The Pension Blueprint podcast video transcript

Episode 2: Preparing for your 100-year life

Celine Chiovitti: Hi, everyone, and welcome back to season two of The Pension Blueprint from OMERS. I'm OMERS Chief Pension Officer, Celine Chiovitti, and I'm so excited to have this conversation with Dr. James Aw.  

Dr. Aw is the Chief Medical Officer of OMERS where he provides leadership and medical expertise on health and wellness. He's also a part-time faculty member at John Hopkins University in Baltimore and has over 20 years of experience in corporate health and occupational medicine. Prior to that, he was the Chief Medical Advisor at Scotiabank and the Chief Medical Officer of Medcan where he still works as a senior medical consultant. And with all of that on the go, he also maintains an active primary care clinical practice in Toronto. One of Dr. Aw's areas of interest is longevity. In particular, he's passionate about how we can live longer and stay healthy, happy, and active. And you'll hear a lot about that in this episode. This is a great conversation and I think you'll be fascinated to hear Dr. Aw' perspective on how our ideas around aging and retirement are changing rapidly and how we can best prepare ourselves for our 100-year lives. So let's get into it. 

Hello, Dr. Aw. 

Dr. Aw: Hello.  

Celine Chiovitti: It's so great to see you here.  Are you okay if I call you James for this episode? 

Dr. Aw: Absolutely.  

Celine Chiovitti: Okay, awesome. Well, I'm so glad that you're here and I'm happy to have this conversation. I feel like we have this conversation a lot. This is actually really interesting to the both of us, but happy to share it with the world today. 

Dr. Aw: Great. Thanks so much for having me, it's great.  

Celine Chiovitti: So I'm just going to get right in there and start asking you some questions. 

The first question I will ask you, we've talked a little bit about this, about sort of the combination of longevity and a graying world. And so when OMERS was created back in the 1960s, I think we were only ever expected to live until around 70 years old. And today our oldest living member is 109, which is just phenomenal and crazy at the same time. And then if you factor in also the fact that we've got over half a million centenarians, I believe, across the globe, and in Canada, there's about 13,000 centenarians. So people living over 100, which is about a 43% increase from 2018. So when you hear all those numbers, can you actually break down what that means to us? Why should we care? And what does that data tell us? 

Dr. Aw: Yeah, no, absolutely. Humans are living longer. I mean, I remember when I was in med school, you know, people wouldn't live, you know, past their 70s and now because of the advances in technology and medicine, vaccines, access to care, and also neonatal childhood mortality's way down, now you've seen people that are living kind of 70s and 80s. And as you said, even the centenarians. Actually, one thing in the data though which has changed was there was a bit of a flattening where actually the life expectancy went down because of COVID. So like 2019, 2020, 2021, there was actually kind of a plateauing or a bit of a decrease. And that was because of COVID, which, you know, disproportionately affected older folks. And also the opioid crisis. So the problems with addiction and suicide, mental health, that affected a lot of folks on the younger side. So in the last year, I think there's still an uptick in terms of life expectancy. But those are the couple of things that we had noticed that were unusual, particularly in Canada. And so despite all the good things that are happening in terms of advances in science and longevity, some of the negative things are the gaps and the socioeconomic, you know, the widening between, you know, the haves and the have-nots and access to care and also the obesity epidemic. So you're starting to see obesity causing things like diabetes and cancer in younger folks. So it'll be interesting to watch that there's a lot of social kind of dynamics that are affecting longevity. 

Celine Chiovitti: So do you see that starting to sort of tip the other way? Or do you still sort of see longevity expected to go back to we are living longer lives? 

Dr. Aw: Yeah, I think we are still living longer. All the predictions I've seen from WHO and these big groups like United Nations, what have you, the projections are still that we are continuing to grow older because of the advents of medicine and better knowledge of things. 

Are we living well, you know, in our elderly, you know, phase of life? That's a different question. But are we living longer? Absolutely. 

Celine Chiovitti: So that brings me to my next question. You've talked a little bit about this. I'm just going to get you to expand a bit more. You've talked about lifespan versus health span. So we're living longer, in some cases, we're living to maybe 100. What's the difference between lifespan and health span? 

