Aging, Youth Bulges, and Population

Panelists discuss the longevity challenges facing countries around the world, the foreign policy implications of dealing with aging societies, and the comparative advantage opportunities for countries successfully managing older populations. Please note there is no virtual component to this meeting. The audio, video, and transcript of this meeting will be posted on the CFR website.

Jess Maurer, executive director of the Maine Council of Aging, discusses demographic trends in Maine and the work of her organization. Jennifer Sciubba, global fellow at the Woodrow Wilson International Center for Scholars, discusses demographic trends and the implications of an aging population at home and abroad. A question-and-answer session follows their opening remarks.  TRANSCRIPT FASKIANOS: Thank you. Welcome to the Council on Foreign Relations State and Local Officials Webinar Series. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. CFR is an independent and nonpartisan membership organization, think tank, and publisher focused on U.S. foreign policy. CFR is also the publisher of Foreign Affairs magazine. And CFR takes no institutional positions on matters of policy. Through our State and Local Officials Initiative, CFR serves as a resource on international issues affecting the priorities and agendas of state and local governments by providing analysis on a wide range of policy topics. Thank you all for being with us today for this discussion. The webinar is on the record. We will circulate the video and transcript and post it on our website after the fact at CFR.org. We are pleased to have with us today Jess Maurer and Jennifer Sciubba to talk about demographic trends. We’ve shared their bios with you, but I’ll give you a few highlights. Dr. Jennifer Sciubba is a global fellow at the Woodrow Wilson Center. She’s an expert on demographic trends and their implications for politics, economics, and social relationships. Previously, she worked for the Hess Center for New Frontiers at the Center for Strategic and International Studies and was a tenured professor at Rhodes College. Dr. Sciubba is the author of 8 Billion and Counting: How Sex, Death, and Migration Shape our World. Jess Mauer is the executive director of the Maine Council on Aging, which she co-founded in 2012. The Maine Council on Aging consists of over 135 organizations, businesses, municipalities, and community members. Its recent achievements include increased pay for direct care workers and increased eligibility for the Medicare Savings Program in Maine. And Ms. Mauer previously worked in the Maine office of the attorney general for nearly two decades. So thank you both for being with us. Jennifer, I thought we could begin with you to give an overview of the global demographic trends you’re seeing and their political, social, and societal, and economic implications. SCIUBBA: Absolutely. Glad to do so. And I have just a few slides to show and tell a little story, if we can pull those up. Perfect. Let’s go to the next one, but it might even—that one might be blank, and it might be the one after that. Perfect. Let’s start there. So pop back one to the star. So let’s think about that.  I love this, the idea of the night sky as a metaphor for understanding global population. Because I remember learning—I had to take one science class in college as an International Studies major. And that one science class was astronomy. And I was so fascinated in learning that when we look at those stars in the night sky, some of them are so far away from us that they don’t even exist anymore by the time their light reaches us here on Earth. And when I think about where we are in this moment of global population trends, I think it’s a lot like that night sky.  In parts of the globe, the human population is already or will soon be shrinking. And that’s really different from what we hear all the time. We hit eight billion globally in November. And Irina mentioned, that’s the title of my most recent book. And we know that we are continuing to see global population grow. But what I don’t think everyone grasps is that while those overall numbers are increasing, there’s a tectonic force underneath that is leading us towards shrinking. It’s kind of like looking at a star that seems to be shining brightly, but in actuality it’s already imploded. And so to understand where we are today in terms of global population, and where we’re going, I want to explain first how we got here. And what I hope you’ll take away from this few minutes that I have to speak with you is thinking about the night sky as representative of our soon-to-be shrinking population is that it is a trap in data analysis. And so I’m actually going to talk about two traps and data analysis and how they relate to demographics, that I think can help us understand how to incorporate demography into our larger planning, which is exactly what I hope you’re all doing at the state and local levels. So let’s go to the next slide, please. Alright, so how did we get here? There are just three ingredients to population change. So that’s all we have to wrap our brains around, and that’s fertility rates. We typically talk about the average number of children born to a woman in her lifetime. Mortality rates. Think about us dying. And, of course, migration. And if we’re at the global level, like the whole planet, migration doesn’t much matter. We don’t have other species coming here yet. But when we zoom down, it matters a lot. And I know to a lot of you on this webinar it matters a great deal for what determines population change at your local level, whether it’s in-migration or out-migration there. So where else did we—how else do we get here, putting these components together, particularly the births and deaths? Next slide, please. A quick overview of our human history in thirty seconds here. It took from all of human history until around the year 1800 for Earth to amass its first one billion people. But as we started to get control over that second variable on that preceding slide, over death, we started to see populations boom. In particular, we were able to help infants and children live to reproductive ages. And that allowed population to boom. If you’ll click one more time you’ll see that it actually boomed from 1.6 billion at the start of the century to 6.1 billion by the century’s end.  