The Future of Almost Everything, page 9
However, birth rates in some Western EU nations are likely to rise rapidly, partly as a result of migration, as in the UK. More than 1.7 million a year enter the EU, and a further 1.7 million migrate within the EU – mainly from newly joined EU nations where wages are very low. Most migrants are young, single adults who are likely to settle down and raise families. Another reason why birth rates may rise is that a generation of women delayed motherhood by 10–15 years, and biological clocks are ticking.
10 million more people heading for Britain
For the past decade, more than 500,000 people moved to the UK every year, and just over 300,000 left (many of them British born). Of those arrivals, 40% are from the rest of the EU, but the majority are from all over the world. On current trends, barring the UK leaving the EU, over 10 million people will move to Britain in the next 20 years, and 2 million babies will be born to those 10 million arrivals, offsetting low national birth rates. White children could be a minority in schools in England by 2037. The number of ethnic minority children in primary and secondary schools has soared by over 60% in a decade.
Immigration will continue to be a hot political issue for the next three decades. We will see many attempts (and failures) to control numbers, with growing popularity of extreme right wing groups, and attacks on minorities. However, the UK will remain a very attractive destination. In every nation population size is strongly linked to size of the economy, so the UK economy will also grow.
At the same time, expect serious decline in the numbers of people living in rural areas and smaller towns or cities in countries like Poland, the Czech Republic, Bulgaria, Albania, Slovakia and what was East Germany – as over 15 million younger workers leave for better opportunities during the next decade, many of whom are well educated. Most will only work in other nations for a while, and then return to the largest cities in their home countries.
Germany is likely to develop a more polarised attitude to immigration, with street protests a common occurrence, at the same time as challenges from an ageing labour force deepen, which will threaten economic growth.
Future of real estate linked to cities
In most nations, the future of property markets will be dominated by what happens in the largest cities. In uncertain times, investment in real estate provides stability compared to investment in stock markets. In addition, there is the emotional attraction of property – visible, tangible, with history.
Despite all the real estate booms and busts that we will see in major cities around the world over the next three decades, over $100 trillion dollars will be added in real terms to the total value of global real estate, from $180 trillion in 2014, simply because cities are expanding, economies are growing, and numbers of middle-class property owners are rising.
Globalised travellers move near airport hubs
Growth of air travel dictates that all globalised executives will have to be close to a large international city airport, however virtual their teams. This ‘hub effect’ will also be true of high-speed train links.
Those who are fed up with city life and are part of the middle class can afford the luxury of bucking the trend, going ‘back to nature’, getting out of cities for a greener life, greater security, lower housing costs. However, the wealthiest will just live in both, with two, three, ten or twenty homes. An increasing number of super-wealthy will have private helicopters and planes that link their offices, homes, hotels and holidays direct, or via big airports.
Future of UK property linked to largest cities
UK property prices will be linked to the future of London, Manchester, Edinburgh, Glasgow and other major cities. As I predicted many years ago and more recently during the UK real estate crash in 2009, real estate has remained a good long-term investment for many reasons.
Rapidly growing population due to net immigration of over 200,000 a year
Acute shortage of land for new housing in a tiny island, and severe planning controls
Outsourced jobs in other nations returning to the UK as it becomes more competitive due to low wage inflation and exchange rates
Recovery of the banking sector
Strong growth in services and creative industries
UK seen as safer haven for investors than other EU countries or regions where there is conflict
Family breakup means smaller households, more homes
Ageing population, and better care to help stay at home
Equity release by parents to help children buy property
Bank of England policies to keep interest rates low, until certain of recovery, even if the result is a new real estate boom
Low rates of return from government bonds, bank deposits and company shares so real estate more attractive
Many people don’t trust pension saving and prefer property
Traditional mind-set/psychology of property ownership as an investment
No capital gains tax on your own home – yet
Tax benefits for personal pension funds that own property.
Future of London
The population of London has grown by more than 1 million over a decade, and will grow by a further million in the next, while the number of houses has hardly increased. London will continue to experience a top-end boost from international buyers who are worried about the future of their own nations, and whether they might need to make a rapid transfer of assets or even of their families. As a result of all this confidence in the market, many other international and national investors will pile in to buy more property.
London will continue to be firmly placed near the top of the world order in popularity as a place to live. Private schools and private health care are world class, and streets are so safe that police don’t even carry guns. London is France’s sixth biggest city by French population, for example.
Restaurants and wine bars have multiplied, together with cinemas, hotels and nightclubs. London has become one vast work and leisure complex offering the very best of world-class time out for busy executives, round the clock.
London will continue to be a global centre of financial services. Expect a fierce fight from London to remain the main player for foreign exchange. The City will struggle to retain the world’s largest collection of foreign banking offices. There will be growing competition from New York and Shanghai, together with Singapore, Hong Kong, Tokyo and Mumbai. London’s banks and other financial services will remain dominant employers, even though the total number of workers is unlikely to match that of before the 2008 economic crisis, until 2020.