Dr. Aw: Yeah. So lifespan is your biological years, how many years you actually survive. But historically, you know, the last, you know, I don't know, 10, 20% of your life is kind of suffering, kind of chronic disease or the beginning of the decline. So this new notion of health span is basically living well, you know, how can you prepare yourself from a health point of view so you live your best life. But then this concept of compression of morbidity. So when you do get sick, it's quick and it's fast. So you're healthy, you do all the things that you want to do, but when you get sick, you get, you know, sick very quickly. And actually, we've learned that from some of the centenarians, the people that live over 100, or the people that live in their 80s and 90s, if they can dodge the bullet and outrun cancer and these other kinds of things, they've kind of figured out a way to live well. But then when they go, they kind of go quickly. So there's a lot of excitement right now about this longevity research. 

Celine Chiovitti: Yeah, and that's, you know, when we think about living long, we want to live long and we want to live healthy. And so are there things that we can do in our 30s, our 40s, our 50s to better give us a good shot at living healthy, longer in life? 

Dr. Aw: Yeah, I think, you know, the famous stat is always, the World Health Organization talks about determinants of health. So a lot of what determines how healthy you're going to be is where you were born, where you grew up, where you decide to work, where you decide to play, and you know, what communities are you part of. And so 80% of determinants of health is determined by lifestyle things, and 20% is sort of genetic. So it's the simple stuff. It's like, don't smoke, you know, don't drink too much alcohol, watch your blood pressure, check your cholesterol, have strong social connections, exercise, plant-based diet, the usual stuff, which the good news is it applies for all folks across the different life stages. But the problem with the different life stages is we've got other distractions in life. So sometimes you can't always stick to these fundamentals if you will. 

Celine Chiovitti: But is it the rule, like the earlier you start, the better chances you have for...Like, the earlier you start living a healthy lifestyle, the better chances you have for longevity and living well? 

Dr. Aw: Yeah, so as you know, I'm still a clinician. I still see patients. It's never too late. It's never too late to start and you always have to be hopeful that you can always play a part in your future health. But, of course the earlier the better. So the earlier the better. And some of the things are based on things out of your control in terms of your environment. But other things you can kind of control over time. 

Celine Chiovitti: Yeah. So it's phenomenal that people are living longer. I think that's something we're all really excited about. But at the same time, an older generation, you know, as we're living longer, as we're having less children, that does put a strain on society and communities. And you know, as we're starting to fast forward to 2030 and beyond, and I think about the challenges facing us, you know, in our communities, share some insights on how you think we can come together to tackle those challenges? And what challenges do you see ahead for society in that space? 

Dr. Aw: Yeah. It's a big problem. As you mentioned, you know, people are living longer, maybe they're not prepared for the health shocks or the financial shocks that they didn't plan because they didn't expect to live this long. The financial shocks might be that, "Hey, I didn't expect to live this long, or didn't expect to be taking care of my adult son or daughter and their grandkids because it's hard for them to get a job in this crazy economy." So there's the financial stuff and then there's the health shocks of, "Hey, my master plan was laid out, but you know, this was a curve ball that I didn't expect." So there's the aging population about living longer in the financial and health realities, and have they planned properly for those shocks. And then the socioeconomic thing keeps coming up. So are we going to get better at addressing inequities so that we can create preventative solutions that are scalable? So to all people, we learned about that the hard way in COVID, that certain lower socioeconomic, certain cultural communities, disadvantaged communities were left behind. And, you know, very sad story. And did we learn anything? So I think the next generation, we have to figure out how do we address the inequities so that we can come up with solutions that's accessible, scalable, affordable to the masses. And so that's one. And then the other one is how do we personalize things using technology, maybe genetics or other kinds of biomarkers so that it might change behavior. And then also this anticipatory guidance. It's, you know, what's going to be the roles of employers, insurance companies, the state to educate the different generations of folks to say, "Hey, have you thought about your future self, like in five to 10 years, if you don't do this, it's going to be like, who's going to take care of you in 10 years?" So you need to start thinking about this stuff on the health side and the financial side and on the social side. So also, the other, you know, climate change, the geopolitical stuff. I mean, we're at a moment in history. 

