Professor John Middleton gave a keynote speech on the public health challenges for healthcare systems in aging societies. He argued for a public health approach that focuses on healthy aging, including creating healthy environments, strong communities, social prescribing, and reorienting health and social care services around prevention. Some challenges he discussed were addressing lifestyle factors like exercise, shaping attitudes through social prescribing, and adapting public health teaching for new issues and partnerships. The overall goal is to help people stay active and independent for as long as possible.

1. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public
health challenges for healthcare
systems in ageing societies
Professor John Middleton
Honorary Professor of Public Health, Wolverhampton University,
President, Association of Schools of Public Health in the European Region
John Middleton

2. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Sir Richard Doll,
picture at
University of
Oxford Cancer
Epidemiology Unit
Richard Doll
Building

3. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

4. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

5. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

6. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

7. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

8. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

9. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
All-cause mortality, ages 45–54 for US White non-Hispanics (USW), US Hispanics (USH), and six
comparison countries: France (FRA), Germany (GER), the United Kingdom (UK), Canada (CAN),
Australia (AUS), and Sweden (SWE).
Anne Case, and Angus Deaton PNAS 2015;112:49:15078-
15083
©2015 by National Academy of Sciences
The diseases of
despair

10. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Mortality by cause, white non-Hispanics ages 45–54.
Anne Case, and Angus Deaton PNAS 2015;112:49:15078-
15083
©2015 by National Academy of Sciences
The diseases of
despair

11. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
About Sandwell
 Located in the Black
Country
 High levels of deprivation
 Inequalities in health
 Multi-cultural community
 Six distinct towns

12. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Six Towns in the West Midlands of
England Known as Sandwell

13. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

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Healthy Ageing
KEY-NOTE SPEAKER

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Healthy Ageing
KEY-NOTE SPEAKER

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Healthy Ageing
KEY-NOTE SPEAKER

17. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
The Triplex
foundary Tipton is
now …

18. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
The New
leisure
centre for
Tipton

19. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
The
‘Elephant
rock of
Hamstead
colliery slag
heap is
now….

20. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Sandwell Valley,
King George Playing
fields and RSPB
bird sanctuary

21. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

22. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
John Middleton

23. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

24. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
John Middleton

25. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
A Public health approach to healthy ageing
Good data to describe health of older people, to propose solutions
and evaluated interventions
Knowledge of major causes of ill health dependency and inequality
A thorough understanding of the major causes of ill health – its social
origins in poor environments, poor housing, low income, unrewarding
work and poor chances for a fulfilling life and leisure
Understanding of the assets which people survive because of, and live
by, and the support they get
And advocacy for healthy public policy to secure these

26. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
A Public health approach to healthy ageing
Healthy environments
Accessible cities
Dementia friendly cities
Safer cities
Healthy cities

27. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

28. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
John Middleton
Breda,Holland,
awarded Access
City 2019

29. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Recent Access City Awards
Warsaw, Poland
Breda, Holland
Lyon, France
Milan,Italy
Avila, Spain
Salzburg,Austria
Berlin, Germany
Gothenburg, Sweden

30. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Access and tourism/leisure
Nantes, France
Sicily, Italy
Barcelona, Spain
Melbourne,Australia
Llubliana, Slovenia
Chester,England

31. Better Future of
Healthy Ageing
KEY-NOTE SPEAKERHousing and health
Repairs on prescription
Affordable warmth

32. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
32
Birmingham
Sandwell /
Urban Living
Smart
housing
manifesto
2004

33. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
A box plot of the
Baseline SAP
measures for the
Sandwell MBC
housing stock,
1st April 2001, by
housing type,
n=25,595 dwellings

34. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
A box plot of the
Baseline SAP
measures for the
Sandwell MBC
housing stock,
31st March 2011,
by housing type,
n=25,595
dwellings

35. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

36. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
i- House, demonstration
house West Bromwich 2008

37. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
A Public health approach to healthy ageing
Strong community development
Citizen led activities
Support to enable communities to lead – for governance and services
Resources for health and for ‘optimal ageing’
Inter-generational activities
Social prescribing – for better or worse ?!

38. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Asset based public health
Community assets
For example:
Libraries, leisure centres, open spaces for
leisure and cultivation

39. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

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Healthy Ageing
KEY-NOTE SPEAKER

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Healthy Ageing
KEY-NOTE SPEAKER

42. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Asset based community
development:
Salop drive Community
agriculture project, Sandwell

43. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

44. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

45. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Agewell-Sandwell 2013

46. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Agewell Sandwell 2020
A community interest
company representing
local older people, an
advocate and service
provider for older
people

47. Better Future of
Healthy Ageing
KEY-NOTE SPEAKERPeople as ‘assets for health
improvement for
themselves and their
communities’ not
‘problems to be treated’

48. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Social prescribing
More appropriate care

49. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Sandwell
welfare rights
services

50. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

51. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Social prescribing
Complementary care

52. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

53. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

54. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

55. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
A Public health approach to healthy ageing
Supporting personal resourcefulness for health
Health information and education
Health literacy
Health on the net
Microtechnologies for health and independence

56. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Addressing ‘lifestyle issues’ in meaningful ways
Keeping people mobile and active for as long as possible
delaying and avoiding frail states
Gentle exercise routines
Joe Wicks- ‘Body coach’ UK lockdown hero
Muir Gray‘ Dr Gray’s Walking cure’ and ‘Activity therapy:
preventing or delaying the need for social care’ and ‘Sod 50, 60,
70’

57. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

58. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
https://www.ukactive.com/wp-
content/uploads/2018/05/The_
Miracle_Cure_2017.pdf

59. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

60. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Joe Wicks
‘The Body
Coach’
And now
‘lockdown
hero’

61. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Social prescribing : shaping attitudes
and behaviours?
People given skills by their
involvement:
 CPR training certificates?
 Practical knowledge to share with
their communities?
 Better references for jobs?
 Training qualifications?

62. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
Social prescribing : shaping attitudes
and behaviours?
People entitled to gain from ‘the health
dividend’
Corporate citizenship in commissioning and
providing health and care
Local economic impact assessment

63. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
A Public health approach to healthy ageing
Reorienting health and social care services
Needs led
Person centred
Involves individuals and their carer indecisions about their care
Geared to prevention and early intervention- ‘can do, not must do’
Community supported
In clinical and social care, value-based intervention
Critically appraised health and care services through clinical audit and evaluation
and research where answers not known
Co-production of health

64. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton

65. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
National Health
and Social Care
Systems ?
‘universal health care’
but including care as well
?

66. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
End of life care
Compassionate
communities
approach
End-of-life care
beyond palliative
care boundaries,
describing a public
health vision that
involves whole
communities
adopting a
compassionate
approach to dying,
death and loss.

67. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER

68. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
• The new Midland Metropolitan hospital
• Opening 2022 – corporate citizenship offers of local construction
employment, low carbon footprint, local health service employment,
key worker housing and relocation of services to community

69. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Saving lives with Solar’ Royal
North Midlands Hospitals,
Stoke.

70. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Challenges for public health teaching and learning
‘ISIS, crop failure and no antibiotics’
Mobilising a wider public understanding and desire for public health
Speaking new languages and building new partnerships:
international lawyers, poltical scientists, climate scientists,
ecologists, theologians
Surrendering expertise? Co-production of the public’s health
Challenging fake news and populism
Harnessing social media and new communications
Re-asserting our values

71. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Law, ethics, rights, values
(LERV!)
Restating and reasserting our values -
Respect, dignity, compassion, autonomy of individuals, equality and
fairness, solidarity
And respecting and valueing people who work with older people

72. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Towards outcomes, and a people and planet focus
Health is to disease
As
Independence is to care
As
Access is to transport
As
Safety is to policing
As
Sustainability is to environmental protection

73. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
John Middleton
UK Faculty of Public Health
#publichealthlookslike’ photo
campaign 2018-2019
Audrey and Nana by Andrew Turner
© Andrew Turner and FPH
Audrey and
Nana
by Andrew
Turner

74. Better Future of
Healthy Ageing
KEY-NOTE SPEAKER
‘Dying young as old as possible’? public health challenges for healthcare
systems in ageing societies: John Middleton, June 4th 2020
John Middleton
Thank you
Professor John Middleton,
University of Wolverhampton
University of Chester,
Immediate Past President, United Kingdom
Faculty of Public Health
John.middleton@aspher.org