Our common future: a rapidly growing and rapidly aging humankind

‘No man loves life like him that's growing old.’

Sophocles (496?–406 BC)

(Acrisius, Fragment 64)

The aging male revisited

Axel Oxenstierna (1583–1654), the great Swedish statesman, said that ‘At fifty you begin to be tired of the world and at sixty the world is tired of you’. If so, what happens at higher ages? There are many views on this, ranging from extreme pessimism to extreme optimism. The most general reaction of aging males is that of an enormous surprise. Leon Trotsky says that ‘Old age is the most unexpected of all the things that happen to a man’ [1] and François de la Rochefoucauld remarks that ‘Few people know how to be old’ [2]. In fact, already Cicero warned us that ‘You must begin to be an old man early if you wish to be an old man long’ [3].

Among the more pessimistic views, Benvenuto Cellini states – in no uncertain terms – that when people get older and older, they become more and more foolish [4]; I would even be prepared to accept this, provided we agree that – compared to younger individuals – the difference is mainly quantitative, rather than qualitative. Voltaire remarks that ‘Man can have only a certain number of teeth, hair and ideas; there comes a time when he necessarily loses his teeth, hair and ideas’ [5]. Moreover, J. Chandler Harris (1848–1908) is credited with saying that ‘I am in the prime of senility’ (1906?) and sometimes – rather reluctantly – we are reminded of Shakespeare's words: ‘O, sir! You are old; Nature in you stands on the very verge Of her confine’ [6]. However, there is, on record, also an interesting attempt for compromise in a medieval proverb (around 1500) stating that ‘Young men think old men are fools, and old men know young men to be so’.

Fortunately for us aging males, there are also some more optimistic assessments; Waldo Emerson remarks that ‘We do not count a man's years until he has nothing else to count’ [7].

A reflection I particularly like, says that ‘Growing old is like climbing mountains: the difficulty is increasing with every step, but so does the perspective’; unfortunately, I could not trace its exact origin. What is worse, a friend of mine – who read it in German – told me that it may have a Swedish origin, perhaps Ingmar Bergman; if so, then I am really embarrassed.

However, one of my favourites is a poem by Longfellow: ‘For Age is Opportunity no less than youth itself. Though in a different dress, and as the evening twilight fades away, the sky is filled with stars invisible by day.’ [8]

Is confusion good for you?

I did not mention above an oriental proverb sometimes quoted by me, that may also have some bearing on our reflections: ‘When a man is young, he writes songs; grown up, he speaks in proverbs; in old age, he preaches pessimism’. In view of this, I have to emphatically state that I am not a pessimist. However, I am not an optimist either. I am simply confused. Why am I confused? Because every day I am confronted with at least three levels of reality: the scientific, the economic and the political.

When these three levels converge, progress can be amazingly rapid. When they do not, which is frequently the case, the political (or what is even worse, the ideological) reality assumes a controlling power. In fact, I have even heard people saying that if you are not confused by the realities of these modern times, you are not well informed [9]. Hence, the obvious conclusion would seem to be that confusion is good for you. In fact, confusion appears to be one of the principal characteristics of the twentieth century – if not of most of our history – and in 1950, Albert Einstein remarked that ‘perfection of means and confusion of goals seem – in my opinion – to characterize our age’ [10]. Will it also be a dominant factor in the twenty-first century?

How to cope with the new realities?

‘Human kind cannot bear very much reality’, says T.S. Eliot [11]; however – whether we like it or not – there are major challenges ahead of us in the form of new realities. As Professor Soedjatmoko, the first Rector of the United Nations University in Tokyo, has formulated it, ‘our fundamental challenge is how to deal with problems for which we can not find analogies in older, often petrified systems of wisdom’ [12] and the problem of aging societies is an entirely new one that has never occurred before in the history of humankind. How to cope with those new realities? In our – perhaps prematurely – globalized world, this appears to be a monumental challenge, given the fact that in a world in which the amount of new scientific and technical information is said to double every seventh year, the classical value systems of our markedly different societies – that are based on historical tradition, parochial identities and religious dogma – can no longer accommodate some of the new realities. Hence, our contemporary history gives to me the impression of a stormy sea, where the fragile vessel of rationalism is constantly threatened by the high waves of passion, fanatic faith and emotion. We can only hope that the motto of the city of Paris also applies to the vessel of rationalism: fluctuat nec mergitur; it is thrown by the high waves, but does not sink.

