A guest blog from Professor Alan Walker, Professor of Social Policy & Social Gerontology at The University of Sheffield, on how the creation of a social policy for ageing could lead to a better later life for all.
If we are concerned about the quality of later life we must focus on the ageing process as a whole, the life course, and not only the last segment of it. This is because the financial, social and mental resources that people possess in old age are often determined at much earlier stages of the life course. This is obvious in the case of pensions, which depend massively on occupation, but is also true with regard to physical and mental health. For example, childhood deprivation is associated with raised blood pressure in later life.
There is mounting scientific evidence of links such as this across the life course. Two recent major research initiatives provide a wealth of evidence: the New Dynamics of Ageing Research Programme and the European project MOPACT. On this basis we can say with confidence that, while ageing is inevitable, it is also variable and malleable. The precise course of ageing over a person’s life varies according to the interaction between our biology and a range of environmental factors. In this process genes play a minor role, around one-fifth of the association with chronic conditions and death, while the latter non-genetic factors play the major one.
What are these ‘environmental’ influences? First there are political-economic determinants of how we age, or if we reach old age, including factors such as social class, occupation, income, food consumption and air quality. Deprivation and low socio-economic status, food poverty, excess sugar, poor air quality and stressful work are all known risk factors for the main chronic conditions associated with ageing and which blight the lives of millions of older people: coronary heart disease, stroke and diabetes. Air pollution is a huge environmental threat to health, resulting in 40-50,000 premature deaths annually in the UK and an unknown number of chronic disabilities. Poor housing leads to a range of health conditions such as cardiovascular disease, asthma and mental ill health.
Second, at the individual level, smoking, poor diets, lack of physical exercise and excess alcohol are all associated with the main causes of functional limitations in later life and therefore reduced quality of life – adult obesity and smoking are the two biggest global drivers of chronic conditions and premature death. Inactivity results in a loss of fitness (strength, stamina, suppleness and skill). Variable exposure to these potentially avoidable risk factors helps to explain this country’s large inequalities in life expectancy and healthy life expectancy, and the vastly different expressions of old age, where two people of the same age may have sharply contrasting capabilities, and resulting life qualities. For example wealthy people living in affluent neighbourhoods have half the amount of frailty of poor people in deprived areas.
Once our focus shifts to ageing and its causes are understood, the next step should be very simple, but it has seemingly escaped policy makers and others who could help to transform the experience of later life. Since ageing is malleable and the main causes of chronic ill-health in old age are, to a large extent, preventable, a combination of individual and policy actions are urgently needed. These measures should include radical reductions in tobacco, alcohol, salt, saturated fat and sugar consumption. There should also be a national programme of physical exercise because of its proven benefits in the prevention of chronic physical and mental conditions. Ideally such a programme would be organised on intergenerational lines.
A social policy for ageing would face formidable barriers, such as the vested interests in later life chronic conditions, ageism and the short-term nature of political horizons, but a better old age for all depends on it.
A more detailed case for a social policy on ageing can be found in this article in the Journal of Social Policy.