"Ageing Alla Milanese" | Episode Two

00:00:00: Dan: Milan has one of these great little airports. It's like your airplane seat is just seconds away from this vintage tram and you're riding down the street, listening to a guy playing accordion, and everyone around you is just a little bit more stylish than the city you came from.

00:00:18: There's a lot of glasses which are thick rimmed in like just a really cool way.

00:00:23: I want to connect to the world that all of this demographics is operating in, the people, the policy. And I want to start to think about these things a little more pragmatically. I wanna look at the policy and like the real world and you know. Milan's an amazing place to do this. Not only is it the home of Bocconi University, which happens to be the headquarters of the FutuRes Project with whom I'm working on this podcast.

00:00:53: It's also just the kind of place where. You show up and, and you take a walk and minutes later you're in front of what seems to be a really cool little wine bar full of people who are young, relative to yourself, and are extremely happy to chat with you on a podcast.

00:01:12: In this Episode, I'm gonna talk to a researcher who also spends a lot of time talking to policy makers. A woman who gets the call every time the Italian press is alerted to the fact that they're having less babies every year. And a health economist , who's considering what the real numbers are in terms of caring for the health of our society. But we're gonna start at the wine bar, chatting with a wonderful woman named Valentina.

00:01:44: you know make sense, okay? At this point for me is just, uh, the reason why I would choose to maybe it's a little bit selfish and it's to have someone who can take care of me when I will be really old. Uh, I mean, I've seen, uh, um I mean I've seen my grandmother passing away couple of weeks ago, and I've seen how could I support my father, in this whole process, so her kid took care of her and I took care of my father's feeling in the moment that she passed away.

00:02:35: Dan: And how did your dad find time to take care of her?

00:02:39: Valentina: Oh he is unemployed at the moment so that was pretty easy for him.

00:02:54: Dan: I am Daniel Stern, and this is episode two of Certain Futures.

00:03:03: My one day in Milan was packed full of interviews with the experts who I'd flown there to speak with, so I really only had one evening to get all of the street conversations I wanted to collect, and it was about to rain and I didn't think it was gonna happen, but it turns out that the streets of Milan are either 100% full of people who are ready to talk about demographic issues, or I just got kind of lucky.

00:03:36: Paolo: My name is Paolo. I'm Italian, we are in Milan. And we live in, Milan, and we are very very happy to live in a shit of a city.

00:03:52: Dan: It's really, and that's fan.

00:03:54: Paolo: Scusi.

00:03:54: Guy at Bar: he not happy because we. He tell a joke.

00:03:58: funny.

00:04:00: and, um, do you work?

00:04:03: Paolo: I work, I'm engineer.

00:04:04: Dan: do you think you'll retire? Um, stop working?

00:04:10: um, i'll use the machine to translate.

00:04:13: Paolo: Pensione?

00:04:14:

00:04:14: Paolo: Ten more, ten, fifteen, no.

00:04:18: Dan: Well, do you, do you expect that your, uh, pane is good?

00:04:23: Paolo: No, no, in Italy pensione.

00:04:26: little,

00:04:27: little little little little um um no, la pensione in Italy is very very very little.

00:04:36: Dan: Che si a presso...,

00:04:41: Paolo: Um My father, Died ten years ago. And

00:04:50: Dan: the, I'm sorry,

00:04:51: Paolo: he

00:04:53: He work all life. All life.

00:04:56: Dan: have one son or,

00:04:57: Paolo: Five sons

00:04:58: Dan: You have five sons? Okay. your pensione. For them. Is that also realistic?

00:05:05: No no

00:05:06: Paolo: no no

00:05:07: Guy at Bar: no,

00:05:08: Paolo: no no no, no.

00:05:11: Dan: What is your biggest worry for the future?

00:05:14: Guy at Bar: Qual è la tua

00:05:14: più grande preoccupazione

00:05:15: per il futuro?

00:05:18: Paolo: I live for today.

00:05:22: Dan: When I finish speaking to Paolo, the trickle of rain turns into a torrential downpour that lasts through the night and into the morning. It's so bad that I, it looks like I might have to record my interviews remotely from my hotel room, even though I have flown to Milan to meet in person with these people.

00:05:38: Uh, but it does let up eventually. And I go to meet with Arnie. One of the leaders of the future as project. He's at home with his two kids, and I learned a great tip, um, if you get yourself in air fryer, a teenage boy can basically feed themselves and, and you'll hear the clinking clack of that air fryer in the background.

