Category: Reading

Projection of the American ageing population

Yesterday, GOOD issued an infographic of America’s Aging Workforce (reproduced below). One of the key learning I take from it is that many Americans are unprepared for retirement. Indeed, the average American worker has saved $25,000 for retirement but it is estimated she/he will need $350,000 if she/he wishes to retire at 65 (i.e. 14 times more money!).

I was also wondering: after China and Belgium, how will the population age in the USA?

The US Census Bureau maintains national projections of the population and its latest data is from 2009. Among other things, it takes into account the resident population and demographic components of change (births, deaths, and net international migration). For international migration (in and out of the USA), there are four alternative assumptions (described in the method statement):

in the High Net International Migration scenario, they increase the previously projected net international migration by a fixed ratio ;
in the Low Net International Migration scenario, they decrease the same previously projected net international migration by the same fixed ratio ;
the Constant Net International Migration scenario illustrates the effect a level trend in international migration would have if maintained over the projection period ;
finally, in the Zero Net International Migration, the number of immigrants and emigrants is held constant at a value of zero for the entire projection period, thus assuming a closed population and no movement of individuals into or out of the United States.

By proceeding in this way, the overall number of migrants projected to enter or leave the population is (optionally) modified while maintaining the assumptions about the distributions of demographic characteristics.

Now, as expected, the American population is indeed aging. From approximately 12% in 2000 the population above 64 years old will increase to more than 21% in 2050 (in the constant scenario, see below). We also see an acceleration of the increasing number of elderly in the USA between 2010 and 2030. This US estimation is a bit lower than the estimations for China (>23%) and Belgium (>25%).

In the graph above, I took the Constant Net International Migration scenario as I consider it as the most conservative. When one plots all the scenarii, we can see the difference is not so big: the US population above 64 years old in 2050 will be between 19% (High scenario) and 23% (Zero scenario) of the total US population (see below).

The main issue remains to maintain older people as much as possible the same levels of health and independence as they enjoyed during their active lives. As highlighted by GOOD, America’s workforce will need to work well past age 65 to save enough money for retirement.

Waiting for an internet of things for everybody

There are a few days left to vote for the Internet of Things Awards 2011. Initially I thought it was a very good thing, with lots of nice ideas for the future. But then I felt something was missing, imho of course: practical projects that will help the remaining 5 billion people who are not affected by that internet of things as it currently is. Let me explain …

Although the definition isn’t still very precise, Wikipedia defines the Internet of Things as “uniquely identifiable objects (things) and their virtual representations in an Internet-like structure”. The basic underlying goal is that by communicating between themselves and with interfaces in the human worlds, things would be able to help up improve our lives, health and well-being in general. As I previously wrote before, I’m 100% for this idea.

I was thus happy to have a look at contestants in Postcapes’ Internet of Things Awards 2011. In this competition you have several categories like consumer products, networked art, entreprise implementation, self tracking products ; but I was also very pleased to see they included wilder categories like DIY projects, open source projects and environmental implementation. The inclusion of such diverse categories with a huge diversity of projects also shows that people (human beings) are still searching, discovering and defining what is and what will be the Internet of Things. At the most literal level, projects shown contain objects (things) connected to the internet/web and sending their status or responding to simple commands (a kind of home automation connected to the internet): BIKN tags, the Little Printer, Botanicalls, Twine, and all kinds of remote sensors to keep track of a fleet of vending machines, trucks, pallets, packages, etc. In my opinion, I categorize these projects as “a network of things for itself”: these things are created for themselves and can survive within their own world; they add data to the real world but this data still need to be processed to form information and to be relevant enough to create additional knowledge.

Don’t get me wrong, I know the field is still in its early infancy. In its Hype Cycle for Emerging Technologies of 2011, Gartner locates the Internet of Things on the increasing side of the expectation curve and gives it 5 to 10 years to be adopted globally. The fact DIY projects and prototyping/hobby boards like the Arduino are present in the contestant list also show that. These are first-generation products, lots of customization are needed as well as refinement of their uses. But early adopters are already investigating the field. And this diversity of directions is really good to explore all possibilities the connectivity of objects would allow.

This phase of early development also means that practical projects are currently targeting improvement of the occidental life style and sometimes tackle issues related to increased wealth and development (like the Nike+, the Jawbone UP, the Zeo sleep manager for sedentary and stressful lives). Some projects are even targeting the increasing isolation of people in occidental worlds not really by increasing their interaction with each other thru technology but by making them happy being alone. Watch for instance the following video (from Ericsson in category design fiction)!

