The importance of healthy ageing
Life expectancy may have increased, but years spent living in good health have not1. More time in poor health as people age places huge demands on health and social care2. That’s why it’s so important to help people age healthily, including recognising the impact of early life experiences on long term health3.
Improving health in older age also has significant financial benefits. It can reduce the current high level of demand on the NHS and social care. Keeping older people in good health could also reduce the likelihood of their early withdrawal from employment, thereby increasing their income, their pension, and government tax revenues1,4.
Inequalities in healthy ageing
People with high socio-economic status usually live longer than people with low socio-economic status. Higher status is often determined by income, wealth, education, and occupation5. For example, a man in the affluent area of Kensington and Chelsea will live, on average, 11 years longer than a man in less affluent Glasgow. Health inequalities can also be seen with regard to differences in gender and ethnicity6.
Socio-economic status can impact housing quality, social connectivity, environment, health behaviour and financial stability, potentially affecting the health of individuals across their lives7. These inequalities extend into older age too. In England today, a person born into a disadvantaged household may only spend 53 years in good health, free from a disability, compared to 70 years for individuals from advantaged households8.
Social determinants of healthy ageing
Diet and physical activity:
Lower socioeconomic status can result in poorer physical and mental health10. Social determinants may act early in life - causing deprived households to make unhealthy decisions due to the inability to afford healthy food or have good access to physical exercise. Behaviours formed in childhood can then continue into adulthood, increasing the likelihood of poor health outcomes such as CVD, diabetes, and cancer.
Unhealthy eating habits can arise in older age too, due to loneliness, depression or cognitive or physical disabilities that inhibit the ability to buy and prepare food. Older individuals may also lack the financial means to pay for healthy or nutritious foods4 – leading to an increased risk of chronic diseases or even undernutrition and consequent loss of bone density and increased likelihood of bone fractures4.
Insufficient physical exercise can continue into older age, especially in deprived areas with higher crime rates. This can deter older people from even leaving their homes, depriving them of the health benefits of exercise1.
Lower income households are more likely to live in areas with poor access to services and public transport, again preventing older people from leaving their homes as frequently, and accessing services, increasing their risk of isolation and depression1. The elderly without relatives nearby can be particularly isolated, especially if language is a barrier to finding support services1. Depression, loneliness, and isolation can all contribute to declines in cognitive functioning3.
Low-income households are often able to afford only poor quality housing which can have negative effects on health, with poorly heated and ventilated homes increasing the risk of poor recovery from infectious diseases such as influenza and COVID-19, which can be fatal to older people1.
Most people in need of social care support would prefer to live at home rather than in a care home10. Receiving care in your own home is also considered more effective for maintaining quality of life11. However, low-income and low-educated individuals are more likely to live in nursing homes12.
Residents in care homes in the most deprived areas are more likely to lack the support they need for their care needs, because poorer councils have suffered the most from cuts13. This can result in a lower quality of life.
Care homes are also vulnerable to transmissible infections, due to elderly people living in proximity in shared spaces and to staff acting as spreaders between the care homes they work in. This is the case where many staff are on part time or zero-hour contracts and need to work at multiple care homes to earn a decent salary14. The COVID-19 pandemic saw extremely high rates of infection and death in care homes. 30-60% of overall COVID-related deaths in Europe in spring 2020 took place in care homes12.
The government’s 2021 Spending Review has failed to provide sufficient means for the social care sector to meet the growing demand for adult social care, not providing the additional £7.6bn required in 2022/202318.
Pensions are crucial for financial security in old age. Without financial security, people are less likely to afford healthy food, suitable housing or activities that improve their physical and mental wellbeing9.
Inequalities exist in both access to and the amount of state pension and occupational pension received. State pensions require national insurance contributions during people’s working lives. Such contributions cannot be made by people outside the formal labour market. Additionally, individuals in low paying jobs will have lower pension contributions compared to individuals in higher paying jobs. Also, occupational pension schemes, with employer contributions, are not available to the self-employed. Many people in the gig economy, such as Uber drivers, until very recently were considered self-employed and did not receive employer pension contributions15.
People’s ability to extend their working lives varies according to socioeconomic status. People from poorer backgrounds or those in receipt of state benefits are likely to find it more difficult to work beyond traditional retirement age in England due to their increased risk of underlying health issues.
There are also intersectional inequalities. Women are more likely than men to take time off work to care for their children or elderly parents. These breaks in employment or working part-time reduce their pension contributions and thus financial security later in life16. Ethnic minority groups are also more likely to receive lower pensions. In part as a result of racial discrimination, they are more likely to be in lower paid occupations and are more likely to be in employment that doesn’t offer occupational pensions17. Women from BME backgrounds are therefore particularly likely to face financial insecurity in later life because of this.
Recommendations to reduce inequalities in healthy ageing:
To reduce health inequalities as people age:
- Policies and interventions need to address social determinants of health in early life, as well as across the life course7 – including provision for more good quality affordable housing, a levelling up of educational provision and good quality employment that pays a genuine living wage and provides an occupational pension.
- The Sure Start programmes launched in the late 1990’s provide a useful model for early life intervention19.
- Research should be commissioned by the government into how to ensure pensions provide financial security in old age, not least for the low paid, the self-employed, women and ethnic minority groups – including the respective roles of employers, employees and the State.
- The UK Government must ensure sufficient investment in social care to ensure staff are paid, trained and treated well, to provide the best care to the elderly and avoid transmitting infections between care homes through unnecessary, low wage-induced mixing.
Sigrun Clark, December 2021.