life extension, human rights, and the rational refinement of repugnance. Journal of Medical Ethics 31: 659–663.
Gruman, Gerald J. 1966. A history of ideas about the prolongation of life. Philadelphia: The American Philosophical Society.
Hadley, E.C., E.G. Lakatta, M. Morrison-Bogorad, et al. 2005. The future of aging therapies. Cell 120: 557–567.
Harris, John. 2004. Immortal ethics. Annals of the New York Academy of Sciences 1019: 527–534.
Harris, John. 2007. Enhancing evolution. Princeton: Princeton University Press.
Hayflick, Leonard. 2007. Biological aging is no longer an unsolved problem. Annals of the New York Academy of Sciences 1100: 1–13.
Jagger, Carol., Clare Gillies, Francesco Moscone, et al. 2008. Inequalities in healthy life years in the 25 countries of the European Union in 2005: A cross-national meta-regression analysis. Lancet 372: 2124–2131.
Jonas, H. 1992. The burden and blessing of mortality. Hastings Center Report 22: 34–40.
Juengst, Eric.T., Robert H. Binstock, Maxwell J. Mehlmann, Stephen G. Post, and Peter Whitehouse. 2003. Biogerontology, ‘‘Anti-aging Medicine’’, and the challenges of human enhancement. Hastings Center Report 33: 21–30.
Kalache, Alexandre., Sandhi Barreto, Maria Barretto, and Ingrid Keller. 2005. Global ageing. In The Cambridge handbook of age and ageing, ed. V.L. Bengtson, P.G. Coleman, and T.B.L. Kirkwood, 30–46. Cambridge: Cambridge University Press.
Kass, Leon R. 2003. Ageless bodies, happy souls. The New Atlantis 1: 8–28.
Kirkwood, T.B.L. 2005. Understanding the odd science of aging. Cell 120: 437–447.
Lafortune, G., and G. Balestat. 2007. Trends in severe disability among elderly people. Assessing the evidence in 12 OECD countries and the future implications. OECD Publishing.
Manton, Kenneth G., XiLiang Gu, and Gene R. Lowrimore. 2008. Cohort changes in active life expectancy in the U.S. elderly population: experience from the 1982–2004 National long-term care survey. The journals of Gerontology Series B Psychological Sciences and Social Sciences 63: 269–281.
Meerding, W.J., L. Bonneux, J.J. Polder, et al. 1998. Demographic and epidemiological determinants of healthcare costs in Netherlands: Cost of illness study. BMJ 317: 111–115.
Momeyer, Richard W. 1988. Confronting death. Bloomington: Indiana University Press.
Moody, Harold R. 1994. Four scenarios for an aging society. The Hastings Center report 24: 32–35.
Nagel, Thomas. 1970. Death. Nous 4: 73–80.
National Institute on Aging. 2007. Living long & well in the 21st century. Strategic directions for research on aging. http://www.nia.nih.gov/AboutNIA/StrategicDirections. Accessed 29 Dec 2008.
Olshansky, S.J., and A.B. Ault. 1986. The fourth stage of the epidemiologic transition: The age of delayed degenerative diseases. The Milbank Quarterly 64: 355–391.
Omran, Abdel R. 2005. The epidemiologic transition: A theory of the epidemiology of population change. 1971. The Milbank Quarterly 83: 731–757.
President’s Council on Bioethics. 2003. Beyond therapy. Washington D.C: President’s Council on Bioethics.
Rasulo, D., M. Bajekal, M. Yar, Laura M. Woods, Bernard Rachet, Michael Riga, Noell Stone, Anjali Shah, and Michel P. Coleman. 2007. Geographical variation in life expectancy at birth in England and Wales is largely explained by deprivation. Health Statistics Quarterly 34: 35–45.
Rawls, John. 1971. A theory of justice. Cambridge, Mass.: Belknap Press of Harvard University.
Rose, M.R. 2008. Making SENSE: Strategies for engineering negligible senescence evolutionarily. Rejuvenation Research 11: 527–534.
Seshamani, Meena, and Alastair Gray. 2003. Health care expenditures and ageing: An international comparison. Applied Health Economics and Health Policy 2: 9–16.
Seshamani, Meena, and Alastair Gray. 2004. Time to death and health expenditure: An improved model for the impact of demographic change on health care costs. Age and Ageing 33: 556–561.
Walker, Alan. 1981. Towards a political economy of old age. Ageing and Society 1: 73–94.
Windler, E. 2002. Medizin des Alters. Forschung des Alterns und Prävention des Alternden. Gynäkologie 35: 944–950.
Woods, Bob. 2005. Dementia. In The Cambridge handbook of age, ageing, ed. M.L. Johnson, 252–260. Cambridge: Cambridge University Press.
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Ehni, HJ., Marckmann, G. Social Justice, Health Inequities, and Access to New Age-Related Interventions. Medicine Studies 1, 281–295 (2009). https://doi.org/10.1007/s12376-009-0027-3
- Biodemographic scenarios
- Life span extension
- Priority setting in research
- Biomedical aging research