Whither human survival and longevity or the shape of things to come

With the continuing increases in life expectancy, populations are ageing rapidly. Governments are concerned for the future of pensions and health care for which population forecasts are an important component for planning purposes. In this paper we focus on human survival rather than mortality rates which are the more usual starting point when estimating future populations. Using a simple model we link basic measures of life expectancy to the shape of the human survival function and consider its various forms. We then use the simple model as the basis for investigating actual survival in England and Wales from 1841 onwards and investigate the concept of a ‘maximum age’. We show how the model can be used in a predictive sense and demonstrate in two tests that show our model would have given more accurate results than comparable government forecasts using the same base information. We then go on to show that, based on trends in life expectancy, official population forecasts could undershoot the population at age 50+ by 0.6m, with consequent financial implications for pensions, health and social care

The 100-year family Longer lives, fewer children

This paper investigates how the role and resilience of the family in the UK has changed over time, and explores how it is coming under increasing pressure from external demographic and economic forces. We investigate these effects using a novel approach based on survivorship. We also propose a new way to define ‘family,’ using a framework flexible enough to model a range of family structures and situations: by centring analysis on the ‘focal woman.’ Survivorship is the probability of living to a given age (see section 2 for more detail); we take this data from the UK Office for National Statistics (ONS) life tables for England and Wales. These are constructed using mortality data and are available from the mid-nineteenth century onwards. We construct the joint survivorship of typical families based on the number of births. We also employ novel ‘family accounting’ methods to quantify and analyse the potential overlapping of care responsibilities that face today’s families. Our work is informed by the effects of two broad transitions, widely recognised by demographers as occurring across many societies: The first is the progression from high to low mortality and from high to low fertility rates (the average number of children born to each woman in any given population). These two changes combine to produce a surge in population and economic growth, accompanied by rapid increases in life expectancy. In the UK this period lasted from around the mid-nineteenth to the mid-twentieth century or later. The nature of the second transition is not universally accepted among demographers, but broadly it refers to the societal changes in any given population that have taken place since the 1970s; these include changes in family structures, and a shift towards women choosing to have fewer children, later in life. The arrival of protected rights and wider access to education for women during this period have been key factors in driving these shifts. We posit that the economic benefits of the first transition are in danger of being reversed by the second, and that our social, political and economic structures are not aligned to support the families in which we now live. We explore this possibility through analysis of family structures in a context of increasingly stretched welfare systems, widening inequalities and ageing populations. This context raises questions: Whether our population can continue to replace itself given that families are having fewer children, later in life: our analysis indicates that, at a family level, our increased longevity does not offset the decline in fertility rates. How to address the additional strain on our underfunded social, health and state pension systems, with more older people living alone, and a greater need within today’s smaller, older families for external support. How to address the likelihood that the tendency towards older families leads to each family’s main carer being responsible for multiple generations at once. Whether the additional burdens of juggling work and caring responsibilities will have a further stagnating effect on the wider economy. How to address the inheritance gap that delays the passing of wealth to the next generation as we all live longer. We believe that society must adjust itself to the new reality, by taking steps to move into a third transition. This will require action to enable more of us to spend our additional years in good health and in decent housing, with the capacity to undertake paid work, to care for our families, or to do both. We suggest that as part of this transition there may be a need for: Reformulated personal financial services to address the current gaps in provision at the family level. A new approach to social protection that focuses on families as well as individuals. Our analysis shows that the changes occurring during the second transition have put society on a demographic escalator to economic stagnation, and that matters can only get worse. We believe it will take conscious action by the UK’s decision-makers to make a third transition reality and step off the escalator

Using queuing theory to analyse completion times in accident and emergency departments in the light of the government 4-hour target

