Healthy ageing: how health inequality can be tackled at the local level

Image: Peter Kindersley via Centre for Ageing Better

Older people make up a significant portion of our population, and projections show the proportion of people over the age of 60 within the global population is set to rise even further over the coming years. ONS data shows by 2066 there will be a further 8.6 million projected UK residents aged 65 years and over, taking the total number in this group to 20.4 million and making up 26% of the total population.

Supporting people to age well, and age healthily is something which both local and national policymakers will have to take account of in order to not only ensure good quality of life for their ageing populations but also ensure that services are not overwhelmed.

Studies show the higher levels of deprivation people face in their earlier years, the more likely they are to enter older age in poor health and die younger compared with people who experience lower levels of deprivation. This highlights the need to tackle inequality across the life course, with the preventative action having a positive knock on impact on health inequalities in later life.

Some of the main drivers of inequalities include: social exclusion and isolation; access to and awareness of health and other community services; financial difficulties including fuel poverty and housing issues; insecure or low paid employment, with reduced opportunity to save or enrol in a formal pension to prepare for retirement; a lack of transport and distance from services; low levels of physical activity; and mobility or existing poor health, often characterised by long term chronic health issues.

These inequalities often combine and overlap to create even more challenging situations as people move into older life. More recent research has shown that the Covid-19 pandemic has only exacerbated these inequalities further.

Tackling inequalities at the local level

Alongside the national discussions around ageing, local demographic change has received comparatively less attention, despite place-based policies and concepts like “ageing well in place” being used in public health conversations for a number of years.

Research from the Resolution Foundation explores the intersection between demography and place, and its implications for politics and policy while further research is looking increasingly at local level case studies to highlight pockets of best practice which could help to inform the national approach.

A review from Public Health England looked at the specific experiences of older people in coastal and rural areas and the specific challenges they face in comparison to people living urban areas, exploring local level interventions and interventions which adopt a place- based approach, responding to the specific needs of people living in the area.

Other research in this area stresses that councils have a clear leadership role in supporting an ageing society and that they are uniquely placed to create strategies which reflect the needs of their populations. Through local engagement of older people systematically and regularly, and through co-production and co-design in the production of local policies and services, councils are in a position to underpin a more positive outlook on ageing, ensuring that older people are regarded as full citizens, rather than objects of charity or pity.

Approaches to poverty reduction in Greater Manchester

In Greater Manchester, healthy ageing and age inequalities have been made mayoral priorities and the Greater Manchester Combined Authority set up the Greater Manchester Ageing Hub to respond to what policymakers there see as the opportunities and challenges of an ageing population.

In 2018 the city published an “Age Friendly Strategy” to promote increased social inclusion within the city by trying to tackle the barriers to inclusion created by poverty and inequality, including creating age friendly places which allow older people to participate within their local communities, and promoting healthy ageing through strategies like GM Active Ageing, a partnership with Sport England.

Image: Peter Kindersley via Centre for Ageing Better

Creating a consensus on healthy ageing

The Centre for Ageing Better and Public Health England established 5 principles for healthy ageing which they are urging government and other policy actors to adopt to support future healthy ageing the five principles are:

  1. Prevention
  2. Opportunities
  3. Good homes and neighbourhoods
  4. Narrowing inequalities
  5. Tackling ageism

These principles can be used as building blocks to help organisations create strategies and policies which accurately reflect the core needs of people as they age. One thing which continues to be a challenge, however, is integrating intersectionality into both research and strategies or frameworks on ageing.

Not treating “older people” as one homogenous group, but taking account of the individual experiences of specific groups and how this may impact on their experience of inequalities: this is something researchers are making efforts to resolve in their work, and while there are limited studies which look specifically at BAME or LGBT groups, in the future taking account of intersectionality in ageing and inequalities will become more commonplace.

The future of ageing

We are living longer than ever before. Taking steps to reduce inequalities and support healthy ageing will ensure that those extra years are fulfilling, both for the individual and for society.

Helping people to continue to contribute to society, to really live into old age, embrace and enjoy it and not just exist in old age should be a priority for everyone, Reducing inequalities to support people to age well will be a major contributor to ensuring this happens.


If you enjoyed this article you might like to read:

A home for life? Developing lifetime neighbourhoods to support ageing well in place

“Same storm, different boats”: addressing covid-19 inequalities and the ‘long term challenge’

Inclusive streets: from low expectations to big dreams

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Five blog posts that told the story of 2019

As the old year makes way for the new, it’s time to reflect on some of the topics we’ve been covering on The Knowledge Exchange blog over the past twelve months. We’ve published over 70 blog posts in 2019, covering everything from smart canals and perinatal mental health to digital prescribing and citizens’ assemblies. We can’t revisit them all, but here’s a quick look back at some of the stories that shaped our year.

