Amgen Inc. (AMGN) Earnings Call Transcript & Summary

Welcome. My name is Paul Irving, and I chair the Center for the Future of Aging at the Milken Institute. Today, our panel is Two Perspectives and One Goal: Strategies Across the Pacific for Healthy Longevity. And with us is a fabulous group of speakers and colleagues and friends: Victor Dzau, the President of the National Academy of Medicine; Linda Fried, who's the Dean and DeLamar Professor of Public Health at Columbia University Mailman School of Public Health and also the Senior Vice President of Columbia University Medical Center; Glenna Shen, who's the Head of Advocacy Relations, General Medicine at Amgen; and John Wong, who's the Isabel Chan Professor of Medical Sciences and Senior Vice President of Health Innovation and Translation at the National University of Singapore. So welcome to all of you. It's great to have you with us today.

So we have a big topic to get through for the next hour, and it's a particularly important topic today in light of the challenges that all of us are experiencing with the coronavirus pandemic. But the challenge is for us to define healthy longevity. Where should we go? What does it look like? What should we aspire to? And what is the rough road ahead for us to get there? So I'd like to start out maybe just asking you that question, and let me begin with Victor Dzau. Victor, what is healthy longevity to you?

Well, healthy longevity is not about living longer, but it's about living healthier, more productive lives, more quality, whatever the age is. I think the goal is really important not only as individuals but for the whole of society. Just imagine what one can do with the benefits of living longer. [ History has ] a life. Well, you can run for office. Look at our incumbent and our President-elect, they're all in the 70s. The country can use your wisdom, your experience, your value. So all you can, take the time to be a disruptor, a discoverer, maybe write that epic novel. So I think healthy longevity is living to -- life to a fullest with health. And so when you think about aging, also [indiscernible] thing is "a burden." You get more disease, more cost of health care, burden on your family. I think we need to turn that into a health span, not just lifespan. So the way I look at it is about healthier life, more productive lives as well as well-being. Thank you.

So Linda, let me go to you. So Victor is painting this very positive picture of the potential of healthy longevity, political leadership, leadership in the arts, the opportunity to live fuller lives, to do all kind of interesting things with these additional years of health span. What does it mean to you?

So I fall out on Victor's side here that the evidence says that this is a definition of something that is filled with opportunity. As Victor said, for individuals, conditions on health, if we have -- we've created longer lives. If those longer lives are healthy, then I see that as the key in the lock to unlock the possibilities of the longer lives we wanted. And those possibilities exist, just as Victor just said, for individuals with the possibilities and opportunities are huge for society. And if we actually design to align those opportunities, then it is a tremendous win, not just what we wanted for the future to have longer lives, but what could mean the difference for people of all ages, to know that they have longer lives and society with longer lives. That's huge possibility.

So John Wong, let me get to you. Older adults have traditionally been venerated in Asia. So in that sense, maybe a greater understanding of the potential of older adults to serve and to engage in productive roles for longer. From your vantage point in Singapore, how do you see this question of healthy longevity? What's the imperative? What's the goal?

Well, thanks, Paul. I fully agree with Victor and Linda. I think it's really about unleashing the full potential of a -- of someone's life span. And I think the only way that we can do this is to make sure that health span and lifespan are as close to each other as possible. I think the UN Decade of Aging actually defines it pretty well, if I could sort of paraphrase it a bit. It's really making sure that we have that functional ability to really be and do everything that we value. And for that to happen, yes, we need to have great health because it's dictated by both our physical and mental capacity as well as the physical, social and economic environment that we live in. So it's really about making sure that we can unleash that full potential of our entire lifespan. And the only way that we can do that is to really make sure that we remain healthy. Thanks.

So Glenna, you obviously see this from a perspective of a business person, working at a global company that's involved in health. I know it's been a significant interest of yours and something you've kind of driven inside Amgen this question of how the company can contribute and be part of a broader business initiative to encourage healthy longevity. What do you see as the potential? What's in it for all of us?

