Trend: Live Forever (Ageing/NCDs/Covid)

A trend indicates a direction of change in values and needs which is driven by forces and manifests itself already in various ways within certain groups in society.

We are living longer and healthier lives, but they are not all healthy years. Non-communicable diseases (NCDs) are the leading cause of death globally and cases are rising. Currently, about two thirds of all deaths in Europe are due to diabetes, cardiovascular disease, cancer, chronic respiratory diseases and mental health conditions and the prevalence is set to increase with an ageing population. In addition, the onset of NCDs is happening at younger and younger ages, in part fuelled by increasing childhood obesity.

NCDs appear throughout the life-span, and are due to genetic, environmental and physiological factors. They are influenced by behavioural factors such as smoking and alcohol. People with NCDs have a higher risk of severe COVID-19 and COVID-19 intensifies an NCD. The evidence is growing that the so-called ‘long-COVID’ could turn into a chronic condition, with cases of heart inflammation and other organ damage persisting. 1.3 million people in the EU lost their lives due to cancer alone in 2020, and the number of new cancer cases is estimated to grow by 3.2 million per year by 2040. The pandemic-related removal of early cancer screening steps will increase the burden of cancer (and other NCDs) on patients and healthcare systems, and will increase NCD-related deaths.

There are counter signs appearing to the increasing ageing and NCD population with a push to ‘live forever’. People are increasingly aware that, for e.g. >40% of cancers might be preventable through healthier diets, not smoking, more physical activity, less alcohol consumption and reducing pollution. Targeted health promotions could complement innovative population and system-wide public health actions for the future. Alongside huge advances in medicine, biotechnology start ups are working to reverse the ageing process too, by applying AI and digitalisation tools to create ‘everlasting avatars’.

This Trend is part of the Megatrend: Shifting health challenges

Manifestations

Developments happening in certain groups in society that indicate examples of change related to the trend.

Increasing chronic disease burden and COVID-19

COVID-19 is continuing to spread around the world, with more than 550 million cases and 6.3 million deaths recorded (July 2022). Symptoms can persist for months and the virus can damage organs, which increases a patient’s risk for long-term health problems. ‘Long Covid’ could turn into a chronic condition. COVID-19 treatments may cause life-threatening and have long-lasting impacts too. COVID-19 and NCDs exacerbate each other and people with compromised immune systems (due to cancer, or a steroid treatment) have a higher risk of complications and/or death. The pandemic has shown how important the overall health of the population is: a healthier population that is less burdened by NCDs will be healthier, more productive and more capable of withstanding a future pandemic. The main types of NCD are:

• cardiovascular diseases (63 million in the EU in 2019);
• cancers (2.7 million diagnosed in the EU in 2020);
• respiratory diseases (8% of deaths in the EU in 2020);
• diabetes (estimated at 61.4 million in 2021);
• mental health and neurological disorders (more than half of the European population).

Advances in diagnostics, therapies (personalised), radiotherapy and surgery for NCD patients are saving lives every day. Prevention, detection, screening and treatment of NCDs, as well as palliative care, are key components of the response. However, these have been massively disrupted due to the overburdening of health care systems during the pandemic and COVID-19 is continuing to disrupt essential health services. This has led to a backlog and missed cases - the impacts of which are coming into focus and which have implications for the future.

The pandemic exacerbated and underlined the unequal healthcare of different communities and populations everywhere. NCDs disproportionately affect older people and people in low- and middle-income countries - where 77% of NCD deaths occur (31.4 million annually). Disparities in health among older people reflect accumulated disadvantages related to socio-economic status, gender, location and ethnic background, as well as the long-term effects of unhealthy behaviour. There is an increased likelihood for poor people to contract COVID-19 too, to develop more severe symptoms and to have an unfavourable outcome, alongside an uneven distribution of vaccines, medicines and misinformation. The pandemic has exacerbated the increasing challenge associated with poor mental health too, especially for youth. The worldwide prevalence of dementia is estimated to almost triple between now and 2050. For more on this, see below and the ‘Mind yourself’ trend.

Signals of change: EC JRC, BBC/John Hopkins, SAPEA, EC, PAHO/WHO, WHO,

The increasing ageing population needs care

In the EU, the right to timely access to ‘affordable, preventive and curative health care of good quality’ is enshrined in the Pillar of Social Rights, but the basis for health and long-term care (LTC) systems to be able to deliver these rights is a strong health workforce. The COVID-19 pandemic has put the resilience of national health and LTC systems to the test, and has made it even more obvious that ‘health is a precondition for our society and economy to function’. The ageing population directly influences health care, LTC, and other forms of social protection (see Increasing Demographic Imbalances megatrend).

