Examination of Witnesses (Question Numbers
150-159)
MR RAPHAEL
WITTENBERG AND
PROFESSOR CAROL
JAGGER
5 NOVEMBER 2009
Q150 Chairman: Good morning. May I welcome
you to what is our second evidence session on our inquiry into
social care? For the record, may I ask you to give us your name
and the current position you hold?
Professor Jagger:
Carol Jagger. I am Professor of Epidemiology at the University
of Leicester.
Mr Wittenberg: I am Raphael Wittenberg.
I should explain I have two posts: I am a Senior Research Fellow
at the Personal Social Services Research Unit at the London School
of Economics and Political Science; I am also an economic adviser
at the Department of Health.
Dr Stoate: You have been referred to
as a boffin already today.
Q151 Chairman: We had a discussion
about what boffins are but it was nothing personal. May I first
of all ask a question of both of you? Last week David Behan from
the Department of Health told us that in 1948 life expectancy
for men at birth was 66. He then said "so you retired at
65 and then lived for a year" and that was it, whereas today
it is 77. Life expectancy at age 65 in 1948 was for a further
12.8 years, so in actual fact, if you got to 65, you were likely
to live until you were 77.8 years old. Are we being misled into
thinking that changing life expectancy is having a much more dramatic
effect than it really is?
Professor Jagger: No, we are not.
In fact you were misled in the interpretation of the period life
expectancy and what it is. It is an estimate of the average number
of years that a man of that age would survive to, if he experienced
the mortality rates at that time in 1948 throughout the rest of
his life. It does not take account of the fact that mortality
rates may improve and a cohort life expectancy does that; the
cohort life expectancy therefore is a more appropriate measure
of how long we would expect to live but in fact the trends are
much the same and the period life expectancy is less subjective.
You are quite right that the life expectancy at age 65 is a much
more appropriate figure but the trends there have been increasing
as well and by 2017 the life expectancy at age 65 will be 20 years
for men and 22 years for women. From that point on it will be
over 20 years.
Q152 Chairman: Raphael, do you agree
with that analysis.
Mr Wittenberg: Yes, I agree that
looking at it from age 65 it is clearly the life expectancy from
65 that is relevant.
Q153 Chairman: Clearly core to social
care is this issue of the ageing population. How much is the ageing
of the population actually down to the bulge of people born in
the post-war baby boom getting old rather than people living longer?
There are quite a lot of us. Is this showing up statistically?
Professor Jagger: It is both.
The post World War I baby boomers are now 85 and over. The post
World War II baby boom was in fact bigger and they are coming
now to be in the 65 age group and life expectancy has increased
so that the cohorts in between there are living longer. There
might be fewer of them but they are living longer. I do not think
we can say it is something which is going to go away.
Q154 Chairman: And it is not just
because there are more of them.
Professor Jagger: No, because
the probability of survival to old age has risen as well quite
considerably.
Q155 Dr Stoate: We know that people
are likely to live longer and we know that life expectancy at
certain ages is extending, which is obviously good news. What
we do not know is the level of dependency that is likely to lead
to. Just because someone gets older does not necessarily make
them more dependent. What do we know about levels of dependency
and projections on levels of dependency in the coming years?
Professor Jagger: Not as much
as we would like. In this country we do not have any really good
cohort data like some other countries such as Denmark and Sweden
have. We are in the process of getting that; there is a study
in the field at the moment which will address that much better
than we have done before. However, there does not seem to be any
indication that the years of disability are reducing very much.
Q156 Dr Stoate: You do not subscribe
then to the "compression of morbidity" theory?
Professor Jagger: No, I do not
for this country. The data we have is rather mixed. Do you want
me to say something about what I mean by "compression of
morbidity"?
Q157 Dr Stoate: Yes; for the record.
Professor Jagger: "Compression
of morbidity" is really looking at the relationship between
life expectancy and healthy life expectancy and how one is changing
with respect to the other. As an example, male life expectancy
in 2001 at age 65 was 16.1 years and disability-free life expectancy
was 8.9 years, life expectancy with disability was 7.2 years.
By 2005 life expectancy had risen by one year (to 17.1 years),
disability-free life expectancy had risen by 1.3 years (to 10.2
years). So the years with disability had reduced by 0.3 years
and that is a compression of disability. The same was not true
for women. For women the years with disability had increased,
despite the fact that life expectancy had increased and disability-free
life expectancy had increased because disability-free life expectancy
had not increased as fast as life expectancy.
Q158 Dr Stoate: Do we not know why
it does not apply to women but it does apply to men?
Professor Jagger: No. Women have
more disabling diseases and so in most studies in most countries
women have a higher prevalence of disability than men.
Q159 Dr Stoate: Do you know much
about the relationship between future levels of dependency and
key health conditions such as coronary vascular disease, stroke
and cancer? Do you know anything at all about how those are going
to play out?
Professor Jagger: Coronary heart
disease rates and the mortality from coronary heart disease are
reducing. The incidence is reducing somewhat as well. The mortality
from stroke, which is another disabling disease, has reduced considerably
since the 1950s. There is some evidence for coronary heart disease
that the rates in some younger age groups are levelling off but
all that means is that we are keeping more people alive who have
the disease as opposed to actually stopping people having the
disease to begin with. More people are living with disease now.
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