Richard Suzman: helping the world to grow old more gracefully

Ageing, says Richard Suzman, is “reshaping our world”. Like climate change, “it seems inexorable, and is gradual”, he says; but the global impact of ageing on health, disability, wellbeing, and poverty might eventually turn out almost as profound for society as rising temperatures. As Director of the Division of Behavioral and Social Research at the National Institute on Aging (NIA), US National Institutes of Health (NIH), Suzman has been “essential not only in transforming approaches to ageing research in the USA”, says James P Smith, the Distinguished Chair in Labor Markets and Demographic Studies at the RAND Corporation, “but he has been instrumental in fostering research on ageing around the world”. Renowned as a trailblazer in biodemography, famed for bringing health economics and behavioural economics to the NIH (no fewer than three past winners of the Nobel Prize in Economic Sciences lined up to honour him at a National Academy of Science ceremony held to celebrate his work), Suzman is probably most widely known for the Health and Retirement Study (HRS), which he helped start in the USA in 1992. The HRS was the first large-scale longitudinal study to combine detailed health metrics with economic data such as work status. “By the end of the year almost all of the more than 20 000 respondents will be genotyped”, Suzman explains, and the HRS has served as a template for a growing number of longitudinal studies that aim to gauge the impact of ageing on individuals and societies. The English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), and WHO's Study on Global Ageing and adult health (SAGE) all owe a debt of gratitude to Suzman and the HRS, whilst the NIA has funded HRS-style studies in Mexico, China, and India. In the past decade, Suzman has also devoted enormous energy to the INDEPTH network of health and demographic surveillance systems, which aims to support a major multicentre ageing study in sub-Saharan Africa in the near future. “I’ve no doubt all this was fuelled by a deep desire to ‘give back’ to his South African and African roots”, says Stephen Tollman, who is based at the School of Public Health at the University of the Witwatersrand in South Africa and serves as Principal Scientist of the INDEPTH Network. “Richard's determination that Africa too justified a major ageing study will ensure returns long into the future”, he says. Recently, that idea of leaving a lasting legacy has taken on added importance for Suzman. On his last trip to South Africa for the INDEPTH general meeting, Suzman began to struggle with his walking and breathing. “Although I had not been diagnosed at the time, I suspected it was ALS [amyotrophic lateral sclerosis]”, he says. “Now I am on a respirator and work mainly from home, with occasional trips to NIH or the NAS. I listen in to meetings and make a few comments since my voice is going. My office staff have been terrific.” Born in Johannesburg, South Africa, in 1942, Suzman was the second of four brothers in a family where high achievement was the minimum standard. His father was a high-flying QC, his aunt was Helen Suzman the anti-apartheid firebrand, a cousin, Janet Suzman, is a famous actor and director, while the developmental biologist Lewis Wolpert is also a cousin. There was never any doubt that Suzman would go to university. He was in his second year of a BA at Witwatersrand University when the political situation in South Africa forced him to look abroad. “There were several reasons to want to leave South Africa. Several friends had been arrested, and while I had escaped the draft in a lottery I had heard that the exemptions were going to be cancelled. While I would have served in the army during World War II if I were more than 3 years old, I would never serve in the current army then since it was used as an adjunct police force”, he recalls. “I became angrier and angrier about the unjust actions of the National Party. I intensely disliked their authoritarianism.” He got out, and after an abortive spell at the University of London, where he was prevented from enrolling because of a missing 6th year of Latin, Suzman ended up at Harvard University. There, Gordon Allport, author of The Nature of Prejudice, and Thomas Pettigrew took him under their wing. “I worked in a department that integrated psychology, sociology, and anthropology”, he recalls, and after a year at Oxford University doing a diploma in anthropology, he returned to the same Harvard department for his PhD under the stewardship of Alex Inkeles. After following Inkeles to Stanford, Suzman was weighing up his options when fate intervened. “I met a woman at a swimming pool in Palto Alto, who later became my wife. She was going to San Francisco, so I took a position at the University of California Medical School in San Francisco where both of us ended up working. The programme I joined was on ageing, not a topic I knew much about. At that time it was a somewhat sleepy field.” Having done more than most to shake the field out of its slumber, there are still many questions that keep him awake at night. “Will there be a cure for Alzheimer's (though ALS now supersedes AD in my own thoughts)?” he ponders. “What are the macro solutions for population ageing, especially in low-income countries that will become old before they are wealthy? As support ratios decline and chronic disease and disability increase due to ageing, how will countries pay the bills?” Find the answers to those questions, he says, and the world will have a fighting chance of growing old gracefully. Health in an ageing world—what do we know?The ageing of populations is poised to become the next global public health challenge. During the next 5 years, for the first time in history, people aged 65 years and older in the world will outnumber children aged younger than 5 years.1 Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanisation, modernisation, globalisation, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic conditions. Full-Text PDF