Are we killing with kindness?

Our places of work and play are encouraging inactivity, risking our future health argued Public Health England (PHE) (everybody active, everyday) earlier this month.

“The design of schools, public buildings and urban spaces prioritise convenience and speed ahead of walking or cycling. People sit all day in offices where it is often easier to find the lift than the stairs. Concerns about vandalism and maintenance have left public spaces without the benches and toilets that allow older or disabled people to venture out. Cars and other vehicles dominate, not the needs of pedestrians.”

The new report points to a strong and growing evidence base that proves that physical activity is good for us. Yet it also points out that lots of us aren’t doing enough of it. Almost half of all women and one third of men are damaging their health through a lack of physical activity. This physical inactivity is costing the UK around £7.4bn a year. In historic terms, we are now 20% less active than in 1961. Much of the evidence isn’t new but it is very useful having it in a single place.

Everybody active, everyday, is interesting in its emphasis on the importance of interventions across the lifecourse. PHE state that “Being active at every age increases quality of life and everyone’s chances of remaining healthy and independent”.

The report notes that “physical activity declines with age to the extent that by the age of 75 years only one in ten men and one in 20 women are active enough for good health”. At the other end of the age spectrum they PHE that “between 2008 and 2012, the proportion of children aged two to 15 years meeting recommended physical activity levels fell from 28% to 21% for boys and 19% to 16% for girls.”

The report argues that we need to “embed physical activity into the fabric of daily life, making it an easy, cost effective and ‘normal’ choice in every community in England”. They emphasise the importance of everyday activity (cycling and walking), active recreation and (to a lesser extent) sport.

PHE point to the potential of the move of public health to local authorities by highlighting the successes witnessed by Finland over the past 40 years:

“Once the world record holder for heart disease, Finland started a nationwide campaign for change 40 years ago. The government shifted money to local authorities, a move similar to the transfer of public health responsibilities to a local level in England. Authorities responded by creating heritage and conservation trails, building active outdoor play and exercise spaces, and encouraging sport at all levels, formal and informal. They developed innovative approaches for distinct groups, such as the elderly or the persistently hard-to-reach, that directly addressed their problems. Change has run across all age groups: young people, working age and older people are all much more active.”

ILC-UK will next month publish a new think-piece (Public health responses to an ageing society) which explores the extent to which local authorities are making the most of the new public health powers they have. Without a doubt, the new powers could provide a major opportunity.

But without breaking our own embargo, it is fair to say that we have yet to be convinced that local authorities are making the most of the potential. PHE mention the importance of public toilets in public spaces, for example, yet the new powers does not appear to have reversed this trend.

If we want people as active road users (cyclists/pedestrians), we need to ensure these spaces are safe. Older people remain disproportionately likely to be killed on the roads yet road safety doesn’t seem to have adequately hit the agenda of public health.

The focus within PHE on active environments is extremely important. As is their emphasis on interventions across the life-course. But do we need to go further? If local authorities are to make a difference in this area do they need more power to make a difference? Yes they need to encourage and inform, and yes planning needs to be more holistic. But perhaps they also need more powers to influence the environment which has contributed to such inactivity?

Much of the emphasis in the report is in encouraging ‘good’. But sadly there is little if any emphasis on whether we might need to ban ‘bad’. If we want to get people to get on a bike or walk to the shops, for example, we may need to reduce the reliance on the car. This is an area we need evidence. But it is also one where we need a grown up conversation which isn’t immediately shut down on the grounds of “personal freedom”.

David Sinclair

‘Public health responses to an ageing society’ will be published by ILC-UK on 17th November 2014.

7 lessons from the Missing Million

Yesterday we published our Missing Million report with the support of Prime and Business in the Community.

What did we find?

Involuntary unemployment is not the exclusive preserve of the young

• Of the 3.3 million economically inactive people aged 50-64, approximately 1 million people have been made ‘involuntarily workless’
• There are around 1.2 million people aged over 50 would be willing to work if the right opportunity arose

Older people don’t take jobs from the young

• A higher proportion of older workers does not “crowd out” the labour market for younger workers. Our analysis shows that, on average, those local authorities that do well with regard to the employment of older workers also do well in terms of employing younger workers.

There is huge economic potential if we maximise labour market participation of older people

• 26% of people aged 50-64 who are currently out of work would like to work – this rises to 45.8% of all those out of work aged 50-54.
• 50-64 year olds account for 41% of the total number of people who are economically inactive aged 18-64 (as at Q1 2014).
• If the skills and abilities of the 50-64 age group were fully utilised and the employment rate matched that of those in their 30s and 40s, UK GDP could be £88.4bn higher in 2014 (equivalent to an uplift of 5.6% of GDP).

