Health and the older worker Kevin P Balanda, PhD FFPH Presentation to the “Living Longer – Working Longer?” Seminar. Belfast, 10 November 2010

Institute of Public Health in Ireland All-Ireland body:  North-South cooperation  Inequalities in health  Social determinants of health Three work strands:  Capacity building  Policy support  Information & intelligence

Ageing population Source: CARDI (2010)

Population prevalence of chronic conditions – RoI (2007)

Increasing life expectancy (age 65) Source: CARDI (2010)

Some questions 1. “Big question”: Are people living longer, healthier lives or are we just extending the years spent with chronic illnesses and disabilities? 2. What are the factors driving the trend? 3. What is likely to happen in the future? 4. How should we respond/plan for this?

Health and the older worker 1.The big debate: prevention or treatment? 2.Those who are in paid work 3.Those who are not in paid work 4.Equity and fairness 5. The health and social care system

Life and health expectancies 1.Describe the temporal, demographic, geographical & socio-economic co-variation of Life Expectancy (LE) Disability Free Life Expectancy Healthy Life Expectancy (HLE) on the island. 2.Highlight implications for older workers

Estimated expectancies (age 65) – 2005/2006 LE (65) DFLE (65) HLE (65) 2005NIMale NIFemale RoIMale RoIFemale

Social inequalities in partial expectancies - males aged 65 NI 2005 SC (lowest:highest) ratios % % 74% 89% 94% 66% 76%

Trends in expectancies– males aged 65

Trends in expectancies– females aged 65

Trends in social inequalities in (partial) health expectancies– males aged 65 NI (Lowest SC / Highest SC)

Trends in quality of older years: percentage of expected years that are disability free - age 65

Social-class-specific trends in quality of older years: percentage of (partial) expected years that are disability free – males aged 65 NI

Trends in quality of older years: percentage of expected years that are in good health - age 65

Social-class-specific trends in quality of older years: percentage of (partial) expected years that are in good health –males aged 65 NI

(Tentative) summary (age 65 years) Males in lower SC-SEGs have lower life expectancies and health expectancies. There is a social gradient in life expectancy and health expectancies in NI but they are unclear in RoI (possibly due to inconsistencies in coding). In NI; during the inequalities in male LE(65) and male HLE(65) appear to have decreased and the inequality in male DFL(65) appears to have increased In RoI; during the inequalities in male LE(65) and inequalities in male DFLE(65) appear to have increased; inequalities in male HLE(65) appears to have decreased.

(Tentative) summary (age 65 years) Looking at disability; There appears to have been an compression of morbidity in females in NI and an extension of morbidity amongst males in NI (possibly due to relatively high levels of self-reported disability in NI). The extension of morbidity for males in NI seems to have occurred in all social classes in NI (greatest in the lowest SC). (Note: partial expectancy used) Looking at self-rated health; There appears to be a compression of morbidity amongst males and females in NI. The compression of morbidity seems to have been limited to the middle social class in NI. (Note: partial expectancy used).

Concluding remarks Impact of work on health and health on work Planning needs to take into account –Impact on paid work –Impact on unpaid work –Impact on retirement Equity and fairness Implications for health and social care system Do we know enough to continue the debate? –Fit-for-purpose information systems? –Relevant research?

Thank you …