The Future of the Company – The Global Challenge

Big business has become disconnected from the broader society within which it operates. A narrow focus on short-term returns has prevented businesses from investing in innovation to foster long-term sustainable growth.

The common understanding of the purpose of publicly listed companies, particularly in Anglo-American markets, is that they exist to maximize shareholder value. Publicly listed companies are under tremendous pressure from activist shareholders, takeover threats, and general market dynamics to generate short-term value by spinning off parts of the company, buying back shares, and laying off staff. External pressure is compounded by executive compensation schemes that are heavily weighted towards stock options. In theory, incentive compensation systems should reduce agency costs so that managers will act in the interests of shareholders. In practice, they create perverse incentives to extract value from the company at the expense of customers, employees, organizational health, the community in which the business operates, and ultimately society as a whole.

A number of unintended consequences result, including:

  • The failure of companies to adequately consider and respond to societal challenges, such as environmental damage and climate change, due to the perceived cost;
  • Erosion of trust between society and the corporate sector, including the role of corporations in shaping public policy, which in turn leads to a loss of trust in democratic processes; and
  • Firm mismanagement through stock manipulation, insider trading and tax evasion, with a number of associated firm-level and macroeconomic risks including treating employees as disposable; undermining investment, research and development; hollowing out whole organisations; turning executives into caricatures of self-interest and greed powered by narrowly focused remuneration schemes; focusing talent in the corporate world on systematically extracting value rather than creating it; stock price manipulation; and fueling market failure and economic crash.

Inequality has greatly increased in the last twenty years, in part due to the failure to translate corporate profits into increased salaries across the firm. Even as worker productivity has continued to rise, real worker wages have essentially flat-lined. At the same time, executive compensation has markedly increased due to the afore-mentioned stock option schemes. Rising inequality within companies has in turn contributed to macro-level inequality that threatens to concentrate economic and political power in the hands of a privileged few.

The biggest questions we face go to the very core of business: what is the purpose of the corporation, and specifically of the large listed company with dispersed shareholders? Will the current model of large publicly listed companies survive the next decade, and if not, what will it be replaced by?

Another question is about the alternatives to public companies, such as B-corporations, co-operatives, companies controlled by foundations, privately held companies, partnerships and family-owned businesses. Many of these alternatives have shown themselves to be capable substitutes for corporate bodies, but will they pick up momentum and drive the way forward? Will they eventually eclipse publicly listed companies? Research by the CFA Institute shows that global equity listings have declined by 17% between 1998 and the end of 2012, from 56,119 to 46,674. US stock exchanges were hardest hit, losing nearly 50% of their listings from their high of 9,253 in 1997. Europe has also seen a significant decline of 23% of its listed companies, while Asian exchanges have seen the least change with less than 5% lost. Given the sharp decline in number and longevity of public companies, it is unsurprising that many ask if a model of public limited company will survive the next decade.

Perhaps the most pressing issue today for financial regulators is the question of how to address short-termism in the markets and its significant influence on the strategies of public companies. It is widely acknowledged that an excessive focus on quarterly returns fed into the 2008 crisis but opinions vary widely on the causes of and solutions to short-termism. What is the role of financial markets and investors in promoting responsible capitalism? Can we turn institutional investors into patient capital, willing to invest in innovative research that will yield returns in the long-term? And conversely, is it possible to limit short-term trading, or at least to reduce its impact on the governance of companies?

Stewardship has become a central focus of regulators seeking to push markets to a long-term orientation. What do good stewardship and responsible investment look like in practice? Is it reasonable to expect institutional investors and corporate managers to serve as good stewards and act sustainability?

The Future of the Company – Options and Possibilities

There is little that is guaranteed but change is certain. In the words of Lawrence Bloom, the co-founder of B.e Energy (a triple bottom line energy company), we are no longer in an age of change but in a change of age. The world faces three converging crises – economic, environmental and social – that require urgent and visionary action. Behind these crises are the failure of a worldview based on the single-minded pursuit of growth and the failure to work collaboratively to ensure that benefits are shared widely.

In the next decade, we will certainly see the effects of our failure to proactively address challenges such as inequality, the regulation of financial markets and youth unemployment. The effects of our failure to make capitalism inclusive will become apparent: we have a generation of young people with uncertain prospects and we face rising inequality with a rising share going to the wealthy even as our wages stagnate. The corporation will be increasingly associated with these problems due to its status as the place where much of the distribution of the benefits of capitalism take place.

