In this webinar, members of the informal MISPA group highlighted some of the unintended consequences for public health due to the legislated increases to the State Pension Age. Such consequences will impact the NHS, occupational health, social care, the voluntary sector, and older people themselves. Preparing for these impacts can help mitigate them, and the necessity of such preparation is underscored by the current COVID-19 crisis.

1. Public health and policy reform:
Mitigating Increases in the State
Pension Age (MISPA)
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2. What is ILC?
ILC is the UK’s specialist think tank on the impact of longevity on
society and what happens next. We:
• Are independent and politically neutral
• Use evidence-based research for policy
• Work collaboratively to pioneer solutions for the future
Our work focuses on three strategic priorities:
• Maximising the benefits of longevity
• Ensuring longer lives are good for everyone
• Future-proofing policy and practice
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3. Partners Programme
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4. Welcome and
introduction
Dr Brian Beach, Senior Research Fellow, ILC
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5. Members of the MISPA group
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Prof Melanie Bartley, Professor Emerita, University College London (UCL)
Dr Brian Beach, Senior Research Fellow, ILC
Prof David Blane, Professor Emeritus, Imperial College London
Dr Jenny Lisle, Fellow, UK Faculty of Public Health
Dr Claire Mawditt, Research Fellow, Canon Foundation Europe
Dr Jessica Sheringham, Senior Research Fellow, UCL, & HonoraryConsultant in
Public Health, Public Health England

6. Prof David Blane
Professor Emeritus, Imperial College London
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7. Possible public health implications of raising the
State Pension Age and how to mitigate them.
MISPA (Mitigating Increases in State Pension Age)
International Longevity Centre Webinar 14th May 2020.
MISPA is an informal grouping of specialists in public health who are concerned about the
possible unintended consequences for health & health services of raising the state
pension age and wish to contribute to discussions of how to mitigate these.

8. Background.
• UK Parliament increased State Pension Age by eight years for
women and three years for men, to both reach 66 years by
2020, 67 years by 2027 & 68 years by 2038, during which
period there will be many changes in the nature of work.
• Parliament has not reviewed the issue since March 2017,
during which time: new consensus life expectancy flat-lining;
new findings bad work physiologically hazardous; coronavirus
challenge <68 work normally >70 shield (high risk).

9. Unintended consequence 1:
Worsening the health of those already ill
A significant minority of people already work beyond the State Pension Age; these tend
to be healthier and wealthier than their peers and to enjoy their work. Legislation to
increase the state pension age adds an element of compulsion to what previously had
been a personal choice.
We estimate that raising the state pension age to 66 years will add annually some
760,000 older women & men to the workforce, of whom 10 per cent (76,000) will
report one or more limiting longstanding illnesses that may be worsened by an
extended working life.
Mitigation: The health risks of extended working need to be medically supervised and
the benefits of retirement for those in poor health recognised.

10. Unintended consequence 2:
Overwhelming sparse occupational health services and new demands on
primary care
Occupational health services remain outside the National Health Service. Only a minority of
the UK workforce has access to them, mainly those employed by large companies with their
own in-house facilities & staff. The majority of the UK workforce does not have access to an
occupational health nurse or physician because they are employees of small or medium sized
enterprises (SMEs) which lack such facilities. The proportion of SMEs providing occupational
health support could be as low as six per cent, with those employees on low incomes in areas
of widespread job insecurity at highest risk. As a result much of the medical supervision will
come from primary medical care.
Mitigation: Evidence-based triage criteria need to be identified in order for the occupational
health services and primary medical care services to meet this challenge.

11. Unintended consequence 3:
Worsening the crisis in social care through loss of informal
carers
Formal social care services already are under-staffed in relation to the number of
dependent older people and in future they are likely to rely increasingly on informal
carers, who may also be supplying the child care that allows their younger relatives to
take paid employment. Older people who combine such informal caring with their
own fulltime or part-time employment may be forced to choose between these socially
productive activities. A large proportion of those facing this dilemma are the women
who now are expected to remain in paid employment for an additional eight years.
Mitigation: Older employees who also act as informal carers require flexible hours of
work to accommodate fluctuation in the chronic diseases of those for whom they care.

12. Unintended consequence 4:
Damaging the NHS and charity sector through loss of volunteers
Volunteers support NHS hospital employees, in a ratio of up to one volunteer to six
paid workers, and also staff the many disease-specific patient support groups. Many
charities relevant to public health are also dependent on volunteers (Citizens’ Advice
Bureaux giving access to health-related benefits; AgeUK delivering meals-on-wheels &
luncheon clubs; RSPB providing access to nature). Like informal carers, such volunteers
may be forced to choose which socially productive activity to abandon: paid
employment or volunteering.
Mitigation: Certified volunteering should be recognised by the Department for Work &
Pensions as a legitimate alternative to continuing in paid employment.

