Healthy Ageing: A public health perspective

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This blog was written by Baroness Sally Greengross as forward to the report ‘Healthy Ageing: A public health perspective. A collection of short essays from leading experts’ which can be accessed here.

Across most of the developed world, society is experiencing unprecedented demographic change characterised by increasing longevity, a growing older population and falling birth rates. These demographic changes are leading to a lower old age dependency ratio (the ratio of working age to nonworking age people), which presents challenges for the social solidarity and long-term sustainability of health, social care and pensions systems.
Arguably the biggest uncertainty facing governments in the context of demographic change is the extent to which spending on health will increase. Spending on health care is likely to see the largest rise of all elements of age-related spending, rising from an annual cost of 6.8% to 9.1% of GDP between 2016/17 and 2061/62 (equivalent to a rise of around £36bn in today’s money)¹. The figures could be even higher if tomorrow’s older population are less healthy than today’s but could fall with further investment in the prevention of disease.

The potential economic costs associated with ill health highlight the importance of preventing disease in the first place. But the focus of our concerns should not be the economic costs of poor health but tackling health inequalities. The average life expectancy of men and women living in poor neighbourhoods in England is seven years lower than those living in the wealthiest areas. Health inequality measured by years of disability-free life is even more unacceptable, with differences of up to 17 years². These trends can be explained by two main factors: poor lifestyle choices and damaging environments.
We have a huge amount of evidence that for example, keeping active and eating and drinking well play a huge part in helping us live to a healthy old age. Yet too many of us are failing to live as well as we could.

The contributions in this report highlight and promote a range of views as to how to ensure a healthy old age. Collectively they contribute to growing awareness of the importance for all of us to take individual action.

But they also highlight a need for policymakers to act. To encourage people to look after themselves we can either force, “nudge” or educate individuals to make the right choices. The smoking ban in public places has had an impact on changing the social norm of smoking and had a positive health impact. Yet the Westminster Government now seems reluctant to regulate or ban, as the recent debate on minimum pricing for alcohol has highlighted. Education is important but are we investing enough in it and do we know what sort of education works? And whilst Government is interested in “nudging” behaviour, changing social norms require significant investment in time and resources. Government must use the mix of nudge, compulsion and education and should focus energies on better understanding what works.

Robert Butler, founder of the ILC Global Alliance introduced the term ‘productive aging’ in 1983, arguing that “Many people express concern about the costs and dependency of old age… I wanted to stress the mobilization of the productive potential of the elders of society”. Productive ageing does not sit separately from healthy ageing. If we want to live and retire well we must do more to deliver healthy ageing across the lifecourse.


1. Fiscal sustainability Report. Office for Budget Responsibility. July 2012
2. Marmot M. Fair Society, Healthy Lives. The Marmot Review. Strategic Review of Health Inequalities – England Post 2010

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