Your front page story “Japan wrestles with age-old problem as population declines at record rate” (Report, April 13) and the letter in the same edition from Tim Hill, “A gently declining population is no reason to panic”, both describe what all societies face as they modernise in the 21st century.

It’s a topic Japan’s Prime Minister Fumio Kishida and US President Joe Biden should have had on their agenda this past week. The challenge presented by the stunning increase in the number of older adults and the huge transformation so that for the first time in history there are more old than young is at the centre of Japanese and US fiscal and economic, and health policy. But instead of pretending government can “encourage families to have more children” as Kishida is doing — which in any event will have no impact for a generation or two — Japan and the US have three policy changes they could make that would have real impact today. First, they could start serious health spending on prevention (adult vaccines, cardiovascular disease, preventing the second fracture, fixing the antimicrobial resistance crisis would be great starts) as an investment in healthier ageing.

Second, they need to redefine the work-retirement model, now almost a century out of date. Third, they should put in place real life-long learning infrastructure, itself having positive impact on brain health as we age.

Kishida and Biden could pick this up later this year at the Asia-Pacific Economic Cooperation leadership summit, and then bring it to the UN “decade of healthy ageing” dialogue in 2025.