A conversation with…Dr. Richard Suzman

May 29, 2013

Richard SuzmanDr. Richard Suzman is director of the NIA’s Division of Behavioral and Social Research (DBSR), one of the largest funders of social science research in the country. He joined the NIA staff in 1983 and served previously as chief of Demography and Population Epidemiology. He was also director of the Office of the Demography of Aging, the focal point for demographic statistics and research within NIA and across other Federal and international agencies.

Dr. Suzman was one of a small group of researchers who developed the U.S. Health and Retirement Study (HRS), a nationally representative, observational study of the health, well-being, and economic status of Americans 50 and older. A key feature of the HRS has been its adaptation worldwide, fostering a new era of informative cross-national research. He has played a leading role in developing and supporting new academic fields such as the demography of aging, biodemography, the economics of aging and in encouraging the incorporation of biological and genetic components into social surveys and social science models.

A native of South Africa, Dr. Suzman briefly attended the University of the Witwatersrand and then received his undergraduate and graduate degrees from Harvard University, along with a Diploma of Social Anthropology from Oxford University. He was a postdoctoral fellow at Stanford University, where he also served on the faculty. He was a member of the faculty of the University of California, San Francisco, prior to coming to NIA.

Spotlight on Aging Research asked Dr. Suzman to talk about NIA’s involvement in international research on population aging.

Q: How and why did the NIA start to study aging globally?

A: One of our first global initiatives was the start of a series of reports on global aging by the Bureau of the Census—An Aging World in 1987 and Aging in the Third World in 1988, initiated by Barbara Torrey and Kevin Kinsella. Over time, these reports have been updated and new country and regional reports have been added. Census staff also assisted in the development of additional reports, such as Why Population Aging Matters, which we prepared for a joint meeting of NIA and the U.S. State Department, where the Secretary of State called in all the Ambassadors and Heads of Missions to hear a morning of presentations by NIA grantees on population aging. There have also been related reports with the World Health Organization (WHO) and other organizations. (Editor’s note: See NIA Initiative on Global Aging for these and other publications).

Of course, we are not only interested in describing the demographics of aging worldwide. It is very useful to compare the U.S. with other high-income countries, especially ones that are further along the process of population aging. In a study of 11 high-income countries—including the U.S.—of the determinants of retirement, a group led by Jon Gruber and David Wise found that the age set for retirement by some public pensions and tax systems had a significant effect on how long people stayed in the work force. Japan and the U.S. had later ages of retirement, while in Italy, Belgium, the Netherlands, and France, workers retired very early. Working longer is a key element in managing the fiscal aspects of population aging, and these results have had a meaningful impact on the policies of many European governments.

There was a significant paper that came out in JAMA in 2006, by Banks, Marmot, Oldfield and Smith, comparing the health of white people age 55-64 in the United States and England. The paper showed that while U.S. study participants said their health was better than that of similar people in England, it turned out—when you looked at prevalence of disease and biological measures such as cholesterol, blood pressure, or blood sugar—the U.S. did far worse than did England. Later, when another research team compared Europe to the U.K., they found that the U.K. did even worse than Europe. This means that the health of middle-aged people in the U.S. was worse than that of similar people both in England and Europe.

NIA has also supported research on international differences in life expectancy. In a Senate Special Committee on Aging hearing in 2003, Jim Vaupel, of Duke University and the Max Planck Institute in Germany, presented data showing that, since 1980, the life expectancy of American women had slowed compared to other high-income countries. This sparked interest in finding out more about these differences. A National Academy of Sciences panel requested by NIA led to two important reports in this area: Explaining Divergent Levels of Longevity in High-Income Countries and U.S. Health in International Perspective: Shorter Lives, Poorer Health.

The rapid population aging in the U.S. was essentially postponed by the baby boom. Other countries that didn’t have the equivalent of the U.S. baby boom, mainly Western Europe and to some extent Japan, can show us the impact of rapid population aging on a scale greater than the U.S. has yet experienced. We can see how these countries have—or have not—adjusted.

Population aging is changing the world slowly and inexorably. In some ways, it’s a little like climate change. You don’t notice it day to day, but it is happening and it’s very powerful. It’s going to have a significant effect on world economy, rearranging productivity, trade, migration, and other activities.

Q: How many studies in other countries have used the HRS as a model? Why is that important?

A: NIA started developing the HRS in the late 1980s and the first wave was fielded in 1992. In 1997, the White House asked for a pre-conference on population aging here at NIH before the Denver G8 Summit with some of the G8 representatives, and I was asked to set that up.

At that meeting, we discussed the importance of the determinants of retirement which had come from the Gruber and Wise cross-national study. There was agreement that countries needed to increase the length of time people spent in the labor force, because life expectancy had increased dramatically. We also discussed NIA’s study of national long-term care in the U.S., which showed that disability among the 65+ had declined by almost 20–25 percent since the early 1980s. But, we didn’t know if a similar decline had occurred in other high-income countries. This was a major motivation in setting up the cross-national studies.

Another point of discussion was the importance of having comparable data across different countries. Norman Glass, the chief U.K. representative who attended the Denver pre-Summit meeting, happened to be the person in charge of longitudinal studies at the UK Treasury. Norman and I arranged some meetings in the U.K. at Oxford University and Treasury that resulted in the development of ELSA, the English Longitudinal Study of Ageing, which has proven to be a very close collaborator with the HRS. In fact, many improvements developed in ELSA have been adopted by the HRS.

Then, some of the group of researchers who had worked with Wise and Gruber plus other U.S. researchers got together at a meeting in Italy to discuss an international HRS. That meeting helped start SHARE, the Study of Health, Ageing and Retirement in Europe, which has grown from an initial 11 countries to 20 countries today.

