ilc-uk and the actuarial profession debate: the economics of promoting personal responsibility for...
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ILC-UK is delighted to be working with Alliance Boots and the University College London School of Pharmacy to explore why public health has just got ‘personal’ and if such a trend will yield cost savings or cost some groups of society or sections of the economy more than others.The event will also mark the launch of a report produced by Professor David Taylor and Dr Jennifer Gill from the UCL School of Pharmacy, supported by Alliance Boots entitled ‘Active Ageing: Live longer and prosper? Towards realising a second demographic dividend in 21st century Europe’.The debate will focus on the balance between encouraging individual accountability and accepting collective responsibility for achieving longer lives and the consequent implications for health outcomes and cost.The Coalition Government (like its predecessors) is trying to move away from the ‘nanny state’ towards ‘nudging’ people in the direction of choosing healthier behaviours.Few people would question the desirability of encouraging more informed personal decision making to prevent avoidable illness. But too much reliance on individual choice and responsibility could fail those most at risk and potentially impose needless costs and losses on individuals, their families and the wider community. Promoting the behavioural and cultural changes needed to deliver better public health and keep NHS and social care costs as affordable as possible remains a pressing and complex challenge.Subject areas to discuss will include: The philosophical and political underpinnings of public health policy, including: social solidarity, fairness, entitlement, risk and personal responsibility. Are we in danger of unravelling the principle tenets of the Beveridge model welfare state in ways which may not only disadvantage the most vulnerable, but may in time increase financial pressures on other sectors of society? Determining the boundaries of personal and societal level responsibility, and the legitimate as opposed to illegitimate need for publicly funded care and support. In areas ranging from smoking cessation to reducing the threat of an obesity driven diabetes epidemic, communities have to make tough choices between limiting risks and accepting the consequences of personal, social and corporate freedom. The impact of current trends and possible future policy decisions in areas ranging from the costs of health and life insurance to the price of pensions for individuals and society. The role of private employers in promoting and requiring healthy living. The winners and losers if the trend towards personal responsibility continues, with particular regard to older people and disadvantaged groups and what impact could this trend have on the cost of care?Agenda from the event16:00Registration16:30Welcome, Baroness Sally Greengross16:40 – 18:25Presentations and responses from:Prof. David TaylorProf. Nick BosaonquetTricia KennerleyMartin GreenTRANSCRIPT
Economics of promoting personal responsibility for improved public
health – saving costs or costing society?
25 April 2012
This event is kindly supported by Alliance Boots
#responsiblehealth
Welcome
Baroness Sally GreengrossILC-UK
This event is kindly supported by Alliance Boots
#responsiblehealth
Professor David TaylorProfessor of Pharmaceuticals and Public Health Policy
School of Pharmacy, UCL
Active Ageing: Live Longer and Prosper
This event is kindly supported by Alliance Boots
#responsiblehealth
Active Ageing: Live Longer and Prosper
Presentation for The Actuarial Profession
Staple Inn Hall, High Holborn, April 25th 2012
David Taylor
Professor of Pharmaceutical and Public Health Policy
The UCL School of Pharmacy
This presentation addresses
• Population ageing as a desirable form of social and economic development, central to demographic, epidemiological and care transition
• Recent trends in life expectancy and healthy life expectancy
• Key policy issues, including those relating to the current and future role of (community) pharmacy and pharmaceuticals in the contexts of primary, secondary and tertiary prevention
• Challenges and opportunities relevant to the Actuarial Profession and its future
Disability
Impairment ComorbiditiesPrimary
prevention
Secondary prevention
Disability and dependence
FrailtyHandicapTertiary
prevention
From WHO’s 2012 World Health Day global brief
Years of life lost per 100,000 population aged 60+, by condition (WHO 2012)
Years lost to disability by cause per 100,000 population over 60 (WHO 2012)
Key issues
• As life expectancies increase, what happens to health expectancies?
• Is population ageing inevitably associated with a relative loss of economic competivity?
• What policies and strategies are most likely to contribute to increased healthy life expectancy without undermining public interests in sustainable economic development?
Some answers?
• There is robust evidence that, as life expectancies increase, age specific disability rates decline
• There is limited evidence of ‘disability/morbidity compression’, even without focused policies in place
• The traditional use of measures such as EDRs is unhelpful and misleading. Given the right macro-economic and social policy environment, improved health in later life could lead to productivity gains which outweigh the costs of population ageing
Pro-active policy options• Not waiting for minor problems to
develop into major ones• Cascading where possible
preventive and ‘maintenance’ care ‘down’ from medical environments into lower cost settings – actively seeking new paradigms
• Investing in new technologies likely to protect health and prevent disability throughout unnaturally long lives
• Providing good quality social care for everyone living with disabilities with ways which reward independence and self reliance and do not foster ‘learnt helplessness’
Bevan, Dilnot, a Matron and a wholesome patient
The NHS has often relied on scandal to drive improvement, and there is a case for believing this to be desirable in an open society
Perhaps the true scandal today is that while we are preoccupied with at best questionable claims about the efficiency savings the NHS will have to make in the next few years and improbable projections of the costs of diabetes and dementia in future decades, what may in reality be being cut is already low spending on long term social care for the minority of older people who have lost their independent living abilities
Pharmaceuticals in the 21st century
• We have already changed the links between conditions such as T2 diabetes and mortality. But 20th century drug innovations will be used to significantly better effect in the 21st century
• 21st century pharmaceutical innovations will foster not only ‘personalised medicine’, but better mass protection against conditions currently prevalent in later life. This may impact on HLE more than overall LE
Female life expectancy, England 1975-2005
Actuarial risks and uncertainties (?)
• Calculating future LEs and HLEs, and understanding the determinants of working life expectancy
• Evaluating the risks associated with disability and long term care insurance provision, and contributing to the design of sustainable products and policies
• Factoring in the effects of ongoing bio-pharmaceutical innovation on health and the human ageing process, nationally and globally
Conclusions
• Continuing population ageing will challenge all communities in the next century. But it will not in itself present unaffordable barriers to the future provision of good quality health and social care, or increased general prosperity
• We need to leave behind ambiguous, needlessly negative, attitudes towards both population ageing and the use of medicines in modern societies
• Pharmacists and all other established health sector stakeholders could help introduce appropriate ways of serving older communities more (cost) effectively than is currently possible
Dr Jennifer Gill and I are grateful to Alliance Boots for the company’s financial and other support for our work, and to ILC-UK colleagues for their contributions to its dissemination
Tricia KennerleyGroup Healthcare Public Affairs Director
Alliance Boots
Martin GreenChief Executive
English Community Care Association
Panel Debate and Q&A
This event is kindly supported by Alliance Boots
#responsiblehealth
• What are and should be the philosophical and political underpinnings of public health policy?
• Are we in danger of unravelling the principle tenets of the Beveridge model welfare state in ways which may not only disadvantage the most vulnerable, but may in time increase financial pressures on other sectors of society?
• How do we determine the boundaries of personal and societal level responsibility, and the legitimate as opposed to illegitimate need for publicly funded care and support?
• What is the role of the wider health community such as pharmacies and employers in promoting the healthy living agenda?
• How can we ensure the white paper on social care responds to the challenge of greater life expectancy and delivers a social care system which provides high quality care and support for all?
• How can we ensure a life course approach to active ageing and living longer?
Panel Debate and Q&A
Economics of promoting personal responsibility for improved public
health – saving costs or costing society?
25 April 2012
This event is kindly supported by Alliance Boots
#responsiblehealth