In general, very few of these projects are aiming to help the remaining 5 billion people who are not affected by that internet of things as it currently is. The only project in this contest that could help less wealthy people is the SolarSinter project (also in category design fiction). Here, Markus Kayser uses sunlight and sand as raw energy and material to produce glass objects using a 3D printing process. He tested his device in the Egyptian desert where sunlight and sand are abundant. This could be used as small manufacturing devices to satisfy local needs when they occur.

In addition to the purpose of these devices, there is also the question of the infrastructure needed behind. For instance, Vietnam is very well equipped and connected (relative to its standard of living).

Computer equipment in Vietnam -vs- GDP per capita — Computer equipment in Vietnam is higher (per 100 people) than in India or China, the two next superpowers (x-axis) (from Gapminder)

But we didn’t mentioned that some infrastructure are still switched on manually, like this public light bulb in the picture below.

Electric connections in Vietnam — Electricity in Vietnam: very well connected (left) but some infrastructure still needs manual intervention to be switched on (right).

So the Internet of Things is definitely something to watch in the coming years. I will be also waiting for new technologies and solutions that will actually help most of people and overcome their specific issues 🙂

Photo credit: The Internet of Things by IBMSocialMedia on YouTube for the two first pictures and myself on Flickr for the pictures of Vietnam.

Health talks at TEDxBrussels

When I wrote my last post, videos of health talks at TEDxBrussels were not out yet. Now they are and you can watch them below …

First Andrew Hessel started by talking about synthetic biology, biotechnologies and his participation in the open source biology movement. One day, there will be an org (organism) for the things you want to do.

Then Jack Tiszynski followed with the drastic idea of replacing doctors by software for diagnostics and brought the idea that we will have a “virtual double” in our future smartphones. This double will know our predisposition to diseases and suggest prevention methods and cures.

Finally David Duncan talked about extreme ageing and some of the important issues brought by prolonging life and being healthy for a longer period of time than before.

But among talks I didn’t attend, Peter Hinssen presented his idea of S-curve for the future and especially the future of healthcare. For him, the flip in healthcare didn’t occur yet. But he can already predict that health will become more personal, more numerical, more proactive, more community-oriented. That’s funny because he put words on part of what we are going to say at the closing ceremony of the International Year of Chemistry, this Thursday in Brussels. Hope to have the same vibrant words 😉

Visualizing how a population grows to 7 billion (NPR)

The NPR has produced a nice visualization / video showing how population grew to 7 billion (original article):

If you want to model the improvement in child survival, you just turn the birth tap off (or nearly). Then, with wealth, prevention, healthcare and better food, the population will also grow older (death tap also turned off or nearly) and during a certain time, lots of adults will be economically active (i.e. they will work and consume). This is a demographic dividend. But it comes with a risk: at the next stage, there might be a disproportionately high number of people compared to / depending on a small number of active adults (the next generation). In addition, if you fill it up slowly but you also empty it slowly, the container risk to be full soon, it all depends on the various rates …

Note that this representation is also very effective to understand the basics of compartmental models in epidemiology 🙂

Human Development Index 2011

The United Nations Development Programme (UNDP) released its Human Development Report 2011. It “argues that the urgent global challenges of sustainability and equity must be addressed together – and identifies policies on the national and global level that could spur mutually reinforcing progress towards these interlinked goals“.

In this report, there is a ranking, the Human Development Index (HDI). The HDI is a way to measure the development. It combines indicators in three main dimensions: health, education and living standards. The mathematical way used to combine these indicators is explained in a technical note (PDF). The interest is of course to have a single number to use in comparison for both social and economic development. It’s not the only element to take into account to compare development. It’s merely a starting point giving an overview of development. An in-depth discussion about development and comparison between countries will need to go further and analyze each indicator separately (as well as other indicators if possible).

But human nature likes rankings. So be it. Here are the top 10 countries according this HDI:

1	Norway	0.943
2	Australia	0.929
3	Netherlands	0.910
4	United States	0.910
5	New Zealand	0.908
6	Canada	0.908
7	Ireland	0.908
8	Liechtenstein	0.905
9	Germany	0.905
10	Sweden	0.904

And the 10 least developed countries are all in Africa (again, according to the HDI):

178	Guinea	0.344
179	Central African Republic	0.343
180	Sierra Leone	0.336
181	Burkina Faso	0.331
182	Liberia	0.329
183	Chad	0.328
184	Mozambique	0.322
185	Burundi	0.316
186	Niger	0.295
187	Democratic Republic of the Congo	0.286

For information, China is 101st with an HDI of 0.687 ; Vietnam is 128th with an HDI of 0.593 ; India is 134th with an HDI of 0.547 (all three in the group of medium human development countries).

