The Preventive Health Revolution: Insights from the 2024 Annual Lecture

Professor Scott asserted that this demographic shift is a significant change in our reality – but with the right approach to developing institutions that make life not just longer, but also healthier, we can see an aging society as a transformative opportunity, rather than a problem to be solved.

THE LONGEVITY IMPERATIVE

Professor Scott reminded us that the existing narrative of an aging society underestimates the capacity of older people, and therefore the capacity of our own later years. As a result, we don’t invest in changing that narrative – and as a society, we therefore fear aging and what we imagine will be the consequent loss of our health, wealth, relationships and sense of purpose and engagement.

However, this doesn’t have to be the case. Professor Scott argued that a paradigm shift towards an evergreen economy could allow us to achieve a three dimensional longevity dividend: where we live healthier, more productive and more engaged lives for longer. Since a majority of us are now expected to surpass the age of 70, across the world, it is therefore imperative that we invest in a longevity society.

MACROECONOMIC GAINS FROM PREVENTION

The data shows that more than 50% of the gains in life expectancy are being driven by declines in mortality after the age of 70. However, it also shows that we live more of our later years in ill health – as the scholar Eileen Crimmins put it, we have slowed down the dying process, and now we must slow down the aging process. Prevention is a key component of that.

Aging-related illnesses currently form the largest component of the global burden of disease, and especially so in developed countries. The impact of us living in ill health for longer has significant costs to the economy. The data shows that the value of health gains is falling substantially, due to the fact that people are less healthy and therefore less productive later in life.

Historical comparisons

Source: Scott, Ashwin, Ellison and Sinclair “International Gains to Achieving Healthy Longevity”, Cold
Spring Harbour (2023)

Professor Scott shared the key findings from a paper he co-authored on the economic value of targeting aging: primarily, that if gains to life are spent in deteriorating health, the value of these extra years of life is diminishing. It is therefore more important to ensure that healthspan equals lifesplan than to seek further gains in life expectancy, both for individual wellbeing and for broader society. Professor Scott’s research found that in the United States, one more year of healthy life expectancy is worth $51 trillion, or about 3-4% of GDP every year.

In the UK, we have very low GDP growth and nearly 3 million people out of work due to ill health. The evidence shows that in high income countries, health increasingly has first order macroeconomic effects.

Population Structure and Work-Limiting Health

Source: UN World Population Prospects 2022 & ONS Labour Force Survey

Recent research co-authored by Professor Scott shows that if the instance of six chronic diseases was lowered by 20%, we would see a 1.14% increase in GDP after 5 years. The research also shows that these diseases skew towards lower income deciles – so tackling prevention not just improves GDP but has the added benefit of reducing health inequalities. He therefore concludes that in an aging society, we need to start thinking more critically about the link between health and GDP.

Cumulative Change in GDP due to 20% Reduction in NCDs

Source: Schindler and Scott (2024) “The Macroeconomic Impact of Chronic Disease on the UK Economy”

WHAT NEXT? SHIFTING HOW WE THINK ABOUT HEALTH

Professor Scott reminded us that most of what determines health – from the air we breathe to the food we eat – falls outside the remit of the healthcare system, and that’s a crucial factor to consider in a world where we must necessarily focus on prevention, not just intervention. This also means that emphasizing prevention will not lead to governments spending less: we will necessarily have to spend the same, or more, to keep us well and not just to treat us when we’re ill.

The lecture urged audiences to consider how we measure health, beyond just disease. Professor Scott proposed a framework of resilience to measure health, considering one’s intrinsic capacity to think and move in ways that are useful to your own individual context. If we don’t measure health, he warned, we will continue to have health systems that don’t deliver good health outcomes.

He proposed that in a world where we all live much longer, healthy life expectancy should be a key measure of government success – and as part of that, the state pension age should be a reflection of healthy life expectancy and not just life expectancy.

CONCLUSION

We have already surpassed the first longevity revolution, where now most of us can expect to live longer. Fewer children die in infancy. More of our grandparents meet their grandchildren. Fewer of us encounter death in middle age. That, Professor Scott said, is an incredible position for us to be in. The question that faces us now is how we reckon with the second longevity revolution: living better and healthier lives, not just longer ones.

Professor Scott concluded by reminding us that aging is malleable. There are things we could be doing ourselves to age better. Our health systems can, and should, focus on aging better, to benefit not just ourselves, but the economy and society as a whole.