Yes. I think when we think about healthy longevity, I don't think about it much differently than healthy living. And that's basically enabling individuals to anticipate, plan and then live the life that they intend. And in order to do that, I really think we have to not look at aging as a separate segment of life but rather have it be integrated as a consideration throughout your entire life cycle. And so when we think about that, it's all about integrating the concept of aging or the understanding of the consequences of aging into everything that we do, including the social services infrastructure, the health care ecosystem, financial services. And so I think from an employer standpoint, we have to really think about -- or sorry, from a business standpoint, we have to think about the business role, right? And I think most businesses happen to be employers, and I think that's a key interface when we think about what we can do for employees, especially here in the U.S. where most health care is employer provided. What can we do to enable employees and individuals who either want or have to work for longer than they anticipated? What do we do to enable that? And so I think there are, not to be a follower here, but plenty of opportunities. And I think many of us started out talking about this hyper-aging phenomenon as a crisis, right, much like the global warming or climate change crisis. And the reality is I do truly believe, if we come up with solutions to counter some of the potential vulnerabilities of aging, that there is a real opportunity to turn this into a net positive. If you can enable these individuals to continue contributing, I mean, how is that not net positive for society and potentially economy?

So we could stop the session right here and just declare a victory. But the problem is that this lovely vision that really all of you have painted seems actually quite far away. So Glenna mentioned what some refer to as a silver tsunami, and I think all of us look at this as a golden opportunity but maybe an opportunity unrealized. So here we are in the middle of a pandemic in which older adults are most susceptible to hospitalization and death. We have a rapidly aging population across the world. We know that the population 60-plus will roughly double by mid-century. And it doesn't seem like people get it, like people get the need, get the imperative, get the opportunity, get the realization that this is something that is going to affect all of us, our families, and it's the one characteristic that we all share in a world that's divided in so many ways. Linda, let me go back to you on that front. So between the vision that all of you have painted of this lovely future where all of us can realize our potential, serve important roles and remain healthy, really, to dramatically compress mortality and morbidity to remain healthy for much of our lives, what do we begin to do to get from here to there?

I think there are many things to be done. I think the overarching things to think about are what our goals are. So we -- because of human investment over the last 100 years, we've created 30-year longer and more life expectancy, unprecedented in the history of the world. It's amazing. We added a new stage to human life expectancy. But we haven't designed the society for longer lives. So that's a decision, and that's in every sector alignment. But I think the other piece of this is why do we care about it. And I think we can do better for the reasons that everybody has already said and what are the possibilities. And I think the new entry in here are that -- the science tells us the possibilities are fantastic. They include the evidence accrued over the last 50 years in science for health that it is possible to live a long life with health. We didn't know that 30 years ago. And we know now what it takes because there's a subset certainly in the U.S. of the population that's experiencing that, and we can begin to understand why. And it has hugely to do with the 2 sides of the health coin: the environmental and prevention sides and the medical care sides, along with education and poverty alleviation.

So Linda, let me just -- give us a couple of specific examples of the things that we've learned that enable the kind of health that you're talking about.

Sure. So we know, for example, Victor Dzau knows this very well, that cardiovascular disease is a highly preventable disease. When countries and regions have invested in cardiovascular disease prevention, you substantially decrease the rates of onset of disease as well as low morbidity and mortality. We can -- that is malleable to probably previously inconceivable degree. The other thing we now know is that our mindset, which is highly ages, that everything declines as you get older is not true, that, in fact, as people get older, they accrue assets. And I'm not just talking about financial assets. I'm talking about intellectual and socio-emotional assets and problem-solving capabilities, and if I can even say it, the attributes of wisdom, which actually are in short supply, and power, new roles and responsibilities in society that we really could benefit from. So the science says that we both have the potential to create health span that matches life expectancy, which we never knew before. And the science says that as we get older, it's not about inevitable death, decrepitude. There are -- there's an accrual of a huge amount of assets that people can exercise to greater fulfillment and that societies could really gain from.

Paul, can I comment on this?

Please. I was going to ask you, Victor, just to -- yes.

Well, [indiscernible] carry the science. I mean there's social science. There's prevention. But actually, the basic science is really quite amazing. We begin to know the pathway by which cells grow old, they die. We know in fact the genes that determine longevity in animals. And possibly, if you look at sequencing of octogenarian families, you know about them. But I think what's really exciting these days in science is the ability to turn the chronologic age clock to younger biologic age clock. So we now begin to understand the difference between chronologic age and biologic age.

And Victor, I'm 100% sure that every single person watching this session right now is going to go, "Okay, how do I turn back the clock?" So since you raised -- what are you...

