What colour would you use to describe the great advances in population health of the last hundred years? Perhaps something bright and cheery? A nice vibrant yellow, or perhaps a warm orange? As appropriate as these might seem I would argue the colour grey possesses a strong case. My reasoning? The massive increase in life expectancy we have witnessed and so the associated increase in grey heads to be seen amongst our populations.
In the 1900s life expectancy in England and Wales was 46 for men and 50 for women. A century later these had increased to 77 and 81 respectively. Spectacular improvements by any standard. Not all countries have shared the benefits equally, progress is not even across countries or socio-economic groups. It is worth reminding ourselves that Africa saw a fall in life expectancy during the 1990’s due to the AIDS epidemic, which was only reversed when effective responses (political, social and medical) were deployed. Eastern Europe also suffered a drop-in life expectancy in the period of turmoil following the end of the Soviet era. These both serve as reminders that there is nothing inevitable about progress and improvement.
But we should celebrate this global achievement even while we consider the fresh challenges an ageing population poses. Last years City Health conference in Basel included several sessions that looked at meeting the needs of older people, helping promote physical activity, considering their needs in urban planning and public transport. These presentations were delivered by a wide range of speakers drawn from the fields of research, policy makers and service delivery. One of the insights I gained from these sessions was that issues which could be viewed as a problem can also be a valuable resource and that actions which benefit one specific group will often help others, the link between the young and the old in terms of transport was particularly striking. Action to support one specific group can help improve an entire municipality. The issue of age was something I was dwelling on during a visit to Glasgow last week. One of my reasons to be in that wonderful city was to learn more about Drink Wise Age Well. This is a fascinating project, working across England, Wales, Scotland and Northern Ireland to support people make healthier choices around their drinking as they age.
There is great work going on to support service providers, communities and individuals with a clear intention to share the learning. Hopefully this process will help prompt policy makers and service commissioners to realise that we need to improve alcohol (and drug) services for older people. In London funding pressures have seen us lose some excellent services aimed at this group at the same time as demand increases. There are of course many challenges in supporting our ageing populations, but this area is one that requires some swift action. Dealing with individuals with significant cognitive impairment, substance use problems and other health issues pose real challenges for our health systems, requiring new thinking and realigning services. If we don’t manage to improve care for all our older citizens then the great gains in life expectancy, arguably the crowning glory of the last century, will be tarnished. Our cities with their existing services and concentrations of older populations need to be at the forefront of these developments.