And I want to flag this as a moment to understand that probably for everyone on this webinar—maybe a few of you who are in your early twenties not so much—but this is what you were born into, right? I know this is what I was born into. We were born into this context. And when I talked about traps—you know, a little hint about the traps in data analysis, this is one part for us to take stock. What kind of world were you born into? What kind of messages were you receiving about population? We’re going to think about how that colors our view of it. Next slide, please. We’re not just talking about size of the global population. We’re talking about a shift in the composition of the global population as well. So what you see here, they’re commonly called population pyramids because they actually used to all be shaped in this little pyramid, like 1950s, but maybe more accurately called population trees now because they’re actually turning into more of trees. And it’s typically males on the left, in the blue, females on the right in the red. And we see age groups in the ascending order there. So it’s thin at the top in the 1950s. Not a lot of folks living to be over ninety, a hundred years old. And we see that it’s fatter at the bottom. And if you think about where people of reproductive age, particularly women of reproductive age, would be located on that pyramid, and you see that it’s fatter at the bottom, you know that your fertility rate—the average number of children born per woman—was over replacement level. By the time we get to 2023, we now have a total fertility rate globally of 2.3 children per woman on average. And that’s really close to replacement level of 2.1. And where we’re headed is a more tree-like structure. Next slide, please. That mirrors what happens at the country level. And so still today there are countries in the world that do have high fertility rates. In case you thought I was off my rocker in talking about shrinking populations and forgetting about places like Nigeria, or Tanzania, Ethiopia. No, that’s certainly still the case. But there are fewer of them. There are only about eight countries left in the world, out of two hundred, where women have five or more children on average. That is a complete sea change from 1960s, when it was, you know, about 130 countries. So the shape of Turkey’s population today looks a lot like the shape of the global population. And if you’ll click one more time you’ll see that Japan’s population has that tree-like structure, with lots and lots of folks at those older ages and fewer people at the younger ages. So the next slide, we’ll see why that happened. I said there were tectonic forces at work all along. Well, here they are. Since the 1960s, the rate of global population change has been slowing. And so what we end up with, next slide, is that in 1968 lots of women—lots of countries had high fertility. Very few had two or fewer children on average. And now, we click again, and we see that very few have high fertility and that two out of every three people on the planet live somewhere with below replacement fertility. And nearly half the countries that are above replacement, are only just above it, with women having fewer than three children on average. So we’re part of a global trend. And I think this is a spot for us to pause and think about why it matters. And that, you know, we’ll get into this in Q&A because I don’t want to get into Jess’ time, but when we think about priorities, and setting priorities and policy—and I’m at the global level—then we’re thinking about how the interests of those countries that have rapidly aging and potentially shrinking populations might increasingly differ from those that still have very young and growing populations. And it’s just something that I want us to keep at the front of our minds, is how investments and policy priorities might be different in those different settings. But, of course, we all need to be thinking about demography. Next slide. Because if you are thinking about planning for education, care work, et cetera, demography matters. This is just a quick map to show you places where fertility is still higher, which are some of the poorer places on the planet, as you might expect. OK. Next slide. OK, so the first trap is getting stuck in the past in terms of our trends here. So we know that trends change but sometimes our thinking does not change. And so I want to make sure that we understand how much the global situation behind fertility has changed, like those stars. OK, next slide. And, of course, that matters at the state level as well. So state—here, I’m thinking about the United States. And we’re about to make that a very different kind of state. But we—whoops. My own little screen just did something strange. So U.S. population has been, in some ways, exceptional compared to some of its peers for a while. We had relatively higher low fertility, if that makes sense to you. So low could be anywhere from zero to two, right? And we were on that relatively higher end of low. But that’s not necessarily the case anymore, as we’ll see here. And I’m sure some of you—well, probably all of you saw the news coming out of U.S. Census in November and December of last year, that really talked about these changes at the regional and state level in the United States, and which regions are growing or not growing. Next slide, please. That, much like the slide I showed with the little baby and the death and the migration, it’s driven by births, deaths, and migration at the state level as well. So we see here in the United States, our total fertility rate is somewhere around 1.6 to 1.7 children born per woman, on average. That places us, again on that higher—still kind of on that higher end. For comparison, in Japan is probably around 1.3, maybe a little bit lower than that. So this is, you know, kind of typical of a wealthy, industrialized country. And places in the country that it has historically been lower are the Northeast. So we typically see lower fertility rates. This down here is called the general fertility rate. So it’s expressed a different way, which is basically the birth rate—births per one thousand, women fifteen to forty-four. You can see where it’s slightly higher. It’s already, I think, starting to fall again in North Dakota and South Dakota. And, but we see regional differences here. Next slide, please. And we see regional differences in terms of migration. Now, let’s—look, this is taken from the Tax Foundation. So you know that they’re trying to make the point that people are moving to states with lower taxes, but that is true, demographically speaking.  You start to peel down at the level here, and we see people are moving to Texas for jobs and cheaper housing. They’re typically a working-age population. Most of Florida’s growth came from people between the ages of fifty and seventy. So, you know, nuance is always really important with demographics there. So I would submit to you that U.S. exceptionalism is over. We have low fertility. We do have some in-migration that is propping up the size of the population, but the U.S. is facing the same set of issues and opportunities—challenges and opportunities—that other wealthy industrialized countries are. And I think it’s time we wake up to that. Next slide. And we’re almost done.  And then trap two, I just really quickly want to point out that we are all carrying biases in with demographic data. All kinds of ones. Jess has a whole other set of biases besides the ones I’m going to talk about. But it’s really important for us to recognize that. I saw it when I worked at the Pentagon. I saw the U.S.—that line about U.S. demographic exceptionalism, perfect, was talked about all the time. Yeah, you can go to that one. And I say—would often say, we’re not that different from Russia and China. Just look at the little shape of our population here. A lot of things are really similar there. And in fact, if you are a democracy and you need to pivot quickly to deal with an aging population, it is very difficult. If you’re not a democracy, it’s a lot easier.  