Of course, the overhand of irrational elements in human affairs is by no means new; in 1733 Alexander Pope formulated this aspect of the human condition in a very succint way: ‘The ruling passion, be it what it will, The ruling passion conquers reason still’ [13]. A few years ago, I tried to describe the contemporary state of affairs by saying that ‘the wind of new realities is blowing with increasing strength; some people will try to construct protective windshields and those who are more enterprising, new types of windmills’ [14]. Whichever approach they choose, they will need a new vision, since ‘Where there is no vision, the people perish’ [15].

What about history?

Already Aristotle emphasizes that ‘Poetry is something more philosophical and more worthy of serious attention than history’ [16], and in Bernard Shaw's play, The Devil's Disciple, Swindon asks: ‘What will history say?’ and Burgoyne answers, that ‘History, sir, will tell lies as usual’ [17]. In addition, more than a century ago, English historian John R. Seeley is credited with saying that ‘History is past politics and politics present history’ [18]. Such views make it perhaps easier to understand why Stephen, in James Joyce's Ulysses, says that ‘History is a nightmare from which I am trying to awake’ [19] and why Elias Canetti feels that he must divide all of us into two groups, ‘those who accept history and those who are ashamed of it’ [20].

Both Joyce and Canetti may be right or wrong; it depends entirely on our definition of history. In 1945, some fifteen years before the publication of Canetti's book, Karl Popper emphasized that ‘there is no history of mankind, there are only many histories of all kind of aspects of human life. And one of these is the history of political power. This is elevated into the history of the world’ [21].

And indeed, history is much more than just an account of how people are double-crossing and killing each other; it is also an account of intellectual progress, scientific and technical development, the gradual (albeit slow) improvement of the human condition and the evolution of new ideas. I am convinced that ideas are much more important in shaping human destiny than the kaleidoscopically changing political power; thus, I feel that Jean Monnet was right in his statement that ‘when an idea meets the exigencies of an epoch, it becomes stronger than political power; it becomes the common property of humankind and it may resist the historical forces of destruction for a long time’ [22].

Chiaroscuro and the twentieth century

‘Es bueno vivir mucho para ver mucho’ (it is good to live long in order to see much) says Sancho Panza in Don Quixote [23]; I also have seen much – who knows – perhaps even too much: I have seen most of the history of the twentieth century. When I was born in 1920, the world population was less than two billion people; today it exceeds six-and-a-half billion.

Hence, in my lifetime, I have seen the birth of another two worlds, equal in numbers, needs, aspirations, hopes and dreams. I have seen in operation two powerful determinants of human destiny; the arrogance of power and the arrogance of ignorance, and I have followed three generations of politicians in action. And – to slightly paraphrase Arthur Schopenhauer [24] – the man who sees the politicians of three generations in action is like someone who sees the tricks of a magician three times in a row. They are meant to be seen only once. In fact, I have watched the tricks of three generations of political magicians, their heavy flirtation with the apocalypse under the shadow of the hydrogen bomb and – more often than not – their classically hypocritical approach to power.

Sancho Pansa then continues: ‘El que larga vida vive mucho mal ha da passar’ (those who live long also pass through much evil). In the century that I have lived I have seen the devastating consequences of two world wars and have lived through a time, in which some 200 million human beings were systematically killed by other human beings, on orders of political magicians. It would appear that this approach is still so attractive to some that it has been carried over into the twenty-first century. This ‘development’ reminds me of the words of Albert Szent-Györgyi, my former mentor at the University of Szeged in Hungary: ‘It is said that man is not intelligent enough to solve problems without killing’ [25]. In fact – excepting those in power – few people would question the validity of the remarks of Edmund Burke, in a relatively little known essay, that ‘power gradually extirpates from the mind every humane and gentle virtue’ [26].