13. Unintended consequence 5:
Increasing the mortality rate of those employed in the most demanding
occupations
The final challenge to the policy of raising the State Pension Age comes from research
which suggests the policy itself could be contributing to the flat-lining of life
expectancy. In the Work History Italian Panel-Health Study, each additional year of
paid employment at older ages increased by two per cent the risk of hospitalisation for
heart attack or stroke, with this relationship confined to those employed in the most
disadvantaged occupations.
Mitigation: This finding needs to be tested for replication (or not) in other data sets.

14. Recommendations
We have identified two fairly straightforward strands of mitigation: commissioning research and fine-
tuning administrative regulations.
Research may be required to establish (a) evidence-based triage criteria to guide occupational health
services - and where these are sparse or non-existent, general medical practitioner services - in deciding
which older employees are most at risk; and (b) whether extending working lives will increase the
mortality rate of older employees in the most disadvantaged occupations.
Administrative regulations may need to be made more flexible in the age range 65-68 years to
accommodate patterns of relapse & remission in chronic diseases and to accept that paid employment
is not the only type of socially productive activity at these ages.
From a public health perspective: pending identification of evidence-based triage criteria, interim
guidance can be based on the probability that any health-damaging effects of raising the state pension
age will be most prevalent among those who spent their working lives in the most disadvantaged
occupations. These are the employees about whom the occupational health services should be most
vigilant and, where such services are scarce or absent, the patients about whom primary care should be
most concerned.

15. Dr Claire Mawditt
Research Fellow, Canon Foundation Europe
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16. https://www.waspi.co.uk/

19. Dr Jessica Sheringham
Senior Research Fellow, University College
London, & Honorary Consultant in Public Health,
Public Health England
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20. Department of Applied Health Research
Department of Applied Health Research
Implications for public health
in the context of the coronavirus
Unknowns
1. Worsening the health of those already ill
2. Impact on carers/informal care
3. Potential to affect strategies for mitigation:
20

21. Department of Applied Health Research
Department of Applied Health Research
Implications for public health
in the context of the coronavirus
Unknowns
1. Worsening the health of those already ill
 Those in lower skilled occupations at greatest risk of COVID
2. Impact on social care through loss of carers
3. Potential to affect strategies for mitigation:
21

22. Department of Applied Health Research
Department of Applied Health Research
Implications for public health
in the context of the coronavirus
Unknowns
1. Worsening the health of those already ill
2. Impact on carers/informal care
 COVID may increase prevalence of long-term conditions:
 Directly e.g. long term damage to lungs
 Indirectly, through lockdown leading to health service disruptions,
constraints on ability to adopt healthy behaviours e.g. sedentary lifestyles
3. Potential to affect strategies for mitigation
22

23. Department of Applied Health Research
Department of Applied Health Research
Implications for public health
in the context of the coronavirus
Unknowns
1. Worsening the health of those already ill
2. Impact on carers/informal care
3. Potential to affect strategies for mitigation:
 Lessen ability to negotiate changes to working conditions for
older workers given workforce insecurity vs…
 Increase urgency to maintain healthy workforce
23

24. Prof Melanie Bartley
Professor Emerita, University College London
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25. Q&A
Please submit your questions to panellists via
the Q&A tab
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26. Closing remarks and close
Dr Brian Beach, Senior Research Fellow, ILC
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27. Work with us
Business intelligence: we’ll give you advance notice of our latest research,
ad hoc briefings on areas of specific interest to your organisation, as well as a
discount on any research you commission from us.
Networks and connections: our Partners events have included visits to
Number 10, briefings with prominent influencers, as well as the opportunity to
meet ministers, policy experts and fellow Partners.
Brand benefits: as a Partner your brand will be visible through our numerous
events, press releases and presentations, and give you the opportunity to be
positioned at the heart of the debate on longevity.
For more information contact
Redvers Lee: redverslee@ilcuk.org.uk

28. Future of Ageing 2020:
Together for tomorrow – Delivering a
better society for all generations
Date: Thursday, 3 December 2020
Time: 9.00am (for 9.30am) - 5.30pm
Location: Wellcome Collection, 183 Euston
Road, NW1 2BE
Make the most of our early bird rate.
Register at: futureofageing.org.uk
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29. Thank you
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futureofageing.org.uk
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