Celine Chiovitti: I think that's right, I think it's a moment in history  

Dr. Aw: and I think, you know, on one hand, it feels daunting when you think about it all together. But on the other hand, I think there's opportunity for multi-stakeholders to come together and imagine what a future might look like, right? And so how do we create this future where we can create these vibrant communities that are thriving? But that does mean tackling things like, you know, the Canadian retirement system that was developed back in the '60s, the healthcare system, housing, immigration so we have enough people in this world to do the work that we need them to do in this country. 

Celine Chiovitti: Yeah, I agree.   

Dr. Aw: It's going to be all of the stakeholders. It's so complicated. So it's, you know, I always think about the individual, you know, the family, the community, the employer, society, the country, the world, right? So how do you align everybody with things that are actionable that actually can be integrated? 

And the medical story's pretty clear. Chronic disease is a problem. It's a slow-motion disaster. Heart disease, diabetes, you know, cancer, mental health, obesity even. We need to figure out chronic disease. We keep talking about it, but no one's doing anything. We got to figure out prevention, we got to bring it into the house. 

Celine Chiovitti: Prevention is key, I think, to everything.  

Dr. Aw: Don't wait until something happens? How do you start to? Because we can't afford the sickness medicine side of things. And then how are we going to not leave our aging loved ones behind? So how do we integrate them so they have a meaningful life? How do we mix generations so that is a norm, it's not a favor? 

Celine Chiovitti: And there are other countries to look at, like there are other countries. If I think of a country like Japan, I believe that has the oldest demographic, and I know they've done some innovative things. 

Dr. Aw: Yeah, I think they're one of the largest populations of older, I can't remember the number, but 20, 30% are like over 80 or something, over 75 or something. Yeah, I think a lot of people are studying. What are they doing? How are they solving these problems?  

Celine Chiovitti: What are things that we could be doing differently? Can you tell us about the phenomena around the blue zones? What are they and what can we learn from them?  

Dr. Aw: So I was lucky enough to sit on a panel with Dan Buettner. So Dan Buettner is one of the founders from the National Geographic. And so we did a thing talking about the blue zones. And I always thought he had the coolest business card because he sent me his business card, or he gave me his business card when I first met him. It was National Geographic Explorer. 

Celine Chiovitti: That's a great title. I like that title.  

Dr. Aw: So that was the coolest thing ever. So he was with National Geographic and the National Institute of Aging at the time. They looked at census data around the world to say, "Hey, which areas have the highest concentration of people that lived the longest? So centenarians, people, hundreds, over 80. And he basically found these different hotspots they called blue zones around the world that had the highest concentration. So that was, you know, Ikaria, Greece; Sardinia, Italy; Loma Linda in California, a place in Costa Rica, and, of course, Okinawa in Japan. And these were kind of farming villages, fishing villages, small villages that people lived off the land. They were small communities, very tight. And he found that they're very similar lifestyle patterns that they all shared in common. So what were they? There was something called the power of nine. So nine different activities. And the anchors, like the pyramid of hierarchy of needs. So on the bottom was the social stuff, which is, you know, loved ones first, you know, spouse, family, parents, you know, so healthy behaviors are contagious. So you know, who you hang around with kind of makes a difference. You know, belong to a community. So who's got your back, you know, whether it's faith based or hobby based, that's really important. And on the dietary stuff was they learned from the Okinawa ones, eat till you're 80% full. Like, don't overeat. 

Celine Chiovitti:  I need to take that one.  

Dr. Aw: Right, right.  And then don't drink too much. And when in doubt, have plants. And then the other stuff is more behavioral purpose. A lot of these folks, when they roll out of the bed, they have a strong sense of purpose. They help each other. They still work. You know, purpose is really important. And they have downtime, which is they permit themselves to have fun 'cause play is important in terms of youthfulness and longevity. And then moving naturally sort of the top. So exercise, of course. So instead of like hiring a personal trainer, you know, or to going to the gym that we do in the urban jungle, for them it's like moving naturally, do stuff. 

Celine Chiovitti: Yeah. They just incorporate it into their day to day.  

Dr. Aw: Garden, cut the lawn, do stuff, be active. So that was kind of, you know, the concept of power of the nine, which is in all these types of villages where they kind of have each other's back. 

Celine Chiovitti: It's just the way they live.  

Dr. Aw: It's just the way it is.  