00:05:58: During this interview,

00:05:59: The coffee's good. Thank you.

00:06:02: Arnie: That's good. That's good. My name is Arnstein Aassve I'm a professor of demography at Bocconi University here in, uh, Milano, in Italy. I'm, Norwegian, And, I lived here since 2007

00:06:16: Dan: I did a study of exactly three people last night. um, I met one man , he's expecting to work until 75.

00:06:23: Arnie: So, you know, there we start to touch on a certain demographic issues, that Is, uh, let's say, I dunno if I should use the word plaguing, the, the country or, or not.

00:06:33: Dan: What's your hesitancy to use the word plaguing?

00:06:36: Arnie: I mean that sounds a little bit dramatic, but of course, uh, I think, uh, Italians are pretty aware of the demographic realities, that we find in this country. Because it's been in the news for a long time, the very low fertility rates and, um, and that has its consequences. And, you know, one consequence is of course, that many people might have to work longer.

00:07:00: And, uh, and, and then So, you know, you, you get this worry that the whole system is kind of rigged against these young people. And, and the worry is that, okay, my generation X generation and the boomers are gonna run away with the cake.

00:07:18: Now the other concern about this is inheritocracy Uh, so, you know, how important it is for your own wellbeing, being a young person today about how much wealth your parents have, right? Because you're going to inherit, or you you're going to get support by your parents. So, this demographic shift we are seeing might also be a source or greater social differences between people.

00:07:48: do worry that, uh, the public pension system is not going to be very generous in the future. Uh, so there you have it.

00:08:10: It's interesting to see. The, the decline in fertility rates in, in the Nordic countries. You know, Nordic countries always hailed as a success story

00:08:19: so

00:08:19: you kind of thought, wow, you know, they, they did it. They, they, hacked it, then, um, but then the fertility rates since 2010 started to go down. Rather steadily. And, and I, I met, I met people at the conferences and so on,

00:08:36: I said, you know, "What's happening in the Nordic countries?"

00:08:38: You know, things worked until a certain stage, but you know, things change. And then you have to change the policies as well. And I think this is at heart of this project that we are running, you know this, this idea of resilience,

00:08:52: Because being resilient also means that you need to be able to cope with the fact that life changes for people. But society is change as well.

00:09:03: Dan: Like there was this crazy rainstorm all morning here and you said, well, I've never, this is unusual.

00:09:07: It's for

00:09:08: Arnie: you, and you didn't bring your umbrella.

00:09:09: Dan: I did pack my umbrella. I was so proud of myself. I didn't use it though. You sometimes have, uh, I guess, irrational actors within your models, but, uh, the, the, you know,

00:09:19: how does resilience, which is like a buzzword. Translate into anything helpful?

00:09:24: Arnie: Yeah, yeah, yeah, yeah. So, so resilience is indeed a buzzword. And people have very different sort of ideas and opinions about what it actually means. And, , because everyone talked about it, it became so vague.

00:09:39: Therefore it lost a little bit of its power. So one of the things that we've been trying to think about is, okay, what does resilience really mean?

00:09:47: How should we think about it for people?

00:09:51: But not only how should it also work for societies?

00:09:54: majority of the population, it came outta the blue, we don't know what the next shock is going to be. In Nordic countries now, every household is asked to make sure they have, one week supply of clean water and a bit of, uh, tin food, you know, just in case.

00:10:15: But resilience is a bit more basic in the sense that let's try to give these people capacities to overcome whatever comes their way. Right? AI wasn't there. And, and suddenly it's changing our lives very, very fast. And, um, the danger is that you try to design a new welfare state for the next 20 years, but you just might be wrong.

00:10:39: Dan: For me, one of the, silver linings of the COVID pandemic was all of a sudden you saw very slow moving governments doing things very quickly. Yeah. And in very pragmatic ways,

00:10:49: Arnie: perhaps one of the biggest misconception about, uh, resilience is that we need to cope with the shock in order to get back to where we were. But that's not, inherent in this, concept. So going back to normal, it has to be a new normal. It's not said that there is only one steady state equilibrium that we always going to seek to get back to. It just isn't

00:11:16: Dan: resilience means find the new normal.