We have already started to see the effects of climate change and business has started to sit up and take notice. How will we react and will we be able to turn the ship around? The answer to this question largely depends on the readiness of the corporate sector to support progressive political solutions. It is becoming patently clear that exhausting the planet’s resources is not an option – a growing number of politicians and business leaders recognize we cannot burn our fossil fuel reserves without destroying the world as we know it.

Not all is grim; in the next decade we will witness the continued rise of a new generation of leaders pushing for responsible business, broader recognition of the need for gender and racial diversity in boardrooms and C-suites, and the shift of power from the global north to south and from west to east. Companies from emerging economies will certainly take on a key role in the global economy. They will bring with them different models of governance which might be more able to respond to changing conditions, although they will also introduce new challenges. Finally, the line between public and private will continue to blur. There will be mounting pressure from civil society and the general public for sustainability in business and for corporations to take responsibility for the impacts generated by their value chains and off-shore operations. The reordering of transnational legal and political frameworks will offer us the opportunity to revision the respective roles of the State, the corporation and civil society. Concerted effort is needed to nudge the process in the direction of democracy and broad-based participation.

On our current path, another crash of the financial markets is highly likely. We have not addressed the root causes of the 2008 crisis and momentum for a significant overhaul of the markets has slowed to a crawl. Will the erosion of trust in business caused by the cyclical boom-and-bust nature of markets have an impact on policy-making? It’s hard to say.

The relative power of stakeholders within companies is similarly uncertain: will employees regain their voice? Will responsible investors play a more important role in influencing companies?

There are several events that could occur at the world stage that would have a profound impact on the global economy: another global energy crisis, the eclipse of Western economies by emerging economies, and the dissolution of the European Union.

The overarching uncertainties are whether we will see a rebalancing of power between different stakeholders, whether big business and key interested parties will lead or resist a rebalancing of influence, and how big a crisis is needed to jar us from our current trajectory. The risk is that entrenched interests that benefit from the current state of play will thwart reforms that threaten to limit their influence.

The Future of the Company – Proposed Way Forward

The backlash against big corporations has already fostered interest in alternative business models that will continue to gain momentum over the next decade. There is not one perfect alternative to publicly listed companies but rather a plurality of legal structures that each have certain benefits and drawbacks, including privately held companies, partnerships, benefit corporations, cooperatives, and worker-owned enterprises.

Major changes are on the way for company boards. Although problematic, the concept of stewardship has become the go-to response for regulators seeking to address short-termism in the markets, along with increasing shareholder rights. In theory, strengthening ‘shareholder democracy’ by giving shareholders additional powers such as a say-on-pay seems like a good way to encourage institutional investors like pensions and sovereign funds to steer companies in the right direction. In practice, however, it is unclear whether we can expect investors to take on this responsibility. A slight variation on this would be to assign different powers to different classes of shares.

It may be that other stakeholders besides shareholders will take on an increasingly important role. Board level employee representation is well established in much of continental Europe and has started to receive some attention at the EU level. Board diversity is also a key topic now and will almost certainly be into the future. We may see reserved seats for women, visible minorities, and other traditionally under-represented groups.

The classic maxim says that what is measured is what matters. The traditional focus of firms on measuring and reporting on almost exclusively financial indicators is changing to look at a broader set of indicators. In the EU, the recently adopted Non-Financial Reporting Directive requires certain large European companies to disclose information about environmental matters, social and employee-related matters, respect for human rights, anti-corruption and bribery matters. Integrated Reporting (<IR>) was devised less than a decade ago but has been picked up by an increasing number of companies who welcome the ability to tell a story about the whole picture of the company, which is often overlooked in quarterly reports. Closely related is the question of how to share information about companies to potential investors and the public. There are several ideas out there for developing benchmarks and labeling standards to identify sustainable companies and financial products, similar to what has been done for Fair Trade products.

There are two main ways to influence behaviour: sticks and carrots. Ideally, we will push companies to be pro-social through a combination of both regulatory policy and economic incentives. For example, there has been a lot of discussion in the context of climate change about introducing taxation of externalities, e.g. carbon taxes, as well as a carbon market. The EU has also considered proposals to impose a transaction tax on financial markets to reduce volatility and generate revenue, which has been used in other jurisdictions with inconclusive results. We may see requirements imposed to devote a certain percentage of revenue to CSR, as is being implemented in parts of Asia.