Celine Chiovitti: It's just the way they live. It's so interesting. Because I find we're, you know, really leaning into one of our primary duties is helping our members retire and retire well, and we do, I think, a really good job at helping people understand their pension. And financially, you know, they will get a paycheque for the rest of their lives when they retire. So that steady access to income is there. But we've been trying to lean in more to kind of say, well, "What else do you need?" And so if part of our mandate is helping people retire well, what does that mean? Because the finances in and of themselves isn't enough. And so this concept of, you know, you need those social connections, you need that sort of purpose-driven mental stimulation. And so having those conversations I think is really important, especially as we start to see people living longer. So can you talk a little bit about NORCs? Population, aging, impact on family, like the way communities are changing. 

Dr. Aw: Yeah, so NORCs, they've around for like, I don't know, 40 years, like decades, right? So ‘Naturally Occurring Retirement Communities’, that's what it's called, NORC. And so that was basically the concept where these naturally, organic occurring areas where older people congregate. So like over 65 and you sort of have a higher concentration or density of people that live there. And they said, "Gosh, is that good for your health? Because you've got a lot of like-minded people that are lonely that can, if we give them the right support, that they can have social infrastructure, they can have the social networks, and they have access to different healthcare needs that they need, wouldn't that be a great concept?" So a lot of academics, there's one group out of Kingston that started a lot of this research called Oasis where they would sort of insert themselves in these different kind of communities and provide all these programs so people could get together. So theoretically, academically, it's been great for people to feel connected and have social networks and have a sense of resiliency. 

Celine Chiovitti: Community.  

Dr. Aw: Community.  

Celine Chiovitti: Community would think. Yeah.  

Dr. Aw: And I think it's early days where they're looking at the longitudinal research to say like, "Hey, what's the measurable outcome? So is the outcome that they have less visits to emerge? You know, is it less visits to hospitalization? Do they have less utilization of drugs? Like, what's this all kind of leading to and who pays? So I think one of the challenges for some of these communities is funding. So is it funded by an academic, doing a study pilot? Is it funded by the government? Is it funded by good Samaritans and volunteers? You know, philanthropy dollars? And then who works there? So the volunteers. Who's keeping it safe? But I think big groups, because we have an aging population, because we have a population, the Baby Boomers are getting older that have cash, so they want to spend money. They're not going to sit back and say, "Hey, don't lock me up." 

Celine Chiovitti: Yeah. They're like one of the, I think, wealthiest generations. 

Dr. Aw: Groups, right?  

Celine Chiovitti: Yeah.  

Dr. Aw: And so they're looking at how can we create longevity cities? How can we create these sorts of smart cities where we'll have everything that we need so we can be independent as long as we can. And if we can deliver on this promise of health span versus lifespan, then it could work. 

Celine Chiovitti: Then it could work.  

Dr. Aw: One of the challenges with this health span concept is brain health. Yeah, so that I think is a big challenge because again, when I went to med school back in the, you know, eons ago. 

Celine Chiovitti: Not that long ago!  

Dr. Aw: We didn't have to worry about this stuff. Like, it's a kind of a new type of medicine, like an 80-year-old, 90-year-old coming in. Of course, the brain shrinks, you know, of course, you're going to have problems with executive functioning. Of course, your reflexes are going to be slower, as long as it's not Alzheimer's or one of these neurodegenerative diseases. But like, how do you treat it? How do you prevent it? Because if you don't have your mental faculties, it's very challenging to remain independent. And then if you need support workers, then it gets expensive. So it's not a straight line, which on the optimistic side of things is we should probably invest more in brain health. If people are going to live longer, the brain's the most complex, you know, organ, how do we get ahead of that? 

Celine Chiovitti: And so what tips, is it the same sort of tips? Don't overdrink alcohol, don't smoke. Should we be doing brain games, like quizzes, puzzles? Give us some tips. 

Dr. Aw: Yeah. Yeah. So the easiest tips is the brain needs fuel. So exercise, so daily activity, habits, move, something that makes you sweat, something that gets your blood circulating. Water the plants. Get the blood going to your brain. So move. Second thing is don't poison the brain. So don't smoke. Don't drink too much alcohol. And then the plant-based Mediterranean diet is always the best. So fish, fish oils, healthy sources of protein, avoid the processed foods, ultra processed, kind of balance plant-based diet. 