So first of all, there's pretty good evidence that it's epigenetically controlled. But more recently, the research done on using technologies such as partial reprogramming can take an older cell and make it a younger cell and reset the clock. And studies in animals, progeria models where mice age very, very early, once you put in this partial reprogramming with the Yamanaka factors, they actually become young animals. So it's not just also younger. Functionally, they are much better. There are lots of studies that show when you turn the cell to younger cell, they also perform much younger. So it's not expanding lifespan, it's expanding heath span as well. So the science is really good. Then the other part of science is all the digital science, the robotics, the engineering science that can really bring in to make huge differences to this age group. So I'm excited as Linda, and I'll go beyond the social and the prevention to say that we actually are at the point where we can begin to intervene biologically, if not technologically.

So Victor, let me stay with you for a minute because nobody is more familiar and more engaged in the World Health Organization's activities, its Decade of Healthy Aging. And of course, you launched, along with a lot of other things that you've launched since you took over the presidency of the National Academy, this very interesting and important project, a road map for healthy longevity and also a grand challenge for healthy longevity. I'm curious, and I know that process continues, but I'm curious as to whether you think that COVID has set you back or potentially has COVID propelled these efforts. Has it elevated the importance and awareness of the critical need to get people healthier throughout their lives and certainly, again, to compress the time in which we're unhealthy?

Sure. Well, first of all, I should point out that Linda and John are co-chairs of Commission, and you're part of it. So I'm only becoming the mouthpiece, if you will, to talk about the road map. I think the road map is exactly that issue. We talk about science and technology. It's one of them. In fact -- but we also talk about social practices, policy, the kind of thing that Glenna talked about and health care. So the road map is supposed to put together truly a vision and a pathway towards healthy longevity for policymakers, for health care workers, for social programs and also the science. Now what happened with COVID, I think it only makes us better because COVID shows what -- the older population is called vulnerable. So what does that really mean, right? So you do know that people, when they get older, they have a lot more co-morbidities, chronic disease. And so if we can make them healthier, they won't be as vulnerable to COVID. So as you know, 80% of death in the United States are people over age 65 from COVID. So that teaches a lot about the need for health span and healthy longevity. It also makes us much -- feeling much more urgent this issue because older people in the United States live in nursing homes, long-term care, which are really not set up appropriately for good care and easy transmission. Globally, people live in multi-generation homes, where, in fact, they can transmit from younger people to older people. So there's a lot of lessons learned. But I think the sense of urgency -- the COVID allows us a sense of urgency to say, "We know what we need to fix. Let's do it faster because the world is going to benefit from healthier, older people."

So let me avoid expressing all the frustration that I'd like to express about our American experience over the last year. And I want to ask John in that regard about public health in Singapore and public health in Asia more broadly. So 64 million COVID cases to date, roughly about 1.5 million deaths, more than 270,000 of those deaths in the United States. I think of the great public health successes in my life in the United States, and I think about things like successes in smoking cessation and tobacco control. And I think about the polio vaccine and various other things. And yet we have just had, I think, frankly, and I know it's a frustration to all of you, a shameful performance in the United States relative to our peers in other parts of the world, and the results have been tragic. John, for some reason, and I'm always trying to figure it out, is it a better system? Is it a different culture? What has enabled Singapore to do so much better than the United States, number one? And take it beyond Singapore, in Taiwan, in Japan and in many countries across Asia, there's been better experience. What are we missing from your perspective, looking at us from the other side of the Pacific?

Well, I think, Paul, this is as challenging to Asia as it is to the whole world. With regards to COVID, I think we actually had a major dress rehearsal in 2003 with SARS. And SARS taught us what can happen when a virus basically travels, thanks to global travel, through the ease of global travel. So I think that Asia has been basically preparing and readying itself for the next pandemic. And I hate to say this, but I don't think that COVID will be our last pandemic in our lifetime. I think the chances of further pandemics is just going to increase with deforestation and the high degree of urbanization.

Sadly, very sadly. I see Victor Dzau nodding. So unfortunately, [ fairly ], there's agreement with you on that front.

