Why the UK Needs a Social Policy on Ageing
This article just published in JSP is a direct challenge to official and mainstream social policy orthodoxy on the issue of ageing which focuses on old age, not ageing, and assumes that later life is a natural period of decline. It also provides an antidote for the poisonous tendency of politicians, seen most glaringly in the recent General Election, to regard rising social care costs as the inevitable result of population ageing. Rather than asking if the projected demand for social care is inevitable and, if not, what can be done about it, the common response across the political spectrum is to concentrate only on supply side funding.
Using a range of biological and social science evidence, produced particularly by the ESRC-led New Dynamics of Ageing Research Programme, it is argued that, while ageing is inevitable, it is also malleable. That is, the precise course that ageing takes, and its individual impact, is subject to various influences. Among these genetics play a minor role, around one-fifth of the association with disability and cause of death, while the other ‘environmental’ factors play the predominant role. What are these environmental factors? First there are the structural determinants of how we age, or if we age, including socio-economic status, food consumption, air quality and employment. Deprivation and low socio-economic status, food poverty, excess sugar consumption, poor air quality and stressful work (including domestic labour) are known risk factors for the main chronic conditions associated with ageing, coronary heart disease (CHD), stroke and diabetes, which either result in premature death or disabilities requiring treatment and long-term care. For example high blood pressure is a main risk factor for cardiovascular diseases, especially stroke and CHD. Air pollution is one of the biggest environmental threats to health, resulting in 40,000-50,000 premature deaths annually in the UK and an unknown number of chronic disabilities.
The second set of behavourial risk factors, including tobacco use, poor diets, lack of physical exercise and excess alcohol consumption are similarly associated with the main causes of functional limitation in later life. Variable exposure to these risk factors helps to explain the large inequalities in life expectancy and heathy life expectancy, and the vastly different old age outcomes, where two people of the same age may have hugely contrasting capabilities and attendant life qualities.
Once the causes of ageing are understood, and the evidence is now overwhelming, the next step should be revelatory but seems to be studiously avoided by policy-makers and academics alike. Since age is malleable, as well as personal actions to modify the assumed path of later life, social policies also have a big role to play in trying to reduce the prevalence and severity of chronic conditions. These policy measures could include actions to radically reduce tobacco, alcohol, salt, saturated fat and sugar consumption. They could also include a national programme of physical exercise, because there is very strong evidence of its benefits with regard to preventing chronic conditions.
As well as these sorts of low cost measures the article argues for a longer-term strategic approach, called ‘active ageing’. Although this term may be familiar to some in the social policy community the version proposed is primarily focused on the life course, with the explicit intention to prevent the widely accepted ‘natural’ course of later life. Illustrations of what this would entail at different stages of the life course are provided in the article.
Finally the question of why the sort of approach suggested has not been picked-up by policy-makers is tackled in the article. At first glance this lacuna is baffling, but, when the various formidable barriers to change are considered – factors such as vested interests in later life disabilities, ageism, short-term political horizons – it is not so surprising. In particular the article spotlights the barrier created by the UK’s extreme neo-liberal political economy, which scorns collective action. Yet this is exactly what is required urgently if the forecast social, economic, personal and family costs of old age are to be mitigated.