A ripe old age should be for everyone



We have just published a summary report of our joint conference on healthy ageing with the Royal Society.

In February 2020, the Academy of Medical Sciences and the Royal Society hosted a two-day FORUM conference on healthy ageing. The event centred around the Healthy Ageing Grand Challenge proposed by the UK Government with a focus on addressing health inequality and improving health in older age.

A summary report of the conference has now been published examining current research into the biology of ageing, the identification, diagnosis and treatment of age-related disease and the effectiveness of non-medical interventions.

The blog post below, originally published on 27 March 2020, explores some of the themes covered in the ‘Inequalities and avoiding harm’ panel that took place at the conference.

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Between 1980 and 2011, your life expectancy was increasing by on average 6.5 hours per day[i]. But in the past decade this has reduced to an average of just 1 hour per day[ii], and life expectancy among the poorest people in the UK is actually decreasing.

Against this backdrop, the UK Government has pledged to increase healthy lifespan by 5 years by 2035 as part of the Ageing Society Grand Challenge. At the Healthy Ageing Conference, George MacGinnis, Ageing Society Challenge Director at UK Research & Innovation, described this plan as an ambitious but necessary “moonshot”; at current rates, it will take over 75 years to reach this goal. It was clear from discussions that tackling inequalities is key to achieving the Government’s target. Here are the five key points raised by our panel:

  1. Target the Big Four: Smoking, Alcohol, Diet and Exercise

The most significant risk factors affecting healthy ageing are the Big Four – that is smoking, excess alcohol consumption, poor diet and physical inactivity. These are more prevalent in people with low socioeconomic status, who are typically more exposed to unhealthy ‘choices’ and may not have the resources to make healthy lifestyle changes. These factors contribute to dramatic health inequalities – for example, 65 year-old women can expect to reach their 89th birthday if they live in Camden, London but only their 83rd birthday if they happen to live in Manchester.

Interventions that address the Big Four can both prevent and improve long-term conditions. “Unlike traditional drugs, targeting the Big Four through societal action improves all aspects of a person’s health instead of only one condition”, remarked Professor Carol Brayne CBE FMedSci. “Most drugs treat conditions separately meaning that the 16-58% of older people in the UK who suffer from multiple diseases struggle with the side effects of ever-increasing numbers of pills. Tackling the Big 4 [through making all our environments healthier] is as close to a ‘silver bullet’ as we are going to get.”

  1. “Knowing and doing are quite different things”

We all know that smoking and alcohol are bad for you and a healthy diet with plenty of exercise are good for you. So why do so many of us still have unhealthy lifestyles?

Well, as Ruthe Isden, Head of Health Influencing at Age UK, pointed out, “knowing and doing are quite different things.” Education is not enough to make us change our behaviours.

“To achieve lifestyle change, you need to change people’s environment, normalise healthy behaviours and give them the support and brain space they need to put health at the top of their agenda.” To address the Big Four, healthy behaviours need to be the path of least resistance.

“If a person is struggling with fundamental problems like debt or insecure housing, frankly worrying about whether or not they are getting their five-a-day is going to be low on the list. People only have so much ‘bandwidth’.”

  1. Different sectors need to work together tackle healthy ageing

Designing and shaping healthy environments – that address the Big Four by making healthier behaviours the default option – requires an integrated approach across the whole public sector, not just health and public health.

“A similar cross-sectoral approach is required to tackle climate change,” commented Professor Dame Theresa Marteau DBE FMedSci, “In fact, many of the interventions required to build health-enhancing environments, such as improving the nation’s diet and reducing air pollution, will also help to meet the UK target to bring all greenhouse gas emissions to net zero by 2050.”

  1. Healthy ageing cannot survive cuts to local government

Professor Andrew Steptoe, from University College London, pointed out that “budget cuts make it difficult for departments to think outside their own siloes”.

Cuts to local government and the subsequent erosion of community and education services have been eroding pillars of support, damaging public health and wellbeing, and increasing inequalities, as shown by the recent review, Health Equity in England: The Marmot Review 10 Years On.

  1. Everything comes home to roost late in life.

Racist, sexist and homophobic discrimination, along with factors such as abuse, homelessness and addiction all have effects that are felt throughout a person’s life. The impact of generational and historical suffering on health as we age is only just starting to be understood and more research is important to ensure that these populations are not left behind in the healthy ageing revolution.

In the current conversation around healthy ageing, no matter how old the speaker, the ageing population is usually discussed as the ‘other’, ‘them’. But there is no ‘them’ and ‘us’. We are all ageing together. We all own this agenda. We need to set up our society to be kind and healthy for older people at all levels of society. Because one day, if we are lucky, that older person will be us.

This blog was written by Anna Hands, a Wellcome Trust-funded PhD student who worked in the Academy policy team as part of a 3-month internship in early 2020.

References:

[i] For UK adults. Based on the rate of increase shown in Figure 2 of https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-uk

[ii] Between 2012 and 2018 for UK adults., based on the rate of increase shown in Figure 2 of https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-uk

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Read the full conference report here from the Academy of Medical Sciences and the Royal Society. The report covers the biological mechanisms, disease pathologies and the socio-economic, ethnicity and geographic inequalities associated with healthy life expectancy, and the challenges faced in adopting a national approach to healthy ageing. 

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