Right. But then you were asking more about -- and I can best describe Singapore's health care system. Firstly, Singapore is like the size of a medium American City. I mean our population is about 5.85 million. We're only about 280 square miles at low tide. But actually, there are 2 -- I would say that there are 2 pieces of work that I would recommend when people ask about Singapore's health care system. One is actually written by Bill Haseltine, he published in 2003 called Affordable Excellence: The Singapore Healthcare Story. And so Bill came to Singapore, spent a year in living care and wrote, I would say, a pretty objective book, looking from the outside in. And then the June 2020 Commonwealth Fund report on Singapore and the International Healthcare Systems Profiles edited by Roosa Tikkanen. But I go back to Bill's book. And actually, Bill said that he found that there were 4 factors that enabled Singapore to achieve its current health care goals of pretty good health care at an affordable cost. First, the political unity and a constancy of purpose and a culture of cooperation within government. I mean there's a standard phrase that's been going around Singapore for quite some time, and that is it's a whole of government, whole of society and whole of nation effort. And certainly, when COVID hit Singapore, it was all 3, whole of government, whole of society, whole of nation effort. The second is Singapore's ability to recognize and establish national priorities. I mean we have basically -- the only 2 resources, I would say, Singapore has, number one, are its people; and number two, while -- our current geography, where we're cited. And everyone knows that geography can change overnight when transportation and logistics change. So really, our only natural resources are people. And so Singapore invests everything in developing its people to their maximum potential. The third is -- I mean Bill says that he found that there was a -- he -- and I quote him, "an overwhelming desire for collective well-being and social harmony." I mean we're a very fragile nation. We're only -- we were independent in 1965. So we're a young country, 55 years old. And we all experience what can happen when there are ethnic tensions. So it's -- we're a fragile society. And the last aspect that Bill mentioned was that Singapore, way before -- I mean from the very start, because Singapore believes in investing in all its people, Bill was -- Bill credited the attention to the rights, education and health needs of women because healthy women, you have healthy antenatal care, healthy children, healthy families. And so those 4 factors really allowed Singapore to really invest in how to protect itself and how to try and navigate through stormy seas over.

Let us all move to Singapore.

Yes, I think so, Victor.

We welcome -- everybody knows that we -- Singapore only can survive because of its friends internationally. And I think all of you here have helped Singapore. And Glenna, certainly, you're now -- your company has been -- has really been a great supporter of Singapore, so thank you.

And that recognition about the importance, the risks of division, for those of us on this side of the ocean, we are experiencing it in very disturbing ways. And of course, the really interesting observation about the exceptional, the extraordinary role and importance of women and, of course, particularly with respect to this question of healthy longevity, longer lives, extraordinary caregiving roles, risks related to dementia, et cetera, so women may, in many ways, be the answer to the challenge. Glenna, let's shift for a second. I want to go to you because all of us, in some way, are connected to policy initiatives and change-making through government. Again, looking at John, he happens to live in a place where that may be a more successful effort than the rest of us are at least experiencing currently. But the private sector obviously plays a really important role as well in this process of change, not just for employees but for customers, patients and the broader society in messaging and changing culture, a different culture of aging. You spent a fair amount of time traveling the world, I know, over the last year or 2, and you've been engaged in an interesting project, kind of mapping the healthy longevity landscape. Talk a little bit about that, what you found, maybe what concerns you or what excites you and I think what of your findings may be a little bit of a call to action to be of the 3 people that you're speaking with today. So talk a little bit about that.

Yes. Would it be okay if I share a little bit about the work we did with The Economist on the aging...

Yes. Absolutely.

Yes. So Amgen partnered with The Economist intelligence unit to create an index. We -- it was [ funny, Paul ], that he was shifting a bit, and I thought he was teeing this up because we named this index The Aging Shift Index, Shift somehow being acronym for Scaling Healthy Aging, Inclusive Environments and Financial Security Today. And what this index did was basically assess a baseline understanding of each of the G20 countries enabling environment, anchoring around 3 key initiatives or criteria, one being an adaptive health and social care system; two, around accessible economic opportunities; and third, around inclusive social structures and institutions. And as basic as it sounds, this is actually a pretty foundational piece of work. And the findings were really interesting. Not surprisingly, we found that the wealth of the countries really was not a correlation to preparedness. None of the G20 countries are fully prepared or really, I would say, marginally prepared to support healthy, financially secure and socially connected older people. But what I found was really interesting is just this dearth of good data, right? So we have a lot of data collection, but I would argue not the right kind of data. And so we have a lot of information, but I don't think we fully understand what the problems really are and what the opportunities are, right? So I think we have a good idea of what the solutions need to be, but we don't really have a good sense of the underlying driving causes, especially when we go from region to region. And so I found that to be particularly interesting because when you look at the findings of the index, and our findings came out right before the pandemic really reached, I think, its height, it showed that the United States was actually, of the G20 countries, the best prepared and that China was the least prepared. And I think it also identifies or really brings to light the policy really does not equate to activity or real action, right? And so I think from this, it occurs to me that we really need to get better information. And I guess Paul and I were chatty about this, and I respectfully put a challenge out there to the 3 leading minds on aging here, what kind of data should we be looking to collect, right? And especially, I think, representing the business sector, we recognize that the time for passive engagement has passed. We need to really be active participants in our community to really help solve this problem. But we really want to do so intentionally and really find that sweet spot where we can contribute good value. So what is the data that we need to collect, right? I think these indices are only as good as what we were measuring back then, right? We measured what we knew. If we want to be innovative, we have to look ahead and think about what is the new definition of success. What are the new data points that we need to be tracking? And that's something that I would welcome input and reaction to because I think that will really help drive the collaboration and public -- private partnerships that can really drive some solutions.