This paper uses a queuing model to evaluate completion times in accident and emergency (A&E) departments in the light of the Government target of completing and discharging 98% of patients inside 4 hours. It illustrates how flows though an A&E can be very accurately represented as a queuing process, how the outputs of a queuing model can be used to visualise and interpret the 4-hour hours Government target in a simple way and how queuing models can be used to assess the practical achievability of A&E targets in the future. The paper finds that A&E targets have resulted in significant improvements in completion times and thus deal with a major source of complaint by users of the National Health Service. It finds that whilst some of this improvement is attributable to better management, some is also due to the way some patients in A&E are designated and therefore counted. It finds for example that the current target would not have been possible without some form of patient re-designation or re-labelling taking place. Further it finds that the current target is so demanding that the integrity of reported performance is open to question and that a different approach is needed. Related incentives and demand management issues resulting from this Government target are also briefly discussed

Gender convergence in human survival and the postponement of death

It has been a long accepted demographic maxim that females outlive males. Using data for England and Wales, we show that life expectancy at age 30 is converging and continuation of this long-term trend suggests it could reach parity in 2030. Key among the reasons identified for the narrowing of the gap are differences in smoking prevalence between males and females which have narrowed considerably. Using data from 30 comparator countries gender differences in smoking prevalence are found to explain over 75% of the variance in the life expectancy gap, but other factors such as female emancipation and better health care are also considered. The paper presents a model which considers differences in male and female longevity in greater detail using novel methods for analysing life tables. It considers the ages from which death is being postponed to the ages at which people now die; the relative speed at which these changes are taking place between genders; how the changes observed are affecting survival prospects at different ages up to 2030. It finds that as life expectancy continues to rise there is evidence for convergence in the oldest ages to which either gender will live

The decomposition of disease and disability life expectancies in England 1992-2004

ISBN 978-1-905752-23-2 www.cass.city.ac.uk "This paper originated in an independent report for the Department of Health. Any opinions expressed in this paper are my/our own and not necessarily those of my/our employer or anyone else I/we have discussed them with. In particular, the views expressed may not necessarily reflect the views or policies of the Department of Health. You must not copy this paper or quote it without my/our permission"

In sickness and in Health? Dynamics of health and cohabitation in the United Kingdom

The purpose of this paper is to analyse the dynamics of cohabitation and functional impairments among older people. Our research has three main aims. Firstly, we want to analyse the effects of cohabitation on disability. Secondly, we want to study time trends in disability and cohabitation jointly to explore relationships between the two. Thirdly, we examine socioeconomic differences -- as captured by educational attainment -- in disability. These issues are of great interest from several points of view. Firstly, they address an emerging theoretical debate concerning the effects of cohabitation on health and contribute to a sparse empirical literature on the topic. Secondly, our findings are highly policy relevant. Concerning long-term care for older people, for example, cohabitation is of double importance: firstly, since people who cohabit tend to be healthier, and secondly, since a partner is the typical provider of informal care. In a time where family structures among the old are likely to change (due to changes in life expectancy and divorce rates), our research will be useful for planning purposes. Finally, the model can be used to simulate populations of certain characteristics. Hence, it can be used to derive insurance premiums in order to reduce the problem of selection effects in the market for long-term care insurance. Using the British Household Panel Survey dataset, we apply panel data and simulation techniques to exploit the longitudinal characteristic of the panel. We estimate the two dependent variables -- cohabitation status and disability -- jointly, and allow for time trends, age effects and unobserved heterogeneity. We find that there are systematic differences between single and cohabiting people so that a cross sectional analysis would overestimate the causal relationship; nevertheless, cohabitation has a strong and positive effect on health. Furthermore, we find that bereavement of a partner has a significant negative impact on health

Investigating the market potential for customised long term care insurance products

Previous economic research into long-term care (LTC) has mainly been focussed on one issue: the reasons why the LTC insurance market has not been successful. In this contribution, we analyse the prospects for a new type of insurance policy, which offers a top-up on the resources already available to the individual. We abstract from most problems inherent in LTC insurance markets and derive premium rates for various types of insurance policies. Generally, we find that the top-up option reduces premium rates considerably, to the point where it might be expected that a substantial number of people would take up policies, were they available

