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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.