Better Health For All

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.

FOOTNOTES

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.