From Shanghai to São Paulo, people around the world are living longer than ever, challenging long-held ideas about retirement and well-established national retirement systems. Stanford health economists Karen Eggleston and Victor R. Fuchs offer an innovative view of the global aging phenomenon in an article published recently in the Journal of Economic Perspectives.

Drawing on a century of demographic data from 17 countries, Eggleston and Fuchs show that the share of increases in life expectancy realized after age 65 was only about 20 percent at the beginning of the 20th century but close to 80 percent by the dawn of the 21st century. Expected lifetime labor force participation as a percent of life expectancy is now declining. Eggleston and Fuchs share four interrelated responses to the economic and social challenges posed by this “new demographic transition:”

• Increase the retirement age.
• Encourage savings.
• Strengthen education.
• Emphasize healthy lifestyles early to ensure productivity in old age.

Eggleston is director of the Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center. Fuchs is Henry J. Kaiser, Jr., Professor Emeritus, in Stanford’s Department of Economics and Department of Health Research and Policy, and a senior fellow at FSI and SIEPR.

Of the four policy responses the article proposes, is one especially critical?

Fuchs: The most important solution in terms of its potential impact would be people changing their attitudes toward retirement. This would mean people postponing retirement and saving more during their working years. If you work five years longer, for example, you would have greater savings and a shorter period of time when you would need the money.

Eggleston: We tend to think of the solutions as being interrelated. To address this longstanding and inevitable global demographic transition, organizations and policy structures need to support changes in individual behavior. In the case of the retirement age in the United States and European countries, policymakers need to change the many incentives that encourage people to retire younger.

What do you most hope policymakers will take away from the article?

Fuchs: We hope they will recognize the absolute need for individuals and organizations to plan for later retirement.

What are the special challenges faced by China and India, the world’s largest populations?

Eggleston: Longer lives in China and India contribute to improved human development, yet population aging also brings special challenges. China’s population is aging more rapidly than India’s and both countries need to invest more in the education and health of their young people, especially in poor rural areas.

In India, nutrition and education will help to reap a one-time boost to economic growth if the large cohorts of the working age population can be productively employed, while building a foundation for sustained improvement of living standards. China’s youth need to be as productive as possible to support the elderly while continuing to improve the national living standard.

The coming decade will be crucial in China, as the country transitions into a new economic phase and expands its fledging social protection system. The goal should be to ameliorate disparities and protect the vulnerable, while maintaining a financially sustainable and culturally appropriate balance of government and family responsibility for old-age support.

Former U.S. Ambassador to Afghanistan Karl Eikenberry has been awarded a William J. Perry Fellowship in International Security at Stanford’s Center for International Security and Cooperation (CISAC), where he will continue to address emerging security challenges facing the United States.

Ambassador Eikenberry has an ambitious agenda for the coming academic year, which includes teaching and mentoring students, public speaking and working closely with former Secretary of Defense William Perry. He also will take part in activities at the Walter H. Shorenstein Asia-Pacific Research Center (APARC), such as the new China and the World research initiative.

“It’s a lifetime honor to receive the Perry Fellowship,” says Eikenberry. “I can’t think of an American in modern times who has better exemplified inspirational commitment to public service than Dr. William Perry. And I can’t think of a better institute of higher learning to be associated with than Stanford University.”

Ambassador Eikenberry has been at Stanford since September 2011 as the Frank E. and Arthur W. Payne Distinguished Lecturer and is an affiliated faculty member for CISAC, APARC and the Center on Democracy, Development and the Rule of Law (CDDRL), as well as research affiliate at the Europe Center – all policy research centers within Stanford’s Freeman Spogli Institute of International Studies.

Before coming to Stanford, Ambassador Eikenberry led the civilian surge directed by President Obama from 2009 to 2011 in an effort to reverse the momentum gained by insurgents, and set the conditions for a transition to Afghanistan sovereignty. He retired from his 35-year military career in April 2009 with the rank of U.S. Army Lieutenant General after posts including commander and staff officer with mechanized, light, airborne and ranger infantry units in the United States, as well as Korea, Italy and as the Commander of the American-led Coalition Forces from 2005-2007.

"Karl Eikenberry's record of public service amply demonstrates his unique qualities, not only as a leader of the American military at a challenging time, but as a strategic thinker and an insightful diplomat,” says CISAC Co-Director Mariano-Florentino Cuéllar. “He has a rare understanding of the profound challenges facing our world, and has been a tremendous asset to CISAC and Stanford.”

Ambassador Eikenberry’s research areas include U.S. strategy in the Asia-Pacific region; China’s evolving security strategy; the United States and NATO; the future of the U.S. military; Washington’s policies in Central and South Asia; and assessing the risks of military intervention.