If I put all this in a map, it gives (thanks to the UNDP Statplanet tool):

The UNDP also has a data explorer tool à-la-Gapminder. Yesterday, I wrote about Hans Rosling’s talk urging us to continue to improve child survival in order to curb the world population growth. If I plot the HDI -vs- the “under-five mortality rate per 1,000 live births” (the probability of dying between birth and exactly age 5, expressed per 1,000 live births), I get the following graph that intuitively makes sense: the smaller is your under-5 mortality rate, the bigger is your HDI (meaning the country is more developed).

Now the HDI is admittedly a theoretical value: it doesn’t take into account inequalities within each specific country. That’s the reason why the UNDP created in 2010 the Inequality-adjusted Human Development Index (IHDI). The IHDI is thus the actual level of human development (taking into account inequality). The average loss in the HDI due to inequality is about 23%. And although the loss is variable from country to country, it increases on average when you go down the human development index (HDI), see figure below. This average loss is the smallest in Europe and Central Asia (-12.7%) and the biggest in Sub-Saharan Africa (-34.5%).

How to feed 7 billion people?

The world reached a population of 7 billion people at the end of October 2011. United Nations symbolically chose Danica May Camacho, a girl born in Philippine, to mark this global population milestone. I recently wrote about the world population getting older, about non communicable diseases becoming the most dangerous threat to health (here too) or about World Population Day(11th of July 2011). We are now 7 billion and new projections tells us we will be 9.3 billion in 2050. When I heard all the news around this, I couldn’t help but think about Hans Rosling’s presentation on population growth at TED Cannes, in 2010.

In this presentation, Hand Rosling made a small recap of the situation in 1960, when the world was divided between 1 billion wealthy people and 2 billion poor people. He made this situation more obvious by plotting the number of children per women -vs- the percentage of child survival.

Then, if you watch the movie (watch it at the end of this post), you’ll see how the different populations evolved to the situation of 2005 where the differences were still there but less marked than in 1960. And all this was thanks to soap, hygiene, education, vaccination, family planning, …

So, one thing is to worry about what would be the world with 7 or 9 billion people. Another thing is to prepare the environment (i.e. both our container – the earth, its ecosystems, its water resources, etc. – and its content – us, other animals and plants, etc.) to cope with such an amount of people. And a third thing is to try to curb that curve and find ways to slow the world population progression.

In the remaining of his talk, Hans Rosling states that one way to curb this population growth is to continue to improve child survival to 90%. This would help reach a sustainable size population of the world. Unfortunately there isn’t any “gold recipe” in order to improve child survival. Two general goals can achieve this (as well as achieve many other things): an improvement in education and a reduction in poverty.

If you improve education (especially of girls/women because they will become/are mothers, they could give their voice in that matter if we give them enough power), you will decrease fertility. The less children you have, the more time you have to take care of each of them, to give them more education, to feed them properly. On the other hand, if you reduce poverty, you also decrease fertility and, at the same time, you have more wealth to take care of your children, to send them to school and to give them proper food. This is not always the case, just generally the case.

Improving child survival will not solve all the issues. An addition of 2 billion people during the next 35 years or so is something big and it will have an impact of every aspect of our lives. But I really like the idea of having a leveraging effect starting from the improvement of child survival.

I let you watch Hans Rosling’s talk, now …

First promising results for a malaria vaccine

Malaria is the 5th cause of death in low-income countries (according to WHO). That’s why I’m very happy to read that a malaria vaccine showed promising results in a phase 3 clinical trial (in The Guardian, The New York Times or Google News). As usual, I find very interesting to get all the information at the source: the original scientific paper was just published in The New England Journal of Medicine.

The main result of this study is that “the vaccine reduced malaria by half in [young] children […] during the 12 months after vaccination”. The study also showed that “the vaccine has the potential to have an important effect on the burden of malaria in young African children“. The conclusion of the article ends with “additional information on vaccine efficacy among young infants and the duration of protection will be critical to determining how this vaccine could be used most effectively to control malaria“.

Indeed, as highlighted by the timeline reproduced below, the clinical trial isn’t over yet. Some data still needs to be reported (regarding younger children and duration of protection, as stated above).

RTS,S malaria vaccine candidate timeline (Source: PATH MVI) — RTS,S malaria vaccine candidate timeline (source: PATH MVI)

If you want to follow what’s happening with this vaccine, the PATH Malaria Vaccine Initiative seeks “to accelerate the development of malaria vaccines and ensure their availability and accessibility in the developing world” and their website contains lots of useful information.