Next slide. I also often point out that there is a sense in the United States that migration will continue forever, whether you want it to or not. That does not matter to me. It’s just this idea that this—you know, we have the world’s largest stock of migrants in the U.S. So we tend to think global migration is really high. But really, 2 to 4 percent of people live outside the country in which they were born. That’s been true over the last decades and decades. There are actually far more older people worldwide than migrants. If you look at just those ages sixty-five to seventy-four, there are about 200 million more of them than global migrants. So this is a huge segment of the global population and of the U.S. population. But I think we kind of carry some of that bias into looking at the data there as well. And so a question we might ask is, will migration continue at these levels, and for the United States, or not? And last slide for me is just to say—I got two plugs for you here. One is the personal plug. The list of you on this webinar I’m salivating over because I would like to talk to you. Sorry, Irina, but I got to give this plug. My next project, research-wise, is trying to understand how we can thrive, not just survive, economically particularly, in this era of shrinking populations. And so if anybody is talking about this at your state or local level, please shoot me an email or find me for us to chat. And then the other is I’m on the board of the Population Reference Bureau, which does a lot of data and analysis for state and local governments about population projections. And I’m sure that soon—if this is the kind of thing that you’re interested in, I’d be happy to send you their way. Thank you so much. FASKIANOS: Jennifer, thank you so much for that and your wonderful slides. And we will circulate your contact information after the fact as well, in case people did not get it on the—on the slide presentation. So, Jess, now we’re going to over to you with your experience. Talk about what you’re seeing in Maine, what policies you were looking at to prepare there. And I know you’ve been advising other governments as well as the federal government—some national governments and the federal government. So what you were saying and where you see things are working well, and any best practices you can share with the group. MAUER: Sure. And thanks for inviting me. Glad to be here. And I just learned a whole lot from Jennifer. So I’m really excited to be here. And I have questions. And I’m going to be using some of—some of this data as I talk about this stuff in the future. So if whoever is going to share my slides could do that, that would be great. And so you can go right ahead to the next slide. I just thought before we jump into the issues that we’re seeing and some of the solutions, I’d talk a little bit about Maine. So Maine is the oldest state in the country by median age. Our median age is 45.1. We’re also the most rural state, which a lot of people find interesting. And I find that when I talk about rurality, a lot of folks particularly in urban areas don’t really think the same way we do. For instance, I’ve heard people talk about a city of twenty or twenty-five thousand people as rural. So, for reference, I like to say, only nine cities in Maine have a population greater than twenty thousand. And 83 percent of Maine’s five hundred towns have a population of five thousand or less. And, in fact, 44,000—sorry—44 percent of Maine’s population lives in towns with fewer than five thousand people. We have towns, like, with five people in them. And so, you know, we have a lot of rural communities.  We also have the lowest working-age population, which creates a significant challenge. Not just for business, but also when we’re talking about the direct care workforce and a significant growing care gap that we have for populations of all kinds across all settings. So next slide.  So here’s an actual look at our demographics. We have 44 percent of our entire population—entire population—is over the age of fifty. For reference, 18 percent of our population is under eighteen. And 23 percent is over sixty-five. So, this means for the better part of the last decade we’ve had significantly more people every year turning sixty-five than we’ve had babies, and sometimes twice as many for a good three, five, or six years. We had about 24,000 people turning sixty-five and about 12,000 babies born every year. Next slide. So in 2020, we launched a three-year municipal data dashboard project to help communities in Maine understand the challenges that older people in their community might be experiencing, and to take a look at their demographic challenges generally. These were our pilot communities. Just want to say that three of them were remote rural communities. One was our—one of our largest cities. One was a midsized city, and two are sister suburban towns. Next slide, please. So these are two different data points that highlight the differences between rural and urban communities in our—in our community, in our state. One generally looks at the median age. And you can see that, particularly for urban areas, not surprisingly, our median age is lower. But in some of our most rural communities, is very high. So in Eastport, the median age is sixty-one versus forty-five, as a state average. And in that same community, you’ll see that just over 70 percent—70 percent—of the households in that community include a person over the age of sixty. Next slide. So one of the shocking, really, pieces of data that we learned when we started digging deep at a community level was that some communities do better and others do worse at supporting people later in life. So you’ll see here, one community has very few people living in their community who are eighty and older, as opposed to another community which has a much larger percentage. And the next slide is actually the data. And you’ll see that these two communities have essentially the same population of people who are over sixty-five. And so you have to ask yourself, why is one community the community that’s better for older people—which is a city setting, walkable, access to transportation, access to affordable housing—so much better for people over eighty then another, which has no transit, all single-family homes, very few affordable housing units, rural, and very few services? So these are the reasons we start, like, saying, you know, it’s really important for municipalities to look at their own data and not just rely on state and county data to sort of see how they’re doing. I will say, interestingly enough, and why it’s important, this community that I mentioned in the last slide, that has—more than 70 percent of the households have sixty and older, they have a very, very low working-age population. And they said, well, that’s because nobody can afford to live in our city anymore. And they all live outside of our city. So we did a demographic profile of all the communities around their city that they said that older people—that younger people lived in. And