Good health for all in later life should be our goal | Letter

You rightly point out the triumph of ageing and the importance of focusing on preventing ill health in later life (Editorial, 18 August). The emphasis should be on increasing healthy life expectancy – the number of years people live in reasonably good health. But unlike other European countries, the average healthy life expectancy in the UK is fallingbut with great inequalities between different places and groups.

For example, women in the Orkney Islands live an average of 20 years of a healthy life than those in Blackpool (75 versus 55). Such stark inequalities show that it is not medicine or health systems that determine how people age, but the social and commercial determinants of health – the circumstances in which we are born, live, work and age – the domain of public health. These factors contribute as much as 60% of the variations in health in later life.

To address these broader determinants of health, a cultural revolution in policymaking is needed: health equity in all policies, a focus on the life course and the three Ps (prevention, prevention, prevention). In essence, this was advocated in the 1970s by then Secretary of State for Social Services Barbara Castle, but never enacted. Perversely, given that Michael Marmot has shown that under the Tories’ austerity regime, health budgets have been significantly cut. It is vital to restore them if Labour achieve her mission to halve the gap in healthy life expectancy between the richest and poorest regions.
Alan Walker
Professor of Social Policy and Social Gerontology, University of Sheffield