I see Victor Dzau nodding. Victor, do you have a comment on that?

Well, first, let me strongly agree with Glenna. In fact, Glenna, we participated in this Amgen-Economist Intelligence Unit Index. It certainly -- actually someone that both John and Linda know, [ Cece Mongado ] was my representative for that group to look at this. But I think that if you look at COVID pandemic preparedness, which is what Glenna is saying, U.S. ranked #1 in the Global Health Security Index, the Johns Hopkins [ Index ]. And as you can imagine, we performed very poorly, among the bottom. What we've learned in the Global Preparedness Monitoring Board, which I serve, we did a report on this, is the following: One, leadership counts, leadership that's based on science to make policy decisions, as Glenna said. Citizens should count. Human dimension is really important. This is back to John's point. If every citizen see it's their own responsibility to protect themselves and to protect others as we can witness in our country about mask and others, that matters. So human dimension is important. So I would say, Glenna, to you, Human Capital Index is something you need to measure. Education, attitude, culture and health is critically important, as Jim Kim has done in the World Bank to create the Human Capital Index, which is a great measurement of social wellness, if you will, right? I think the other issue clearly is solidarity, equity, social justice, and importantly, therefore, multilateralism. In our country, I think it exhibits very starkly, in my opinion, the lack of racial justice, the issue of inequity. So until you reach that stage, you can measure all you want because you can always be direct to the one end. There's a lot of money here. There's a lot of technologies. There's a lot of preparedness. What you're forgetting is all the people on this end who don't have access to those. I would say those are things you need to measure: equity, social wellness, citizenship, culture and solidarity.

So let me -- it's a great segue to Linda. Linda, you've spoken about, written about the fact that the COVID pandemic has, in many ways, uncovered a dark underbelly in the United States, revealing the impacts of social inequities, the disparities that reflect the social determinants of health and, of course, outcomes, very much related to that. We know that we have exceptional longevity and equality in the United States. And what we also know is that the COVID vaccine has preyed on communities that are vulnerable. Do you think that somehow this year, 2020, will have changed the conversation in that regard? Obviously, to some extent, this is a policy question. It's an implementation question. It's also a culture question. I mean very much I -- Victor's point, the things that we care about, the values that mean something to us, the things that John reflected as being kind of the bedrock in Singapore. What will 2020 have meant in terms of addressing those things that are so important to you and to, I know, everyone at the Mailman School of Columbia?

So I think to build on what Victor was saying, I think that this pandemic, mixed with, certainly in the U.S., deep distress about what has been revealed in terms of racial injustice and its structural, long-standing dimensions that have compounded the consequences of COVID. Now the lessons there are lessons about what we have to address to accomplish the goals that Glenna and Victor just laid out. And I think we -- the countries that have done well in COVID have followed, as John just said, what the headline phrase perhaps in South Africa, which is physical distance and social solidarity. That is absolutely critical that we recognize that you can't conquer a virus and you can't strengthen a society unless we recognize that we're all in this together, and there are things that we could only accomplish together with shared goals. And things rise and fall on those. And everybody gains if we do it. Everyone, if it's done right, should raise all boats. So I think COVID to me, in a lot of ways, this experience for the U.S., in particular, raises the necessity to see what the fraying of those approaches leads to. If we talk about healthy longevity, then many of the solutions could arise from our learning from that. I'll give you 3. One is that we need to create a healthy and resilient population that isn't wiped out by the next pandemic. To do that, we need to actually invest in everyone's health and through a variety of approaches, through the right medical care, through prevention, through population-based approaches, which actually are the most economical and have the greatest return on investment, redesigning health systems, public health and medical care absolutely. But we also need to check on how we actually not just balance protecting health but building connection and cohesion, both for what our goals are and to protect us as individuals. I think the tip of the spear in seeing the consequences of not having the right balance on those 2 is, of course, through the 40% of COVID deaths, which have occurred in nursing homes. That's the tip of the spear. But we have not designed our nursing homes clearly to provide both safety from infection and human contact. And people don't do well. Human beings need human contact. So there are some very fundamental lessons. The third is that you cannot separate health and the economy. There is no division. They each flourish because of the other. And investments in health and healthy longevity are the key to economic well-being and productivity, I might add. And they even go to inform how we need to stretch our imaginations in a world of longevity. So Victor raised Human Capital Index. Very important how we invest in our human capital, as John just pointed out. But in a world where we're getting to live longer lives, the return on that investment doesn't end at 64. It's very clear that we have a huge amount to gain through the rest of our longer lives. But we have to think about this differently. We have to create the metrics that guide us to both our values and to raising the floor and the ceiling for everybody.