The spread of the HRS model and the development of an international network of researchers were helped by a series of reports that we commissioned from the Committee of Population at the National Academy of Sciences on industrialized countries, Sub-Saharan Africa, Asia, and now Latin America.

Other countries got into the act: South Korea, Mexico, Japan, China, Ireland, and most recently India established studies based on the HRS. Brazil, Northern Ireland, Scotland, and Australia are currently planning studies.

Probably well over 30 countries have adopted some version of the HRS. But, it's important to note that there are different families of studies. Some are modeled more or less on the HRS, but there is another set of studies that started out at the WHO, called the Study on Global Ageing and Adult Health, or SAGE. It’s being conducted in six countries including Ghana and South Africa and is more epidemiologically oriented. The SAGE studies are partially coordinated with the INDEPTH Studies, a set of 48 demographic surveillance sites, with a growing number of sites including a focus on aging.

The SAGE studies are coordinated with the HRS family, and we’re moving toward greater harmonization and consolidation in some areas such as outcome measures and genetics.

H R S and SAGE Cohort Studies. H R S (Health and Retirement Study); United States. SHARE (Study of Health, Ageing and Retirement in Europe); Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Netherlands, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland. ELSA (English Longitudinal Study of Ageing); United Kingdom. SAGE (Survey of Ageing Globally); Mexico, Russian Federation, South Africa, Ghana, China, India. TILDA (The Irish Longitudinal Study of Aging); Ireland. KLoSA (Korean Longitudinal Study of Aging); South Korea. JSTAR (Japanese Study of Aging and Retirement ); Japan. CHARLS (Chinese Health and Retirement Study); China. LASI (Longitudinal Study of Aging in India); India. MHAS (Mexican Health and Aging Study); Mexico. Brazil H R S; Brazil (planned).  Australia H R S; Australia (planned).

Q: What’s NIA’s role in supporting these studies?

A: NIA funds about half of ELSA, a good deal of China's CHARLS study, and about 10 percent of the central costs of SHARE. Most of SHARE is funded by the E.U. and the individual participating countries. Governments and other groups have provided funding for the other studies. For example, the studies in Japan, South Korea, Brazil, Ireland, and Northern Ireland are all self-financed with NIA-funded researchers providing technical assistance; in some cases, we’ve provided small start-up funds through small planning grants.

Q: How can you compare the data from all of these studies?

A: Currently we have two networks operating to improve harmonization—one on design and measures and another on biomeasures. We want to get studies harmonized to collect some of the same data in the same ways that are appropriately valid. It’s important to try to get as many of the variables to be comparable, especially when we’re looking at cognition measures, personality measures, conscientiousness, time use, and well-being, as well as measures from dried blood spots or venous blood. The RAND Corporation and the University of Southern California have played a very big role in developing this. The RAND Meta Data Repository has made it very easy to analyze these studies and see what the comparable data are. In some countries, you obviously have to ask questions differently. But we’ve tried to use vignettes to try to make questions comparable. We’re also now pushing to try to get DNA from study participants so that we can do genome-wide association studies on these very large population samples.

Q: What resources does NIA have for researchers interested in studying global aging? How would they get access to data?

A: One of the key aspects of this international work is that if any study wants to join this group of researchers and be included in our data sets—which have significant value in terms of methodological or intellectual resources—investigators have to share the data rapidly. To some extent, our efforts have changed the way that data are shared in many countries. Many countries never shared their data. Even government agencies didn’t share with other government agencies. But today, if they’re involved with us, they are sharing data. And, we’re focused on making it publicly available to a wide audience of interdisciplinary researchers as quickly as we possibly can. Data are housed at the National Archive on Computerized Date on Aging at the University of Michigan and the RAND Meta Data Repository and are key entry points to access the data.

Q: If I’m a researcher interested in this field, what can I do?

A: NIA supports a number of demography centers focused on international aging. We have some standing small grant mechanisms for data analysis. We’ve also actually had several RFAs for small grants that have specifically requested international comparative applications. We currently have an open announcement on regional and international differences in health and longevity at older ages related to the NAS reports. So, for a new or young researcher, probably a small grant would be a good way to break into the field.

Within DBSR, Georgeanne Patmios (health), John Phillips (economics), Lis Nielsen (subjective well-being), and Jon King (genetics) are heavily involved in the global initiative and would be good starting contacts for researchers with grant application ideas.

Q: What has been the overall benefit of these international studies?

A: In the last 15 to 20 years, we have created an international, multidisciplinary community of researchers focusing on aging. These researchers are learning from the other member countries. For example, the HRS and South Korean model helped the Chinese. The Chinese model helped the Indian group. And so on. We have created a global activity that is gaining strength—recruiting smart people and significant resources in many countries.

I do believe that this is a golden age. There have been several significant advances, some of which I’ve already mentioned. We’ve never had as much comparable international data as we currently have. This work has brought new researchers from different fields into aging. I think we’re all the better for it, because we really need all the brain power, data, and resources we can get. The issues are too big for any one country to solve on its own; we have to learn from each other. As different countries adopt different policies, we have in effect a series of large-scale experiments. We need to find out if the trajectory of disability differs across countries and what the levers are. We need to better understand if retirement policies result in differences in cognitive functioning, etc.

Looking toward the future, I expect that more and more countries will set up HRS equivalents on their own initiative. Harmonization—not homogenization—should continue, as should coordination of efforts and the ability to rapidly share advances with each other. The studies that started out as social science and economic studies have become significantly interdisciplinary and well-integrated with psychology, biomedical, and genetic components. My hope is that cross-national research that allows us to learn from each other’s planned and unplanned experiments will accelerate the expansion of healthy life expectancy.

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