As part of the compromise agenda, the UK government has set itself an ambitious target of adding an extra five healthy years to the average UK life expectancy by 2035. In this blog, Dr Emily Murray from the Department of Epidemiology and Public Health at University College London highlights lessons from the project “Health in Older People in Settings” (HOPE), chaired. HOPE uses data from the ONS Longitudinal Study to show the link between levels of employment and health in a setting.
We know location matters when working to extend healthy life expectancy (HLE) – there are huge disparities in the health of older people, depending on where they live. The government is aware of this and has set a target of narrowing the gap between those living in ‘healthier’ and ‘unhealthier’ local authority areas by 2030.
There are also strong links between the health of the population in a locality and levels of employment. So if we want people to be able to stay healthy and work longer, narrowing those gaps can make a real difference.
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If the UK had achieved the current Settlement Agenda’s target of reducing the HLE gap by five years between 2001 and 2011, the participation of older people in the labor market would have increased by 3.7% between 2001 and 2011. People are in paid employment. The HOPE project used the Disability Free Life Expectancy (DFLE) g as a proxy for HLE, as HLE data for local authorities were not available in 2001.
While overall disability-free life expectancy (DFLE) has improved in the UK from 1991 to 2011, there is still a significant gap between local authority areas considered ‘healthiest’ and ‘unhealthiest’. In 2011, the DFLE at age 50 varied from 13.8 to 25.0 years–this is an 11.3-year gap between the healthiest and unhealthiest regions, which widened over the study period.
Unfortunately, more than a decade later, the conversation hasn’t moved on much further. Health Equity in England: The Marmot Review After 10 years, a 2020 follow-up to Sir Michael Marmot’s landmark study found that the health gap between affluent and disadvantaged areas continued to grow.
The HOPE project built on this research using census data for England and Wales to show the link between levels of employment and health in a place.
- The higher the proportion of elderly people suffering from ill health in a place, the less likely it is that any adults in that place will work for gain. For example:
- Older workers from unhealthy areas were 60 percent more likely to be unemployed than those living in the “healthiest” areas.
- Women ages 50 to 74 in the “healthiest” areas are 5.6 percent more likely to work for gain than those in the “unhealthiest” areas.
- Men ages 50 to 74 who lived in the “healthiest” areas were 7.1 percent more likely to be gainfully employed than those living in the “unhealthiest” areas.
- How we measure health is important: Links between place health and employment are stronger for self-rated health measures, than for life expectancy figures or mortality indicators.
- Historically disadvantaged areas still suffer: Areas where people left paid work at a younger age due to poor health in 1991 were much more likely to experience this trend in 2011 as well.
- This disproportionately affects people in manual occupations: They are more likely to suffer from ill health, and can expect four fewer years of healthy life after the age of 50, than those in managerial or professional roles.
- There is a relationship between health somewhere and young people in gainful employment: For example, the probability of a woman between the ages of 16 and 49 not being in paid employment was 33.7 percent in the “unhealthiest” areas compared to 26.3 percent in the “healthiest” areas.
- Those in professional occupations were more likely to be in work 10 years later than those in primary occupations or doing repetitive manual labor: This gap in employment outcomes was more pronounced for people living in “unhealthy” areas.
The repercussions of the COVID-19 pandemic and the current cost of living crisis are likely to widen existing inequalities. So it’s unclear how the government intends to achieve its ambitious goals to increase healthy life expectancy and narrow the gap between those in “healthier” and “unhealthier” areas, especially given its recent decision to abandon the promised white paper on health disparities.
We recommend that the government He should:
• Increase spending on preventive health programs to at least 6 percent of the national health budget. This is in line with Canada, which is currently investing more in prevention across the G20 and continues to raise this proportion according to the rise in preventable diseases.
• Set aside part of the £4.8 billion settlement of infrastructure funding for projects that will create decent jobs for older workers in ‘unhealthy’ local authority areas, particularly in those with a high proportion of employment in manual labour.
• Collect, monitor and publish data each year on the health of a place, in particular self-classified health measures and labor market participation for people over 50 years of age.
• Ensure that there will be another census in 2031 and add detailed questions about health and labor market participation for people over 50.
• Improving access to medical services to allow elderly people in poor health to remain at work. This includes reducing waiting times to see a GP, referrals, treatments and accidents.
• Provide support, including vocational training and advice, to help older workers transition to less physically demanding roles, particularly manual roles.
Local authorities He should:
• Develop a five-year strategy to increase employment rates for people over 50 in “unhealthy” communities, in partnership with business. This strategy should recognize that older women often face additional barriers to work, aside from health barriers.
• Include local targets for improving population health in line with the national average for people between the ages of 50 and 74 as part of the annual planning exercise.
• Increase support for older manual workers to stay employed. For example, training and financial support, either through a benefit system or apprenticeship programs, can help older workers transition to less physically demanding jobs as they get older.
• Promote local adaptation of prevention programs to ensure that services fully meet the health requirements of the local population.
• Addressing ageism at the local level, by educating and informing people about how to obtain the best care to prevent or manage health conditions, regardless of age. The aim is to challenge the perception that long-term conditions are an inevitable consequence of aging when many of them are preventable. Local authorities must also work with companies to challenge employers’ perceptions that older people’s health is a barrier to their participation in the labor market.
Despite the often prevalent narrative that one’s health is an individual rather than a societal problem, the entire community is affected by poor health. It’s not just about helping people live longer, healthier lives but supporting local economies and economic growth.
The settlement agenda is more important now than ever, and it is vital that it not be sidelined.
The Health of Aging in Places (HOPE) project is an interdisciplinary research project funded by the Health Foundation under the Social and Economic Value of Health in Place (SEVHP) Program. The research team includes scientists from the Department of Epidemiology and Public Health at University College London (UCL) and the University of Leeds School of Geography. Full report, Health and Place: How Improving Health Can Keep Older Workers Employed, available here. The report was written and published by the UK’s International Center on Longevity.
The work was launched on 19 October 2022, at an event where keynote speakers included Lord James Bethel, Parliamentary Under-Secretary-General for Health and Social Care. Slides from the event are available here: https://ilcuk.org.uk/hope-project-report/
Dr. Murray discussed working further with Dr. Brian Beach on this Connecting Our Lives podcast.