Transcript Size test - Just Ageing

Socio-economic inequalities in older
people’s use of services
Andrew Harrop
Acting Charity Director
Age Concern and Help the Aged
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Context

Equality Bill 2009 proposes public sector duty to
tackle socio-economic inequalities

Traditional approaches to public services ignore
socio-economic differences

‘Inverse care law’ – discussed since 1970s and flagged in
2006 Social Exclusion Unit report ‘A Sure Start to Later
Life’

Increasing focus on ‘life chances’ but narrative relates to
equalising at ‘starting line’ not closing gaps over lifetime

A gap between public policy on ageing and inequality
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
This paper

Review of existing evidence – reveals huge gaps in
knowledge

Draws on review commissioned from LSE and expertise of
our policy and research teams

About socio-economic inequalities among older people, not:
–
Age inequalities
–
Inequalities linked to race, gender, disability etc except where this has a
bearing on socio-economic inequality
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Health Services

Focus on health services not inequalities in health outcomes
(huge literature; but main causes not linked to services)

Important to control for need (low income older people use
primary care more)

Macro studies – contradictory evidence:
–
High income groups favoured across all health services – eg primary care
and especially specialist care and dentistry (BHPS 1997-2005)
–
Similar quality of healthcare irrespective of wealth, with the exception of
continence care and diabetes education (ELSA, 2004)
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Health services: ‘micro’ studies
Evidence of inequalities harming poorer groups
Studies of older people
All-age studies
– Mammogram uptake

Diabetes care
– Aneurysm screening

Arthritis care
– Flu vaccinations

Prostate cancer diagnosis
– Eye examinations

People with cancer supported
to die at home
– Dentistry
– Chiropody
– Hip replacements
– Heart surgery
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Social care

System failing everyone – high ‘needs-test’ (taking family care into
account) and often poor quality


But middle income groups most disadvantaged
–
Means-tested system, so only poor receive free care
–
Under utilisation of care
–
Premature entry into care homes
Socio-economic equity is a critical lense for considering reform of care
and support:
–
Improve access and standards for the poorest
–
And also redress unfairness experienced by mid-income groups?
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Housing and communities
Evidence of inequality
Evidence against inequality
–
Supported housing (high income)

Winter deaths
–
Private rented, and especially

Access to food shops and diet
non-decent housing (low income)
–
Risk of homelessness (low
income)
–
Affordable heating (high income)
–
Access to basic services
(deprived areas)
–
Feelings about neighbourhood
and safety (deprived areas)
–
Social and leisure opportunities
(deprived areas)
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Transport and technology
Transport
Technology


Older people without use of car
find it harder to access services
(especially in rural areas)

Inequalities in take-up of internet
and broadband (all age groups)

One third of people who are
Use of car linked to socio-
socially and digitally excluded are
economic status
C2DE over-65s
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Causes of inequalities
Findings from all-age studies:

Differences in recognition or acceptance of the need for services (eg
glaucoma; cataract).
–

Why? denial; fear; fatilism; no sense of entitlement
Differences in awareness and knowledge about the availability of
services (eg palliative care)

Differences in ability to make themselves heard and to navigate
systems (eg referrals to specialists)

NO EVIDENCE: attitudes of professionals; system design (known to
be in issue in age inequalities)
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Future research – a lot more to do

Cross-cutting studies that explore the interactions between different
kinds of inequalities

Cross-cutting studies that explore the interactions between different
services that people use

Studies of the systemic causes of socio-economic inequalities

Studies that focus on vertical, not just horizontal, equity (appropriate
differentials based on need?)
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Future public policy

Prioritisation and leadership – opportunity of age and socio-economic
duties side-by-side

Analyse causes of inequalities to identify levers of change and the
most effective interventions (service users; professionals; system
design?)

Clear principles for the deployment of public resources - eg utility v
greatest need

Create ways to hear older people’s voices when addressing inequality
(esp most disadvantaged)
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people
Andrew Harrop
Acting Charity Director
[email protected]
020 8765 7547
Acknowlegdements:
Jose-Luis Fernandez, London School of Economics
Michele Lee, Phil Rossal, Jen Watt
Age Concern England and Help the Aged have joined together to form
Age UK, a single charity dedicated to improving the lives of older people