We have been taught to believe our health issues should be treated by health professionals. But for a healthy community to thrive, as we live much longer than predicted at our birth, society needs a much broader approach.
It was not just improved medicines and health care that extended life expectancy; it was better education, food, housing, sanitation, safer jobs and social supports. Urbanisation in under-developed countries has, in itself, improved the health and life expectancy of millions of people worldwide.
Health policy, narrowly defined, will not sustain the well-being of the 7 million Australians aged between 50 and 75 who may well live to be 100, nor of the younger generations who follow them. What we need is a broader health policy, and that requires a coordinated, multi-faceted approach aimed at prevention and lifelong health maintenance.
By 2064, 9.6 million of our population will be over 65; 1.9 million will be over 85. There will be more centenarians than babies born. In the main, they will not be frail and dependent because illness and decline are being delayed until the last few years of life. Recent research by the Australian Institute of Health & Welfare shows men have gained an extra 3.9 years of disability-free life since 2003, women an extra 3 years. We are living longer and healthier lives, not just because medical science has improved but because the conditions for healthy living are better understood.
Remaining healthy over a longer life does not simply depend on the latest drugs and medical technology. Ill-health can be socially induced. Social isolation, job insecurity, low wages and downward mobility don’t make for a stable community or strong family relationships. Pessimism about the future breeds sadness, violence and indifference to social norms. For example, there is strong evidence that 35% of risk factors for dementia can be attributed to modifiable lifestyle conditions such as obesity (1%) and hypertension (2%), social isolation (2%) and depression (4%), failure to complete secondary education (8%) and hearing loss in mid life (9%).
The most important keys to a longer life are not just genes, but education across the life course, a sense of purpose and positive social and personal relationships. These centre on work and family, both of which are undergoing radical transitions.
Jobs are disappearing or being restructured. Current trends towards automation are resulting in serial part-time jobs, under- and un-employment. Work for many may not necessarily be paid work, though without an adequate income, poverty and social isolation can be damaging.
By work we mean activity that is meaningful, that serves a wider purpose with an interest in the well-being of others. Voluntary and caring work are obvious examples. We know babysitting your grandchildren can lengthen your life by another five years. If we persist with the approach that treats those over fifty in the workplace as the first to be made redundant, view them as technologically incompetent, not worth retraining or even interviewing for a new job - we condemn future generations to despair. Such a community environment would be toxic and individual health would suffer.
The ‘traditional’ family of mum, dad and the kids is increasingly rare. Today, family-like relationships can take many forms – friendship groups, shared households, extended family households as young people stay longer in the parental home, lattice networks of formerly married, separated, divorced, remarried, stepfamilies whose links can be even richer than those of a small nuclear family. These new structures require us to adapt to new ways of living.
J.D. Vance’s book Hillbilly Elegy makes the startling point that the life expectancy of America’s white middle-aged has dropped for the first time in history. It’s not because of obesity, diabetes or heart disease, but because of what he calls ‘sadness’, a loss of hope and a sense of personal responsibility and agency. The mortality rate for the least well-educated 45-55 year-olds rose by 22 per cent between 1999 and 2014, an effect, he says, of a learnt helplessness among the welfare-dependent, working classes.
In Australia we may also have lost, as Vance claims America’s poor have, some of that sense of personal responsibility for our own well-being, that sense of mutual obligation that binds a community together, the work ethic that drives achievement. These attributes are not only important for our individual health but for the wellbeing of the whole community. It is often the lack of hope that results in alcoholism and drug abuse, rising domestic violence and inter-ethnic distrust. Trends towards a self-centred, narcissistic culture, that the disadvantage of others is not our problem may go a long way to explain why it is claimed that so many are described as having a ‘mental illness’.
Better health will follow from a rethink of our systems of work and education, if we share more equitably the fruits of labour, access to lifelong education and retraining. We have to see improved urban planning for more integrated communities, solutions to the shortage of quality housing, better public transport to reduce stressful hours of unproductive commuting, a shared vision of caring for others and taking responsibility for how our actions impinge on the lives of others, as keystones of health in a wider context.
Our politicians and community leaders need the courage and imagination to take up this challenge – to rethink our work, education and health systems to cater for major social changes in population age, family structures and the nature of work. It is not just young people, but also the middle-aged who are bearing the brunt of the current failure of political imagination.
Those 7 million middle-aged Australians have in fact much to contribute; we should see them as a resource, not a burden. They may even be the solution to a rising health bill rather than the cause.