London will also continue to be a magnet for creative, imaginative people – for free thinkers, digital marketers, computer games companies, film-makers, artists, entrepreneurs, management consultants and advisors. Expect London’s tech workforce to grow by at least 5% a year for the next decade, fuelled by new venture capital.
Property in America, Eastern Europe, China and Russia
America’s real estate market is likely to have recovered by 2016 across almost the entire country, unless there are local factors such as municipal bankruptcy, as in Detroit. Surplus housing will be rapidly absorbed, loan defaults will work their way through, and the economy is likely to grow well.
Some East European countries suffered over 40% falls in house prices in the recent crisis, and in nations like Ukraine it will be some years before these levels are seen again. In contrast, China’s real estate market is likely to wobble from booms to busts across different regions, as the nation rapidly urbanises, in a poorly balanced process driven by migrations, real estate developers, overambitious property owners, easy availability of credit, and government policies.
It will take more than 50 years to replace Stalin’s world of concrete, identical, low-grade apartment blocks in order to rehouse over 175 million people who still live in them today. His influence will continue to be felt in subtle ways in the minds of the older generation, many of whom will continue to look back with warm affection to the strength of old Soviet Russia.
Future of health
We have seen how the future of every nation is linked to demographics, migrations and cities. But these things are also linked to health: not only how many people are born, but how fit they are and how long they live. And in health, most of humankind will see an astonishing revolution over the next 30–50 years.
The fact is that 65% of all health spending in developed nations is on those over the age of 65, most of whom have several chronic conditions, almost all related to the ageing process. Therefore it could be said that every pharma company and every hospital exists primarily to serve the needs of older people, in those parts of the world.
The greatest health challenges in the next two decades are almost all related to ageing, as many emerging nations also become older.
Shift from sickness to enhancing performance
The whole emphasis of health care is already shifting from treatment to prevention, wellness and improving performance. Many drugs used today to treat illness will be used tomorrow to enhance performance. For the last decade we have seen this trend unfold in sexual health and treatments for memory loss. Drugs like Viagra and Cialis were first prescribed for men with varying degrees of impotence, but both are now more widely used to enhance ‘normal’ sexual performance, with growing sales on the online black market.
The same has happened with Ritalin and other drugs to enhance brain function, either in hyperactive younger people, or in older people with significant memory loss. In terms of enhancing performance, 20% of all US and UK students are now using such drugs to help pass exams.
In the past, the question might be, ‘What do you expect at your age?’ In the future the question will be, ‘What can you do to help me stop feeling my age?’
The commonest complaint of older people is lack of energy, tiredness and slowing down. The greatest blockbuster drugs of all time will rejuvenate old bodies and brains by targeting common systems in every cell, increasing the efficiency of mitochondria, for example, which generate electrical power.
Mitochondria have their own genes, they divide and can be swapped between animals and humans. Old mitochondria have been revived in mice and rats, with treatments such as alphalipoic acid in combination with other drugs. The old mice run around faster, and solve mazes more rapidly.
Future of cosmetics, skin care and face lifts
We are seeing a similar trend in cosmetics – performance enhancement in skin. The greatest drivers of sales in cosmetics will be ageing populations and emerging middle classes. The global cosmetics market will be worth around $300bn by 2020, growing by 3–4% a year.
Hundreds of millions of women over the age of 30 will want to look far younger. Some wealthier women will end up paying more than $1000 every year for the latest ‘miracle’ skin treatments, creams, lotions and other therapies.
The damaged ozone layer still covers 10 million square miles and will continue to fuel tourist concerns about skin cancers. Sunlight will be blamed for an increasing number of disorders, including cataracts and non-Hodgkin’s lymphoma (a type of cancer). Skin cosmetics will increasingly emphasise ultraviolet ray protection. Sun screens are now so strong that with their use it is almost impossible to develop a ‘normal tan’.
Expect dark brown, tanned skin to become less fashionable in Europe as has been the case in India, with a return to paleness as a sign of sophistication, echoing the fashions of the nineteenth century, when a tan was a sign that you were an outdoor labourer. Increasing numbers of people will view beach holidays in hot countries with suspicion.
We will see reliable research over the next decade that demonstrates clearly that certain formulations really do stop wrinkles, restore the skin colloid that gives the skin its natural thickness, help restore elasticity and make people look up to a decade younger.
Major challenges for the next 40 years
Brain degeneration – Alzheimer’s disease is now the commonest cause of death for women in the UK. Over 130 million people globally will be affected by dementia by 2050, up from 44 million in 2015. Expect huge research efforts to find an early marker to detect whether drugs are working, before having to wait 20 years for trials to complete. This research will also teach us more about the physiology of the brain – how we think or remember; where events are stored; how decisions are made; what is conscious thought.
