The Prime Minister has introduced an ambitious initiative aimed at establishing a universal social care system reminiscent of the NHS. Andy Burnham’s proposal brings renewed attention to a significant global issue: the challenges associated with an ageing population and the demographic shifts it entails.
This topic is crucial, but rather than focusing solely on caring for the elderly, what if the government invested political resources into developing policies that promote longer, healthier, and more independent lives? The statistics paint a grim picture. Despite an overall increase in life expectancy over the past fifty years in most countries, healthy life expectancy has been on a consistent decline.
Recent data from the Office for National Statistics indicates that from 2022 to 2024, healthy life expectancy at birth in the UK was only 60.7 years for men (representing 77% of their total lifespan) and 60.9 years for women (73%). In contrast, the overall life expectancy was 79.1 years for men and 83.0 years for women. The situation in Scotland is even more concerning, with healthy life expectancy figures of 59.1 years for men and 59.4 years for women during the same period, both of which are continuing to decline.
This data underscores a significant issue in societies with ageing populations: a considerable portion of the additional years gained in life expectancy are being spent in poor health, reduced independence, or disability. This trend poses serious challenges for social care systems. If these patterns persist, the rise in older individuals facing health issues will increase reliance on family members, the private sector, and public services for care, thereby exacerbating the strain on an already overburdened NHS.
As an expert in public health, I question the extent to which this shift can be mitigated. It’s clear that there is considerable variability in how individuals age. While some of this can be attributed to chance, factors such as remaining active, maintaining social connections, and broader societal policies play a significant role. A primary goal for the UK government across all sectors should be to enhance the number of years individuals enjoy good health.
Healthy ageing is primarily influenced by factors during our 40s, 50s, and 60s, focusing on effective prevention and early intervention for conditions like type 2 diabetes, hypertension, heart disease, and cancer. It also encompasses dietary habits and regular physical activity essential for maintaining daily functional independence—such as climbing stairs, shopping, and personal hygiene. Additionally, the quality of living environments, including access to green spaces, social networks, public transport, housing, and job opportunities, is intertwined with healthy living. The evidence supporting factors that contribute to longer, healthier lives is extensive, as I have detailed in my published work on population health.
Some countries have already acknowledged this demographic shift and prioritized healthy ageing. Japan’s healthy life expectancy extension plan aims to increase the number of years lived in good health by over three years by 2040, targeting at least 75 years for both men and women. This objective is aligned with broader reforms in employment, healthcare, and social welfare. Japan has also developed community-based integrated care systems to help older adults remain in their homes and communities longer.
Since 2015, Singapore has implemented programs aimed at “successful ageing,” encompassing health, social welfare, employment, and infrastructure initiatives. In 2023, the government expanded these efforts by introducing additional policies focused on health, housing, and transportation, explicitly designed to support older individuals in remaining active, socially engaged, and connected within their communities. Both Singapore and Japan currently lead the world in terms of overall life expectancy and healthy life expectancy.
Burnham has valuable lessons to learn from these countries regarding planning for an ageing society. Any discussion around the future financing and organization of social care must not only address the financial challenges posed by an ageing population but also focus on strategies to reduce unnecessary dependency among individuals.
The effectiveness of an ageing society should be assessed not only on its ability to manage the burden of dependency but also on how successfully it can prolong the years individuals can live independently and healthily. If Burnham is genuine about pursuing social care reform, we must shift our focus to the long-term objective: how can we create conditions that enable more people to maintain their health for longer, rather than merely preparing for the care of those who become dependent?
Professor Devi Sridhar holds the chair in global public health at the University of Edinburgh and is the author of “How Not to Die (Too Soon).”