So I want to come back to this -- to the question of what's impeding that. I'd like -- I want you all to think about ageism for a moment. Before I go there, I want to ask John a question. Can you raise the connection potentially between the economy and health, which just seems intuitive, obvious investment in prevention of wellness, investment in human capital leading to what both higher-growth economies, healthier companies, opportunities from people, both old and young? For some reason, John, I sometimes wonder whether paradoxically, Singapore has been blessed by its lack of other resources, that for some reason, it got -- via the brilliance of Lee Kuan Yew, it got -- human capital was the thing to invest in. And maybe in a sense, we are burdened in the United States by a series of other kinds of blessings that actually blind us to the importance of investment in people. But what has created this just deep understanding in Singapore that health is wealth, that health is success, that health is economic growth?

Well, it's very hard to go to school if you're -- if you're bedridden or if you've -- if you're malnourished, if you have infantile -- high infant mortality rates, infectious diseases like measles sweeping through the communities. It's just very hard to be educated. It's not impossible, but it's just more challenging. So I mean Singapore had very limited -- we were -- I mean, Paul, when I graduated from medical school in 1981, I had to buy my -- I bought my own needles and IV drip sets because we were -- Singapore was recycling needles. Every night, you could hear all the buzzing sound as the hospital sharpened the needles before autoclaving and recycling them. That was in 1981. So in 1965, I remember, I mean, people were doing laundry by the drain. So if you want to try and have a country stand on its own 2 feet, and literally, I mean Singapore has nothing. We were even importing water. When Singapore has nothing, you would have to invest in your people, and public health was at the -- was the bedrock. So a clean water supply was the first thing that they wanted to get across. Vaccination against infectious diseases was another program rolled out. Access to primary care, to make it as affordable and sustainable as possible. Singapore really does believe that everyone has to take personal responsibility for their health. So really, nothing is for free. Everyone has to pay something for health care. Of course, it's very heavily subsidized for the lower socioeconomic groups. But I think there's a firm belief that it's -- without healthy people, you just can't get educated, and if you can't get educated, you can't get good jobs. And without good jobs, you can't have good housing and good transportation and everything that makes the society. So I think it really goes back to the building blocks of what a society means. And I think what Singapore tries to do is it tries to take adversity and try and make it into a potential virtue. So I think one of Singapore's perhaps miracles is that we're now a world leader in water technology. We've become water -- we've been striving for water self-sufficiency because it's just so critical. So I'm hoping -- my mantra is that we want to make healthy longevity the next water story in Singapore because that's the great untapped potential that we just really have to realize.

That's great. That's great. So listen, Glenna, I'm going to push you on the spot. So in the midst of a pandemic, at a time of extraordinary political division in the United States and social challenge, at a time when it's clear that government, at least in the very near term, is not going to have all the answers, we hope, for some support for people in need, just even in the coming weeks, the role of business to effect the kind of change that you're hearing that Singapore has done over its -- the time of its existence as an independent country and the vision that Linda has expressed and that Victor has expressed is going to take business weighing in. So what is the role and responsibility of business with respect to this question of promoting, advancing, driving healthy longevity? And I'm not just talking about Amgen. I'm talking about -- it may be Amgen's example, but what do you think about business more broadly?