Disclaimer: I’m currently working for the pharmaceutical company that discovered and produced the RTS,S vaccine in this study. I’m however not part of the malaria team in any way. There is only publicly available information in this post.

Yesterday was International Day of Older Persons

On 14 December 1990, the United Nations General Assembly designated 1st of October the International Day of Older Persons. 1990 … it is already more than 20 years ago! People who signed the resolution at that time are now more than 20 years older. Some (most) of them probably are now considered as “old persons”. Do they still have the same view on elderly? Maybe the highlighted principles at that time (independence, participation, care, self-fulfilment, dignity, …) are too broad, too short, just enough?

So, already a century ago 😉 people were concerned by the dramatic changes in the composition of the world population. Thanks to progresses and greater availability of preventive measures and treatments more people are living longer and healthier. Even in countries where fertility rate is high, there will be less and less working-age adults per older adult. When you look at China, the percentage of people above 65 years old is projected to rise up to one fourth of the total population in only 40 years.

Actual and projected percentage of people above 65 in China (partial data from Leeder et al., Columbia University, 2005)

Imitating other countries like the USA, UK, the Netherlands, etc., Belgium recently launched its Open Data Initiative. Well, don’t expect fancy graphs nor any “web 2.0” widgets, it’s only a repository of data made available elsewhere. Most (if not all) data is provided “as it is”, in proprietary formats and not easily combined nor even visualized. So I welcome this initiative but just wish it will be at least maintained and updated or, better, grown into something better, just like other government open data websites. A dream will be to have at least direct data manipulation online, downloads in open formats, a clearly open license and why not an open API?

So, what about the elderly in Belgium? There is a section about population forecast by age (which comes from the economy ministry in Excel format).

Projected aging of population in Belgium (data from http://data.gov.be)

The Belgian population will continue to increase. The older population in Belgium will increase faster than the younger population. But seen like this, the growth will not be very dramatic.

Actual and projected percentage of people above 65 in Belgium (data from http://data.gov.be)

If we look at the projected percentage of people above 65 years old, we see that Belgium in 2010 is already at the same status as China in 2040. If experts say China will have an alarming percentage of old people in the future, the future is already here in Belgium! But it’s also true that Belgium took many decades to achieve this allowing some adaptations to take place. China will achieve it in only a few decades and will have to cope with these changes very quickly.

UN highlighted some challenges and ways to overcome them at a country / government level. The main issues will be to maintain older people as much as possible the same levels of health and independence as they enjoyed during their active lives.

N.B. For other sources of data in Belgium, one may be interested in visiting the Bureau fédéral du Plan, Statistics Belgium and the Statistics section of the National Bank of Belgium.

NCDs account for the majority of deaths worldwide

A few days before my last post and still about the UN High Level Meeting on Prevention and Control of Non-communicable Diseases, The Economist issued a daily chart showing that non-communicable diseases (NCDs) account for the majority of deaths worldwide. I copy the chart below:

The Economist: non-communicable diseases account for the majority of deaths worldwide

I have nothing to add about the chart on the left (except I don’t think stacked bars are really useful to visually distinguish between quantities ; ok, I added something). My first reaction to the chart on the right was: these countries in the lower middle income group should really do something to tackle non communicable diseases: they represent more than the double amount of deaths than the total number of deaths in other income groups. Even for communicable diseases, they should do something: from the chart, it seems to be a bit less than 10m deaths from communicable diseases, i.e. approximately the same amount as the total number of deaths in other income groups too!

Just for you information (and because I also had to recall which countries were in that lower middle income group), here are some countries in the various groups (*):

Low income group: Afghanistan, Bangladesh, Ethiopia, North Korea, Nepal, Somalia, Togo, a.o.
Lower middle income group: Angola, Bolivia, Congo, Georgia, India, Iraq, Morocco, Pakistan, Sudan, Ukraine, Vietnam, a.o.
Upper middle income group: Algeria, Brazil, China, Cuba, Libya, Malaysia, Russian Federation, Serbia, South Africa, Thailand, a.o.
High income group: E.U. countries, Japan, Singapore, Switzerland, USA, a.o.

(*) Technically it follows the way the World bank classifies countries: economies are divided according to 2010 GNI per capita, calculated using the World Bank Atlas method. The groups are: low income, $1,005 or less; lower middle income, $1,006 – $3,975; upper middle income, $3,976 – $12,275; and high income, $12,276 or more.

Then you realize that if you just take the absolute number of deaths and compare these group of countries (as it’s done in the chart on the left), you don’t compare exactly on the same basis. What if some groups have more countries or lower/higher population? What if the total surface of countries in one group are much higher (lower) than in other groups? Idem for the population density, etc.

