This blog follows the Institute and Faculty of Actuary’s ‘Future of health session’ at last year’s ILC’s Future of Ageing Conference – speakers included Stuart McDonald, Head of Longevity and Demographic Insights, Lane Clark & Peacock (LCP); George MacGinnis, Healthy Ageing Challenge Director, UK Research and Innovation (UKRI); Nicola Oliver, Medical Intelligence; and Professor Les Mayhew, Head of Global Research, ILC, and Professor of Statistics at Bayes Business School.
The UK is one of the most unequal countries in the world, a reality matched only by the US. Last year, the Financial Times described the UK and the US as ‘poor societies with some very rich people’. In the UK, while the top earners rank fifth in terms of global living standards, the average household ranks 12th and the poorest 5% rank 15th. With such significant levels of inequality, averages become a challenge for actuaries, statisticians and policymakers. As Stuart McDonald said at the ILC’s Future of Ageing Conference: “These inequalities of income and wealth translate directly to inequalities of life and health”. Those living in the most deprived areas have a substantially higher rate of death from avoidable causes than those living in the least deprived areas.
In the 25 years since the ILC-UK was founded, inequalities have widened. In 2002 the gap in life expectancy for women between the first and 99th percentile was 10.5 years; by 2019 this had increased to 14 years. For men, the gap in life expectancy over the same period had increased from 11.5 to 13.5 years. And the gaps in healthy life expectancy are even greater; 2018-2020 ONS figures showed the gap at birth between the richest and poorest people in the UK was 18.6 years for men and 19.3 for women.
George MacGinnis said UKRI’s Healthy Ageing Challenge had set out to reframe the solutions, from calling for more public funding to creating opportunities for innovative ‘unicorn’ businesses. However, to address inequalities, for example in the provision of post-diagnostic support for dementia, it was more often the grassroots changes to services that make a real difference in people’s lives. The Health Ageing Challenge programme sought to encourage both public and private investment in impact.
Covid sped up innovation but set back health and widened the gap between rich and poor. Taking action is more urgent than ever. George MacGinnis commented that while the Ageing Society Grand Challenge had sat alongside the challenges of net zero and the Fourth Industrial Revolution as the main societal issues of our time, it had since been ‘downgraded’ to one of 12 missions for England.
In February 2020, the All-Party Parliamentary Group for Longevity’s Health of the Nation Strategy set out key recommendations to meet the government’s target of five more years of healthy life expectancy by 2035, while minimising health inequalities. George MacGinnis said this report highlighted one way forward and emphasised the importance of more cross-cutting government policy and action – and making the most of the opportunities afforded by innovation.
Nicola Oliver said that while the UK had been successful in reducing harms such as smoking and alcohol, the approach to public health should be across the life course and holistic. Public health needs to start before birth. She referred to Geoffrey Rose’s 1985 article Sick individuals and sick populations, which argued that we should have a population-wide approach to prevention and public health rather than simply targeting high-risk groups. Just a small improvement at the population level could significantly reduce risk. For example, Sure Start had a direct impact on childhood obesity, with an even greater impact in areas where families were more disadvantaged. Encouraging good habits from an early age would reduce the rates of heart disease and other major conditions in later life.
Only 4% of the UK’s health budget is spent on public health programmes. The ILC’s global research shows that countries, like Canada, that spend at least 6% of their health budgets on preventative health measures reap the benefits. Determinants of health may be biological, behavioural, sociocultural, economic and ecological, so the prevention of poor physical and mental health must be holistic and include social capital, housing and access to green spaces.
Professor Les Mayhew shared the findings of ILC research into the cost of health inequality. Economically, living longer lives in good health means that the time spent in ill health goes down, as does the consumption of health and social care services. Correspondingly, more time spent in good health means more time is spent in productive activities. The research found that for every year spent in good health, time working increased by around four months. Professor Mayhew remarked that this equated to an additional £12 billion for the UK economy for every extra year the population lived in good health. A five-year increase in healthy life expectancy would boost UK output by £60 billion a year. On an individual level, each year of healthy life translates into an increased life span of 4.5 months, and a five-year increase in healthy life means a boost of two years.
ONS data shows that, currently, the proportion of smokers in the UK stands at 13.3% (equating to 6.6 million people). The data also shows that smoking is more prevalent in deprived areas. While the numbers of smokers has almost halved since the indoor smoking ban in July 2007, smoking-related diseases still kill between 90,000 and 100,000 people a year. Furthermore, according to ILC’s research, someone who has never smoked has six extra healthy years of life than a smoker.
Smoking is extremely damaging for the economy; if current or ex-smokers had never smoked, and remained in good health, overall earnings could be 1.9% higher, boosting the UK economy by £19.1 billion every year. However, analysis by the Health Foundation shows a significant reduction in real-terms spending on public health between 2015/16 and 2022/23. The largest cut in public health grant spending was for smoking cessation services and tobacco control, which fell by 41% in real terms.
In 2022 New Zealand made it illegal for anyone born on or after 1 January 2009 from ever being able to purchase cigarettes legally; the law also makes it illegal for older people to give them tobacco products – the intention being for the country to be ‘smoke free’ by 2025. In a recent New Statesman article, Les Mayhew pointed out that even if smoking was banned in the UK tomorrow, the full societal health benefits wouldn’t be seen for 40 years. However, this doesn’t mean we should stop investing in services to encourage and achieve smoking cessation. But it does mean we need to address the interconnected risk factors associated with smoking, such as mental illness, drug abuse, obesity, poor housing and deprivation.
A holistic approach is needed to achieve shorter-term improvements in healthy life expectancy.
The Covid-19 pandemic has worsened health inequalities. And these inequalities have been further exacerbated by the cost-of-living and NHS staffing crises. There are now over 7 million people waiting for non-urgent treatments in England alone. Without significant government intervention and investment, there was understandable cynicism among the speakers that we would be able to meet the grand challenge of five extra healthy years for all by 2035.
However, while good habits don’t necessarily offset bad habits, they do accrue over a lifetime – and any progress would be welcome. Although small changes are often easier for higher-income groups, small habitual steps supported by policy, such as walking rather than driving, could make a big difference. As Les Mayhew concluded: “We need a new rubric that has prevention at its core and risk management as its guiding light – this should be underpinned by analysis and not a shopping list of concerns.”
The ILC is planning its next Future of Ageing Conference, which will take place at the Welcome Collection in London on 7 December 2023 – save the date.
You can watch the debate from 2022's ILC's Future of Ageing Conference through YouTube.
