Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Viscount Hanworth Excerpts

Wednesday 20th October 2021 Grand Committee

[Viscount Hanworth (Lab)]

The Science and Technology Committee’s report on ageing was written before I joined the Committee. I have no hesitation in declaring that it is an excellent report. It is lengthy and comprehensive and it contains numerous important recommendations.

The report has disposed of the optimistic belief that citizens of affluent societies can look forward with equanimity to the prospect of increased longevity. However, in comparison to the experience of Britons 100 years ago, the average lifespan has already increased markedly. A century ago, average life expectancy at birth for men was 48 years, whereas for women it was 54. By 2015, life expectancy for a man was 79 years and for a woman it was 83 years. It should be noted, however, that it can be misleading to compare average lifespan statistics then and now. The earlier figures are affected by a higher frequency of infant mortality and death in childbirth, both of which have been radically reduced.

The process of increasing longevity has slowed and there is little prospect of further significant increases at the top end of the range. Nevertheless, there remains considerable scope for reducing the incidence of premature death associated with social deprivation. The prospects of a morbid senescence, in which people suffer from the ailments of old age, have increased disproportionately. Both the duration of that period of affliction and the incidence of the associated ailments have increased markedly. Although it should be possible to delay the onset of the diseases of senescence and to mitigate their effects, they will not be eliminated. As the report observes, few of these ailments are liable to be eliminated by natural selection, since they occur mainly after the age of reproduction.

The report also revealed the wide differences in health and longevity among individuals in different socioeconomic circumstances. The expected duration of a healthy period in life—the health span—for those in the most affluent areas is 18 years longer than for those in the most deprived areas. Those in poverty suffer more from the ailments of old age. If there is a realistic prospect of increasing longevity on average and of reducing ailments, it must be by addressing these inequalities.

The statistics of disease and mortality recorded 100 years ago are dramatically different from the modern statistics. The Office for National Statistics has a web page titled “Causes of Death over 100 Years”, which shows the top causes of death by age and sex from 1915 to 2015. The incidence of mortality through infectious diseases has been radically reduced over that period. Until after the Second World War, infections were generally the leading cause of death for young and middle-aged males and females. During the second half of the 20th century, polio, diphtheria, tetanus, whooping cough, measles, mumps and rubella were all virtually wiped out, largely as a consequence of childhood immunisation. Meanwhile, from 1945 onwards, heart conditions became a leading cause of death for middle to older-aged males, followed by cancer. A similar trend, occurring at older ages, has been seen in women during that period, while younger to middle-aged women have more frequently died of breast cancer.

The committee’s report remarks that modern medicine is still dominated by the objectives of defeating single diseases and single ailments. To be more appropriate to treating an ageing population, it should be addressing what is described as multimorbidity, which is the state of having two or more long-term medical conditions. Coronary disease, hypertension—or high blood pressure —diabetes, dementia and strokes are all highly correlated in the aged cohorts; that is to say, they occur together, but they are being treated as if they were isolated ailments.

The experience of death and the social attitudes towards it have changed markedly over time. In predominantly rural communities, the realities of birth and death, witnessed in both the animal and the human populations, are liable to be part of everyday experience. These experiences are curtailed in urban populations.

In late Victorian times, the decline in premature mortality was accompanied by a curious side-effect, which was the ritualisation of death. This can be witnessed by visiting the cemeteries that date from then that accommodate lavish funereal monuments. In London, the Brompton, Highgate and Abney cemeteries are prime examples. Later, when cremation became an acceptable means of disposing of bodies, the memorialisation of the dead was much diminished. The incidence of mortality per head has been much reduced by the increased longevity that we have witnessed in the past 100 years. Nowadays, death is marginalised. It is no longer ever-present in our consciousness. I suggest that this marginalisation has had some deleterious consequences.

Although we are aware that the population has aged, we have been unwilling to face the consequences. Our provision of care for the elderly has not adapted to these circumstances and it has become seriously inadequate. We are frequently surprised and resentful when relatives die. Many appear to believe that death occurs only through medical negligence or malpractice. Doctors are fearful of being blamed for the death of relatives and they seek to indemnify themselves against complaints by asking relatives to assent to “do not resuscitate” orders.

The report is replete with recommendations of what should be done to reduce the impact of the diseases of senescence. It emphasises the well-known circumstances that undermine health in later life. Foremost among these are smoking, alcohol consumption and obesity, but only the first of these has been consistently targeted by public health campaigns. Much less has been done to address alcohol consumption, obesity and the lack of physical exercise. It is notoriously difficult to change human behaviour merely by exhortation and there has been political resistance to the interference of what has been described as the “nanny state”.

The recommendations of the committee’s report are too numerous to recite, but some of them are striking and should be remarked on. The report declares that the piecemeal approach to the problems of ageing needs to be replaced by a co-ordinated approach that addresses the complex and interrelated problems. Patients are often prescribed a multiplicity of drugs, with little attention given to the potential for their damaging interactions or to the harm caused to a patient by a pharmacological overload. It has been recommended that ageing people should be assigned to a designated clinician who has a complete oversight of their care.

The report calls for further research into the processes and problems of ageing and asserts that not much is fully understood yet. It calls for fuller and more enduring longitudinal studies. However, cross-sectional studies are needed that would highlight the disparities in health that are attributable to the inequalities in our society. The Covid pandemic has revealed the health hazards associated with social and economic deprivation and the stark differences in health and mortality between ethnic groups. Surely the most effective means of promoting good health in an ageing population is by striving to achieve a just and equitable society.