Self-employment is an important source of work for older people

• Self-employment accounts for 19.4% of all workers aged 50-64 and for 40.8% of all workers aged 65 and older.
• The 50+ age group accounts for 42.9% of all self-employment in the UK and 2 million people.

Companies who don’t do more to support extended working lives could struggle to get the staff they need

• The size of the UK’s workforce is likely to flat-line, projected to increase by just 4.5% over the next 20 years by comparison to an 18.2% rise over the last two decades.

We need to do more to prevent ill Health

• Among those in their 50s, long term sickness is the cause of half of all inactivity put down to poor health amongst those aged 50-54 and nearly 40% amongst those aged 55-59.

We need to create more opportunities for older people to work flexibly

• People over 50 want to see more flexible working options afforded to them, 15% even said they would even take less pay in order to work fewer hours – indicating that there is a large contingent of older workers who would like additional flexibility but who are locked into working long hours.

The report is available on our website.

Ben Franklin presented a few slides at the launch event.

The Missing Million from ILC- UK

Let's get Britain building

There are perhaps not too many areas where the CBI, the Ready for Ageing Alliance, housebuilders and the Labour, Liberal Democrats and the Conservatives all agree.

But one of them is that we need to build more homes.

ILC-UK’s own analysis has revealed, for example, that just to keep up with demographic change, we need new homes built at the fastest rate since the 1970s.  

Some of these homes will need to be retirement homes. A new study published this month by Knight Frank has highlighted a “chronic shortage” of retirement homes. The organisation, which surveyed people over 55, found that 25% (4.4 million) would buy or rent in a retirement village.

In 2011 Professor Ball said that the UK has capacity to get to 16k units a year for owner-occupied retirement housing. In 2013 Demos argued that around 1 in 4 of the over 60s would consider retirement housing (similar to the Knight Frank percentage).

In the UK, just around 1% of us live in retirement housing. This compares with 17% in the US and 13% in Austria. Even if Knight Frank and others have overestimated demand, it is clear there is likely to be a shortage of new retirement housing.

So why isn’t it happening?. The recession has had a negative impact. There was not enough money around to build and not enough demand as inertia and other barriers prevented older people making the move. Planning remains a barrier.

But perhaps things are about to change? Glenigan have found for example that the number of retirement housing units awaiting planning consent is more than double the number currently being built. This either reflects an imminent increase in new schemes or a slow planning process. Possibly both.

McCarthy and Stone have recently announced plans to reach 3,000 units a year by 2018, having sold 1,667 in the year up to 31 August 2014.

EAC and McCarthy and Stone have provided ILC-UK with new data on the number of retirement housing schemes (1) completed since 2005. These figures reveal a fall up to 2010 and a subsequent increase. The total number of new properties remains a long way off the 2007 figure.

Units (properties) update October 2014
Year completed	McCarthy and Stone	All	%
2005	1747	2708	65%
2006	2296	4152	55%
2007	2205	4542	49%
2008	2452	4249	58%
2009	870	2417	36%
2010	491	1160	42%
2011	892	1745	51%
2012	1166	2376	49%
2013	2071	2938	70%

It’s nice to see industry, charities, thinktanks and the three largest (2) political parties all agreeing. But whilst there is a consensus about need, making it happen seems a harder. Whilst the political parties advocate nationally, local MPs and Counsellors find reasons to object to housing. There is always somewhere better to put it (ideally someone else’s constituency).

And whilst the signs might look good, we have only built 200,000 homes in 4 out of the last 14 years. As our analysis showed, 200,000 is just enough to keep up with demographic change rather than address the current shortage. Even if we were to build 200,000, how do we increase the proportion of retirement housing as part of these numbers?

If we are to ensure the supply meets expectations, new housing (retirement and general needs) must be built according to the needs of an ageing society. We need lifetime homes standards, not a nonsense of “optional” age friendly standards for housing. If we don’t build the right homes, there will be limited incentive for older people to choose to rightsize and potentially free up bigger family homes.

Let’s get building. But let’s also build good stuff.

David Sinclair

Thanks to EAC and McCarthy and Stone for providing the new data.

1) UK numbers only include schemes that are staffed by something approximating to a traditional scheme/court manager. They therefore exclude developments that are simply age exclusive by virtue of planning consent. They are captured by year of completion, ie when people start to move in. The numbers includes schemes whose primary tenure is leasehold / freehold and the Scottish equivalent. There is likely to be some undercounting of (largely housing association) mixed tenure provision. EAC allocate all properties in a scheme to its dominant tenure.

2) In terms of Westminster Parliamentary seats

Adult vaccination in an ageing society

My presentation for ECCMID in Barcelona on Monday

Adult Vaccination in an ageing society: Immune response from ILC- UK