Health in an ageing society

According to the UK International Longevity Centre, between 2000 and 2050, the number of people in the UK aged over 65 is expected to double, and the number of people aged over 85 is expected to quadruple. However, in the same time period, the number of 20 to 64 year-olds will increase by just a fifth.

There is no doubt that this change in population make-up poses a challenge for society. However, it also presents an opportunity. Last week, Prof. Sir Chris Whitty, England’s Chief Medical Officer presented his annual report on ‘health in an ageing society’ to local government leaders. He explained why maximising the health and life chances of older adults should be seen as a national priority and highlighted the role of local authorities in improving quality of life for older people.

However, before we consider how we, as Directors of Public Health (DsPH), can help ensure that older people are living as healthy a life as possible, I’d like to discuss what we mean by ageing. Many people associate ageing with old age, grey hairs and frailty. However, ageing is actually happening to us all, all of the time and starts before we are even born. Indeed, what happens in the earlier stages of life has been proven many times to fundamentally affect life course trajectory.

So, just as it will be too late if we wait until retirement to sort out our pension, we should be building the foundation for a good quality of life in old age right from the very beginning of our lives. Thinking about ageing in this context of what happens in childhood and early adulthood to influence our long-term health is especially important with an ageing society – without creating the right environment for us all to live healthier lives for longer, we will find ourselves with not only an ageing population, but with an increasingly sick one.

As well as being important for our physical and mental wellbeing, keeping people well for longer is an important economic issue – the number of people out of employment as a result of ill-health is rising which has an impact not just on an individual’s finances, but of the country’s too due to lost productivity and demand on health and social care services.

Older people’s contribution to society should not be underestimated. As well as being increasingly relied on to top up the workforce, retirees are an invaluable asset to the community and voluntary sector as well as to their own families, both as much-loved companions and in providing childcare. Healthy, active older people also contribute to the UK and global economy through travel and spending.

Disability and ill-health in older age is not inevitable. However, the fact is that as we get older, we are more likely to experience loneliness and ill-health. The older we are, the more likely too we are to be living with multiple conditions which can interact, compounding their negative effects.

When – and if – this happens to us is dependent on a myriad of factors. How high is our cholesterol? Do we smoke? How much alcohol do we drink? Where do we live? Who do we live with? What do we do for a living? It is a stark fact that people living in more affluent areas are, on average, healthier for much longer. In Sheffield, for example, where I am DPH, there is approximately a 20-year difference between the number of years lived in ill-health for elderly people living in the most affluent, compared to the most deprived areas of the city.

How then we maximise the period of healthy living is crucial to improving older people’s lives so that it can be a time of freedom and happiness for as many as possible. We are after all, all going to die, but we can make sure that until that time, our quality of life is as good as it possibly can be. Most importantly though, that needs to be the case for anyone, regardless of how much money they have or where they live.

The reasons why we have such stark health inequalities are not clear cut. We know people’s health outcomes aren’t down to individual choices – social and commercial influences are continually shaping our decisions and outcomes, and those of the next generation.

We have seen how effective Government legislation can be at preventing some of the biggest causes of ill-health. For example, countless lives have been made healthier, and indeed saved, thanks to prohibiting smoking in public places (a statistic that will rise even more if the current proposals to raise the age of sale come to fruition). This type of legislation, that targets the availability of harmful products, helps to extend the length of time we can be healthy, promoting quality – and length – of life. Much much more can – and should – be done in this space and our Manifesto for a Healthier Nation makes some clear recommendations for the next Government to address some of these fundamental determinants of our health.

Meanwhile, as the CMO said, there is lots that can be done through partnership working at a local level. DsPH, are ideally placed to link the right people and departments together with the right local organisations and support a wide range of initiatives that protect and promote public health.

For example, we work with planning departments, architects and builders to develop housing that will keep us warm when it is cold, and cool when it gets hot – something that will be increasingly important in years to come, particularly for more vulnerable older people. We also work across organisational boundaries to improve access to green spaces for all and advocate for active transport opportunities – enabling both young and old to stay connected to their communities and remain physically active, an important factor in staying strong in older age.

We work with families, health visitors, early years providers, school nurses, and colleges to improve conditions for our children and young people – they need to be well fed, protected from harm and given the right tools to become resilient, healthy, happy and productive citizens in order for them to grow up to be live longer, healthier lives.

We also work closely with the community and our colleagues in the NHS to promote prevention. For example, workforces need to be trained to intervene early where people need support so that mental health issues don’t deteriorate further and to facilitate good working environments that will give people secure, flexible work.

What we need to do is extend this effective, local, cross-sector, societal approach nationally so that everyone is working together to prevent people, right from the very start of life to the very end and at every stage in between, from becoming ill from avoidable physical and mental ill-health.

Initiatives, screening and treatment specifically designed for older people are of course needed to support those experiencing difficulty now, but the next Government should also take a longer-term view and consider the consequences for health in every decision they make to promote a healthier society as a whole.

Unfortunately, over the last decade, cuts to local authority funding have resulted in many services being reduced, or in some cases stopped altogether, including those provided by the voluntary sector. Sustainable funding at a local level is therefore needed to enable the relevant organisations and people to be able to implement those health-centred policies.

It won’t be easy, but it is possible. In fact, it’s essential to be able to confidently sustain our ageing population.