Yes. So this concept of health equals wealth goes beyond just individual, right? I think companies, corporations, business, enterprises are recognizing that, that applies to them as well, right, from a going concern standpoint, that the healthier that their workforce is, the wealthier the company will be. There are lots of studies around absenteeism, presenteeism. But now I think there's a recognition, and you can up level this to the country level, right, that health is wealth when it comes to overall economy. So when you have a lot of countries, many in Asia, although I'm speaking a little out of turn when I thought Dr. Wong on the line, we have a lot of countries where we're losing individuals from the workforce more quickly than we can replace them. And even with advancement of technology, the overall productivity is going down. And that's not only in Asia. A lot of the Nordic countries and even in the United States and certain sectors, that remains the case. What do we do to actually counter that? And what do we do to support this? Again, I think as this concept of a denizen of the broader community, what do we do to actively participate to solve this problem? Certainly, Amgen's role, I think, focuses more on improving and maintaining the health of individuals. But the reality is companies are funders and, therefore, great influencers, right, in a lot of activities. And I think there's an active role that they can play to help drive some behaviors, whether it be modeling as an employer or by partnering, right? In -- Dean Fried, you talked about some of these preventative programs that certain countries have undertaken. Amgen in Asia has partnered with a few of the countries. In particular, Thailand, we entered into a memorandum of understanding with the Ministry of Health. But to your point, with the participation of the Ministry of Finance, because the 2 obviously have to be really interrelated, to basically educate and improve the diagnostic capabilities in the fracture prevention clinics, right, so that Thailand recognized that as their population aged, they're very susceptible to osteoporosis and, therefore, fractures, that was very debilitating. And so they recognized that this was something they wanted to address. And so through a partnership, we were able to -- I think that the data is going to be coming out next year, improving the diagnosis and, therefore, prevention of fractures and falls. And I think those are the types of activities that businesses and private enterprises really need to be participating in to really boost awareness, education and then improve outcomes. One other observation -- go ahead, Paul.

No, no, no. Go ahead. Finish.

Well, I was just going to say, we often -- and I hate to paint the United States in a lower light, but I think especially in our society here, we conflate urgency with importance. And so we often address the short-term needs much more rapidly. And I think here, sadly, the conflation is appropriate with COVID, with, like you said, Dean Fried, in the U.S. has increased re-awareness of social justice. And I think we need to capitalize on that. Again, I think private enterprises and businesses really saw call to action with this conflation of urgency and importance. And I think if we can build on that momentum, there's a real responsibility, I think, to actually follow through on that.

Great point, and I'd love to get back to it if we have a couple of minutes. So I have to ask all of you. It seems to me that the case is obvious. So we have human capital needs and the need for older, older workers, potentially longer work lives to marshal the wisdom and judgment and experience of older adults. AARP's analysis is in the United States alone, the 50-plus market is an $8.3 trillion market, its last number, so a huge market for products and services and innovation and consumption. Older adults are taxpayers. Older adults contribute to communities and to families. Older adults volunteer in disproportionate numbers. Why don't more people get this? And I want to ask specifically about the impacts of ageism, so let me go to Linda Fried first. Relatively quick answer, Linda, we just have a few minutes left.

So I think ageism has been described as the most persistent of all our discriminations in the U.S., at least, if not globally. And it is a lens of anticipating only decline and devaluing people as they get older, which is impeding our ability to see opportunity and to build it.

And something that has to be addressed. Victor, this has to be something that you think about in the context of potential success of these initiatives that you've launched, not just kind of prescribing the potential ways that we can keep people healthier, longer, but how do we change attitudes, culture, et cetera? What's your perspective?

Well, my perspective in bringing together what's been said by a number of our panelists, the wealth and the health issue is that wealth is useless if you don't distribute it. So wealth does not equate health. And I think in our country, we're the wealthiest country in the world, but it's not distributed appropriately. So I think that with all the great work that industry and private sector is doing, they have to look at the issue of how to distribute it to the people who need it. So that, to me, is a very key issue. That includes, of course, the elderly, the vulnerable, the poor and many others. So the way I look at ageism is that we have to preserve the fundamental dignity of people regardless of their age. We have to recognize the value of old people as essential members. And we also have to make sure the intergeneration solidarity, that we work together across all sectors. So if you're to ask me, I would say that we need to have solidarity of all ages, of people in all background and the ability to distribute our wealth to all. I think our country is amazing in the sense of entrepreneurism, innovation. We build some of the best, amazing gadgets. But the problem is it actually only allows some people who can afford to have them. So if you ask me about this picture, I'll say that the whole picture requires all of society commitment, as John talked about, in making sure that everybody, and especially older people, has access. So you ask why is that not a bigger market. I think it is, in fact, the emphasis on those who can immediately buy and make, I hate to say this, revenue, shall we say, for the innovators and companies versus those who can benefit more broadly. And I think that even though as we measure the trillions of dollars of the -- from the older population, many of our older people are not living in wealth. They don't have enough insurance, safety net, pension. So I think there's a real equity issue here that we need to address.

