People in England can now expect to live much longer than was common even in the recent past. This is something to celebrate – changes in healthcare, diet, housing, even the kinds of work we do have all contributed to increasing life expectancy. Many of us can look forward to a retirement involving expanded horizons, travel, the pursuit of new interests, engaging with our communities, enjoying spending time with our friends and families.
But this vision of an active old age relies on remaining in good enough health to be able to participate. Researchers working with data collected by the English Longitudinal Study of Ageing (ELSA) are now trying to understand not just how much longer we can expect to live, but how much of that time will be spent in favourable health.
ELSA has been running since 2002, and follows around 10,000 people aged fifty and over. Face to face interviews every two years and a nurse visit to collect bio-medical measurements such as weight, blood pressure, blood sugar and cholesterol levels every four years provide a unique insight into trends in the experiences of ageing in England. At the recent launch of ELSA’s Wave 7 report, which contains up-to-date analysis of trends in the health, income, employment and wellbeing of older people in England, our collaborators at UCL revealed that there are big differences in the number of years of healthy life that certain groups of people can expect to have.
It’s well-known that women, on average, live longer than men, and the analysis of ELSA data identified that this trend continues with healthy life expectancy – women in England can expect on average to live in good health for three years longer than men. The biggest differences the researchers at UCL found, however, were not gender-based, but divided along socio-economic lines. They found that people with higher levels of education live longer and have more years in good health. Furthermore, of people who are currently aged fifty, those in the lowest-ranked occupational social classes have 25% less healthy life expectancy than those in the highest ranked – an average of another 18 years of healthy life for those in the lowest ranked third of occupational social classes compared to an average 25 years for those in the highest. People in the top third for wealth, meanwhile, can expect to live in good health on average twelve years longer than those in the poorest third.
Graph: Illness free life expectancy (in years) by wealth
It isn’t just in the length of time that people will remain healthy that we see these differences – the proportion of their remaining lives that people will spend free from illness or disability also differs along socio-economic lines. Those currently aged 50 in the wealthiest third of the population can expect to spend more than 76% of their remaining years free from illness, over 80% in good health, and 90% free from disability, while those in the poorest third can expect to spend just over 58% of their remaining years free from illness, just over 60% in good health, and 85% free from disability. These differences are seen most clearly before the age of 70, with socio-economic factors tending to make less difference as people reach the oldest ages.
As the UK’s state pension age rises, for many of us the prospect of retiring at 60 or 65 (as has been the norm in recent decades) is increasingly unrealistic. But continuing to work in later life relies on being healthy enough to carry out that work. The evidence from ELSA suggests that those who have the lowest levels of wealth at the age of fifty – so are most likely to need to keep working as they get older - are also the people likely to have the smallest proportion of their old age spent in good health. The socio-economic inequalities that people experience during their working lives, then, could be further exacerbated by poorer health meaning that they are less able to work in later life. This could see the gap between the richest and poorest widen still further as we age.
Reducing these inequalities in older age relies on making changes earlier in people’s lives. Lifestyle factors such as smoking, obesity and physical inactivity can make a difference to people’s individual health, but they are also part of a larger picture of socio-economic influences. Ultimately, reducing health and socio-economic inequalities in older age relies on reducing inequalities throughout the course of our lives, starting before we’ve even become adults.
You can download an overview of the key topics from the Wave 7 report 'What does ELSA tell us about growing older?'
The full report for Wave 7, 'The dynamics of ageing: Evidence from the English Longitudinal Study of Ageing 2002-15' is available from the ELSA website.