Summary
While life expectancy in the UK has continued to increase year on year, healthy life expectancy—the time an individual can expect to live in good health—has not kept pace. People are living longer, but many of those extra years are spent in poor health.
Older people are increasingly likely to have more than one health condition, known as multimorbidity. The health and care system is not designed to cope with treating people with multiple conditions, meaning that patients often have to see multiple doctors and are prescribed multiple drugs. This fragmentation of care contributes in many cases to even poorer health in older age.
In 2017 the Government identified “Ageing Society” as one of the Industrial Strategy’s four Grand Challenges, with a mission to “ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest.” We are not on track to meet this target. For men, we heard that it will take 75 years to achieve the target at current rates of improvement, not the 15 years that remain. For women, healthy life expectancy at birth has decreased in the past decade, further widening the gap between healthy life expectancy and life expectancy, and making the Government’s target even harder to achieve.
The second part of the mission is also not on track to be met. Inequalities in healthy life expectancy remain stark: people in the most deprived groups on average spend almost 20 years longer in poor health than those in the least deprived groups. There are also shockingly large differences in healthy life expectancy amongst ethnic groups.
There is no time to waste if the Government wishes to achieve the Grand Challenge mission. In this report we identify approaches from science and technology that could help to increase healthy life expectancy, and assess the role of public health interventions and national regulations in helping people to age more healthily.
Understanding of the biology of ageing is advancing rapidly and holds significant promise for improving health in older age. Exciting new and repurposed drugs to target biological processes that affect the development of multiple age-related diseases are beginning to be trialled in humans. The hope is that these treatments will help people to live more healthily in old age. The Government should prioritise funding such research, to give the highest possible chance that treatments will contribute to improving healthy life expectancy by 2035. Even if such drugs are not ready by then, they will likely be an important long-term tool for improving health in older age.
There is a strong understanding of the lifestyle and environmental factors throughout life that correlate with good health in older age, including diet and physical activity. The challenge is to ensure this understanding is used effectively in interventions by public health authorities and backed up by national regulations. Further research is needed to understand how best to motivate and facilitate a change to a healthier lifestyle across the life-course. The priority for public health interventions should be those people living in deprivation and suffering the worst health.
There are numerous technologies and related services to help people live more independently and healthily in older age. The Government needs to ensure that these are deployed more widely and effectively. It should continue to invest in the development of new technologies—including robotics, artificial intelligence and data-driven technologies—that can improve health and wellbeing in older age. However, it should ensure that these technologies and services are widely accessible and do not act to increase health inequalities. As part of this, it will need to ensure all older people are equipped with digital skills and infrastructure—including high-speed internet access—to be able to benefit from these technologies.
We heard enthusiasm for the ambition of the Ageing Society Grand Challenge mission, but scepticism that it could be achieved by 2035 with the Government’s current approach. This is why the Government should urgently devise a strategy for achieving the mission by 2035, including a roadmap for the steps it will take along the way and delivery mechanisms that coordinate activity and funding across relevant organisations. Given the lack of progress towards reducing health inequalities, the strategy should explicitly address this issue and the steps the Government will take to resolve it, including stating who is responsible. A combination of approaches from biomedical science, technology and services, local public health and government interventions will be required.
Improving healthy life expectancy is a vital and worthy ambition, but there has been a lack of leadership and planning for the Ageing Society Grand Challenge mission, resulting in minimal progress. The Government should act now to revitalise the mission and utilise opportunities in science, technology and public health to ensure it is achieved.