The Benefit Corporation and similar models might be supported by governments, either by tax incentives or by preferential treatment in public procurement. Farsighted States may reform their company law to introduce mandatory elements of corporate purpose, such as, for example, the concept of making decisions with an aim to remaining within our planetary boundaries, and adjusting directors’ duties and responsibilities accordingly. These changes have the potential to have high impact because they could shift economic activity to a new model – and for that reason, they are unlikely to be implemented. Other debated regulatory reforms include caps on executive pay and/or pegging executive pay to non-financial returns; changing the rules on the legal liability of multinational enterprises to allow parent companies to be held legally liable for the actions of their foreign subsidiaries; and restrictions on firms’ right to buy back their shares. Each of these reforms is potentially important but it is only when they are taken together that they have a chance to lead to system-wide changes to business conduct.

In terms of incentives, almost any of the regulatory reforms discussed in the previous paragraph could be framed instead as an incentive with a bit of ingenuity. Additional ideas include introducing incentives for boards to change their composition or to balance the short-term financial interests of the company with long-term and/or non-financial interests. Thoughtful policymaking is needed; indeed, perhaps the best we can do is to try to ‘nudge’ behaviour in the right direction and closely monitor the results, ever ready to react to changes.

The Future of the Company – Impacts and Implications

Tailored solutions will be needed to respond to the unique characteristics of each region. For example, the continental European, Chinese, Japanese and Anglo-American economics and business models are each very different. Germany is characterized by a small number (less than 700) publicly listed companies with worker representation on company boards, whereas mandatory board-level employee representation would be a controversial proposition in the UK or the US. The EU will be forced to confront and reconcile these types of discrepancies in the corporate governance models of its Member States as it asserts an increasingly active role in company law, which has traditionally been under the purview of national governments.

Outside of the EU, we need to bring Asia, the Middle East and Africa into the discussion of sustainability, workers’ rights and human rights more generally. This will require thoughtful balancing of the local context with international standards. In the context of human rights, the UN Guiding Principles on Business and Human Rights outline the responsibilities of States to enforce the principles of international human rights law and of companies to respect those principles. But more work is needed to translate the framework into context- and industry-specific guidelines. It is in the implementation of general principles and the reconciliation of potentially contradictory rights that compromises will be most needed.

If this process is successful, we may see a gradual reduction in inequality leading to less social unrest and less partisan politics. We may also see an increasingly prominent role for business in developing both soft and hard law in a transparent way, acting individually and in concert through more progressive collaborative initiatives than the current trade and industry associations that dominate policy circles in Brussels, Washington and London.

We need a new vision for the role of business in society. Part of the reason why the focus on maximizing shareholder value and short-term profits has captured business for so long is due to the failure to create consensus around an alternative conception of the purpose of the corporation. A model of corporate governance narrowly focused on maximizing shareholder value in the short-term is unbalanced and self-destructive. The paradigm that will rise to replace the current one will need to have a more holistic understanding of profit as one indicator of the long-term health of the organization, amongst others. The profit-making motive will sit comfortably alongside a consideration of a broader responsibility to the interests of society.

This new paradigm must be translated into the existing framework of incentives and regulations for corporate governance and accountability. It needs to be reflected in market mechanisms, in particular in the way that financial markets interact and influence companies. The role of shareholders in corporate governance will have to be rethought in order to protect their role in ensuring management accountability, whilst freeing companies from the imperative to maximise the stock price as at all costs.

In order to achieve transparency and accountability, companies will need to provide an accurate accounting of their environmental and social impacts, through required disclosure and through increased pressure for meaningful information from consumers. Boards of directors will also need to revise their decision-making process to consider the effect of the company on the environment and society. Companies should be expected, encouraged and even required to develop long-term plans charting their way towards environmental and economic sustainability. It will be necessary to devise holistic measures for measuring corporate success in the long-term, reflecting their ability to create value in a responsible manner. These metrics should be reflected in incentives for corporate executives as well as for institutional investors. We need to consider whether the current level of public investment in research and development is sufficient and properly allocated to achieve transformative change. Public-private partnerships, while not without flaws, are one path to support and stimulate green growth.

