Archive for April, 2023

Independent Review of the State Pension Age 2022, Baroness Neville-Rolfe DBE, CMG, published March 2023 for presentation to Parliament in May 2023.

The Independent Review1 proved to be a rubber stamping exercise, with a bit of fiddling at the margins.  It recommends that: (1) the State Pension Age should continue to be tied to life expectancy2; (2) the increase in the State Pension Age to age 67 years, as planned, should go ahead during the years 2026-2028; and the further increase to 68 years should be moved to 2041-2043, three years earlier than currently legislated; 2046-48 is suggested for the move to 69 years. 

All of which leaves Public Health with a number of challenges:

Prevention:  To the effect of an extended working life on those already in poor health will be added the futility of Workfare’s hostile medical scrutiny, conditionality (proof of looking for work) and sanctioning (cuts to benefits that are already below the State Pension and far below older people’s extremely conservative Minimum Income for Healthy Living). 

Inequalities:  The health effects of the policy will be amplified for those who have had the hardest lives, including many employed in Key and Essential occupations whose everyday heroism kept the rest of us alive during the recent Covid-19 pandemic lockdowns. 

Medical care:  Informal, unpaid caring and volunteering will suffer at a time when the need for them is increasing and family finances will be reduced where the withdrawal of grandparent care of grandchildren no longer allows parents to take paid employment; with predictable consequences for an already stretched Primary Care service.   

Population science:  Disability-Free Life Expectancy (DFLE) is more appropriate than life expectancy, as the measure to guide changes in the State Pension Age, because the ability to continue in paid employment at older ages requires more than simply being alive; the physical and mental capacity to work is also necessary.    Nevertheless, the use of DFLE is rejected by the Review, perhaps because it is falling (p.55, Table 5), not increasing, so cannot be used to justify further increases in the State Pension Age and, in contrast, would suggest reducing it.   

Having done their duty by HM Treasury, the Review cautiously addresses some of these Public Health challenges, impressed one suspects by the near unanimity of views collected by their diligent research. 

  • Further work is required into the difficulties faced by informal, unpaid carers (p.8, Wider Considerations, paragraph 1), although these are already well established – perhaps the Review was asking for a consensus on the best solutions.      
  • Explore the possibility of early access to State Pension for those who have worked in physically challenging jobs for many years (p.8, Wider Considerations, paragraph 4; also p.81, Recommendations, paragraphs 206 & 207), with a brief discussion of possible actuarial qualifying criteria.     

In summary, State Pension Age policy will continue to be a cause of concern for Public Health, made more complex by the changing nature of work, which draws attention to the potential benefits of closer collaboration between the Faculties of Public Health and Occupational Medicine. 

David Blane, Professor Emeritus of Imperial College London.


  1. The full report can be downloaded from the Department for Work and Pensions website; the reference details in the present blog refer to this full report. 
  2. Rather confusingly, there are two very different things called life expectancy: period life expectancy which is calculated from death rates and cohort life expectancy which is the best guess of a panel of experts.  The Review does not say what assumptions were used by the Government Actuary’s expert panel to produce their cohort life expectancy prophesies, but it is reasonable to wonder whether climate change and its unexpectedly rapid acceleration was considered; and whether the almost inevitable next global pandemic was included.                             

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Dr. Alexander Woodman and Dr. Besher Al Attar at Saudi Center for Organ Transplantation and King Salman Center for Kidney Diseases

Organ donation is an act of mercy, benevolence, altruism, and love for humanity. Since the application of bioethical principles is an integral part of the decision-making process associated with organ donation, knowledge, personal attitudes, social structure, cultural practices about organ donation are essential factors influencing people’s decisions. Consequently, one of the primary responsibilities of healthcare providers is to understand and inform patients, donors, and recipients about what principles support the proposed decision to donate or receive organs. It is equally important to respect the ethical rules followed in each region, country, and ethnic group. 

Saudi medical students and organ donation 

Organ donation is an integral part of medical ethics in Saudi Arabia, which follows the Islamic bioethics, a system of moral assessment designed to identify, analyze and address ethical issues that arise in medical practice and research, based on Islamic moral and legislative sources.

The development of organ donation laws and legislation has been accompanied by numerous social, legal, and ethical debates. The general public of Saudi Arabia is usually skeptical about such a development in science and tends to show significant ambivalence in their attitude. These notions prompted Dr. Alexander Woodman and his colleagues to explore the knowledge, attitudes, and behaviours in relation to organ donation and transplantation among medical students as future healthcare providers. The study conducted in the Eastern Province of the Kingdom resulted in a number of emerging patterns that are essential to be shared with the global community of health science and educators.

The most thought-provoking findings related to knowledge, with less than a third of medical students having adequate knowledge, with the source of knowledge being mostly social media or television. Essentially, the fifth and sixth-year students had higher average knowledge scores. This pattern was truly emerging since the comparison showed that earlier studies resulted in better knowledge among Saudi medical students. Does this mean that the new generation is less interested in organ donation and transplantation? To answer “yes” to this question would be an imprecise undertaking and too persuasive a statement since the patterns of attitude were quite opposite.

The majority of students had a positive attitude towards organ donation and transplantation, with the reasons for organ/tissue donation being mainly helping others (88.8%) and empathy (59.8%). At the same time, attitudes vary depending on specific socio-demographic factors such as gender, age, and educational level. Thus, women had more positive attitudes compared to men, with younger participants (18-20 years old) being more positive compared to 27-29 years old. The latter had a particular emerging pattern, showing that while more experienced students (year of study) had better knowledge, their attitudes were less positive. 

The correlation between knowledge-attitude, knowledge-practice, and attitude-practice in this study contradicted the relationship between knowledge-attitude and practice. Does this study allow to conclude that insufficient knowledge can lead to a positive attitude and better knowledge to a negative one? To answer this question, a health education campaign should be carried out among healthcare providers, students, and the general public to address the gap between the knowledge-attitude-practice of organ donation and transplantation.

The findings of research have been published in Transplantation Proceedings, ELSEVIER publishing and can be found at https://authors.elsevier.com/a/1fZJ~9MbWadC~.

Dr. Alexander Woodman and Dr. Besher Al Attar

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