the reality is, they don’t live there. They just have a really, really low working-age population, and it’s something that they need to consider. So next slide. In 2022, we did a report on the economic status of older women in Maine. And the next few slides highlight some additional demographic concerns specifically related to older women. On this slide, you’ll see why it’s important to explore data by gender, race, and age. Nationally, eighty—women over eighty have a significantly higher rate of poverty due to—than men—due to gender-based wage disparities across their lifetime. But in comparison to White women, Black women or women of color over the age of eighty experience nearly twice as much poverty as White women. So these are issues we just have to look at, right? I mean, it makes a difference if you’ve just experienced gender-based bias versus gender-based and race-based bias across a lifetime. Next slide. And then to truly understand how folks are doing in your community, you also have to disaggregate data related to age. For instance, all the reports we see show poverty among older people at a rate at about 8 or 9 percent. And we can see here, however, that women over eighty in Maine experience poverty at a rate nearly twice that of men over the age of eighty. So it’s really important not just to say, how well are people over the age of sixty-five doing? But now we have to say, how well are people over the age of eighty doing in our community? And are there demographic differences again, by race, or by age? So next slide, please. So the federal poverty level is the piece that we look at when we say whether or not older people are experiencing poverty. But living alone is a clear demographic issue that has big impact for people later in life. People who live alone when they’re older don’t have a second income, right, to help cover costs, and have no informal care within the home if they need help with care. And they also have no basic help with chores. They have nobody to drive them if they can no longer drive. They have nobody to help them with home maintenance. So two times as many women over the age of sixty in Maine live alone. And women who live alone, not surprisingly, have less income than men who live alone. The next slide, please. So we look at something called the Elder Economic Security Index, which is a national index that tells us how much income an older person or older couple needs to meet their basic needs if they’re in poor condition, poor—good health, poor health, excellent health, and also if they own their own home, with or without a mortgage, or they rent. So you’ll see here, this is both the previous slide and this slide, that at least half of the older women who live alone in Maine do not have enough money to meet their basic needs, regardless of where they live, and regardless of their health status. So these are issues that also help us think about: How we target services? And what do we do, right, when we come up against this sort of issue? So next slide. I just want to say a little bit about some of the policy-level solutions. We’ve been focused on really creating new models of housing in Maine for older people to address the very issue of a community that is no longer working for people over the age of eighty. We asked, well, what can we do? How can we help older people find housing, help older people find transportation? So with our focus on housing, we’ve actually just in the last few months—few weeks, actually, signed a contract with a new organization who’s going to start doing a home-sharing pilot project here in Maine, to get that up and running.  We’ve also been doing a considerable amount of work over the last many years on zoning, specifically related to accessory dwelling units. We’ve had a big win recently on that. And so it’s no longer just town to town whether you could—you can put an accessory dwelling unit or a second home on your property, but now really municipalities have to allow for that accessory dwelling unit. Which is a really terrific thing. We’re looking to implement transportation solutions that really knit together technology that we already have, and we already use, and volunteer driver—volunteer driver programs as well as public transit systems. Trying to make sure that they’re more accessible for everybody and also better funded. We’re also focused, and have been for a decade, on growing the direct-care workforce to meet the increasing support needs of older people. And have had some real success. If you’re—if you’re a direct-care worker in Maine and you’re living alone, you can actually earn a livable wage, which is really terrific. But, you know, not if you’ve got kids or a husband. So we’re still working on cracking that nut. But our big focus has really been on older people themselves and reducing poverty. Our biggest win just came in the last legislative session last year, when we used a lot of the data that’s in this presentation to secure economic justice for older people who’ve experienced a lifetime of economic injustice and disparities, by significantly increasing eligibility for the Medicare Savings Program. It’s a program that puts about $7,500 in the pockets of older people. So this ultimately means that about—well, about thirty thousand people in Maine, older people in Maine, will have more income. And they’ll be more on par with a livable income and will be better able to meet their basic needs.  And this is something any state in the country can do. The Medicare Savings Program is a terrific program. And for those of you who’ve done Medicaid expansion, Medicare eligibility expansion is essentially the corollary. It’s the part that lifts older people in your communities out of poverty. And D.C. actually increased theirs to 300 percent of the federal poverty level. We didn’t go that far. We’re up to 250. So pretty exciting stuff. And but totally doable, to really make a huge difference in the financial security of older people. So next slide. Just a couple more pieces, and then I’ll be done. We’ve also been using this data—and I loved Jennifer’s talking about traps. And I think, you know, we talk about this idea that we’re still sort of stuck in that 1950s thinking about older people, and what they should be doing, right? They should be leaving work. They should be retiring. The reality is, they’re supposed to be dying at seventy, and they’re not. They’re living to a hundred. And, but we really haven’t gotten rid of the views that older people aren’t good workers, that they cost too much money, that they’re not good at technology. And so what we see a lot of is ageism, both at an institutional and a systemic level. And so we’ve been using this data to talk about, you know, these outdated views that older people and aging—that they’re a problem.  