Since Neanderthal times, families rejoiced in the birth of young, healthy children to support and perpetuate the tribe. Until the industrial age an extended family was the norm, and "social security" meant productive and faithful children and grandchildren.

As the Information Age progressed, travel became increasingly cheap, credit cards became the norm and the nuclear family was born. In modern society the responsibility to care for the seniors has been, to a great extent, transferred to national government. Nevertheless, government coffers are supported by the tax base, and it is still our children and grandchildren who collectively provide for us when we retire. That is, if there are enough of them.

The hard news is that in many modern industrial societies there simply aren’t enough young people to support the elderly. Typically, as education improves, living standards go up, people marry later and ultimately have fewer children. This trend is further compounded in countries that are slow to accept immigrants seeking a better life. Japan is in deep trouble, as is Russia. Germany is not far behind. Developing countries with a high fertility rate, like Brazil, Indonesia, India and Mexico, have completely different prospects. The United States is somewhere in the middle.

This year, 80 million baby boomers begin to turn 65. As they do, they will start to drop out of the work force and draw from rather than contribute to Social Security, Medicare and the federal coffers. They also will begin to draw down their pensions and, as they age, divest from the stock market. The trend is gripping with the percentage of those over 65 rising to 26 percent from 17 percent in the next 20 years.

Caring for those who can no longer take care of themselves, even with family assistance, is expensive. Long-term care insurance is also costly, and most of us are underinsured in this area. In Hawaii, even with insurance, there is a major shortage of long-term-care beds. Without a concerted public-private effort, that problem is likely to grow.

Although the United States still is not in the worst position with respect to our aging population, we have added to the burden of future generations by leaving them with a mounting national debt, thanks in large part to two recent wars and a hefty economic stimulus. Hopefully, the stimulus, at least, will prove to be a good investment.

Retired people also have more time to vote and tend to turn out to cast their ballots. Politicians know they have to listen. But who is giving more than lip service to the world we are creating for our children? The baby boomers sang about the dawning of the age of Aquarius and protested the war in Vietnam. They spoke out against materialism as they turned on and tuned in. Now, the question is whether, in their sunset years, this generation really means to leave the world a better place. Among the greatest challenges faced by democratic nations is to educate its citizens to vote beyond the tips of their noses. Let’s see what happens.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.