During my long life, I have also witnessed the incredibly enthusiastic acceptance and embrace, by many millions of people, of pseudointellectual political ‘ideologies’, exposing millions of fellow men and women to terror, cruelty, moral horrors and an indescribable amount of unnecessary human suffering. As Friedrich Nietzsche said in one of his many provocative statements, ‘In individuals insanity is rare, but in groups, parties, nations and epochs it is the rule’ [27]. Like Winston, the hero of George Orwell, I also understood HOW, but didn't understand WHY [28] and – rather reluctantly – I eventually understood that ‘the worst enemy of humankind is mankind’ [29].

Like many of my fellow men and women, I have also seen plenty of the so-called ‘classical’ dark aspects of what we call ‘human nature’, be it aggression, barbarity, terror, cruelty, hypocrisy, naked cynicism, moral and intellectual corruption, and the worst of all, indifference, which is certainly the essence of inhumanity. In fact, somewhere I have seen a remark by Martin Luther King, which impressed me very much: We shall have to repent in this generation not so much for the evil deeds of wicked people, but for the appalling silence of the good people. More than 200 years ago the philosopher of Königsberg, G. C. Lichtenberg, remarked that ‘Perhaps in time the so-called Dark Ages will be thought of as including our own’ [30]. One wonders how would he have judged the history of the twentieth century? Martin Luther King did it masterfully: ‘The means by which we live, have outdistanced the ends for which we live. Our scientific power has outrun our spiritual power. We have guided missiles and misguided men’ [31].

What is said above is true; the opposite is also true

Whereas sometimes I have seen darkness at midday, I have also seen plenty of broad daylight. According to Arnold Toynbee, our time was ‘the first age since the dawn of the civilisation in which people have dared to think it practicable to make the benefits of civilisation available to the whole human race’ [32]. In fact, I have also witnessed a century (the very same twentieth century that I have harshly criticized above) in which humankind – for the first time in history – acquired a holistic view of the world, established the United Nations, with its important specialized agencies (such as the World Health Organization), and also hundreds of international professional organizations. This was the first time in history when global identity became a new reality rather than a philosophical concept, and this was the first time when those specialized agencies – and a number of other international and national agencies – started to assist in every corner of the world (on a truly massive scale) those stricken by epidemics, famine and natural disasters. And what an incredible privilege it was for me to be part of some of those international activities in a small and modest way.

In his Essay on Man, Alexander Pope remarks that ‘There must be shadows, if there should be light’, and in my lifetime I have seen an enormous amount of light. Indeed, my worldview – like that of Alexander Pope – reflects Rembrandt's perception of the chiaroscuro (just consider for a moment his masterpiece, the Nightwatch, painted in 1642). To me, chiaroscuro is much more than just a revolutionary development in the art of painting; I feel that it also reflects human nature and the human condition. Therefore, I am convinced that I belong to a most privileged generation of human beings that ever existed on this Earth! Why? Because in my lifetime I have seen more progress in science and technology than all scientists of all preceding periods together, since the dawn of history. This should not be too surprising to my fellow scientists. As Friedrich Engels stated in 1963, ‘science progresses in proportion to the mass of knowledge that is left to it by preceding generations, that is under the most ordinary circumstances in geometrical proportion’ [33] and the twentieth century witnessed an almost incredible progress in science. Science has a unique self-correcting propensity; its ‘track record’ in improving the human condition is unparallelled by any other human activity.

On the other hand, I do not share the rather naive view that science is omnipotent; human knowledge is imperfect and will forever remain imperfect. However, it is indefinitely perfectible. Research – medical research in particular – is indefinitely perfecting human knowledge and constantly improves health and – with few exceptions – the human condition [14]. And by the end of the day, one becomes convinced that the aquisition, critical assessment, systematization and dissemination of positive knowledge are the only human activities that are cumulative and progressive. I am profoundly convinced that this assessment is right, and I feel a great deal of humility and much gratefulness to my Fate, that I was given the chance to have a long and – in my humble view – rich and meaningful life as a scientist …

A short note about optimopessimism

At the onset of this paper I stated that I am not a pessimist or an optimist, only confused. Upon further reflection, I feel that there might be a place for a short qualification. Some ten years ago I remarked that ‘To put it bluntly and in a simplistic fashion, it is rather easy to become a pessimist when reflecting on human behaviour and an optimist when reflecting on the progress achieved by humankind’ [34]. Therefore, I am a pessimist several times every day, but also an optimist several times a day. Hence, in essence – like so many other human beings – I feel that I am an optimopessimist.