And really, this image is what I like to—like, when I think about, you know, for the better part of the last thirty years, we’ve been talking about this, right? A silver tsunami. It’s literally a gray wave of sedentary, medically needy, older people that’s going to crash down on your head and ruin everything. I mean, that’s what we’ve been talking about. And it makes you feel all warm and fuzzy about older people, right? I mean, they’re a problem to be solved. They’re not a solution. So next slide, please. Really, the primary work that we’ve been doing lately is flipping the script, really changing the way we look at this wave. Literally turning the wave upside down, and looking at it as an opportunity. The key here—and I love—I love this point. We’re so focused on in-migration. And we haven’t—we’ve just started to move the needle in increasing the number of people over the age of sixty-five who are working. I mean, we’ve been working on that for a decade. So we’re glad that there’s movement, finally. But the focus has been on getting people to move to Maine.  And so getting this number, this is—you know, there are 200 million more people sixty and over than there are migrants in the world. I mean, that’s a really interesting number. And I’m going to be thinking about how to use that because, you know, we’ve really been looking elsewhere for the solution, when the solution, as we’ve been saying, is sort of right under our nose, that if we are seeing that older people—that people—all people are living longer, healthier lives, and can continue to work long into their seventies, and eighties, even in their nineties, then our solution is right there. But we’ve not yet been able to do that. So we really do need to flip the script and see older people not just as our workers, but also as our volunteers, as our cultural and municipal leaders, stewards of our environment, right? Caregivers for young and old, basically integral parts of our community that we just can’t let go and we need to actually embrace. And then the final slide is a new map. It’s called the new map of life, that’s come out of the University of Stanford. We look at this and it’s basically saying, look, kids are going to—kids born today are going to live to a hundred, by and large. And we have to think differently about our systems. We need to learn differently, right? Space out the way we learn, space out the way we work, and also need to build longevity-ready communities, right? Communities that have these new models of housing, transportation solutions that work for people who can’t drive. Again, not being able to drive didn’t used to be a problem, because people died when they were seventy. Now people stop driving in their eighties and nineties, for many physical reasons. Also just don’t feel comfortable about it. But we just haven’t—we haven’t invested in the solutions that help people move around when they can no longer drive. So we have to do this through this lens of equity. Age equity is what we have been talking about. And need to be intentional about who’s in our communities, who’s being included, who’s being excluded, partner with people in their eighties, nineties, and hundreds to talk about how we design solutions that work for them. We really haven’t been doing this, but it’s really what’s next in relation to, you know, sort of, again, how do we take advantage of what we have and also build what we need to build for the future? So I’ll stop talking there and say thanks for the opportunity. FASKIANOS: Thank you very much. Again, another fantastic presentation. And so we’re going to go to all of you now for your questions and to share what’s happening in your community. As a reminder, we are on the record. So I’m going to take the first written question from Justin Bielinski, who is director of communications in the office of Wisconsin Senator Chris Larson. Do you have any successes from Maine to share regarding increasing density, affordable housing in urban or suburban areas? MAURER: Sorry. We do have some successes. And we passed a really comprehensive—we actually had a committee that worked for a year on recommendations regarding these things and have passed a comprehensive bill in this regard. And I will say, it’s still early days to be talking. So I think the bill—the law itself is a success. But there have been real challenges to implementation. And I’m happy to share a link to that law in the chat. FASKIANOS: Great. And we can also share that out. Next raised hand from Councilmember Jose Trinidad Castaneda. Q: Hi. Good morning. Or, sorry, good afternoon.  So I’ve worked on some of the California ADU legislation. And I’m working on an innovative program for our city, in the city of Buena Park, California. One of the challenges that I have is how do we allocate our Medicare-managed plan funding for ADUs, specifically for categories of our population that are most vulnerable to demographic shifts—employment and economic trends that you were bringing up in both of your presentations? And since we have a silver tsunami right here at home, how do we—how do we balance that, as local policymakers, between what we need in terms of migration, a baby boom, and, like, a long-term kind of stabilization of a very—you know, a massive aging population in our city? So how do we allocate those funds? And how do we balance between those challenges? Thank you. MAURER: And, Jennifer, I don’t know if you—if you have any interest in jumping in. I’m happy to, I just want to— SCIUBBA: I’m listening to this part. Yeah. I’m learning. MAURER: I mean—I’m not going to say that we have it sorted out in Maine, by any stretch of the imagination. And I think the answer is, it’s going to take a lot of different solutions. There’s not one solution that’s going to work, A. And, again, you’re in a very different place than we are, because we’re so rural and we’re so spread out. But one of the things we’ve been talking about, A, is that we don’t ask people what they want. And the things we know that are true is that it’s better for older people to stay in their community. And because we have decided that we have to build—from an economic standpoint, we have to build affordable housing in a certain way or housing with services in a certain way—build and fund in a certain way, we just do. And so that separates people from their community if they, you know, don’t have an affordable housing option in their community. And so, you know, what we’ve been talking about are that we—you know, we really have to build what’s next. We haven’t—we haven’t designed or built that thing, although it’s starting to work. So we—you know, we’ve got a couple of—like, a pocket community in Dover, New Hampshire of, you know, forty small homes, tiny homes. They’re workforce housing, but I think that’s exactly the kind of thing that older people want. And the question is, how do we incentivize the development of the things that people want? I’m not sure I’m answering your question directly, but it’s going to take a mix of doing affordable housing differently. We need some changes within the federal government around Medicare and pairing of—well Medicare, and Medicaid, and also paying for services within housing. And we need to have affordable housing investing in accessory dwelling units and figuring out how to build affordability into them. So I think there’s a lot of solutions. There are a lot of problems that we haven’t found solutions to, but we’re working on them. SCIUBBA: I want to add in a little on that too, because I think what is great about a demographic lens is it lets you see the future in the ways that no other trend does. I mean, there is no other trend where we can be so certain about what the world will look like in twenty years. You know, the people of—the retirees of tomorrow are already born, or they’re sitting in kindergarten desks today. And so we can do this long-term planning. And I’ve even—there’s an architect who looks at age-friendly architecture out of New York City, who’s German, Matthias Hollwich. And he and his firm build modular homes. Imagine being in New York City or in a densely populated area, and when a building is being turned into housing units it’s done so modularly so that it can adjust for: Do you work from home? Do you have two small children? Did your children move out? Do you now have an aging parent move in? And some of this is done in the context of being environmentally sustainable as well.  