At some point, we will be forced to acknowledge that the current approach to governing companies is broken. Perhaps after the next financial crisis, but hopefully sooner. Certainly as we are forced to respond to climate change, which cannot be addressed by governments alone without the support and investment of business.

The Future of Ageing – The Global Challenge

Advances in science and technology coupled with large-scale changes in health practices involving improved sanitation, water purification, and a host of lifestyle changes have led to dramatic increases in longevity in developed nations around the world. On a global scale, life expectancies in developed regions are continuing to rise in the 21st century and, although most people assume that there are biological limits on life span, so far there is little evidence that we are approaching them.[1] Because fertility declined across the same years that life expectancies increased, the distribution of age in the global population changed irrevocably. The once-universal pyramid shapes of age distributions of populations in the western world, with many young ones at the bottom narrowing to tiny peaks at the tops, are being rectangularized, reflecting the fact that most people, not just an exceptional few, are living into old age.

To the extent that the importance of ageing societies is recognized at all, anxiety is the typical response. Terms like “grey tsunami” imply that larger numbers of older citizens will become a drain on societies. Concern is warranted. The demographic changes underway are fundamentally altering virtually all aspects of life as we know it. Workforces are becoming older and more age diversified than ever in history. Families are having fewer children, yet four and five generations are alive at the same time. Education has come to predict well-being and even length of life, yet is unevenly distributed, creating heightened disparities across socioeconomic strata accentuating old age outcomes between rich and poor.

[1] Oeppen, J. and J. W. Vaupel: Broken limits to life expectancy. Science 296, 1029-1031 (2002).

The Future of Ageing – Options and Possibilities

To date, however, the concern has been largely misplaced, with the emphasis on aging as opposed to an emphasis on the cultures that surrounds very long lives. By culture, we are referring to the crucible that holds science, technology, and large scale behavioral practices and social norms. We maintain that the more serious problems concern antiquated social norms and the lack of cultural supports for people 50 and older, such as medical treatments for common diseases of old age and technologies and services that allow people to age in place, and social norms that encourage life-long participation in communities, families and workplaces. The culture that guides people through life today is a culture that evolved around shorter lives. The urgent challenge now is to create cultures that support people through ten and more decades of life.

Although predictions about the future are always perilous, we can comfortably predict that life will change and can change such that longer lives improve quality of life at all ages. Unfortunately to date we have been decidedly uncreative about ways to use added years of life. These years have been tacitly tacked on to the end of life, with old age the only stage in life that has gotten longer. Rather than move forward by happenstance, we need strategic thinking about how to best use added decades of life. Helping individuals and nations visualize, plan and prepare is essential in order to ensure that longer lives are high quality.

Changing the nature, timing and duration of work will be key. Individuals and societies must effectively finance very long lives and so far we are doing a poor job. Life expectancy at age 65 for the world’s population increased by roughly fifty percent from the 1950s to the present time, while the average age of retirement has remained relatively constant. [1] Between now and 2030, the number of people in developed countries over the “conventional” retirement age of 65 will increase by more than thirty percent. At the same time, the size of the conventional working-age population in developed countries is projected to decline by four percent. To the extent that nothing changes, the ratio of the working-age population to retirees will steadily decrease in the foreseeable future. Of course, these projections are based on the assumption that people continue to retire at relatively young ages. One obvious, although surprisingly ignored, way to address the challenges posed by the declining number and share of working-age population is to expand the workforce by increasing the workforce participation of older workers and, in some countries, women.

Increasingly, research findings suggest that this is feasible. A substantial majority of people 60 to 70 years of age report that they are physically able to work. A 2014 paper published in the Journal of Gerontology found that 85% of Americans aged 65-69 report no health-based limitations on paid work or housework.[2] Similar trends are evident in Europe. [3] To be sure, the numbers of disabled individuals has, and will continue to, increase in aging societies and it is extremely important to have policies that support people who cannot work. We maintain that the generosity of disability insurance should increase, yet we must recognize that chronological age is a poor predictor of the ability to work. Even at very advanced ages, substantial numbers of people are sufficiently healthy to contribute to workplaces. Societies that find ways to tap older peoples’ contributions will benefit greatly.