The demographic revolution: a new type of reality

Napoleon Bonaparte is credited of saying that ‘The stupid speak of the past, the wise of the present, fools of the future’ [35]. Since I intend to consider both the past and the future, I am running the risk of having been classified by him as a stupid fool. Enduring this posthumous ‘imperial arrogance’, I am going to present here some historical estimates together with recent estimates and projections for the future by the United Nations [36], which may provide an idea of the magnitude of demographic changes of the global population in general, and those of a rapidly aging humankind in particular.

When Emperor Augustus died in the year AD14 and was followed by Tiberius, the known world population at that time was less than 300 million people. Survival of individuals, clans and nations was very difficult in those times, so that there was little, if any, increase in global population during the subsequent millennium; the world population of the year AD 1000 was still below 300 million people. Then the second millennium brought about dramatic changes in the world population; it is estimated that, whereas by the year 1500 the global population was around 400 million people, by the year 1900 it had reached 1600 million; by 1960 it arrived at 3000 million, and by the turn of the millennium, in the year 2000, it exceeded 6000 million.

The estimated and projected growth of populations during the 100 year period between 1950 and 2050 is shown inTable I.

Table I.  Estimates and projections of the growth of populations between 1950 and 2050 (in millions). Selected regions. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

	Year
Region	1950	2005	2050
World	2.520	6.465	9.076
Africa	224	906	1.937
Asia	1.396	3.905	5.217
Europe	547	728	653

The data ofTable I indicate that between 1950 and 2050 the world population is expected to increase from two-and-a-half to some nine billion people. Most of this increase is projected to take place in Asia and Africa – almost a fourfold increase in Asia and a ninefold increase in Africa; whereas between 2005 and 2050 the European population is expected to decrease from 728 to 653 million people.

Also, students of ‘geopolitics’ may like to reflect on the changing ratio of African and European populations. In 1950, almost two-and-a-half-times more people lived in Europe than in Africa; today, the African population already exceeds that of Europe, and it is projected that by 2050 the population of Africa will be in the neighbourhood of two billion people and will outnumber the European population of 653 million people three times. In my fable of the African Requiem for the last European [37], I have tried to extrapolate (and also exaggerate) the possible consequences of this increasing discrepancy in the growth of African and European populations. It is bound to have an impact on our future.

What about the population aged 60 years or older? Present estimates and future projections are indicated inTable II.

Table II.  Estimates and projections of the population aged 60 years or older, in the years 2002 and 2050 (in millions). Selected regions. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

	Year
Region	2002	2050
World	629	1964
Africa	42	205
Asia	338	1227
Europe	148	221

It would appear from the figures presented inTable II that the global population aged 60 years or older will trebble between 2002 and 2050, reaching almost two billion such people (out of a total population of nine billion) by the year of 2050. Their number will almost quadruple in Asia, and increase somewhat less than fivefold in Africa, whereas in Europe a modest increase of some 50% in such individuals is projected.

Since we can only see what we are willing to see, many people refuse to reflect on the probable consequences of population aging; rather, they prefer to cast some doubt on the validity of demographic projections. They reason that we do not even know what will happen tomorrow; how can one then make projections as to what will, or will not, happen in the year 2050? Well – obviously – demographic projections are neither forecasts nor destiny. They are extrapolations of past and present trends to the future; therefore, they are uncertain. However, some of them are less uncertain than others! The projected two billion elderly people (60 years and older) of the year 2050 are already around us as teenagers and young individuals; hence they do represent a reality not only for today, but also for tomorrow.

For the time being, 65 years still represents retirement age in many countries. Their proportion of the total population in selected countries is shown in Table III.

Table III.  Estimates and projections of the population aged 65 years and over between 1950 and 2050 (percentages). Selected countries. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

	Year
Country	1950	2005	2050
China	4.5	6.8	23.6
France	11.4	16.6	27.1
Germany	9.7	16.4	28.4
Italy	8.3	18.2	36.0
Japan	4.9	17.2	35.9
Spain	7.3	16.7	34.1
United Kingdom	10.7	16.0	23.2
United States	8.3	12.3	20.6

In 1950 (when I was working on my doctoral thesis), the highest proportions of people aged 65 years or over were less than 9% (for instance in Italy, Japan and Spain); in those countries today they are around 17% and are projected to at least double by the year 2050. Even in China, the proportion of people aged 65 and over is projected to increase fivefold between 1950 and 2050.