Nick Youngson CC BY-SA 3.0 Alpha Stock Images

Tomorrow’s world today

Artificial Intelligence was once confined to the realms of science fiction and Hollywood movies, but it’s already beginning to have a very real impact on our personal and working lives. In February, we looked at the pioneering local authorities that are dipping a toe into the world of AI:

“In Hackney, the local council has been using AI to identify families that might benefit from additional support. The ‘Early Help Predictive System’ analyses data related to (among others) debt, domestic violence, anti-social behaviour, and school attendance, to build a profile of need for families. By taking this approach, the council believes they can intervene early and prevent the need for high cost support services.”

However, the post went on to highlight concerns about the future impact of AI on employment:

“PwC’s 2018 UK Economic Outlook suggests that 18% of public administration jobs could be lost over the next two decades. Although it’s likely many jobs will be automated, no one really knows how the job market will respond to greater AI, and whether the creation of new jobs will outnumber those lost.

Tackling violent crime

One of the most worrying trends in recent years has been the rise in violent crime. Figures released in January found overall violent crime in England and Wales had risen by 19% on the previous year.

As our blog reported in March, police forces around the country, along with health services, local government, education and the private sector have been paying close attention to the experience of Glasgow in tackling violent crime.

Glasgow’s Violence Reduction Unit (VRU) was launched in 2005, and from the start it set out to treat knife crime not just as a policing matter, but as a public health issue. In its first ten years, the VRU helped to halve the number of homicides in the city, with further progress in subsequent years.

In March, our blog explained that the VRU takes a holistic approach to its work:

“…staff from the VRU regularly go into schools and are in touch with youth organisations. They also provide key liaison individuals called “navigators” and provide additional training to people in the community, such as dentists, vets and hairdressers to help them spot and report signs of abuse or violence.”

 Protecting the blue planet

Environmental issues have always featured strongly in our blog, and in a year when people in larger numbers than ever have taken to the streets to demand greater action on climate change, we’ve reported on topics such as low emission zones, electric vehicles and deposit return schemes.

In August, we focused on the blue economy. The world’s oceans and seas are hugely important to the life of the planet, not least because they are home to an astonishing variety of biodiversity. In addition, they absorb large amounts of carbon dioxide emissions. But they are also a source of food, jobs and water – an estimated 3 billion people around the world rely on the seas and oceans for their livelihood.

Pollution is having a devastating impact on the world’s oceans, and, as our blog reported, governments are finally waking up to the need for action:

The first ever global conference on the sustainable blue economy was held last year. It concluded with hundreds of pledges to advance a sustainable blue economy, including 62 commitments related to: marine protection; plastics and waste management; maritime safety and security; fisheries development; financing; infrastructure; biodiversity and climate change; technical assistance and capacity building; private sector support; and partnerships. 

Sir Harry Burns
Image: Jason Kimmings

A sense of place

The ties that bind environmental factors, health and wellbeing are becoming increasingly clear. This was underlined at an international conference in June on the importance of place-based approaches to improving health and reducing inequalities.

One of the speakers was Sir Harry Burns, Director of Global Public Health at the University of Strathclyde. His research supports the idea that poverty is not the result of bad choices, but rather the absence of a sense of coherence and purpose that people need to make good choices:

“People who have a sense of purpose, control and self-esteem are more positive and secure about the places they live in, and a greater ability to make the right choices. Ask people to take control of their lives, build their trust, and people can make choices that support their health. We must create places that do that”.

Celebrating diversity

While it sometimes seems as if our society has made great strides in stamping out prejudice and supporting minority groups, at other times the stark reality of discrimination can shine a light on how far we still have to go.

In June, we marked Gypsy, Roma and Traveller (GRT) History Month with two blog posts that aimed to raise awareness of the many issues faced by GRT communities in the UK today:

“Research by Travellers Movement has found that four out of five (77%) of Gypsies, Roma and Travellers have experienced hate speech or a hate crime – ranging from regularly being subject to racist abuse in public to physical assaults. There is also evidence of discrimination against GRT individuals by the media, police, teachers, employers and other public services.”

But our blog also highlighted work being done to address these issues and to spread the word about GRT communities’ rich cultural heritage:

“Today, organisations and individuals such as The Traveller MovementFriends, Families and Travellers, and Scottish Traveller activist Davie Donaldson strive to promote awareness of and equality for the GRT community. The recent Tobar an Keir festival held by the Elphinstone Institute at Aberdeen University sought to illustrate traditional Traveller’s skills such as peg-making.”

 Back to the future

Since first launching in 2014, The Knowledge Exchange blog has published more than 700 posts, covering topics as varied as health and planning, education and digital, the arts, disabilities, work and transport.

The key issues of our times – climate change, Brexit and the economy haven’t been neglected by our blog, but we’ve looked at them in the context of specific topics such as air pollution, higher education and diversity and inclusion in the workplace.

As we head into a new year, the aims of The Knowledge Exchange blog remain: to raise awareness of issues, problems, solutions and research in public policy and practice.

We wish all our readers a very Happy Christmas, and a peaceful, prosperous and healthy 2020.