Adding life to years

Quality of life for older people should be central to the debate
about the so-called “demographic time-bomb”. Alan Walker introduces
a large-scale research programme.

Everybody knows that Britain is an ageing society. The
combination of declining birth rates and death rates mean that
there are fewer young people and more and more older ones. This is
unprecedented in human history and presents unique challenges to
all aspects of society, from the labour market to family life, from
the health and social services to political parties. The trebling
of the numbers of people aged 80 and over in the next 25 years is
an outstanding example of social and economic progress, but it
raises many profound questions about, for example, caring
relationships within families and the social contract between the
generations on which our pensions, health and social care systems
are based. Also, as the World Health Organisation puts it, years
have been added to life but will life be added to years? Can we
avoid the “empty prize” of longevity without quality of life?

Despite the importance of issues surrounding ageing there has
been too little serious public debate, and it is only very recently
that policy makers have begun to give them the attention they
deserve. Unfortunately, this vacuum has been filled by a demography
of despair which portrays population ageing not as a triumph of
civilisation but as something closer to an apocalypse.

Improving quality of life emerged at the top of the policy and
research agendas because of the cost of population ageing.
Demographic pressures alone are not the only reason that welfare
state spending on older people has grown. Only one third of this
post-war spending boom in all advanced industrial societies can be
attributed to demography. In fact, the vast bulk of the increase is
due to policy changes. Up until the late 1970s governments of both
major parties were willing to fund increases in pensions and health
services for older people in order to improve quality of life and
to try to overcome the poverty and deprivation that a large
proportion of older people were experiencing.

However, the relatively privileged position that older people
occupied in the eyes of policy makers in the previous post-war
decades was reversed substantially in the early 1980s. There were
big cuts in public pensions and social services accompanied by
negative political rhetoric about the “burden” of ageing and the
costs of pensions.

The party political consensus on ageing was broken, and the
rhetorical onslaught severely dented public confidence in the
future of public pensions. It is very difficult to overestimate the
importance of those policy changes in the 1980s. It is also
important to emphasise how far the UK was out of step with the rest
of the EU in this policy direction. In practical terms it meant
that the incomes of UK pensioners fell further behind those of
their northern EU counterparts (which became a rallying point for
UK pensioners’ campaigns).

The 1990s brought new policy concerns. First of all, there was
the so-called “demographic time bomb” of falling numbers of young
people entering the labour market. Of course this was no more than
the workforce reflecting the general ageing of the population but
it led to a flurry of public statements. By 2015 the proportion of
the workforce aged 50 and over will rise from 20 per cent to more
than 25 per cent.

Very few employers have addressed the implications of this
although this is slowly changing. Government has concentrated on
trying to educate employers about the importance of adjusting to
workforce ageing and to warn against discriminatory practices. To
that end it has introduced a non-statutory code of practice on age
diversity.

The second policy issue to emerge in the 1990s was that of
long-term care. The fastest growing segment of the older population
is those over 80 – between 2000 and 2005 alone there will be a 10
per cent increase in this age group. The realisation that
population ageing will mean the likelihood of increasing demands
for long-term care led to policy action in most EU countries,
notably the introduction of insurance in Germany.

In the UK, the need for urgency on this front was reinforced by
the cost of the Conservative government’s introduction in the
mid-80s of the perverse incentive for older people to enter
residential homes rather than staying put and the requirement for
some of them to sell their family homes in order to receive social
security benefits to help with the costs of residential homes.

Also groups campaigning for older people and carers helped to
raise the profile of this issue as well as achieving important
social advances such as the Carers (Recognition and Services) Act
1995. The first Royal Commission for a decade was appointed to look
into this issue.

A by-product of this policy focus on long-term care was the
revival of healthy ageing as a public issue. Although there is not
a clearly formulated policy on healthy ageing in this country there
is a commitment to sustaining activity beyond employment, as stated
in the Cabinet Office report Winning the Generation
Game.¹

There are two elements to active ageing: employment focused on
the third age (50-74) and healthy ageing and community
participation targeted at the fourth age (75 and over). Both have
positive potentials for older people and society in terms of social
inclusion, well being, quality of life and in reducing pressures on
public spending on pensions, health and social care.

There is also globalisation which has exerted such a strong
influence on policy discourses for the past five years. In
particular there is the transatlantic neo-liberal consensus that
globalisation makes increasing inequality inevitable, global
competition means that both taxation and social costs have to be
minimised, and traditional welfare states are not suited to a
globalised world of different life courses. The fact that older
people are the main beneficiaries of welfare spending puts
pensions, health care and long-term care to the top of the reform
agenda.

Unlike the US, however, the debate in the UK and the rest of the
EU is not purely about minimising social costs. It is a twin-track
agenda, emphasising prevention as well as remedial action. This
starts from the assumption of individual responsibility but also
includes recognition that the state has a crucial role in helping
to establish the conditions within which people age.

Put together, policy is directed at extending activity and, with
it, it is hoped, quality of life. In turn the clear intention is to
contain the future costs of population ageing. This tendency is
reinforced by three subsidiary factors. There is a cultural shift
towards individual quality of life usually labelled as
post-modernity. This recognises that people experience ageing
differently, and seek to enhance their own quality of life. The
mushrooming of pensioners’ action groups all over the UK in the
past decade is one indicator of the new grassroots politics of old
age which is impacting on the policy system. It is likely to
increase when the baby boomers of the 1960s start to reach
retirement around 2020.

Another factor is the traditional British and European social
and political emphasis on solidarity and partnerships between state
and citizen. Enhancing quality of life is an important element of
this legacy. Important recent policy development such as the NHS
Plan, the Performance Assessment Framework and new Best Value
regime, and the National Service Frameworks all put a heavy
emphasis on quality improvement. It is a major element of what the
government calls modernisation.

Finally, there is the contribution of research to the emergence
of quality of life as a major public issue. The UK’s various
scientific communities and their research councils have been very
influential in raising the profile of both ageing and quality of
life research. There is a rich tradition of such research in the UK
and other EU countries and, without it, extending quality of life
would not have been placed on the policy agenda so easily.

This is the policy context that conceived the Economic and
Social Research Council’s Growing Older Programme and to which, in
turn, it must respond. The central research question of the
programme goes to the heart of these policy issues: how can the
quality of people’s lives be extended? The programme addresses six
areas: defining and measuring quality of life; inequalities in
quality of life; the role of technology and the built environment;
healthy and productive ageing; family and support networks; and
participation and activity in later life. It consists of 24
separate projects and will produce a regular series of newsletters
and findings aimed at different groups of policy makers and
practitioners.

The big challenge facing the programme and the 96 researchers
working on it is not only to produce robust scientific research but
in a form that can easily be fed into policy and practice so that
it can have a real impact on extending the quality of older
peoples’ lives.

¹ Performance and Innovation Unit,
Winning the Generation Game, Cabinet Office, April
2000

Alan Walker is Professor of Social Policy at the University of
Sheffield and director of the ESRC Growing Older Programme. For
more information go to www.shef.ac.uk/uni/projects/gop