20 Jan 2020
Associate Director for Health, Alison Giles, argues that much more needs to be done to tackle the preventable causes of ill-health if we are all to live for longer.
Earlier this month, the media reported the astonishing news that a unique group of people is living to age 110 or more in perfectly good health. Scientists have discovered that this group has an immune system that protects them from the conditions that typically affect us as we age, including cancer and dementia. The hope is that this exciting discovery will lead to new breakthroughs in how we can extend human life expectancy for those of us not born with this super-functioning immunity.
Aside from their longevity, what is striking about these ‘supercentenarians’ is they spend almost 100% of their long lives in good health. Contrast this with the fact that too many people here in the UK are spending 25 years, or a third of their lives, living with chronic avoidable illness that medicine cannot cure.
We don’t need to wait for scientific breakthroughs to prevent chronic illness and improve healthy life expectancy. We have a wealth of evidence about how our environment and the way we live, work and play influence the way we age and our likelihood of developing health conditions. For example, we know that an environment that promotes the overconsumption of food and limits our physical activity has led to the unprecedented levels of musculoskeletal problems, obesity and Type-2 diabetes that are occurring in ever younger cohorts.
The public awareness campaigns delivered by Public Health England and a host of health charities are intended to give us the information we need to adopt healthy habits. In addition to campaigns, we now have a mandatory food labelling system that gives us clear information about the levels of fat, salt and sugar in the foods we buy. And increasingly, restaurants are providing calorie information on their menus and offering healthy options.
However, information is not enough.
Research has shown that the onset of avoidable health conditions in younger age groups is mediated through long-term exposure to stress from childhood onwards.
Psychologists have long known that we prefer to take our benefits now rather than have them at some future date and that conversely, we like to defer costs to the future rather than incur them now. In health terms, this translates to us choosing cake today over the prospect of good health tomorrow. Information alone is not always enough to counter this strong innate preference. It tends to be differentially acted upon by people with more agency and has little or no impact on those with the lowest healthy life expectancy.
The recent Prevention Green Paper signalled a move towards more intelligent public health services that will stratify the population to identify those most at risk of ill-health and provide focused, personalised support to help them act on information and take the steps necessary to protect and prolong their health.
More fundamentally we also need population-level actions to reduce our reliance on conscious choice. Two successful examples of this approach are the mandatory traffic-light food labelling system and the soft drinks industry levy, both of which have encouraged food manufacturers to reformulate their products and make them healthier. Other examples that are supported by evidence are making stairs more prominent than lifts in buildings and reducing the density of fast-food outlets in high streets, both of which influence our behaviour on a subconscious level.
However, there is another cause of the disparity in healthy life expectancy that runs far deeper than the environment in which we live out our adult lives. Research has shown that the onset of avoidable health conditions in younger age groups is mediated through long-term exposure to stress from childhood onwards. Children growing up amidst unstable or violent relationships, in unsafe neighbourhoods, in poor housing, or in families experiencing financial insecurity or debt are more likely to adopt unhealthy behaviours and to experience ill-health at an earlier age.
To increase healthy life expectancy for the most disadvantaged, we need to see a comprehensive package of policies and interventions that recognise that health starts in our homes and communities and is the responsibility of society, not just individuals. Our aim at the Centre for Ageing Better is for people to have five more years free of preventable disability, and to reduce health inequality, by supporting healthy lives at all ages.
We may not all be supercentenarians. But we are set to live much longer than our parents’ or grandparents’ generations, and there is much more to be done to ensure that we can enjoy more of those extra years in good health.