00:11:19: Arnie: Here comes in a very important part. And that is that resilience is not necessarily something positive. Eh,

00:11:27: Dan: Resilience is not necessarily something positive. Okay? Now this is, this is a plot twisted

00:11:33: Arnie: Uhhuh. Uhhuh. Uh, this is important. There are cases where psychopathic people actually score incredibly high on any kind of resilience scale, but being a psychopath, it's not something, it's not something positive, right?

00:11:47: in there for resilience, it scores very high, right? So when you talk about resilience, you need to be prepared to go on a new path, right? Secondly, you need to be very clear about the values, about what. Are important for people, for your citizens? Because these are the deep characteristics of the society that you want to maintain. To have equal opportunities, freedom of speech,

00:12:32: Dan: rich cultural expression.

00:12:34: Arnie: Absolutely. Maybe Russia, you could even imagine that , they turned around their society, you know, okay.

00:12:40: Didn't go so well for them in, in the invasion of Ukraine. , but. They adapted, so you could even argue that they have been resilient but of course, from our point of view, this is not a particularly good thing.

00:12:56: Dan: Resilience isn't an outcome in and of itself.

00:12:58: Arnie: Exactly. Exactly. So you cannot basically say, okay, , we're just gonna try to make societies more resilient and therefore by corollary everything is going to be good.

00:13:08: So then what are the things that really matters here? Education matters.

00:13:15: And community, social networks, friends, colleagues, the bigger network you have, the easier it is to cope with any kind of problems that comes your way.

00:13:26: Makes sense? No. That's very important to keep in mind.

00:13:31: Dan: Our interview ends and Arne lets me know that the true superstar demographer of his family is his wife, Letitia, and he brings me over to her office so that I can sit down and chat with her for a while.

00:13:44: Letizia: So I'm Letizia Mencarini, I'm a demographer. I'm full professor of demography at Bocconi University.

00:13:52: Dan: So you're pulling something up here?

00:13:53: Letizia: Yeah,

00:13:54: were 482 people over 100 years old. In 2023, there were 20,445.

00:14:12: And the forecast are that in 2050, there will be 60,500 people above 100 years old.

00:14:21: Dan: Right?

00:14:22: Letizia: now we, we, if we look our population structure, there are those who say that it's like a, a an atomic, uh, bomb because there is this bulge up, you know? And then the lower part is so thin.

00:14:36: Dan: Oh, okay. An atomic, a mushroom, a mushroom, a mushroom shape. Okay.

00:14:40: Letizia: That is not nice at all. So this mushroom shape eventually should go away. But, but with, uh, which cost for those generation who passed on?

00:14:50: And I'm not only concerned about the elderly, I'm much more concerned about the young people.

00:14:56: Dan: That's amazing. Why?

00:14:58: Letizia: Because this new generation will have to pay the cost and the burden of this bulge without having done anything.

00:15:11: For instance, in Italy, just to take an example, Now there are 7 million below 15 years. There will be 6 million in 10 years. Huh?

00:15:20: So the future are young people, they're few and they need to be cared of in incredible way. I don't know. When a resources becomes scarce, it should be more precious, so you should invest more on them. And this is not what I see in our society. I see that, young people, they have difficulties to enter in the job market. They are not paid enough. They don't have security. In Italy. There is still an enormous dropout from school.

00:15:48: future.

00:16:00: Dan: Most people I've been speaking to very focused on Europe. You know, they'll, point to, Japan or Korea, as an extreme example of this or that,

00:16:09: or they'll look at Africa and say, well, here's where the growth is happening.

00:16:13: So is there a different discussion happening in world demography

00:16:19: Letizia: yeah, sure. , In 1800, we were 1 billion. So , now the rate of the growth is decreasing, but we are still increasing in the total number of the world. And, and I think this, is something that is, an issue for the environment, for support of the world. The other characteristic that we are never been so dis equal.

00:16:43: I mean, EU it will be soon 6% of the total population in the world. How can we think to be euro-centric?

00:16:55: This is not justified anymore we need to be humble and understand that we are small compared to the rest of the world.

00:17:06: So I've worked also in some NGOs in the past and in development. And I couldn't foresee this moment where all the funds were cut. Uh, I think there is really a sort of, uh, middle age medieval, ah, or,

00:17:25: Dan: okay., So we're, we're entering not just like middle aged population wise in terms of uh, no, but also middle, mid, medieval,

00:17:33: Letizia: medieval.