Cancers – most cases are already curable with early diagnosis and the best treatment. Expect many new therapies that teach the immune system to attack cancers, and gene screening to select anti-cancer drugs based on the precise character of each tumour. Most people with cancer over the next 30 years will be treated by combinations of different therapies. Death from cancer will become very unusual in most developed nations by 2065.
Obesity-related conditions including diabetes – 30% of humanity is overweight, which costs around 2.8% of global GDP (in health care and lost work days), and causes 5% of all deaths. Half of the world will be obese by 2030, as more people become wealthier. One in three babies born in New York in 2015 will develop adult-style diabetes as children because they are so fat. Obesity is costing the US economy over $100bn a year in ill health and lost productivity – with over 300,000 deaths a year, while 20% of all health costs in all developed nations are linked to obesity. Expect new therapies, such as ones based on the hormone thyroxine, which are designed to speed up metabolism without affecting the heart. Expect huge growth in regulations, ranging from chocolate advertising to children, to sugar content in convenience foods, or drinks, and major initiatives to encourage fitness.
Heart disease and strokes – we will see astonishing reductions in deaths worldwide from heart disease and stroke due to screening of adults for blood pressure and cholesterol levels, and because fewer people smoke tobacco. Anti-high blood pressure tablets and statins to lower blood cholesterol will be used by over 350 million older people in 2025. We will see more widespread insertion of small tubes (stents) to unblock cardiac arteries – 127,000 people in America are treated with these each year, whereby a flexible tube is inserted through a tiny hole in the groin, and then guided using a thin wire, through blood vessels right up to the heart. Strokes will also be less common, with better recovery, as clot-busting drugs are used more widely.
Chronic wounds – around 100 million older people around the world will be affected by chronic wounds by 2025, particularly in their lower legs, caused by poor circulation. Expect huge investment in new dressings and therapies to accelerate healing including telomerase, to reactivate old and tired fibroblasts in wound margins. (When cells have divided too many times, the ends of strands of genetic code inside them become shortened so the cells cannot divide any more. Telomerase is an enzyme that lengthens those ends or ‘telomeres’ back to a more ‘youthful’ state so they can divide again.)
Bacterial infection and sepsis, including TB – drug-resistant bacteria are a nightmare for surgeons and patients, and make 2 million people ill each year in America, costing $20bn in health care and killing 23,000. If irresponsible prescription practices continue, we could see more than 8 million deaths globally each year by 2045, 150 million deaths over 30 years, wiping out $50 trillion of economic activity. The last major breakthrough in new antibiotics was in the 1960s. Pharma companies do not make big money from antibiotics, because they are taken only for days. Expect new government and industry partnerships. Expect much stricter controls on over-prescribing and bans on use in animal feeds by farmers. The TB pandemic has also been made worse by drug resistance, often linked to HIV infection.
Parasitic infections including malaria – malaria will continue to be one of the world’s worst medical problems for the next 20 years, with 100 million cases a year, killing 660,000, especially young children. Expect major breakthroughs in vaccines and treatment for malaria by 2020, with growing numbers of vaccination programmes in every hard-hit nation by 2030.
Infertility – we will see an ‘epidemic’ of infertile, older aspiring parents. This is because more women wait until age 35 or more to try to conceive, but fertility falls rapidly with age. Sexual diseases are also rising globally and sperm counts have halved.
Care of older people – over 100 million older people in the EU will need care, at home or in an institution, in the next 20 years. Despite popular perception, length of final illness is not much longer than it was 20 years ago, and remains less than two months, even though people are living longer. Most older people die peacefully after a short final illness. Others will need heavy-duty care for a number of years. Expect huge growth in home carers, and growth of e-monitoring of health. Robots will not form any significant part of this solution, even by 2050. Low-cost migrant labour will fill many new, relatively low-skilled, care jobs in the EU over the next 25 years.
Viral pandemics – major health risk
Every year we see new mutant viruses, and as populations grow, mutations develop and spread faster. Mutation is particularly likely when viruses from animals infect humans, or when people are treated with antivirals.
Humankind is very vulnerable to viral attack because we have very few, and relatively feeble, antiviral therapies. There is not a single antiviral today that is as effective as penicillin when first discovered. Antiviral research is 50 years behind antibiotics. Our only really effective weapon is vaccination. Hepatitis C virus is just one threat, carried by 3% of the entire world, including 4 million in America and 215,000 in the UK. Hepatitis B and C kill over a million a year.
AIDS will be a global menace for decades
AIDS has killed over 40 million people with a further 35 million infected, mainly in Africa, and will continue to be a global health threat in 2040. HIV mutated as it jumped from animals to humans decades ago, and is a warning of other mutants to come, against which we will have no immunity, vaccines or treatments.
I have been deeply involved with AIDS work since 1988, when the international AIDS agency ACET started in our family home, as a result of my NHS work with people dying of cancer in London, during which I discovered people with AIDS who were dying in great physical and emotional distress. Today ACET has prevention and care projects in 18 nations, mainly in the poorest parts of the world.