Fortunately, the WHO has a parameter one can use in order to objectivize a little bit this issue: the “Age-standardized mortality rate by cause (per 100 000 population)”. If you plot this parameter in the same way as above, you obtain this chart:

Age-standardized mortality rate by cause (per 100 000 population) per income group

From this you can now say that low income countries should really do something about NCDs but also communicable diseases, etc.

Presented like this, the number of deaths due to injuries and communicable diseases (per 100,000 pop.) decreases if the income of the country increases. In other word, more income you have, relatively less risk you have to die from injuries or communicable diseases. That explains why 1 death under a fallen wall is reported as a big sad news in Belgium while 60 deaths in a bus crash are not even reported in the news in India.

Another striking conclusion is that in low income countries there is approximately the same number of deaths (per 100,000 pop.) due to NCDs and due to communicable diseases (+/- 20%). We are all aware of tuberculosis, malaria, AIDS/HIV, etc. in less rich countries but it seems NCDs are an equally important issue.

But the most frightful conclusion from these numbers is that there is approximately the same number of deaths (per 100,000 pop.) due to NCDs in all income groups (674 ± 75) except the high income one. In other words, irrespective of you location or your income (except high income), you have the same chances to be affected by a non communicable disease. And irrespective on your income (and this time, even for high income countries), you have more chances to die from a non communicable disease than a communicable disease.

Ways to mitigate risk factors for NCDs (end of previous post) are still on.

N.B. WHO numbers are from 2008 for both charts.

The state of non communicable diseases

Last week, United Nations gathered in New York, USA, to talk about prevention and control of non-communicable diseases (NCDs). Non-communicable diseases are non-infectious, of long duration and generally progressing slowly. Due to the fact they are not infectious, there is no pathogen to target and there is no transmission medium to fight. Due to their long duration and slow progression, one usually notices NCDs when it’s too late and eradicating NCDs is less spectacular than other (not less important) infectious diseases. However WHO measured that NCDs represents more than 60% of all deaths in the world. For the occasion, WHO released an introductory video that summarize the issue.

So there are 4 main non-communicable diseases:

Cardiovascular diseases
Diabetes (both of them represent 70% of deaths by NCDs)
Cancers (~ 20% of deaths by NCDs)
Chronic respiratory diseases (~ 10% of deaths by NCDs)

NCDs are not directly in the UN Millenium Development Goals but I already mentioned they represent 4 of the top 5 killers in the USA. Two of them are also in the top 5 killers worldwide. If the Millenium Goals succeed, non-communicable diseases will be the next big issue in health.

Although NCDs were considered as a disease limited to high income countries (with infectious diseases affecting low income countries), this is not really the case anymore. For instance, the map of male deaths due to cardiovascular diseases and diabetes in 2008 shows an approximately uniform rate in high income countries with some higher rates in low income countries (especially on the African continent).

WHO World : Cardiovascular diseases and diabetes, death rates per 100 000 population, age standardized: Males, 2008

If you are looking for more numbers, visit the WHO Global Health Observatory on Noncommunicable diseases.

If nothing is done, the incidence of NCDs will increase. On top of being a health issue, a matter of life and death, it will also become an economical problem as the costs of treatment as well as the indirect costs will also dramatically increase (increase per case treated and increase due to the number of cases treated).

Incident cases and cost of diagnosed diabetes per 1,000 people (adapted from Boyle et al. 2010 and Alternative Futures Diabetes 2025)

If you are looking for more figures about the cost of non-communicable diseases, here are two detailed reports recently published:

WHO: Scaling up action against noncommunicable diseases: How much will it cost?
Harvard School of Public Health and the World Economic Forum: The Global Economic Burden of Non-communicable Diseases

In a nutshell, non-communicable diseases are everywhere and the future doesn’t look happy. However …

However risk factors are identified and many of them are related to our own lifestyle:

Physical inactivity
Unhealthy diet
Tobacco use
Harmful use of alcohol

To end on a positive note, all these risk factors can be easily controlled and for a limited additional cost. For instance, governments can protect people from tobacco (taxes as well as bans on tobacco advertising, promotion and sponsorship, …) and alcohol (access restriction, bans on advertising, …) as well as promote public awareness about diet and physical activity. Companies can also promote healthy diet and physical activities to their employees. On top of that, the food industry can also include relevant actions in their corporate social responsibility policies. Finally on a personal level, we can increase our physical activity, increase fruit and vegetable intake, reduce our use of tobacco and alcohol, etc. Simple, cheap actions ; huge interesting consequences.