00:17:34: fired. The whole program after 50 years was shut down and the data are not available, even the old one in the internet anymore.

00:18:11: A student of mine came and said, I don't find the data. And I said, this is really, you know, not a good student, not even able to find. Then I went there and there was a red mark the data are not available anymore.

00:18:25: What?

00:18:26: Say what? I couldn't believe it.

00:18:29: Dan: That's,

00:18:29: one of the first things someone taught me about demography is that it's, uh, like sort of a non-destructive science in that i the data you've had since the dawn of it is still useful.

00:18:40: That i s really heartbreaking.

00:18:43: Letizia: It is heartbreaking.

00:18:45: Dan: Is there anything, that you didn't get a chance to say?

00:18:48: Letizia: Uh no, I think that people shouldn't be scared about, uh, numbers numbers or simply the description of who we are. And they're not cold, numbers are not cold you can see through the numbers and arrive to people and you can look at the numbers and then go around and find people. And this is what I like and I think, uh, that, uh, humanity is beautiful, but it's also in danger.

00:19:14: In a sense.

00:19:16: Dan: Humanity is beautiful , but also

00:19:18: Letizia: In danger.

00:19:19: Dan: In danger. Okay.

00:19:23: Dan: Now I'm headed two floors up to another department and we're gonna talk numbers with a health economist and well, see what people I can find hiding in those numbers.

00:19:37: Aleksandra: Hello. I'm Aleksandra Torbica. I'm a professor here in Bocconi University in Milano, uh, in the field of health economics and health policy.

00:19:46: And I'm also currently the president of the European Health Economics Association.

00:19:50: how do you say someone from Milan? Mila-.

00:20:01: Aleksandra: Milanese.

00:20:02: Dan: Milanese. And all of them looked to old age as something this was going to be an immense expense on healthcare. Is this fear rational?

00:20:12: Aleksandra: Partially, I would say, of course, we are exposed, uh, continuously to the narrative that aging of the population is a huge threat to healthcare system. That's not entirely true because, all these estimates, and these economic projections are based on the assumptions that, longer people live, uh, they will inevitably get sicker. And that loss of health will lead to greater demand for healthcare services, which is partially true, but it's not the same across all the generations the health status of a 70-year-old or a 60-year-old today is much different than a health status of 20, , or 30 years before.

00:20:52: It's not the fact that we are aging, that's creating the demand for healthcare services.

00:20:57: It's the health status of the aging population that is creating demand for health services.

00:21:02: Dan: But also the longer we live, doesn't it increase the chances that we encounter disease or accident?

00:21:09: Aleksandra: Yes, the probability, uh, rises. But for example, there are evidence that the most of the healthcare expenditure is observed in the long-term care, much less in the acute hospital care, for example, which is the most expensive one.

00:21:22: But I would rather think of it in a way that, um, it's true that with, increased age likelihood of getting certain diseases is higher.

00:21:34: But it's also true that, many of them are preventable to a certain extent. So if you talk about how to make the healthcare systems more, sustainable prevention is a very, very important part of the story.

00:21:48: like midterm. The fact that we live longer, it's a positive thing, but it's how we live longer. You know, what is the quality of life?

00:22:06: What is the health status that's also very important and prevention can really, really make a difference in, in that.

00:22:15: Dan: When you talk about, care for people before they become old, as being a great way to keep costs down in the future. That seems like a great way to sort of say we're all in this together, but it seems like it's inevitable that there's a sort of old versus young, uh, mentality that it's gonna come up.

00:22:37: Aleksandra: I do believe that, what can be done, especially in some context, in really trying to change the narrative from negative, um, let's say a notion like they are the burden to, uh, to more positive one as they are the resource. We talk about active aging, we talk about healthy aging, successful aging, silver economy, all this, uh, uh, labels that show how if kept healthy, that's the, you know, health is the necessary condition. Is actually a resource for the society. You know, the elderly people volunteering,  you know, some continue to be productive also, let's say in a, economic, uh, activities. Or, applying their creativity  involvement in the community, feeling empowered to do so that, that's another stream of research here that, that we are doing with our colleagues here in Bocconi.

00:23:32: Uh, the impact on loneliness on, the consumption of healthcare resources, but also health outcomes, uh, like mortality, and, quality of life and so on. Loneliness is a big, big, big topic.