The rise in the number of elderly people and the parallel rise in NCDs have led to an increasing demand for health and LTC services which, in turn, has generated a rising demand for a qualified workforce. From 2018-2030 alone, EU-27 will need 10.9 million newly trained, or imported health and LTC workers to satisfy this rising demand. However, currently, health care workers are leaving the profession in droves - the pandemic having heightened their already high burden and difficult working conditions, often causing burnout.

These evolving challenges are set to grow in the years ahead, as demand increases, while the workforce does not. In the longer-term future we may utilise fully automated health spaces that make use of AI and other innovations. A number of pilot studies are on-going to provide better medical coverage in remote areas (for example the small islands in Greece). Increasing use of telemedicine generally, automation and digitalisation assistance are appearing, but are not perfect yet. (See the trend ‘Digitize me and my health’ for more).

Signals of change: SAPEA, EC JRC, Elsevier, Forbes, NATO, BMJ, Elsevier, Biomed Eng, ACP Internist

Brain related diseases

The worldwide prevalence of dementia is estimated to almost triple between now and 2050 – going from 57 to 153 million cases. This is mostly due to population growth and population ageing – with the smallest increases projected in high-income Asia Pacific (53%) and Western Europe (74%), and the largest estimates for North Africa and the Middle East (367%) and eastern sub-Saharan Africa (357%). This pattern of Alzheimers, or ageing-related dementia, is affecting those countries where populations are getting older – so mostly first world countries.

The pattern of more women than men with dementia is set to remain (1.7 ratio). There are 12 modifiable risk factors related to education, nutrition and lifestyles - less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact, excessive alcohol consumption, traumatic brain injury, and air pollution.  

Brain-healthy lifestyles may become a cornerstone of dementia prevention policies that could prevent or delay 40% of worldwide cases. Studies show alteration of the brain as one of the effects of COVID-19 in some patients too. 5.8% of COVID-19 patients have been diagnosed with mental illness despite having no previous history, (in other words mental illness on-set is a COVID-19 complication).

Signals of change: BBC, Brain Behaviour and Immunity, Lancet, Elsevier Public Health Em, WEF, Nat Geographic, Ag Ment Health

Taking on the grim reaper

At an accelerating speed, treatments are being discovered to prevent and treat diseases and to elongate and improve quality of life for the elderly. In the coming decade, breakthroughs in 3D bioprinting, nano- and biotechnology and new mRNA technology will bring further advances (see ‘It’s a miracle’ trend). In basic and cancer research, how cells in our body survive or die, multiply or replace themselves in a controlled manner, has always been intensely studied. However, the breadth and depth of longevity research is dramatically increasing. This includes regenerative medicine, DNA repair, and other strategies. The first senolytics treatments (focusing on cell death) have begun, and the idea of anti-ageing therapies that purge the body of dying cells is being picked up by startups. The companies are working to reprogramme cells so they are rejuvenated, aiming to reverse the ageing process and prolong human life. Life extension has been demonstrated in worms and mice and clinical trials in humans have begun (metformin and rapamacyn). Its early days and future challenges will be associated with acceptance and access – which will further increase health inequalities. Tech billionaires are putting their money in the startups (and themselves).

In the virtual space companies are offering immortality through a ‘Live Forever’ mode where people are recreated as avatars. Somnium Space is one metaverse that allows people to have their movements and conversations stored as data, then duplicated into an avatar that moves, talks, and sounds just like them — and which can continue to do so long after death - even if the ethics and/or security has not caught up. This ‘other version of a person’ can continue to evolve alongside AI technology in the coming years, even if all the data was collected years ago (see also the trend of ‘Digital me’ in the Tech MT).

Signals of change: Technology review, Nature, STAT, Tech Crunch, Tech Crunch, Trends in Endo and metabolism, 3d Print, NBC, Fortune

Interesting questions

What might this trend imply, what should we be aware of, what could we study in more depth? Some ideas:

• What if we only die by accident or crime in the future?
• What about long COVID-19? What will it do to NCDs over the long term?
• What if only rich people can live forever?
• Who owns my digital me after I die?
• What if EU financial instruments for rural development and agriculture played a steering role to reach sustainable water resources and zero pollution?