This week I had the pleasure of attending the first Uppsala Health Summit in the beautiful University City of Uppsala in Sweden. The theme of the conference was ageing and health and I was invited to speak on behalf of the Fit for Work Europe Coalition.
The event, hosted by the University of Uppsala, was first addressed by Mr Ulf Kristersson, Sweden’s Minister for Social Security who presented some compelling data about demographics in Sweden. Among other things, he explained that the data on ageing among the Swedish population also masked a significant reduction in inequality in life expectancy. While an inequality gap still exists Sweden has succeeded in reducing some of the negative impact of the main social determinants of ill-health.
Later in the day I presented as part of a panel session on the use of technology, diagnostics and screening to improve health outcomes for older people. My focus was on the need to regard early diagnosis and early intervention for musculoskeletal disorders (MSDs) as an investment rather than a cost, especially if the outcomes had a wider societal value (such as the ability to remain in work). I used the example of narrow policy and financial silos which, in the case of rheumatoid arthritis in the UK, the economic case for NHS investment in early treatment was made very forcibly by the National Audit Office (NAO) back in 2009. Despite this, the NHS has not prioritised early intervention, thereby forgoing the threefold return on investment in labour productivity which the NAO economic model predicted. One participant at the conference likened this example to the annual debate in Sweden about the cost of gritting roads and pavements. Local authorities are under pressure to minimise the cost of gritting, but the health system then has to bear the cost of older Swedes suffering injuries, fractures and trauma from slips and falls on icy surfaces. As the delegate concluded, the evidence that gritting is cost-effective is clear, but politicians choose to pursue short-term savings instead of doing ‘the right thing’.
I argued that the judicious use of diagnostic technologies and medical interventions which can help older workers with chronic conditions to remain active and at work – especially if this was good quality work – would enhance the health of individuals and improve workforce productivity. In addition, I reminded delegates that a high proportion (up to 65%) of working age people with MSDs are the main income earner in their household and that having to leave the labour market prematurely as a result of poor health can have dire financial consequences for individuals and their families. My plea to the conference was to ensure that healthcare decision-makers routinely consider that remaining in work might be a clinically and socially desirable outcome for older patients and that, as we all have to work longer and retire later, this consideration will become a necessity rather than an optional extra.
In many ways, the resolution to this dilemma lies in being clear about both who pays for these interventions and who stands to benefit. As we heard at our Fit for Work Summit in October 2013, it is possible for different parts of the system (eg Health & Social Security) to share both the costs and the benefits of joined-up interventions rather than just opting for the cheapest, short-term option. As one delegate suggested, our politicians have a democratic mandate to make common-sense decisions where spending leads to savings. It is a shame, he reflected, that so few have the political bravery to put these principles into practice – especially as so many stand to benefit.