Although the idea of longer working lives often meets resistance, evidence for the benefits of work to individuals is growing. Arguably, the most obvious reason to work longer is the financial benefit. For many, retirement at age 65 is economically infeasible. In the words of Stanford economist John Shoven, “the reality is that few workers can fund a 30 year retirement with a 40 year career”.[4] Neither can societies. In recent years, it is becoming clear that remaining active and engaged in work is also associated with physical, socioemotional, and cognitive benefits. Studies of healthy aging suggest that older adults who are engaged have lower mortality rates, are less likely to experience various physical and mental illnesses, and are more likely to have a strong sense of identity and well-being.[5] Working longer also has protective effects against cognitive decline, [6] ostensibly by providing a mentally engaging environment where workers can “use it” so they don’t “lose it.” Research suggests that both paid and unpaid work are associated with enhanced well-being, delayed disability, decreased mortality risk, and onset of fewer diseases and associated functional impairments. [7],[8],[9],[10] New models of working longer can relieve some of the pressure to save large sums of money for extended periods of leisure. Importantly, working longer can mean working differently. Many workers would be happy to exchange decades-long retirements in old age for four day work weeks, regular time off for sabbaticals, retraining, and part-time work when children are young as well as at advanced ages as people fade into retirement.

[1] “Population Facts”, United Nations Department of Economic and Social Affairs, Population Division, December, 20-13

[2] Lowsky, Olshansky, Bhattacharya, Goldman, “Heterogeneity in Healthy Aging”, J Gerontol A Biol Sci Med Sci first published online November 17, 2013 doi:10.1093/gerona/glt162

[3] A. Börsch-Supan, Myths, Scientific Evidence and Economic Policy in an Aging World, J. Econ. Ageing, 1–2 (2013), pp. 3–15

[4] Ford, John Patrick. 2014. “How to support a 30-year retirement.” San Diego Source. http://www.sddt.com/Commentary/article.cfm?SourceCode=20141106tza&Commentary_ID=12&_t=How+to+support+a+30year+retirement#.VL6ykS6AyjI

[5] Rowe, John W. and Robert L. Kahn. 1998. Successful Aging. New York: Pantheon; Cohen, Sheldon. 2004. “Social Relationship and Health.” American Psychologist 59:676-684.

[6] Rohwedder, Susann and Robert J. Willis. 2010. “Mental Retirement.” Journal of Economic Perspectives. 24:119-138

[7] Rohwedder, Susann, and Robert J. Willis. 2010. “Mental Retirement.” Journal of Economic Perspectives, 24(1): 119-38.

[8] Carr DC, Komp K, editors. “Gerontology in the era of the third age: implications and next steps.” New York: Springer Publishers; 2011: 207-224

[9] Morrow-Howell N, Hinterlong J, Rozario PA, Tang F. “Effects of volunteering on the well-being of older adults.”   J Gerontol B Psychol Sci Soc Sci. 2003; 58B:S137–S145. Doi: 10.1093/geronb/58.3.S137

[10] Matz-Costa C, Besen E, James JB, Pitt-Catsouphes M. “Differential impact of multiple levels of productive activity engagement on psychological well-being in middle and later life.” The Gerontologist. 2012. Doi: 10.1093/geront/gns148

The Future of Ageing – Proposed Way Forward

From a societal perspective, there is a pressing need to make use of the human capital represented in older people. General knowledge and expertise increase with age, as do emotional stability and the motivation to invest in important activities. If appropriately utilized, older populations can benefit national and global economies. Yet the clarion call to workers today is about saving for increasingly long retirements, instead of actively planning to work longer. In the US, the responsibility for saving has shifted to the individual, reflecting the move from defined benefit plans to defined contribution plans. Unfortunately, the change has resulted in considerable undersaving for retirements. In a 2014 Retirement Confidence Survey, only 64% of all workers age 25 and older reported that they and their spouse had saved at all for retirement, a decrease from 75% in 2009. [1] Overall, 60% of workers report that they have less than $25,000 in total savings and investments, with over one third reporting less than $1,000 in total savings.[2] If appropriate steps are not taken, there could be catastrophic economic implications to both individuals and societies, as low retirement savings could lead to major strains on economies.

