The prime minister has put forward his bold proposal for a universal, NHS-style social care service. In doing so, Andy Burnham has put the spotlight back on one of the major challenges facing almost everywhere in the world: how to manage the demographic changes linked to an ageing society.
It’s an important discussion. But what if government didn’t just look at how to care for people in their later years and instead spent real political capital on policies to help people live longer independently, and in good health? The data isn’t pretty on this. While the trend over the past half-century in almost all countries has been for people to live longer, healthy life expectancy has been consistently falling.
The latest figures from the Office for National Statistics show that in 2022-24, healthy life expectancy at birth was just 60.7 years for men (77% of life) and 60.9 years for women (73%) across the UK, despite life expectancy being 79.1 years for men and 83.0 years for women. In Scotland it is even worse: for 2022-24, healthy life expectancy at birth was 59.1 for men and 59.4 for women, numbers that continue to decline.
The data points to a major problem in ageing societies: that a growing number of the years we have gained in life expectancy are being spent with reduced independence, limited health conditions or in disability. This has huge ramifications for social care. Without anything changing in these trends, more older people in poor health means more people dependent on their loved ones, the private sector and the state for care – and a higher burden on an already struggling NHS.
As a public health expert, my question is: how much of this shift is preventable? We know there is enormous variation in how people age. Some of it is down to luck, but it is also about staying active and socially connected to a community, and about larger social policies. For me, a key UK government planning objective, across all sectors, should be to increase the number of healthy years of life.
Healthy ageing is largely about what happens in our 40s, 50s and 60s. It’s about effective prevention and early management of conditions such as type 2 diabetes, hypertension, heart disease and cancer. It’s about our diet, as well as the regular movement of the muscles we need to stay functionally independent each day – to be able to take stairs, go out to the shops, use the toilet or take a shower. It is inextricably linked to the quality of the environments in which people live, such as whether they have access to green space, social connection, public transport, housing and employment. We know the factors that lead to living longer, healthier lives: I’ve written an entire book about the evidence base on population-level health.
There are countries that have already recognised this demographic shift and made healthy ageing a priority. In Japan, the healthy life expectancy extension plan aims to increase years lived well by more than three years by 2040, to at least 75 for men and women. This goal is linked to wider reforms to employment, healthcare and social welfare. Japan has also pioneered community-based integrated care to facilitate older people staying in their own homes and communities for as long as possible.
Singapore has had initiatives for “successful ageing” since 2015, involving initiatives across health, social welfare, employment and infrastructure. Building on that, in 2023 the government launched further measures targeting health, housing and transport policy, with the explicit aim of helping older people remain active, socially connected and supported in their communities. Singapore and Japan now lead the global rankings for total life expectancy and for healthy life expectancy.
Burnham has much to learn from their planning in this area. Any debate on the future funding and organisation of social care needs to consider not only the financial challenges of providing the best care for an ageing population, but also how we collectively reduce the number of people who reach a point of dependency that could be avoided in the first place.
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The success of an ageing society should be measured not only on how it collectively shoulders the burden of dependency, but also on how well it extends the years in which people can live independently and well. If Burnham is serious about the social care agenda, that is the long-term question we should be asking now: not simply how we will care for people when they become dependent, but how we will create the conditions that allow more people to remain healthy for longer.
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Prof Devi Sridhar is chair of global public health at the University of Edinburgh, and the author of How Not to Die (Too Soon)
