THE SMITH INSTITUTE
YOUR GOOD HEALTH

Improved morbidity, increased longevity and declining birth-rates are causing a period of mass aging in the UK. Life expectancy at birth is now 78, and rising, such that by 2025 the number of people aged 80 or over will be 3.5m, and the number over 50 is already some 19m. How will life change in these conditions? Are we ready for the economic, social and cultural effects of a much longer life than might have been envisaged a few years ago within an older population profile? Are we ready to cope with different pressures on the health services from mental health and chronic disease? And how will we turn the rhetoric of prevention into real change in the life style of the population?

We are planning a series of 4 seminars to be held in the autumn/winter of 2005 in 11 Downing Street (with the kind permission of the Chancellor of the Exchequer) on the general theme of how to cope with increased longevity, and the implications this has for health policy, and for all organisations involved in healthcare in the UK.

Seminar 1: CURRENT AND FUTURE TRENDS

The aging demographics of the UK could simply lead to increased pressure on Health services, and rising costs. In 1911, high fertility and high mortality combined to give a young population structure, tapering off rapidly in middle age. By 1951 the decline in mortality in younger age groups led to a growth in the total population and more and more people living into old age. The projection for 2031 shows what has been called mass ageing. But are we sure that the figures are robust? Some recent research shows big differences in overall population depending on assumptions being made about morbidity and fertility, with some interesting gender differences. We want to use this seminar to establish the best trends for the UK, and while recognising that demography is possibly the least uncertain factor in the mix, try to assess the impact of our changing populations on public policy.

Seminar 2: HEALTHY LIVING

Chronic diseases, particularly cardiovascular disease, type-2 diabetes, cancer and chronic respiratory disease, account from more than 50% of all deaths worldwide. Tobacco use, poor diet and physical inactivity are amongst the major risk factors, yet there is only limited public health, financial, and policy support for programmes aimed at their prevention. With 1 in 5 children in the world now smoking, and 1 in 10 classified as overweight or obese future prospects regarding CVD and type 2 diabetes are grim. There are also clear biological differences between men and women, not just related to sex-specific diseases such as prostate and cervical cancers. They relate to areas of the body where fat is deposited, with implications for the development of diabetes and heart disease and to susceptibility to autoimmune diseases such as MS. At the core, chronic disease prevention and health promotion require a shift in thinking and actions by government and diverse stakeholders. What is required is to help make the healthy choices become the easy choices. But in spite of numerous policy initiatives, policies in the UK have often been un-joined up, gender-blind and have not succeeded in rebalancing health policy away from the short-term imperatives of health care. At this seminar we want to focus on the question of how to promote gender-sensitive, joined-up policies that promote the long-term behavioural changes necessary to develop a preventative healthcare system.

Seminar 3: MENTAL HEALTH

Mental illness is one of the biggest causes of misery in our society and it also imposes heavy costs on the economy. According to the Psychiatric Morbidity Survey 16% of adults of working age have a mental illness, of whom up to a half are seriously ill. They are drawn from all ranks of society, and their condition profoundly affects at least as many relatives again. There are now more mentally ill people drawing incapacity benefits than there are unemployed people on Jobseeker’s Allowance. Until the 1950s there was little that could be done beyond improving the social environment. But today both drugs and modern psychological therapies can make a huge difference to the majority of patients. What needs to be done to improve the availability of psychological therapy? How and on what basis can we rapidly improve the provision of sufficient consultant-led specialist services? How can we ensure that public policy is changed so that the mental health services, together with JobcentrePlus, focus more effort on helping clients to return rapidly to work wherever possible, and to keep them in work? How do we reduce the stigma of mental health through education in schools and changes in employer attitudes?

Seminar 4: DELIVERING THE VISION

It is not only those who are already old, or who are going to reach the ‘third age’ over the next decade or so, who have a stake in the future of healthy ageing. Health and care services, government – local and national - voluntary and community sectors and businesses all have a role to play in moving towards a preventative healthcare system. The companies active in the pharmacology field already make a huge contribution to healthy aging, collaborating in the provision of research, the introduction of new medicines, and other contributions to the problem. But the relationship is often antagonistic, and many involved in the policy debates seek to keep the industry at arm’s length. Given the responsibility on individuals to do more to help themselves to live healthy lives, what is the responsibility of the healthcare industry in the future? How should it work with health service providers to ensure a healthier nation? What are the wider social and cultural issues?

Smith Institute April 2005