And maybe particularly, Victor, at a time when we've had the "Okay, boomer" meme, and we've had leaders in health, unfortunately, in some cases, advocating, in effect, sacrificing older adults through, I think, misplaced herd immunity series, so I couldn't agree more. Thank you for that. John, again, I kind of think about how do we maybe elevate some of those traditional values in Asia, recognizing the -- both the economic and the noneconomic contributions that older adults make to societies, to businesses, to communities and, just as important, to their families? What can we do to advance that notion?

I think that really getting across a lot of the data, a lot of it coming out in the United States, and I think Laura Carstensen's Center for Longevity at Stanford, the data -- that intergenerational teams do better than uni-generational teams. And so Singapore is really trying to invest in this area. But I think that all countries -- it's not an issue of us versus -- one group versus another group. It's really about trying to tap on the strengths of the entire population, of the entire society. I mean young people -- I mean I look at my children. They're fearless. And they're just incredible with technology. But I think that the older generation, probably less fazed. COVID -- the surveys in Singapore show that it's actually younger people who are finding COVID far more stressful than the older generation.

It's fascinating. Research is showing that older adults are more resilient in this, again, paradoxically at a time when they're more at risk.

So we need to bring both together. I mean they actually form -- and everyone says a fist is stronger than 5 fingers.

Got it. Intergeneration connection and collaboration. So we just have just a few minutes left. So I want to ask each one of you. The people who are watching this will come from business. They will come from policy, academia, a wide range of domains, philanthropy. In kind of a lightning round here and just less than a minute, do each one if you have a call to action that you might suggest to the people watching the session? Victor, let me start with you.

I have already said quite a bit about equity. I would say that, that's #1 in our priority, that we need to have everybody being able to reach their highest potential. Whatever age you are, whatever race you are, whatever sexual orientation you are, I think equity is the word I would use.

Okay. And we hope for continued great leadership out of National Academy of Medicine in the year to come. 2021 is going to be a really important year in health, not just in the U.S. but around the world. Linda Fried, let's go to you next.

If we make the old society investments we need to accomplish healthy longevity, we will have accomplished equity along the way. We would have had to have accomplished equity, to reach that goal for everyone, and society will flourish. And the data are incontrovertible.

Yes. And if somebody wants to see that data, they can google Linda Fried and find plenty of interesting things that you've written over many, many years. So thank you, Linda. Glenna, let's go to you next. So what would be your prescription? And maybe, again, think about your colleagues and peers in the business community, many of whom, again, will be watching this session. What would you have them do?

Yes. I think my call to action is be committed to the long view, and I think that's something Asia has done particularly well. I think planning really for the future and not reacting only to the immediate. I think with COVID, with the calls for social justice, our attention rightly is focused on right now solving the problem in front of us. But as we do so, really keeping an eye towards future crises, right, or how to solve concurrently for what we know to be future challenges, I think, is going to be very important.

Thank you. John Wong. By the way, John, I'm inclined to ask you what Singapore could learn from the U.S. I'm actually a little bit curious about that. But what's your perspective? What's, again, your call to action on both sides of the ocean?

Well, firstly, Paul, I think Singapore can -- has a lot to learn from the U.S., and we're constantly learning from you and every other country. So thank you very much. But I think -- I mean my call to action is, again, our people. I mean people are our best resource. And the only way that we can make sure that we can have a successful, thriving society is to invest in our people, make sure that they're healthy, make sure that they're skilled, make sure they're secured. And I think this call for collective good and social harmony, this constancy of purpose, I think that we're all in this boat together, and we're only as strong as our weakest link. Thank you.

Thank you. Thank you, John. So we are out of time, unfortunately. We probably could keep this conversation going long into the morning or the night, depending on [indiscernible]. I want to thank our wonderful group. Victor Dzau, Linda Fried, Glenna Shen and John Wong, thanks so much for being with us. And to all who are watching this, I wish you a healthy longevity, and I ask you for your contribution to this compelling vision of the future. Thanks very much. Bye-bye.

Thank you.

Thank you.

Thank you.

Thank you. Thank you.