The United Nations definition calls people aged 80 years and over, the ‘oldest-old’. Willingly or unwillingly, this author also belongs to this ‘club’. The proportion of octagenarians in some populations is indicated inTable IV.

Table IV.  Estimates and projections of the population aged 80 years and over between 1950 and 2050 (percentages). Selected regions. Italy is included for comparison. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

	Year
Region	1950	2005	2050
World	0.5	1.3	4.3
Africa	0.3	0.4	1.0
Asia	0.3	1.0	4.5
Europe	1.1	3.5	9.6
(Italy)	1.1	5.1	15.2

The data ofTable IV indicate that between 1950 and 2050 the proportion of the world's octagenarians is projected to increase more than eightfold, that of Europe almost tenfold and that of Italy almost fifteenfold. Already today, 3.5% of the European and 5.1% of the Italian population is aged 80 years and over.

Selected examples of the proportion of the ‘oldest-old’ in various countries are presented inTable V.

Table V.  Estimates and projections of the population aged 80 years and over between 1950 and 2050 (percentages). Selected countries. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

	Year
Country	1950	2005	2050
China	0.3	1.1	7.2
France	1.7	4.7	10.9
Germany	1.0	4.4	12.2
Italy	1.1	5.1	15.2
Japan	0.4	4.8	15.3
Spain	1.0	4.1	12.3
United Kingdom	1.5	4.4	8.8
United States	1.1	3.6	7.3

It can be seen from the data ofTable V that today the proportion of octagenarians in Japan, as well as in a number of European countries, already exceeds 4% (an approximately fourfold increase since 1950), and it is projected to reach more than 10% (more than 15% in Japan and Italy) by the year 2050. Hence a comparison with the estimates from 1950 indicate more than a tenfold increase in the number of the oldest-old.

What is the sex distribution of the aging populations? A few data are shown inTable VI.

Table VI.  Estimates of the sex ratio (men per 100 women) in the populations aged 60 and 80 years and over, respectively, in the year 2002. Regions. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

Region	60+ years	80+ years
World	81	53
Africa	83	69
Asia	88	61
Europe	68	41

It would appear from the data ofTable VI that Europe differs from other continents in that there are fewer men in relation to women, both at 60 and 80 years, than in other parts of the world.

The potential support ratio is calculated as the number of persons in the so-called working age goups (i.e. aged 15 to 64 years) per one person in the retirement age group (e.g. aged 65 or older.) As an example, some selected data inTable VII from the year 2002 are compared with projections for 2050.

Table VII.  Estimates and projections of potential support ratio (number of persons aged 15 to 64 years per one person aged 65 and over) in the years 2002 and 2050. Selected regions. The data indicating the Italian situation are included for comparison. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

	Year
Region	2002	2050
World	9	4
Africa	17	9
Asia	11	4
Europe	4	2
(Italy)	4	1

In 2002, worldwide, there were some nine persons in the working age group per one person aged 65 years; their number in Africa was 17, in Asia 11, but in Europe only four. It is projected by the UN that, by 2050, these figures will be reduced to four worldwide and in Asia as well, and to nine in Africa, and to ratios as low as two (in Europe) and even one (in Italy). Hence, for the Brave New World of future Italy, it is projected that – by the year 2050 – there will only be one person in the working age group for each person aged 65 years or older. There is no historical precedent for such low potential support ratios. How will a society function with such an age distribution? Chi vivrà, verra …

It is easy to see that the rapidly increasing elderly population will have a major impact on the population structure of many, if not all, countries in the twenty-first century; however, that impact will be compounded and further accentuated by a simultaneous worldwide decline in the population of children, as shown in Table VIII.

