RCGP Severn Faculty discuss ageing and sustainability

For the first blog in our sustainability series, I had the pleasure of meeting Charles Musselwhite (Professor of Gerontology). We had a conversation about policy, health, and climate. I am excited to share my takeaways.

The UK Climate Change Risk Assessment from 2021 for health and social care summarises why there is a convergence of these topics and the necessity to consider policy and its implications. “Health Inequalities mean that the health risks from climate change are not evenly distributed. Adaptation planning needs to consider who benefits and who is potentially disadvantaged by specific measures”.

Health inequality

Age is well documented as an example of a health inequality in society, and older people could be vulnerable to extremes of weather. It is then necessary to consider the implications of the policy discourses of successful ageing and ageing in place, whereby older people might be required to make individual, sustainability driven, personally financed choices to try and limit this potential inequity.

One example is home improvement - making eco-friendly changes to your home requires financial investment which could cost thousands of pounds.

The environmental efficiency vs affordability trade-off has so far meant that the most change has been seen in:

• developed countries
• urban environments
• middle- and upper-class households.

One of the critiques of successful ageing, that I think is widely applicable, is that people with the least resources are expected to change the most.

Sustainability relating to healthcare providers

The second topic that I want to discuss is how sustainability relates to how we engage with healthcare providers and the buildings themselves. Aside from turning off the lights, how we approach clinical treatment can have an impact. Teleconsultations are becoming more popular in primary care. However, it is important to understand how this might impact older people.

There is so much heterogeneity amongst older people, and it would be wrong to assume that all older people do not want to access health electronically. What is more important is to identify the barriers and incorporate older people in the design of e-health technology. How can we strike a balance between the function of a GP in the community, assisting patients in staying connected, and the role of a GP in a whole-person approach that prioritises sustainability? It’s a question I don’t have the answer to, and needs a lot of thinking, planning and research.

Getting it right first time

Another challenging question came up when I started thinking about the “getting it right first time” agenda. In a Utopian world there would be only necessary tests, prescribing, and hospital admissions.

This would have a massive impact on the care of older people and improve sustainability. But this ignores the complexity and multimorbidity of our patients, the social and economic issues that are so intertwined with patients’ health and the issues that are dealt with in frontline primary care.

Access

Finally, I am going to talk about access. How older people interact with the built environment, whether that be in rural or urban areas, is a big policy area. And sustainability in ageing populations within these fields is a crucial consideration. One example being the Bristol 15-minute neighbourhood ambition. This idea is proposed to improve both social and economic outcomes by increasing the time people spend in their local area.

The benefits for older people therefore seem self-evident, but it is important to cast a critical eye over a catchy title for a frankly enormous ambition. A fundamental issue is that one person’s 15 minutes is not the same as another’s, and a catch-up call is not viable in any age group. There is also the argument that because something is available, doesn’t mean it will or can be used/ accessed.

There is a potential to deepen inequalities with ambitions like this, as the reality of the system benefiting those who are already able to access and interact with the built environment in this way. The people who might be precluded from the ideals of successful and healthy ageing might be left behind.

About the writer

Dr Eve Barnes is a Severn F2 who contributes to the Severn Faculty blogs. This blog is part of a series Eve is writing about sustainability. We'd be interested in hearing your opinions on anything we've covered on the blog on Twitter: @SevernFacultyGP, @eve_barnes, @charliemuss.