Shifts in hexapod diversification and what Haldane could have said

Data on species richness and taxon age are assembled for the extant hexapod orders (insects and their six-legged relatives). Coupled with estimates of phylogenetic relatedness, and simple statistical null models, these data are used to locate where, on the hexapod tree, significant changes in the rate of cladogenesis (speciation-minus-extinction rate) have occurred. Significant differences are found between many successive pairs of sister taxa near the base of the hexapod tree, all of which are attributable to a shift in diversification rate after the origin of the Neoptera (insects with wing flexion) and before the origin of the Holometabola (insects with complete metamorphosis). No other shifts are identifiable amongst supraordinal taxa. Whilst the Coleoptera have probably diversified faster than either of their putative sister lineages, they do not stand out relative to other closely related clades. These results suggest that any Creator had a fondness for a much more inclusive clade than the Coleoptera, definitely as large as the Eumetabola (Holometabola plus bugs and their relatives), and possibly as large as the entire Neoptera. Simultaneous, hence probable causative events are discussed, of which the origin of wing flexion has been the focus of much attention

A jam-jar model of life expectancy and limits to life

Age at death will increasingly cluster in the 90s and the life expectancy of men and women will converge, according to a study by academics from Cass Business School in partnership with the ILC-UK. Over the coming decades, men in particular will live longer, increasing the need for the country to face the challenges of an ageing society. Based on historical mortality data from England and Wales, the researchers developed a new method for forecasting life expectancy – the results will be beneficial to individuals, government policy makers, pension providers and insurers as the new forecasts provide more certainty with which to plan. One of great success stories in the United Kingdom is that people are living longer and men’s life expectancy is catching up with women’s. Male life expectancy at birth is now almost 80 years, having advanced 14 years since 1950 thanks to reductions in smoking, a decline in hazardous occupations, better health care and higher standards of living. This success presents the country with a huge economic opportunity if these extra years are spent in prosperity and good health, but significant economic danger if they are not. Realising the full potential of older citizens of the United Kingdom will be central to the Government’s response to changing economic circumstances and the drive to build a strong, fair economy for the twenty-first century. However, the challenges posed by an ageing society come at a cost in terms of pensions, higher health and social care costs and infrastructural change. Professor Mayhew and co-author David Smith used a pioneering new mathematical technique known as decomposition - or the 'jam-jar model' - to produce contributions to life expectancy for each 10 year age band (e.g. 70 to 80). The method provides more certainty over which age groups are experiencing significant gains and more accurate information about possible limits to life expectancy. Talking about the model, Professor Mayhew said: “Each decade of retired life can be imagined as a jam-jar which if filled to the brim with life years would give a maximum of 10 years. As each jam-jar approaches the brim, extra life years are transmitted to the next decade of life in a predictable wave-like fashion until all are full.” To illustrate this, in 1950, when male life expectancy at 60 in England and Wales was 15 years, the contribution from the decade of life between 80 and 90 was only 9.1% of the total. By 2009, when life expectancy was 22 years, this decade of life contributed 18.5

The UK Equity Bank - Towards income security in old age

A brief for ILC-UK on the role for an equity bank in providing secure income for retirement. With shrinking pension pots and longer life expectancy, retirement incomes look set to come under increasing pressure unless alternative sources of income become available. The UK Equity Bank would allow people to exchange a fixed proportion of the equity in their home for a lifetime income linked to inflation. Providing people with a secure income by unlocking the equity in housing assets could improve standards of living for the benefit of the people themselves, the local community and society as a whole. This paper was launched at a breakfast meeting in the House of Lords on Thursday 12th June. Speakers included Professor Les Mayhew, co-author of the paper, Nick Kirwan of the ILC-UK and Paul Burstow MP, former Social Care Minister