Table VIII.  Estimates and projections of the population of children (persons aged 0–14 years) between 1950 and 2050 (percentages). Selected regions. The data on Italy are included for comparison. Source: Department of Economic and Social Affairs, United Nations Secretariat [36]

	Year
Region	1950	2005	2050
World	34.5	28.2	20.2
Africa	42.0	41.5	28.7
Asia	36.5	27.8	18.3
Europe	26.2	15.9	15.0
(Italy)	26.3	14.0	13.1

In 1950, more than 34% of the world's population consisted of children, i.e. people aged less than 15 years; today it is only 28%, and is expected to diminish to some 20% by the year 2050. The decline in Asia is also impressive; from the figure of 36.5% in 1950, it was reduced to 27.8% in 2005, and is projected to diminish even further, to 18.3% by the year 2050. Today, the population of European children constitutes only 16% of the total population and is expected to decline further to 15% by the year 2050. It is also projected that in Italy – the European country with the most marked structural changes in its population – by the year 2050, the population of children will be 13%, i.e. less than that of the population of octagenarians. The same consideration applies also to Japan.

When in a society the proportion of elderly increases and that of children decreases, it must result – in the long-term – in an aging of the general population, as reflected by an increase in median age. Median age – expressed in years – can be characterized as an imaginary line, dividing the population into two equal age groups: those younger and those older than the median age. The marked worldwide increase in median age between 1950 and 2050 is presented in Table IX.

Table IX.  Estimates and projections of the median age (in years) between 1950 and 2050. Selected regions. Italy is included for comparison. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

	Year
Region	1950	2005	2050
World	23.9	28.1	37.8
Africa	19.0	18.9	27.4
Asia	22.0	27.7	39.9
Europe	29.7	39.0	47.1
(Italy)	29.0	42.3	52.5

The data ofTable IX indicate that between 1950 and 2050 the worldwide median age is projected to increase from 23.9 to 37.8 years, in Asia from 22.0 to 39.9 years and in Europe from 29.7 to 47.1 years. It is projected to significantly exceed 50 years both in Italy and Japan.

Another useful demographic term for the characteriziation of populations is life expectancy at birth (in years). Some characteristic sex differences in life expectancy at birth are illustrated inTable X.

Table X.  Estimates and projections of life expectancy at birth by sex (years) in the years 2005 and 2050. Selected regions. The Italian data are included for comparison. Source: Department of Economic and Social Affairs, United Nations Secretariat [36].

	Year
	2005		2050
Region	Male	Female	Male	Female
World	64.3	68.7	72.8	77.5
Africa	49.3	50.6	63.8	67.0
Asia	66.8	70.8	77.5	83.6
Europe	70.2	78.4	77.5	83.6
(Italy)	77.5	83.6	82.2	88.1

Life expectancy at birth has continuously increased during the twentieth century and is expected to further increase (albeit at a slower rate than before) in the first half of the twenty-first century. ln 1950, worldwide life expectancy was only 45.3 years for men and 48.0 years for women. In Africa it was even less: 37.1 years for men and 39.7 years for women, whereas in Europe it was 62.9 years for men and 67.9 for women. Between 2005 and 2050, life expectancy is projected to increase worldwide for men from 64.3 to 72.8 years and for women from 68.7 to 77.7 years. Corresponding figures for European men are projected to rise from 70.2 to 77.5 years and for European women from 78.4 to 83.6 years. The highest life expectancy in Europe is expected to occur in Italy, with a projected rise from 77.5 to 82.2 years for men and from 83.6 to 88.1 years for women.

Hence, it would seem that the so-called health planners of the next few decades will be confronted by a new type of reality never experienced before by humankind since the dawn of history. Also, because of the significant gender difference in life expectancy, as shown inTable X, the majority of the elderly will be women (Table VI), many of them particularly poor and in poor health and the medicoethical problems associated with their situation will go far beyond the ability of health professionals to resolve [38].

Longevity and the socioethical dimension

By now, it is established beyond any reasonable doubt that the last years of life are accompanied by a marked increase in disability and sickness, with particularly high demands for social and health services [39]. As Daniel Callahan perceived in 1988, ‘Given the rising proportions of the elderly in the population and the increasingly effective and expensive technologies that will be applicable to them, we are at the edge of a new and endless frontier of ethical inquiry’ [40].