So, you know, if we build for that, as Jess said, that can look all kinds of different ways depending on the community. In New York, it looks one way. You’re not going to do that kind of thing, you know, in my suburb of Memphis, Tennessee. But there are many options. And I think also, when we start to do an international comparative context, we can learn a lot there as well. Like, we can learn from other states but, like I said, the U.S. has seen itself as demographically exceptional for so long that in many ways we’re way behind. You know, I remember doing some fieldwork in Singapore in 2009. And they were working on complete streets there for older people to get on the buses, and how did they make that age-friendly? And that was, you know, fifteen years ago. So I think there are some places that have aged faster or have been aware of their aging faster that might serve us as models. Yeah. FASKIANOS: Fantastic. Texas Senator Donna Campbell has raised her hand. Q: Hello. Good afternoon. Can you hear me? FASKIANOS: Yes. Q: Yes. My name is Jim Morales. I work policy for Senator Donna Campbell here in Texas.  Thank you, Jennifer, for that presentation earlier. It was very enlightening. And also Jess, as far as the state of Maine. We are taking some good notes here. As you presented earlier, the growing population here in Texas from basically all over the country and other parts of the world. And we are currently working on legislation for the next session that addresses the workforce, especially, like it was mentioned earlier from Jess, as far as the age population—working population. The infrastructure, medical facilities and centers, nursing homes as well for that—in preparation of that longevity. My question is, if you can share, if you have that information, does Maine have any—have data or best practices on nursing homes, preparation for public health emergencies, and natural disasters? Of course, our natural disasters are going to be different from state—from state to state, but there’s some commonalities there, especially when addressing and sustaining our aging population. Thank you. MAURER: Yeah, and I wish—I wish I knew. You know, I don’t do direct advocacy, nor support—I mean, we’re partners with all of the aging services in Maine. But I can certainly find out for you. I know of a lot of our policies, but I don’t know of a specific—or a specific report that would answer that question. But I will find out and be happy to share it with you if I—if I find it. FASKIANOS: Great. One question, how does women’s access to reproductive care influence the population trends that you’ve cited, both globally and domestically? I think, Jennifer, maybe you can start. SCIUBBA: Yeah, sure. I’d be glad to take that. It makes a difference if you have a desired number of children, and you’re able to act on those desires. Certainly, that is why we have seen global fertility fall from, you know, seven children per woman on average to lower. But by the time you get to a wealthy country and how far it is along the demographic transition to lower fertility and mortality, we’re really talking about a lower number of pregnancies generally. So that would be women’s ability to control whether or not they get pregnant. And women have been getting pregnant less, particularly teen women. So in the United States, what a lot of people don’t realize is that that drop to below replacement fertility has really been in large part at the teen level. And so we see fewer teen pregnancies. That is not just from contraception and reproductive health. It’s also from the fact that they are less sexually active than previous generations were. So, you know, it’s always good to look behind those numbers and really see things like, you know, we see increasing pregnancies in my age group, in the forty-plus age group, is actually up. And so it does differ for those different age groups, yes. But having the ability to control who gets pregnant, when, and where does make a difference, of course, as to how many children are born. FASKIANOS: Great. I’m going to Patricia Farrar-Rivas. How are you addressing the high costs of care for individuals with dementia and Alzheimer’s? I think, Jess, you marked that you could answer that. MAURER: Well—I’m not sure that we’re addressing the high cost, but we are trying very specifically to, A, support informal family caregivers. We’ve increased the respite care benefit and have created a respite care program specifically for people with Alzheimer’s and dementia. Are doing a better job of trying to do care coordination. So that is one of the bigger cost drivers in the federal government, or CMS, or—you know, sort of uncoordinated care for people with dementia. We also have just completed the revision of our state plan on Alzheimer’s disease and related dementias, and have a BOLD—the second iteration of the BOLD grant, and are working collaboratively—starting implementation of many of the recommendations of that. And, again, a lot of that talks about coordination of care early, early diagnosis, early connection to services, and then additional training for all kinds of providers. Which I think is really critically important from EMS and Fire and Rescue to local municipal officials needing to understand, you know, sort of how do we—how do we intervene with people who are in our communities, particularly, as I mentioned, right, I mean, women are more likely to live alone than men. And this is a trend not just in Maine, but nationally. And so—and also, we didn’t talk about this, but I think, Jennifer, you bear this out, the generation before—Boomers had 10 percent fewer babies than the generation before it. And so you have a lot of older people who don’t have kids. And so you’ve got a lot of older people with dementia, with moderate dementia, living in the community, and really no supports. And so we’re really talking about, you know, looking at dementia-friendly communities, and how do we integrate some of the good work that’s been done nationally at a local municipal level to put supports in place, both for people living with dementia and with family caregivers. So happy to provide some more support. I’m not sure that we’re—I’m not sure we can say we’re addressing—we’re addressing the cost drivers at a very local level. I’m not sure we can say we’re being successful at the CMS level. FASKIANOS: Thank you. I’m going to go next to Tom Flight, board member in East Hampton Village in New York, with a raised hand. Q: Hi. Good afternoon. And thank you both very much. A fairly straightforward question, which is: What have you found to be the most effective means of educating the public on the changing profile of the population and the services required? SCIUBBA: I’ll add some global part of this. I think that we have a long way to go to get people to understand that this shift towards fewer babies is permanent, and not a problem to be solved. So that is, there’s just a long way to go in getting that. But it is a necessary first step then if we are going to implement these policies and programs that Jess talked about in detail, and all of you are concerned about in detail. It seems to me that without getting that first hurdle—getting over that first hurdle, we don’t plan for the long run.  