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Reframing ageing

This definitely isn’t the first time I’ve sought to write about the error of the media-fuelled “ageing tsunami” or the misguided assumption that “the ageing population spells doom for health and social care”. I and many others have made the case repeatedly that this misguided narrative causes harm. For this blog, I will focus on framing a response to ageing.

We broadly know the drivers of the population health problem and why it matters. The population is growing. It is true that illness is correlated with age and now more than ever before there are a greater number of older people.

Baby boomers are getting older and reaching an age where the impact of policy and individual decisions 30 years ago is beginning to be felt. Many argue that recent austerity policies and cutbacks in the social safety net are making the problem worse. There ARE more people in absolute terms in the population and many of these are reaching the stage in their lives where loss of functionality and illness is more common.

However, the problem is not that we are living longer but that we are not getting healthier. Historic improvements in life (and healthy life) expectancy are stalling and there is continued inequality between groups. For example, the age of onset of multiple illness in those in the poorest groups is 15 years earlier than those in the most affluent.

We need a social approach because ageing is a social issue, not a clinical one. The aim might legitimately be expressed as ‘to delay the onset of loss of function or independence often associated with ‘ageing’ but more correctly associated with illnesses’. Professor Walker’s article sets out an excellent route map that pushes us away from a medical model towards a social model.

A life course strategy includes an active population-level response to supporting people to be as healthy as possible at all life stages; and obviously incorporates social policies with a wide range of focus. Ageing is a life course issue, it starts from birth (or before) with what happens early in life having been proven many times to fundamentally affect life course trajectory. Just as it will be too late if we wait till we are 65 to sort out our pension, if we see ‘ageing’ as only a problem of “the elderly” it will be too late – and any return may be marginal compared to if whole life course strategy was employed.

The numbers of people working beyond state pension ages have risen significantly in recent years and this is projected to continue. Keeping people well to maximise wellbeing is also an important economic issue: there are obvious economic losses for those who retire early on account of illness. As more than half of over 60s have two or more long term conditions, this makes preventing, delaying and treating those LTC a quality of life AND an economic issue.

The WHO definition of healthy ageing is wide-ranging:

“The process of developing and maintaining functional ability than enables wellbeing in older age”

…or more bluntly: enabling people to do what they believe is valuable and providing support wide enough to encompass social processes: welfare reform, poverty, employment, spatial planning and housing.

The WHO strategy identified ten priorities, with five strategic objectives. Practically speaking, the Five Ways to Well Being is as good as any framework to hang a practical response around. It can and should be applied at multiple levels, from individual, to city-wide and larger.

It’s easy to delay investing in future gains if we haven’t enough capacity today. Often what we are judged on is small, visible and high profile, not long term and invisible.  There isn’t a neat business model to describe the gains. Mehta and many others have tried to quantify the substantial future savings by attending to the issues of healthy ageing now but there is no clearly written and articulated ’business case’ . Whilst it’s easy to say “yes, we agree to move resource differentially” the rubber will hit the road when it becomes about moving resource commitments.

Five reasons why our reaction may be slow and sub-optimal:

  • There is deeply ingrained ageism and a short-term focus in financial and political thinking
  • There is unending faith in the power of medicine to ‘cure’ the downstream consequences
  • It is arguably too big and diffuse an issue to be ‘owned’ by one single institution
  • There isn’t a burning platform: the issue is not seen as mission critical to the business
  • We don’t yet have the right public-facing narrative, which currently sees older people as “a burden”.

Ageing is inevitable but also malleable. A coherent response to ageing must be a societal one; it can’t be sector-specific and cannot be addressed in silos. It should start before birth and requires a committed long-term approach.

Greg Fell

Greg Fell is a Director of Public Health in Sheffield. He graduated from Nottingham University with a degree in biochemistry and physiology in 1993. He has worked as a social researcher in a maternity unit; a number of roles in health promotion and public health before joining the public health training scheme. Greg worked as a consultant in public health in Bradford in the PCT then Bradford council. Since Feb 2016 he has worked for Sheffield as director of public health.

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5 comments

  1. Peter J Gordon says:

    What an important, thoughtful and considered piece this is Greg. I agree with all you say.

    You may be interested in my response to the “Edinburgh Consensus”:

    http://www.bmj.com/content/359/bmj.j5524/rr

    aye Peter
    Scotland

    aye Dr Peter J Gordon

  2. david demko says:

    Excellent, and much needed, perspective on human aging. Congratulations, and good luck on your efforts to right our course toward a productive, age-integrated society.
    David Demko, PhD, Clinical Gerontologist, Editor
    AgeVenture News Service

  3. Honey Smith says:

    This article completely hits the nail on the head. Well said. I will share it with my groups of 4th year medical students

  4. Ian Spero says:

    Interesting, well articulated article Greg. Your observations resonate with our work at http://www.agileageing.org.Please feel free to join our alliance, you would be most welcome.

  5. Brian Finney says:

    The alternative is laissez faire – there is ample information available for people to improve their health, should they feel able.

    In a lot of cases work/life gets in the way eg long sedentary commutes to work, both parents working reducing free time for exercise, relaxation and a good diet, which is even more applicable to a single parent – these will all influence future health in a manner that is difficult, if not impossible to modify.

    We are living longer as you state, whether that is sustainable from a financial viewpoint is another matter, with its increased health and social care costs that will rise with length of life.

    Occupational Pension schemes are in a lot of cases failing to meet expected pay outs, in part due to increased longevity. In the UK we have one of the lowest state pensions in the modern world.

    There is no point in living longer if that means a lower quality of life due to health and financial constraints – hence the attraction of the laissez faire approa