Obviously, the soaring elderly population of the world is bound to raise major economical, social and ethical issues, and may strain to the limit the ability of health, social and political infrastructures – particularly, but not exclusively, in the less developed countries – to cope. Hence, it is understandable that we have to frequently face some uncomfortable questions, reminding us, for instance, that ‘longevity has been our quest for ages; now that we have found it, can we afford it?’ [41]. One would almost like to retort with an even more provocative question: Well, if not, then what?

What is not appreciated well enough is that a rapidly aging population is basically a new feature in the world's history and that no country – as yet – is willing to grasp all its implications. It would appear to me that people and their governments have not had sufficient time, vision, willingness and perhaps not even courage to face up to this new reality and consider the fundamental social, cultural and political readjustments that it will require. In fact, it becomes more and more obvious that aging populations worldwide will profoundly affect many, if not all, aspects of our life, our institutions and also our moral and ethical values. However, we can only see what we are willing to see …

To quote an almost ten-year-old paper, ‘In simplistic terms, our problem is that – as individuals – all of us hope to live a very long and healthy life; however – as a society – we are greatly preoccupied with the aggregate consequences of aging, but are not ready as yet to make the necessary – and in part fundamental – socioeconomic and political adjustments to meet one of the greatest challenges of the 21st century’ [38].

Part of that adjustment must be a ‘quantum leap’ in support of research on the various aspects of aging of individuals as well as of societies, already strongly advocated by the author at the First International Congress on the Aging Male [39] with – needless to say – little, if any result. It would appear difficult to convince others, including our policymakers that even they will be old, and much sooner than they could ever imagine …

How sapiens is Homo sapiens?

In one of his famous statements, Sophocles exclaims: ‘Numberless are the world's wonders, but none more wonderful than man’ [42], but philosophers of subsequent generations appear to be much less enthusiastic about human nature than Sophocles. Aristotle states that ‘man is not the best thing in the world’ [43] and Seneca remarks that ‘tanta stultitia mortalium est’ (what fools these mortals be) [44]. Perhaps there is some foolishness in every wisdom and wisdom in foolishness; however, the wisdom of the book of Erasmus, Moriae encomium (The Praise of Foolishness), appears to be just as valid today as it was at the time of its publication in 1509: ‘All things in life are so multifaceted, contradictory and obscure that we can never be sure about the truth’ [45]. In the view of Francis Bacon, ‘There is in human nature generally more of the fool than of the wise’ [46] and, according to the classical remark of Sancho Pansa in Don Quixote, ‘Cada uno es como Dios le hizo, yu aún peor muchas veces’ (everyone is as God created him and oftentimes a great deal worse) [24]. In his elegant analysis of the human condition, Henry Bergson states that ‘Homo sapiens, the only creature endowed with reason, is also the only creature to pin its existence on things unreasonable’ [47].

Of course, human nature is a most complex and intricate mixture of logical rationalism and emotional irrationalism, and we seem to be endowed with a much greater capacity to note the latter in others than in ourselves. By the way, an emotion-free life – what sort of life would that be? And where is the ‘physiological’ limit? How much emotion should be considered to be too much? It would seem to me that the species Homo sapiens embraces a number of widely different subspecies, such as homo scientificus, homo dogmaticus, homo fanaticus and even homo bellicosus, and I suspect that most of us may represent strange and unexpected mixtures of these subspecies, probably in different proportions.

To reflect on human nature has been one of the favourite topics for after-dinner conversation of many generations since the dawn of history and, probably and hopefully, it may remain so for many more generations to come. Nevertheless, we may wish to pose a somewhat provocative question to ourselves: how good is it for Homo sapiens to be always sapiens? David Lawrence feels that ‘It's bad taste to be wise all the time, like being at a perpetual funeral’ [48], which seems to imply that – at least in his view – a little bit of intrinsic foolishness may perhaps assist us in facing some of the difficulties associated with the human condition. Another more serious and more philosophical consideration comes from the Prophet of Kahlil Gibran: ‘In truth we are neither wise nor foolish. We are green leaves upon the tree of life, and life itself is beyond wisdom and surely beyond foolishness’ [49].

And the other side of the coin?