00:23:43: Dan: Is loneliness expensive to fix

00:23:46: Dan: are we supporting friendship enough?

00:23:49: Aleksandra:Creating the community for, you know, their pension or for their elderly ages. So like, you know, all buying houses in the same area. So basically investing in their, aging, uh, together. It's a great example and great proof. How much, again, social interaction, is important to the, good quality, uh, uh, aging. How much policymakers, how much institutions can do about that while creating conditions or incentivizing maybe some of these, for example, efforts that the individuals, um, or groups of individuals put that. That would be also very, very, very positive.

00:24:38: sign

00:24:39: but, again, Aging. It's a good thing. It's a great result of, the progress, technological progress that we had. Education, empowerment, the knowledge,

00:24:51: also within the healthcare system. It's a positive thing that people are living longer. There are challenges associated with this demographic trends, but, we have to recognize that, uh, this is an opportunity. Aging well, aging healthy, is something that we should strive for, in order to be able to, decrease this, let's say pressure that we talk about. Being a, a pressure for the healthcare system

00:25:16: Dan: and for the individual, so it's,

00:25:18: Aleksandra: and for an individual of course, especially for an individual, you know, aging well and aging healthy allows the individual to live the life to the fullest, so prevention is the key.

00:25:28: Dan: For the last few weeks I've been talking a lot about aging not necessarily as a problem, but as maybe creating problems or the idea like how are we gonna deal with this?

00:25:38: But I think a starting point in terms of reframing it is we've achieved something remarkable and, you know, unprecedented and beautiful. And, and,

00:25:49: as a, in the best possible shape.

00:26:02: Dan: Like, what are we burdened with? Like a longer, richer life full of, full of better health.

00:26:09: , This is an embarrassment of riches in a way. Uh, I, I appreciate you giving me that, that perspective on it.

00:26:14: Aleksandra: You're welcome.

00:26:21: Dan: I met researchers with projections, stretching 10, 20, 50 years into the future. I also met Paolo who told me 'I live for today'. Mathematical facts and street corner opinion are both really valuable seeing moments where scientific conclusions align with the thoughts of the people that I met was like the most powerful validation of both of those perspectives.

00:26:46: We need community and loved ones and a fair chance of being healthy, and I know that's not like a hot take. But it's a foundation from which we can imagine policy and craft messaging and think about how to build resilient societies.

00:27:03: I think with a superficial glance it's it's easy to get a false sense of old versus young , but the conversations I'm having and the demographic perspective as Jacob called it in episode one, keep giving me hope that, that we can make choices that serve short and long-term needs of society.

00:27:28: Remember Valentina, the woman I spoke with at the top of the episode? She gave us a candid off the cuff vision of her future, which honestly sounded a lot like the community aging, as described by Aleksandra, the president of the European Health Economics Association went like this.

00:27:47: Valentina: I don't know, I think that we are

00:27:49: think that we are a generation that still

00:27:51: still keeps living with other people because we cannot afford a home and so on. So maybe

00:27:56: net, the

00:28:01: net us will be bigger than the one that our parents had And I will

00:28:05: net around us be bigger than the one that I will still living with. A roommate or someone that can take care of me and I can take care of him or her or whatsoever, I don't know.

00:28:16: Maybe we would be

00:28:17: more connected.

00:28:19: Maybe we will be

00:28:19: more connect connected in this sense, I mean we share the cars because we have Uber, we share the bicycles, we share the motorbikes, maybe we will share this kind of relationship.

00:28:30: I wanted to be surrounded by love and people that care about me honestly the only thing I'm asking.

00:28:36: I think it's the important thing at the end of the day and the life.

00:28:41: yeah. Is to

00:28:41: to have someone that cares about you.

00:28:49: Dan: I am Daniel Stern, and this has been episode two of Certain Futures. This podcast was produced by Radio Spaetkauf in cooperation with the EU funded research project, Futures towards a resilient future of Europe.

00:29:05: You will find plenty of information and links in our show notes. Please subscribe to the podcast because we have two more amazing episodes coming up. I appreciate the time everyone in Milan spent with me, from Valentina and Paolo to Arnie and Letizia and Aleksandra. Thank you all very much.

00:29:25: Coming up in episode three, I'm gonna dive into fertility and try and figure out how we can, uh, make some more babies or, or why we're not making more babies.

00:29:36: listening.