So that’s why I do always start by putting it in global context. This is not some fluke. This is not an exception. This is a permanent shift, the likes of which we’ve never seen before. But we worked so hard to get there. We worked so hard to get infants and children to live to reproductive ages. We’ve worked so hard to create economic opportunities outside the home, and to educate people and, you know, to thrive. The result of that was having fewer children on average. And so I think we’ve got to—that is a first hurdle, and then understanding how to be resilient and adapt to this is the next step, which I’ll hand over to Jess.  MAURER: Sure. And, you know, I mean, I know this is going to sound ridiculous, but I’m going to say the answer is really just conversation. And we’re hosting those conversations at multiple levels. So we actually have created a thing called the Leadership Exchange on Ageism, which is a fourteen-hour, very intensive peer learning, leadership learning experience. We’ve had 180 leaders graduate through that. And we’re really digging deep on these issues. And what we found, which I don’t—you know, it’s sort of been stunning, actually—is that people—the program itself leads people to take rapid action within their own institutions, systems, and spheres of influence to create some change. It is an aha moment. And so we’ve now taken that. We’re having community conversations. And, again, we are finding them very impactful. People haven’t had a chance to have these conversations. And when you kind of bring cold, hard facts—as Jennifer presented them, and, you know, we talk about them, that people get it and they want to know then, what do we do next? And so, anyway, I will just say, we’re just hosting a series of conversations with employers. Again, helping employers understand why—what are the benefits of a multigenerational—first of all, what’s the business case? And then, what are the benefits of a multigenerational workforce? And if you approach it in that way, and then you give them examples of multigenerational workforces in Maine that are thriving, that are actually attracting workers because of—because they’re multigenerational.  And the ways—that’s the other piece. Is there’s a lens that we talked about, right? When you—when you do things to address challenges—real or perceived, by the way—for older people, older workers, it works for everybody. I’ve heard, you know, it takes longer to train an older worker. And then I say, well, even if that’s true, don’t you think that would benefit younger workers too?  Let’s start there. It’s not true. But even if it were true, wouldn’t it be better for younger workers to have a four-week onboarding process instead of a two-week? And don’t you think they’d probably do better, and feel actually better connected to the organization if you did that? So conversation is the key to this. And I’m going to say it works. I swear it does. So that’s my answer, and I’m sticking to it. FASKIANOS: Great. I’m going to go next to Emily Walker, legislative director in the Office of Pennsylvania Senator Katie Murth. Q: Hi. Thank you guys so much. I’ve learned so much from both of you. I am a Pennsylvania native myself, but I lived in York, Maine, for a long time, and I have family in Dover, Delaware—I’m sorry; Dover, New Hampshire, not Delaware. But, so familiar with the area and the issues that they face. And so it’s very helpful to see the work that you’re doing there. I have a question about kind of tying in sort of the needs of our younger generations into the needs of older generation. You mentioned, you know, more accessibility to affordable housing, more accessible public transportation, and just generally, like, more working—more workplace accommodations as well. Do you think there’s more opportunity that we could be bringing in young—so for being—I’m at the end of the Millennial Generation, and right at the beginning of the Gen Z generation. So I feel like, is there opportunity to kind of build on things that we do need for our aging population, and then the things that our younger generation are also asking for, that they want in their communities? And how can you sort of bridge that together a little better? MAURER: Yeah, I mean, I think that’s work we really have to do. And, yeah, all right, well, I’ll just say it out loud because I feel like, you know, it’s my—it’s my duty to say, you know, I’m not sure generational—like looking at generations are really helpful. Because I think it skews things. What I think is to say, you know, we have older people who need X, Y, and Z. And if you solve that solution—by the way, we have younger people who need X, Y, and Z. As a matter of fact, you know, older people—they’re lonely and isolated. That’s, like, I hear it all the time, like, with pity in your voice. Poor older, lonely people. Well, all of the data suggests that the people who are struggling most with isolation and loneliness are in their twenties and thirties, particularly young people who are going to college right now, because of the pandemic, are really struggling, right? And so, you know, it’s sort of, like, we need to stop talking about age and start talking about what we all want. And what you find, right, is if you look at workers today, right, older workers—oh, they need flexibility, or want flexibility. They want—they don’t want to work forty hours a week. They want to—well, OK, that’s also true for younger workers. I mean, all the trends say it. And so, you know, like, moving to a value-based sort of view, or what do we—what do we—where, where is there common ground, right?  