One of the weaknesses of all the above philosophies is that they do not provide any advice as to how to meet intolerance, aggression and violence generated by fanaticism and fundamentalism. Such advice would be greatly needed in view of the monumental challenge on the horizon for future generations of scientists. How will they be able to convince some five to six billion fellow men and women that fanatic faith, fundamentalism and obscurantism will not improve the quality of life of their children and grandchildren, and that only science has the proven ability to do so?

Some three-word summaries revisited

In the closing paragraph of my opening lecture at the Second World Congress, I referred to a publication (in Hungarian) by the greatest Hungarian composer, Béla Bartók, in which he said that ‘if I ever would cross myself, I would say this: In the name of nature, science and art’, and I suggested, for the consideration of my colleagues, a slightly paraphrased version of it: ‘In the name of human dignity, science and charity, In nomine dignitatis, scientiae et caritatis’ [9]. And the events of the past six years convinced me even more that – in the difficult years to come – the medical profession will have a more important role than ever, not only in providing modern care based on the latest scientific breakthroughs, but also in providing charity, compassion, comfort and encouragement to their patients, both in general and to an increasingly large number of elderly patients in particular.

However, a crucial role of utmost importance for the medical profession will be to function as the chief custodians of human dignity. In the 1950s my generation was naive enough to believe that – after witnessing large-scale genocide and a variety of unbelievable horrors in the 1940s – humankind has gained some immunity towards the microbes of senseless violence. How wrong we were! When assessing contemporary events, one feels that there hardly has been a period in our history before when so much lip service was paid to human dignity as today and when, at the same time, it was so frequently violated, cynically and brutally, and sometimes, again, on a massive scale. Just some 50 years ago it was masterfully stated in the very first sentence of the Constitution of Germany, that human dignity is unassailable (‘die Würde des Menschen ist unantastbar’), but one wonders whether this had any impact at all on the behaviour of many political and military leaders during the past 50 years …

What can we do about this state of affairs? Perhaps more than we think. Publilius Syrus said to the Romans that ‘No one knows what he can do till he tries’ [50]; so why do we not try? I feel that the time has come for many international associations of the medical profession (like ISSAM) to join forces to coordinate and greatly increase their efforts to convince people and their governments that the ultimate goal of all progress and development is human dignity, well-being and good health for all, including even the rapidly increasing elderly populations.

However, I also feel that they must go a step further and jointly unmask the falsehood and hypocrisy of the political leadership and many others worldwide when they are flagrantly violating human dignity. I very much hope that, eventually, the physicians of this world will be those willing to realize my dream and will initiate ‘the greatest of all social revolutions: a universal search for human dignity’ [29]. Thus, dear colleagues, I have rolled out my dream for you as a carpet; please, try to prevent the enemies of human dignity from stepping on it …

Humility and hope

In 1940, in his poem ‘Burnt Norton’ (Four Quartets), Eliot remarks that ‘the only wisdom we can hope to acquire is the wisdom of humility; humility is endless’ [11]. However, I feel that – in addition – there is also another wisdom we can acquire, and that is the ‘infinite wisdom of hope’ [34]. All of us are prisoners of hope; indeed, hope is the quintessence of our existence. Further reflecting on our common future, I am more and more convinced that there is a great deal of hope for a better future for humankind. Today we have all the means to greatly reduce human suffering, provide health services for all, eliminate many diseases and even eradicate hunger and poverty. All this can happen if we will let it happen. Most drugs used today by millions and millions of fellow men and women have been developed within our lifetime. Thus, science has radically changed our world; it will change even more the world of next generations and will improve the human condition on Earth. There is plenty of hope for the future of Homo sapiens!

To put all this into a wider perspective, just remember the powerful arguments of Bertrand Russell, ‘In a biological sense, Man, the latest of species, is still an infant. No limit can be set to what he may achieve in the future’. Then Russell continues, ‘Man can look forward to a future immesurably longer than his past, inspired by a new breadth of vision, a continuing hope perpetually fed by a continuing achievement’ [51].

A final comment: last, but not least, I strongly feel that all of us can (and should) generate more hope; there is such a tremendous need for it among the scientists of the new generation! In fact, there is a need for a multitude of different hopes. As Epictetus said almost two thousand years ago, ‘A ship ought not to be held by one anchor, nor life by a single hope’ [52].