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Opinion: Health equity in older age

Contributor:
Fuseworks Media
Fuseworks Media

By Associate Professor Mary Breheny

The media often focus on older people as a discrete group, whose needs must be balanced against the needs of younger groups. As a result, suggestions for healthy ageing tend to focus on promoting healthy choices among people who have already aged. But we know that there are marked differences in health and wellbeing among people of older age.

These differences do not just arise in later life; they reflect a life time of experiences. These may include health risks in younger years such as poor housing, workplace conditions, family experiences, and lack of access to resources and opportunities. Our research programme examines the differences between older people, based on their entire life experiences, rather than treating older people as if they were all the same.

Our longitudinal research shows five different profiles of wellbeing among older people over time. After following them for ten years, we found most older people (about two thirds of our sample) were in robust health or average good health. These groups were ageing well, maintaining good physical and mental health over time and remaining socially engaged. A smaller number experienced declining physical health whilst maintaining good social and mental health.

There were two groups who showed limitations in mental health and social wellbeing or vulnerable health across all domains. This represents a small but important group of older people with significant health limitations who tend to reach later life in poor health, rather than experiencing sharply declining health in old age. Taking this as a starting point, our research sought to uncover the specific lifetime and environmental factors that explain health differences in older age.

To answer questions about the factors which lead older people to reach later life in poor health, we used the Health, Work and Retirement longitudinal study of ageing. This includes life history data on childhood socioeconomic status, childhood health, and lifetime education and occupational status and health behaviours. These data are linked to our survey data which includes measures of quality of housing and neighbourhoods, as well as employment and living standards. Together, these data allow us to answer important questions on the factors which predict physical, mental and social health trajectories over time.

We found health in later life was significantly related to childhood socioeconomic status, which predicts standard of living in later life, and is strongly linked to physical and mental health. Later life living standards, satisfaction with housing, quality of neighbourhood, and social cohesion of neighbourhood - also influenced health and wellbeing. Even health behaviours, such as alcohol consumption, are best predicted by childhood family and socioeconomic factors. Once these health behaviour patterns are set early in life, they tend to persist over the life course.

Our research shows that the environments and health practices that influence healthy ageing generally reflect a lifetime of inequitable access to resources, rather than the result of individual abilities or choices. Policies to address this could focus on social and physical environments rather than suggestions for healthy activities in later life.

These research findings have important implications for public health and health promotion for older people. Current approaches neglect environmental effects across the life course on health and wellbeing for older people. Our research programme suggests that income support and housing are two of the most important areas for the health and wellbeing of older people. These provide clear opportunities for policy intervention, both to safeguard income support in later life and to ensure access to secure housing for older New Zealanders.

Recognising the factors that produce vulnerability shifts the focus from healthy behaviour in later life to environments that support health for all across the life course. These factors provide a clear focus for efforts to ensure health equity throughout the life course, and minimise the health disparities we see in later life in New Zealand.

Associate Professor Mary Breheny will present her findings at the IUHPE 23rd World Conference on Health Promotion in Rotorua from Sunday. This opinion peice was first published on the Health Central website.

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