Originally an ophthalmologist practicing in Philadelphia, Marlon Maus, MD, DrPH, developed an interest in public health and aging that led him to pursue a master’s and doctorate degree at the UC Berkeley School of Public Health. Now an adjunct professor at the school, Dr. Maus researches the relationship between the built environment and public health and aging. He recently co-edited a book, Aging, Place, and Health: A Global Perspective (Jones & Bartlett Learning, 2018), with the late William Satariano, a world-renowned expert on aging and public health. Dr. Maus spoke with us about the global challenge of healthy aging.
Why has aging become an urgent public health issue?
Older people constitute a larger segment of the population than at any other time in history. In 2010, there were over 500 million people older than 65. By 2050, that number will reach 1.5 billion, or about 16 percent of the world’s population. In the past, infectious and parasitic diseases were the biggest threat to human health. The goal of medicine was to cure these diseases. Today’s unprecedented life spans, which have doubled since 1900, are a measure of how successful we’ve been. Now the leading causes of death are late-onset conditions such as cardiovascular disease, cancer, type 2 diabetes, arthritis, and stroke. Given the growing population of older people around the world, we don’t have enough resources to try to cure these diseases in everyone who develops them.The paradigm has to shift to prevention, which is what public health does best.
What factors help ensure that people remain healthy as they age?
There are many. Genetics, for example. And lifestyle—things like exercise and healthy diet. But the contributing factors are even more complicated than we once thought. We’re learning that exposures and experiences throughout a person’s life, even before birth, can affect how that person ages. Epidemiologists call that perspective the “life course approach.” We’re also learning that the “ecology” of a person’s life—not just the home and community they live in, but also the built and natural environment, the country, even global factors—have a profound effect on how people age.
Let’s start with “life course.” Why is it so important?
We’re all familiar with the idea that lifestyle factors—diet, activity levels, whether you smoke or not—are powerful predictors of health, especially as you age. But it turns out that the effect of these exposures and experiences begins very early, even before birth. Consider the example of memory and cognition, a critical element in healthy aging. There’s good evidence that prenatal and early life exposures have a significant influence on brain development and indirectly influence a wide range of health outcomes later in life, including lifetime risk of stroke, heart disease, type 2 diabetes, and memory loss.
Socioeconomic status and educational attainment as a child and young adult also influence brain health much later in life. People with a college education, research shows, are less likely than those with less education to develop Alzheimer’s disease and other forms of dementia, even after controlling for factors such as socioeconomic status.To give another example, we’ve been hearing a lot about high lead levels in water in places like Flint, Michigan. The impact of lead exposure in infants and children plays out across the life course. Babies and young children exposed to lead are likely to have lower IQs, lower educational achievement, lower-paying jobs, greater risk of poverty, and less healthy lives.
Your new book is titled “Aging, Place, and Health.” Why is place so important?
Experts in the field of aging sometimes say, “Tell me where you live and I will tell you how long you will live.” In 2001, the Centers for Disease Control and Prevention created the Healthy Aging Research Network to begin to get a better picture of what contributes to healthy aging. The results have shown how important “place” is. A community with sidewalks, for example, promotes walking, which in turn helps people stay healthy as they age. A living space with railings and good lighting can prevent falls, which can have a huge impact on health. A neighborhood with convenient access to nutritious foods encourages a healthy diet. A community with good public transportation for older people enables them to stay in their homes longer rather than moving to a nursing home or assisted living facility. That, in turn, keeps them healthier.
But the ecological model goes beyond home and immediate community. A state or a country that provides good health care obviously plays a big role in promoting healthy aging. International policiesalso play a role. On a global scale, for example, the threat of climate change will increasingly be a factor. We’ve already seen heat waves centered in Chicago and Paris that have killed thousands of people collectively, many of them older adults who could not leave their homes or apartments. Countries that have plans in place to address the consequences of global climate change—a program to notify residents when heat waves are forecast and to provide alternative housing for those who need it, for example—will be safer places for older people.
We’re in an era of sweeping technological innovations. How will they affect the future of aging?
The rapid expansion and adoption of portable digital technology, the Internet, social media, and new transportation technologies is already beginning to have a big impact on aging. It’s now possible to have an appointment with your doctor without leaving your home, using video conferencing on your computer or smartphone. Voice recognition programs offer new options for older people with limited vision to get information and use computers or phones. We have crosswalks that tell you when you can and can’t cross. Self-driving cars could offer unprecedented mobility to people who can no longer drive.
To give another example, Professor Satariano and I have been involved in creating an app called “WordWalk” that combines mental and physical activity. A group of older adults walk together, following a map on the app. Each time they reach a point along the circuit, a certain number of letters appear. At the end of the route, they sit together and play a word game with the letters they’ve gathered. After we tested the app, the volunteers we’d recruited liked the experience so much that they continued getting together to use it. Technologies like this can offer new ways to encourage older people to stay mentally and physically healthy as they age.
What can we, as individuals and as a society, do to create an environment conducive to healthy aging?
Let me start with the global perspective, which is important because the fastest-growing populations of older people are in developing countries. As the World Health Organization has made clear, progress towards a healthier world requires strong political action, broad participation, and sustained advocacy. Especially at a time like this, with talk about erecting walls between countries, we must understand that we are all connected. Programs that work in one community can inspire similar programs in other communities, even on the other side of the globe. By supporting research into aging here in the U.S., we help people everywhere.
On a national level, making sure that people have access to basic health care at all stages in life is essential. In our local communities, we must advocate for facilities and infrastructure that promote healthy aging, like safe sidewalks, recreation centers for older people, meal delivery services, transportation options, and other resources. We must also do what we can to make sure that nutritious food is available to everyone, including pregnant women, since we know that a healthy diet will give their children a better shot at healthy aging.
As individuals, it’s important to realize that healthy aging is a lifelong process. Teenagers and young adults who choose not to smoke will be healthier throughout their lives. Adults who get regular health checkups, including screening tests for things like high blood pressure and cancer, will live healthier lives. Every healthy decision you make, throughout your life, lays the groundwork for a healthy old age.