The fellowship was established to honor Perry, the 19^th U.S. secretary of defense and former CISAC co-director, and to recognize his leadership in the cause of peace. Perry is co-director of the Preventive Defense Project and the Nuclear Risk Reduction Initiative at CISAC and is an expert on U.S. foreign policy, national security and arms control. Perry Fellows spend a year at CISAC conducting policy-relevant research on international security issues. They join other distinguished scientists, social and political scientists and engineers who work together on problems that cannot be solved within a single field of study.

Ambassador Eikenberry is a graduate of the U.S. Military Academy, has master’s degrees from Harvard University in East Asian Studies and Stanford University in Political Science, and was a National Security Fellow at the Kennedy School of Government at Harvard. He earned an Interpreter’s Certificate in Mandarin Chinese from the British Foreign Commonwealth Office while studying at the United Kingdom Ministry of Defense Chinese Language School in Hong Kong, and has an Advanced Degree in Chinese History from Nanjing University in the People’s Republic of China.

Preparing a meal in some of the world’s poorest rural areas can turn an ordinary activity into a deadly chore. Animal dung and crop scraps often fuel the indoor fires used for cooking. And before any food fills a hungry belly, thick black smoke fills a family’s lungs.

Pneumonia and other acute respiratory infections kill about 1 million people a year in low-income countries, making them the top cause of death in the developing world and the greatest threat to children’s lives. Makeshift stoves belch much of the polluted air leading to those illnesses. About 75 percent of South Asians and nearly half the world’s population use open-fire stoves inside their homes.

“The smoke is asphyxiating,” said Grant Miller, an associate professor of medicine at Stanford working on ways to get people to buy – and use – cleaner, safer stoves. “It burns your eyes and you can’t stop coughing.”

Governments and humanitarian organizations have urged people to trade their traditional stoves for safer models, many of which have chimneys that funnel smoke out of a home. But the switch from dangerous stoves has been slow to come, even though most people using them know they’re harmful.

Miller and his colleagues are studying what’s behind the reluctance and what can be done about it. They suspect much of the problem rests with the widespread approach to clean cookstove conversion, which focuses on educating people about the appliances’ health hazards and offering new models at a low cost.

Their most recent findings, published in the Proceedings of the National Academy of Sciences, boil down to this: Clean and modern cookstoves don’t have features people want. And until they’re redesigned, people are unlikely to bother with them.

“People don’t think of cookstoves as health technologies,” said Miller, an associate professor of medicine and a Stanford Health Policy faculty member at the university’s Freeman Spogli Institute for International Studies. Miller is the senior author of the PNAS paper, which published online June 11.

“They don’t think respiratory illness is the biggest health problem that they have,” he said. “And when you ask them what they want from a stove, they talk about saving time and having better fuel efficiency. They’re not talking about smoke emissions.”

In the first of two studies, Miller – joined by Yale researchers and Lynn Hildemann, a Stanford engineering professor affiliated with the Stanford Woods Institute for the Environment – surveyed about 2,500 women who cook for their families in rural Bangladesh. 

Nearly all of the women use traditional stoves, and 94 percent of them said they know the smoke from their stoves can make them sick. But 76 percent said the smoke is less harmful than polluted water, and 66 percent said it wasn’t as dangerous as rotten food.

“People know their cookstoves are bad, but they don’t think cookstoves are the most important problem they face,” Miller said. “They’d rather spend their money fixing those things and getting their kids into a good school than buying a new cookstove.”

When asked what features are most important in a stove, the women talked about things that could save fuel costs, cooking time and the hassle that goes into collecting fuel.

“A very small percent said reducing pollution was important,” Miller said.

The researchers then tried to assess more directly how Bangladeshis value new stoves. They offered 2,200 customers across 42 rural villages the opportunity to buy one of two models – one boasted improved fuel efficiency; the other had a chimney to reduce exposure to indoor smoke.

At the market prices of $5.80 for an efficient stove and $10.90 for the chimney stove, less than a third of customers ordered either model. And when the stoves were delivered a few weeks after the orders were taken, a very small number of families actually went through with the purchase of either model.  Large randomized discounts increased customer interest in fuel-efficient stoves, but did little to raise purchase rates of chimney stoves.

“A big implication is that the health education and social marketing approaches aren’t going to work,” Miller said. “You need to get inside the heads of the users and figure out what they really want and value – even if unrelated to smoke and health – and then give it to them.”

The lead author of the PNAS paper was Ahmed Mushfiq Mobarak, an economist at Yale. It was co-authored by Yale researchers Puneet Dwivedi and Robert Bailis. Their work was supported by the Freeman Spogli Institute’s Walter H. Shorenstein Asia-Pacific Research Center, Stanford’s Woods Institute for the Environment, and the International Growth Centre.