 

For those who have inadequate retirement savings, the most obvious solution is to work longer. This approach may hold benefits that extend beyond income to include better physical health and cognitive functioning. One major potential barrier, however, is that employers remain ambivalent about older workers. Currently, most employers’ view older workers as expensive and sometimes less productive than younger workers. Research findings increasingly suggest that the latter reflects stereotypes more than evidence. The productivity of workers tends to increase with age. This is especially true for knowledge workers, yet blue collar workers also can retain (and perhaps increase) productivity.[3] One study that measured the performance of more than 400 McDonald’s restaurants across the UK found that restaurants that employed mixed-age workforces, including workers age 60 and above, delivered an average increase of twenty percent in customer satisfaction levels compared to less age diverse workforces.[4] Moreover, there is a net benefit of intergenerational teams on workplace productivity, including a broader range of skills and experience across the workforce, increased mentorship opportunities and skills transfer, a reduction in turnover, and increased staff morale.[5],[6] Companies that adapt to older workers’ needs using cost-efficient measures such as flexible work arrangements, workplace modifications, and on-the-job training can benefit from age diversity in the workforce. [7] BMW’s older worker production line at Dingolfing is an example of how thoughtful design of blue-collar workplaces can support high levels of productivity in older workers. The company collaborated with its older production workers to tailor one of its most labor intensive manufacturing lines to an average worker age of 47. The resultant line reached its production goals with defect rate and worker absenteeism meeting or exceeding the levels achieved by “younger” lines.[8] The cost of older workers is a real issue for employers. By leveraging older workers as source of human capital, employers can better manage their talent, facilitate knowledge transfer to younger workers, and help older workers slowly phase into retirement. Offering bridge jobs or flexible work arrangements such as flex hours and part-time work will allow employers to retain the expertise of older workers while reducing costs.[9],[10]

[1] Employee Benefit Research Institute. 2014. “2014 Retirement Confidence Survey.” http://www.ebri.org/pdf/surveys/rcs/2014/RCS14.FS-6.Prep-Ret.Final.pdf

[2] Ibid.

[3] Burtless, G.(2013).The Impact of Population Aging and Delayed Retirement on Work-force Productivity. Tech. rep., Center for Retirement Research at Boston College.

[4] Department for Work and Pensions (UK). 2011. “Employing Older Worker Case Studies.” https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/142752/employing-older-workers-case-studies.pdf

[5] Ilmakunnas et al. “Diversity at the workplace: Whom does it benefit?” Helsinki School of Economics. http://www.eale.nl/conference2009/Programme/PapersC/add102508_wKXraqYSnk.pdf

[6] Department for Work and Pensions (UK). 2013. “Employing an Older Workforce, An Employer’s Guide to Today’s Multi-generational Workforce. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/142751/emplying-older-workers.pdf

[7] Brooks. 2014. “Productivity and Age.” Age UK.

http://www.50plusworks.com/downloads/Age%20and%20productivity%20briefing%20(March%202014).pdf

[8] Loch, C.H, Sting, F.J, Bauer, N, & Mauermann, H. (2010). How BMW Is Defusing the Demographic Time Bomb. Harvard Business Review, 88(3), 99–102. Retrieved from http://hdl.handle.net/1765/20802

[9] CIPD. 2012. “Managing a Healthy Ageing Workforce, A National Business Imperative.” http://www.cipd.co.uk/binaries/managing-a-healthy-ageing-workforce-a-national-business-imperative_2012.pdf

[10] Backes-Glenner & Veen. 2009. “The Impact of Aging and Age Diversity on Company Performance.” Institute for Strategy and Business Economics, University of Zurich. http://www.zora.uzh.ch/48541/1/Backes         Gellner_The_impact_of_aging_and_age_diversity_on_company_performance-V.pdf

The Future of Ageing – Impacts and Implications

Dire predictions that a “Grey Tsunami” will overwhelm economies with unproductive societies harken back to Thomas Malthus’ 1798 “Essay on the Principle of Population”. There, Malthus predicted that growing populations would outrun the food supply, leading to poverty and starvation. The prediction did not foresee the development of agricultural technologies that greatly increased food production. In the case of older populations, predictions about economic disaster change to discussions of economic growth if people remain productive into advanced ages. Rather than a problem, we may be experiencing one of the greatest opportunities ever in history to dramatically improve quality of life at all ages.