The Marmot Review, longevity and a call to action

Sir John Bell argues that “longevity is the single most important issue of society in the next 30 years” [1]. I agree with him – in the context of the climate change crisis and the Community Paradigm. I also agree that “good health does not mean treating illnesses, it means avoiding them” [2].

Last week, I had the privilege of joining colleagues from across Parliament, health, care, business and academia for the national launch of The Health of the Nation: A Strategy for Healthier Longer Lives. At Future Care Capital, we are proud to have been a key partner of the All-Party Parliamentary Group (APPG) for Longevity over the last year, providing insight into the development of this strategy. The focus of this work is a new call to action to realise the Government’s ambition “for everyone to have five extra years of healthy, independent life by 2035 and to narrow the gap between the richest and poorest” [3]. Tackling these health inequalities is at the heart of the opportunity to drive healthier ageing across our country, so how do we deal with the factors that underpin these issues in practical terms?

Well, it was back in 2008, that Professor Sir Michael Marmot was asked by the then Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. That strategy covered the wider social determinants of health, conditions in which people are born, grow, live, work and age which can lead to health inequalities. It drew further attention to the evidence that most people in England aren’t living as long as the best off in society and spend longer in ill-health. Premature illness and death affects everyone below the top. The report proposed a new way to reduce health inequalities in England post-2010. It argued that, traditionally, government policies have focused resources only on some segments of society. To improve health for all of us and to reduce unfair and unjust inequalities in health, action is needed across the social gradient.

So, what has happened since 2010 and where do we go from here? Well, later this month, on the 10-year anniversary of his initial Review, a new report: ‘Health Equity in England: The Marmot Review 10 Years on’ will be published. This will report on progress and re-state what needs to be done. But recently, it was discovered, for example, that “women on average get their first significant long-term illness when they are 55 years old and so will live with ill-health for nearly 50% longer than we thought” [4]. Worse still, in the poorest places “women get their first significant long-term illness when they are only 47 years old!” [5]. Are we therefore going backwards on addressing health inequalities?

The fact is that our society is built around a fast-paced lifestyle which runs the risk of leaving some people behind. Loneliness and social isolation are also major issues in many urban and rural communities as our increasingly connected world becomes more remote to some. Although we are fortunate to live in a successful country with a strong economy, not everyone benefits from everything modern Britain has to offer.

There remains a gap between wealthy and deprived parts of the country. Our ageing population could also potentially compound this divide. If we want to close the gap and deliver opportunity for all, the government, businesses, and communities will need to respond. ‘Health of the Nation – A Strategy for Healthier Longer Lives’ is a positive and clear call to action in this respect, and the challenge that the demographic shift presents should not be viewed negatively – we should be optimistic about the future.

So how does this read across to Marmot? I am sure that ‘Marmot 10-years on’ will re-iterate how important it continues to be to close the health inequalities gap, whilst supporting and encouraging all people to take more responsibility for their own health and well-being as and where they can. Equally, key strategic decisions will need to be taken in the 2020s about the direction we want to go in as a country to support the needs of our ageing population now, for example – and to embrace the opportunity of having so many more older people in our society.

In their wonderful book The 100-year Life Lynda Gratton and Andrew Scott provide a fascinating and thought-provoking analysis of living and working in an age of longevity. A society that is committed to supporting healthy ageing – in terms of living and working – should be our ambition, ensuring that no matter what a person’s circumstances are, they can be assured of the dignity and security they deserve in later life.

To do this means that we, as individuals, also need to understand the opportunities of the 100-year life and to embrace these. In parallel, government, business and society must embrace innovation and the need for further development of new assistive technology which aims to support older people to remain independent for longer. This decade could witness the birth of a new consensus about what it means to be healthy in later life. Society must grasp the opportunity to build communities where no generation is excluded from the opportunities that tomorrow will bring.