I’ve heard over and over again that people who are described as millennials don’t like to drive, right? They would prefer to be driven. They would prefer to use public transportation. Well, public transportation is what we need. That that wouldn’t be what older people say, but they need—but they need public transportation. That’s what they would say. So for different reasons. So I think it’s like finding commonalities where things work for everybody, regardless of how you come at the problem. We come at the problem through aging, but we always try to solve that problem for everybody. FASKIANOS: There’s a written question from Stuart Murray in the Village of Corrales in New Mexico: It seems this presentation is aimed at higher-density communities. I was raised in a small Oklahoma town where services do not exist. When I talk small, 1,500 people or less. People do lean on other people, churches, et cetera. However, creating these services may not be financially possible. Is this where higher levels of governments need to step in to help these rural communities? MAURER: So I’m sorry if I gave that impression, because, like, all of Maine is rural. We don’t—we have, like—we have, like, nine communities that are not rural. And what we have are—one-hundred-plus communities have started volunteer initiatives called lifelong community initiatives, age-friendly communities, villages, NORCs, whatever you want to call it. We don’t—there’s lots of ones that have no models at all. But these are volunteers within communities that are doing volunteer driver programs, food, lunch programs, home repair initiatives. The key, though—particularly what we found in rural settings—is that you do need some community backbone, some community-based organization backbones. So, for instance, Habitats. And we don’t have Habitats in every community. Well, we also have public housing authorities, but not in every community. So we have some churches—that wanted to—so we look at—from a policy perspective, right, we say we need home repair, right? So the very first—so older people are living in homes that don’t work for them anymore, but we haven’t built the next iteration and we’re not going to build enough affordable housing. So we have to keep people safely in homes. So home modification, and weatherization, and home repair is the—is the first line, right, of keeping people safely at home. So how are you going to get those services affordably? Well, you have to figure out who you have that serves any community. And then we have successfully had Maine Housing then fund those home repair initiatives. Some of them use volunteers. Some of them use public housing authority staff. But it’s about, you know, sort of—we can do this. But it does have to be knitted together through the municipality, through volunteers, and through a community-based organization. We have found, over and over again, different models that work to solve different challenges that people who are living rurally are experiencing. FASKIANOS: Great. I think we have time for one last question. And I’m going to take it from raised hand, Monica Rossman, Glenn County supervisor. Q: Good afternoon. Thank you for letting me ask a question. We live in a very rural county here in California. Population twenty-eight and change. The problem that we’re having right now is getting our seniors to actually take advantage of the services that we are providing, even though it is limited. I keep saying over and over again, in fact I said it during my campaign, you know, a hungry bird only gets fed when it opens its mouth. And if these don’t want to do it, they’re just not going to. And, you know, I’m starting to see all of these programs, which I’m sure, you know, Jess, you could probably agree with me, there are a ton of programs out there. It’s just when they’re not used, they’re forgotten. And, you know, we have a grant for tablets to senior citizens that have been open for two years.  They’re just now, ever since I started—I started peeling an onion, is what I did. When I first got into office, I started taking care of, you know, my senior citizen parents who have Alzheimer’s, dementia, the shared cost, you know, taking care of two households, you know, trying to get two households to run. So my question is, how do we get the—what is the incentive to bring them in? You know, what can we do? That’s the problem that I’m having. And I’m working on it. I feel like I’m going uphill. And I could definitely use some help. So thank you for letting me ask the question. MAURER: Yeah. So, you know, I mean, if I were in a room full of however many people who are here today, I would say how many people like asking for help? And the answer is zero. I mean, like, every once in a while some doctors will raise their hand. I don’t know what that’s all about. But most people really don’t like asking for help. And it’s really true. I mean, like, I mean, I love, you know, it’s a trap, right? Independence is a trap. And what we hear all the time when we ask, when are you old—what’s old and when will you be old, it’s always about what I can’t do for myself. And so there’s a real tension inside of us that says, if I need help, you know, I’m on the—I’m on the downslide here. And so there’s—so one of the things we found that’s really helpful is to ask older people, why is it hard to ask for help and what would help you ask for help? And, specifically, what’s the trusted source? What we heard in my own community when we asked that question is: We don’t want to rely on the same volunteer over and over again. We don’t want to burden our children. We don’t want to, you know, burden our next-door neighbors. But if there was—if we could call the town, or we could call a church, then—and say, I need a ride to the grocery store, that would feel less burdensome for us. So I think it’s about asking the people themselves. And then, I will also say, getting a whole bunch of volunteers, right, together who know about the services to be the bystanders who are there to say: Hey, I know about this great program, when they hear that people are in need of things. And we have found that’s a great way. The final piece, I’ll just say, in my own community, again, we’ve had this—every community has this problem that there are benefits that people don’t want to use. Telling stories in your local paper about people who did use them successfully and how it changed their life is really good. It’s money. It does—it does bring people in. SCIUBBA: Yeah, the two last ones that Jess mentioned, I was thinking come—we have so much research in the public health literature about how to change people’s behavior. And the most effective way being a peer who’s used a service coming into your home and talking about that service. And if we’re talking about family planning, or if we’re talking about old-age services, or, you know, any kind of help in the home, that model just—that community-based model seems to work really, really well. FASKIANOS: Thank you both for this wonderful hour. We really appreciate it, for you taking the time to share your expertise, and for all the great questions and comments. We appreciate you as well. We will send out a link to the webinar recording and transcript, contact information, links to resources. You can follow Jess Mauer at the Maine Council on Aging on X at @mcoaging, and Jennifer Sciubba at @profsciubba. As always, we encourage you to visit CFR.org, ForeignAffairs.com, and ThinkGlobalHealth.org for the latest developments and analysis on international trends and how they are affecting the United States. And please don’t hesitate to share suggestions for future webinars. You can email us at [email protected]. Again, thanks to Jess, and Jennifer, and to all of you. And we hope you have a good rest of the day. END