Celine Chiovitti: So I have to lay back on my truffle fries--  

Dr. Aw: Right, right. And then social connections. 

Celine Chiovitti: Yeah. And then social connections.  And that's what I like about when you talk about those NORCs. To me, it's about community and social connections and you know, just keeping yourself connected to others, which we're such social beings. You really, really need that, whether you have it naturally with your nuclear homes, families, or whether you have it in other communities. 

Dr. Aw: For sure. The other thing with brain health now too is, you know, whether you should keep working. 

Celine Chiovitti: Right, right. Yes.  

Dr. Aw: So, you know, being in the workplace, it forces you to, well, a couple things. You're around energy. You're around lots of different kind of folks that have different perspectives on life and stages of life. So there's energy, that's social connection stuff. And you got to solve problems. And hopefully you're lifelong learning and doing new things. So I think that conversation's changing too. So, you know, can work be good for you? In the right context. And where do you want to use your brain cells to stay engaged? I think that's evolving too. 

Celine Chiovitti: Yeah, I do too.  

Dr. Aw: Yeah.  

Celine Chiovitti: And I do think that's sort of part of the conversation is in the past it's always been fixated around a number. So at this age, I'm going to retire. And for some people that's amazing. Like you said they're excited, they've got things that they're going to do. But I do think taking some time to say, "Well, what does that mean? What are you going to do in your retirement?" Because it's no longer you're going to retire for 10 years. Now you're going to retire potentially for 30, 40, 50 years. And so what will you be doing? And how will you sort of keep that going? And for some people that might be working in some way. It could be volunteerism, it could be going back to school. But I do think having those conversations, we wouldn't have had them 10 years ago. 

Dr. Aw: No.  

Celine Chiovitti: So James, you are clearly very experienced and interested in the space of longevity and the world, sort of aging. What made you interested in that? 

Dr. Aw: Yeah, I think, to be honest, I kind of stumbled into it because, you know, I started off in primary care. My patients, I've seen them grow kind of with me. I've always been interested in innovation and kind of new ways of looking at things. Primary care's in trouble. We're not doing a good job of prevention. We've got an aging population. I'm going through it myself with aging parents. I've had friends, colleagues that have been ill. It's challenging times, right? 

Celine Chiovitti: So you see it, but you're impacted personally. You see it with your patients. 

Dr. Aw: It's kind of personal and then it's also an exciting time. That's one of things which I love being at OMERS and Oxford is because we've got a lot of great minds looking at healthy buildings, you know, healthy way to live, investing solutions in terms of precision medicine, you know, big biopharma. So I think part of the solution to trying to get towards this precision medicine, a new way to deliver preventative care. Like, less complaining, more solutions. And so that's stuff I find really interesting. And then genomics, genetics, big data. Like it's exploding right now for medicine. 

Celine Chiovitti: Well, the macro trends around this aging population, you can't get away from it. And so I think that's phenomenal. You work quite a bit with octogenarians and nonagenarians. What life lessons have you learned from them? 

Dr. Aw: Yeah, so I've grown older with my patients and I do, I'm lucky. I've had patients in their 80s and 90s. We do the high five, you know, like, we got you to this level and you're still healthy and doing great things. So I do start to ask them these questions. Hey, what should I tell my other patients? But what's the secret sauce for what you do? 

Celine Chiovitti: Yes. What's the secret sauce?  

Dr. Aw: And so the interesting answer I always get from the different folks that I poll, it's always the same kind of thing. It's all the social stuff. 

Celine Chiovitti: It's all the social stuff.  

Dr. Aw: It's like, have a purpose. You know, be proactive, you know, have a plan, engage. Don't sit back, lean in, have fun, stay current. 

Celine Chiovitti: It's so interesting because all of those things make such total sense. But when you are busy working and raising a family and paying bills and worrying about life, you kind of put that on the back burner. But it sounds like we almost need to flip the script. 

