As part of its levelling up agenda, the UK Government has set itself an ambitious target to add five additional healthy years to the average UK lifespan by 2035. In this blog Dr Emily Murray from the Department of Epidemiology and Public Health at University College London highlights lessons from the Health in Older People in Places project (HOPE), which she leads. HOPE uses data from the ONS Longitudinal Study to showing the link between levels of employment and health in a place.
We know place matters when working to extend healthy life expectancy (HLE) – there are large inequalities in older people’s health, depending on where they live. The Government recognises this and has set target of narrowing the gap between those living in the ‘healthiest’ and ‘unhealthiest’ local authority areas by 2030.
There are strong links, too, between the health of the population in a local area and levels of employment. So if we want people to be able to stay healthy and to work for longer, narrowing these gaps can make a real difference.
Staying in work
If the UK had achieved the current levelling up agenda goal of reducing the HLE gap by five years between 2001 and 2011, older people’s participation in the labour market would have increased by 3.7 per cent between 2001 and 2011. That would have meant 250,000 additional older people in paid employment. The HOPE project used Disability-Free Life Expectancy (DFLE) g as a proxy for HLE, as HLE data for local authorities was not available in 2001.
While disability-free life expectancy (DFLE) improved overall in the UK from 1991 to 2011, there was still a significant gap between the local authority areas considered the ‘healthiest’ and the ‘unhealthiest’. In 2011, DFLE at age 50 varied from 13.8 to 25.0 years – that’s a gap of 11.3 years between the healthiest and unhealthiest areas, which widened during the study period.
Unfortunately, over a decade later, the conversation hasn’t moved on much further. Health Equity in England: The Marmot Review 10 Years On, the 2020 follow-up to Sir Michael Marmot’s landmark study, found that the health gap between wealthy and deprived areas had continued to grow.
The HOPE project has built on this research by 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 older people with poor health in a place, the less likely it is that any adults in that place will be in paid work. For example:
- Older workers from the unhealthiest areas were 60 per cent more likely to be out of work than those who live in the ‘healthiest’ areas
- Women aged 50-74 living in the ‘healthiest’ areas re 5.6 per cent more likely to be in paid work than those living in the ‘unhealthiest’ areas.
- Men aged 50-74 living in the ‘healthiest’ areas were 7.1 per cent more likely to be in paid work than those living in the ‘unhealthiest’.
- How we measure health in a place matters: links between health in a place and employment are stronger for self-rated health measures, compared with life expectancy figures or mortality indicators.
- Historically disadvantaged areas continue to struggle: 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’re much more likely to experience ill health, and they can expect four fewer years of healthy life beyond age 50, compared with workers in administrative or professional roles.
- There’s a correlation between health in a place and younger people being in paid employment: for example, the probability of a woman aged 16 to 49 not being in paid work was 33.7 per cent in the ‘unhealthiest’ areas compared with 26.3 per cent in the ‘healthiest’ areas.
- Those working in professional occupations were more likely to be in work 10 years later than those working in elementary occupations or doing repetitive manual labour: this gap in employment outcomes was most marked for people living in ‘unhealthy’ areas.
The fallout from 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 to narrow the gap between those in the ‘healthiest’ and ‘unhealthiest’ areas, especially given its recent decision to abandon the promised white paper on health disparities.
We recommend that The Government should:
• Increase spending on preventative health programmes to at least 6 per cent of the national health budget. This is in line with Canada, who currently invest the most in prevention across the G20 and continue to raise this proportion in accordance with the rise in preventable diseases.
• Earmark part of the £4.8 billion levelling up infrastructure fund for projects that will create jobs suitable for older workers in the ‘unhealthiest’ local authority areas, especially in those where a high proportion of employment is in manual work.
• Collect, monitor and publish data every year on health in a place, in particular self-rated health measures and labour market participation for people over the age of 50.
• Confirm that there will be another census in 2031 and add detailed questions about health and labour market participation for people aged over 50.
• Improve access to medical services to allow older people in poor health to remain in work. This includes reducing wait times to see a GP and for referrals, treatments and A&E.
• Provide support, including career training and advice, to help older workers transition to less physically demanding roles, especially those in manual roles.
Local authorities should:
• Develop a five-year strategy to increase employment rates for people aged over 50 in the ‘unhealthiest’ communities, in partnership with business. This strategy should recognise that older women often face additional barriers to employment apart from health barriers.
• Include local targets to improve population health in line with the national average for people aged 50 to 74 as part of their annual planning exercise.
• Increase support for older workers in manual occupations to stay in employment. For example, training and financial support, either through the benefits system or apprenticeship schemes, can help older workers transition to less physically demanding jobs as they age.
• Strengthen local tailoring of prevention programmes to ensure that services fully cater to local population health requirements.
• Address ageism at a local level, by educating and informing people on how to receive 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 old age when many are preventable. Local authorities should also work with businesses to challenge employer perceptions that older people’s health is a barrier to their participation in the labour market.
Although the prevalent narrative is often that individual health is an individual problem rather than a societal one, the whole 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 levelling up agenda is more important now than ever, and it’s vital it is not sidelined.
The Health of Older People in Places (HOPE) project is a multidisciplinary research project funded by the Health Foundation under the Social and Economic Value of Health in a Place (SEVHP) programme. The research team includes scientists from the Department of Epidemiology and Public Health at University College London (UCL) and the School of Geography at the University of Leeds. The full report, Health and place: How levelling up health can keep older workers working, is available here. The report was written and published by the International Longevity Centre, UK.
The work was launched on October 19, 2022, at an event whose keynote speakers included Lord James Bethell, Parliamentary Under Secretary of State at the Department of Health and Social Care. Slides from the event are available here: https://ilcuk.org.uk/hope-project-report/
Dr Murray discuss the work further along with Dr Brian Beach in this Linking our Lives podcast.