Murray, Emily; (2022) Health and place: How levelling up health can keep older workers working. International Longevity Centre UK (ILC-UK): London, UK.

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Abstract

The Government’s ‘Levelling Up’ agenda comes after decades of health inequalities. The effects of the COVID-19 pandemic and the long-term impacts of the UK’s ongoing cost of living crisis have both increased these inequities. 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. 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 has continued to grow. 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 HOPE project has built on this research by showing the link between levels of employment and health in a place. It finds that: 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 are 60% more likely to be out of work than those who live in the healthiest areas: Women aged 50-74 living in the ‘healthiest’ areas of England and Wales were 5.6% more likely to be in paid work than those living in the ‘unhealthiest’ areas. Men aged 50-74 living in the ‘healthiest’ areas of England and Wales were 7.1% 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% in the ‘unhealthiest’ areas compared with 26.3% 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 levelling up agenda is more important now than ever, and it’s vital it is not sidelined by the Government. It’s not just about helping people live longer, healthier lives but supporting local economies and economic growth. 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. As part of its levelling up agenda, the UK Government set itself an ambitious target to add five additional healthy years to the average UK lifespan by 2035. It has also set a target of narrowing the gap in Healthy Life Expectancy (HLE)8 between the ‘healthiest’ and ‘unhealthiest’ local authority areas by 2030. It’s unclear how the Government intends to achieve these two goals, especially given the recent decision to abandon the promised white paper on health disparities. In addition, the fallout from the COVID-19 pandemic and the current cost of living crisis are likely to widen existing inequalities. 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% between 2001 and 2011. This is equivalent to 250,000 additional older people in paid employment. The HOPE project used Disability-Free Life Expectancy (DFLE) as a proxy for HLE, as HLE data for local authorities is not available in 2001.

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