Dr. Aw Yeah, and that's why, my own way, I try to frame when I see the patients about their life stage. So sometimes you try to make it more pragmatic, if you will. Sort of like hey, what's the checklist? What can we get accomplished? Let's talk about your daily habits. What are your goals? And then when you get to a different phase, maybe in your 50s or 60s, it's, "Hey, let's get to know your future self. So, you know, how do you see yourself at 60, 65, 70? Well, like who do you want that person to be? Hiking with the grandkids, sitting on a board, working in the garden, doing some paintings? Like, who is that person? So how do we train you to get there? Then if you want to be that person, then why are you working so hard? If you want to be that person, why are you doing that? So sometimes it's sort of that evolution of getting to know and also leaning in on the communities that matter. So the other thing I find that's liberating for folks in their 50s and 60s is they start subtracting. So it's like, I don't really need to hang out with those folks. I kind of like...That that's my community. So you get more selective because, you knows, it's so cliche, but time's the luxury. So how you manage your time, what you choose to do with it is everything as you get older. When you're younger, you're dreaming, you're going for it. You're trying to get established. There's too much pressure from social media to be perfect. It's a minefield. But you got to try and experiment and fail and that's all part of the journey. But when you get older, it's a bit different, right? 

Celine Chiovitti: Yeah, I think with everything that comes with getting older, the one good thing, or maybe there's a few good things, but one is definitely you just don't care as much about some of the petty things that you would've worried about in the past. 

Dr. Aw: Because you've got nothing to prove, right? But you've earned that right because we've all had some scars of the battle wounds. 

Celine Chiovitti: There's some science and you know this better than I do about even, because one of the things that we try and do is obviously help people prepare for the future. And it's hard to think so far away when everything's sort of immediate gratification and how do I get through today? But there's some scientific, I think, evidence that if you use AI to sort of get your image and have you look at an image of yourself in your older years, that you actually have sympathy for your future self. And it's like, okay, now I actually see it. And that helps to sort of make you make decisions early on about doing things. 

Dr. Aw: Yeah, I think these avatars, these personas, I think that's helpful because the biggest nut to crack is behavioral modification. So behavioral modification is difficult, but I think it has to be personal and I think more people need to plan ahead on the prevention side because it's harder to see a doctor, it's harder to get access to care sometimes. 

Celine Chiovitti: You know, it's a problem.  

Dr. Aw: We've got an aging population, we've got less young people. We got some challenges ahead, despite all the exciting stuff in science and technology and all these great things that we can do. So I think people are looking for unique, creative ways that are personal that can say, "Hey, you know what? This makes sense." Like, sometimes for me, even my own patients, the simplest thing is I don't want to go on a pill. Like, I had a patient last week actually who lost 30 pounds only because I scared them saying, "You're going to go on a pill."And they said, "Well, I'm not going on a pill."  

Celine Chiovitti: They don't want... So that forced them to... 

Dr. Aw: That just stuck, so out of the things I said, that was the thing that stuck. And then he just sort of got that over the finish line. So I think a lot of it needs to be your own personal values about health, how you see your future self. You know, how much do you want to be a partner with the medical community or be independent. So it's all this stuff. In medicine, they call it shared decision making where... 

Celine Chiovitti: Shared decision making. So you're kind of joining with your medical practitioner to sort of figure out what's the right thing. 

Dr. Aw: Which is depending on your stage of life. Right?  So it's like, what's your goals? What's your wellness goals? 

Celine Chiovitti: Love it.  

Dr. Aw: But here's the scorecard. We got to deal with this stuff now because this stuff's important and like, I don't want to talk about it next year. So let's kind of knock this stuff out.  

Celine Chiovitti: I love it.  

Dr. Aw: Yeah.  

Celine Chiovitti: Thank you.  Always, always, always full of great information and advice. And I appreciate it. I know our listeners appreciate it and it's about dinner time and so I am going to go out tonight, but I'm going to try to make better choices 

(both laughing) 

and maybe give up my glass of wine and make the right decisions for my future self. 

Dr. Aw: Great.  

Celine Chiovitti: No guarantees, but I'm going to try.  

Dr. Aw: Right. Well, you can have fun.  

Celine Chiovitti: Yeah.  

Dr. Aw: You can play just 80% rule.  

Celine Chiovitti: Fun is good too.  

Dr. Aw: Fun is good.  

Celine Chiovitti: Like that's important as well.  

Dr. Aw: Thanks so much for having me.  

Celine Chiovitti: Yeah.  

Dr. Aw: It was a pleasure.  

Celine Chiovitti: Thank you, thanks, James.  

Dr. Aw: Thank you. Thanks, Celine.