Life and Death in the 21st Century

Interviewer: Lucy Vernall (Project Director, Ideas Lab)
Guest:  Professor Jean McHale
Recorded: 14/09/2011
Broadcast: 26/09/2011

Intro VO: Welcome to the Ideas Lab Predictor Podcast from the University of Birmingham. In each edition we hear from an expert in a different field, who gives us insider information on key trends, upcoming events, and what they think the near future holds.

Lucy: Today we’re joined by Professor Jean McHale who is Professor of Health Care Law at Birmingham University. Welcome, Jean.

Jean: Hello.

Lucy: And you are one of the Commission Academic Directors for the Commission on Healthy Ageing in the 21st century for which there’s a debate later on today at the Labour Party  Conference.

Jean:  Yes, there is indeed. The debate that’s going to be held at one of the fringe events of the Labour Party Conference today is on healthy ageing in the 21st century, a question of individual rights, state responsibility or something we simply we can’t afford.

Lucy: So the debate is to kick off the commission which is going to report kind of this time next year.

Jean: It is indeed, yes, yes. We’ve got a multi-disciplinary team that’s going to look at questions around healthy ageing and actually at the debate itself we’ve got a range of people representing different perspectives including somebody from Age UK, Mervyn Kohler, and also from the British Geriatrics Society, Finbarr Martin, to try and sort of kick around and spark some interest in the issues that the commission itself are going to sort of address over the next year.

Lucy: And it’s being chaired by Professor Adam Tickell who’s the Pro-Vice-Chancellor here at Birmingham University.

Jean: Yes, that’s right.

Lucy: So anyone lucky enough to be going along to the Labour Party Conference today will be able to go along to the debate. Ageing is something – or our ageing population - is something that feels like it’s been on the cards for a long time. We’ve talked about it and thought about it a lot and yet it feels like we haven’t really moved on in terms of, I suppose, policy and in terms of research.

Jean: In many ways that’s right and I think the whole question really of are we really going to live forever and the implications of ageing is something which you’re right, although the media has grabbed it and in the social care area perhaps it’s been addressed more than in health generally, a lot of the debates have been around perhaps the questions of death and dying and end of life decision making in that way, but what we want to do is pan out beyond that and look at expectations of a good life itself, a good death and indeed a good age.

Lucy: So over 2012 you’re going to be hearing representations from different experts to explore the issues around this. What exactly are you going to be looking at?

Jean: We’re going to look at what actually is good ageing really and what is a good death, how do we actually frame the sorts of ideas around age and indeed about being old or being elderly and of course flowing from that there are policy implications, there are also political implications too – who should pick up the tab for this?  And of course, what about questions of rights and indeed responsibilities? Where I think we came from in terms of establishing this was very much in terms of people aren’t being viewed as ‘old’ and certainly not from our perspective as such, but as ‘ageing’ and what are those challenges?  Something else I think the commission is very very interested in taking forward is the fact that we’re working today, providing healthcare delivery in what is a very rich, multicultural society. Birmingham is a great city for focusing upon and taking this sort of research forward and what those sort of challenges that we need to address in that context and what we want to do is work together with the healthcare professions and also, we hope, representatives from patient groups as well, trying to tease out the questions for healthy ageing in a multicultural society itself and by that as well, how much are we looking at questions of culture and questions of faith and belief in a multicultural society.  I mean our fourth question too and the issues that came up very much and where we want to go to with the debates as well are, you know, is that life and more life, whatever the quality anyway, better than death itself and what are perhaps some of the ethical tensions around life that might be tremendously extended, not just three score years and ten but far more people are passing the hundred mark today and what are the changing healthcare needs of the ageing population in developed countries?

Lucy: Because the point is that our life expectancy has extended dramatically over the past century but the years of healthy life that we have hasn’t really kept pace with that. We live longer but we have a longer period of ill-health before we die.  

Jean: Absolutely. And medical technology itself has to work round those sorts of challenges and one of the really interesting things as well is that a lot of the debate in recent years has been around patient choice, patient expectations, in relation to the scope and delivery of healthcare have changed so much and of course part of that is due to the fantastic developments of new medical technology, but of course all this costs and it goes straight into the heart of the rationing debate as to who should be entitled to healthcare resources, what resources and have you ever had your innings in effect for the purposes of the NHS in getting those sort of resources as well?

Lucy: It feels like there’s very much kind of two bands of people in this plus-65 population so there’s the healthy younger end who seem to be quite vocal, they’re quite political, they vote, they volunteer, they can stand up for themselves and then there’s the plus-85 age group who are much more likely to suffer ill-health, to be more frail, to have less representation and maybe suffer the thinner end of the wedge.

Jean:  Perhaps, certainly.  I mean one of the questions of issues that we have to consider is the issue of visibility of people once they reach a certain age and whether ageing itself renders you invisible in modern day society and how we address those questions.  It links to the broader equality debate but it also links to that question of voice and indeed of challenge as well.

Lucy: I think the issue that you raised about multiculturalism is a really interesting one.  That seems to be part of the debate that’s not yet been had at all, in that we focus on this kind of baby boomer generation retiring and it seems like diversity and multiculturalism is something that happens to young people and it’s not something that we really look at when we get to older age in this country.

Jean:  Certainly it doesn’t seem this debate has been explored and at least nowhere near as extensively as it needs to be and one of the very interesting things as well within a multicultural society is the danger of labelling groups within it as having certain perspectives, both in relation to living and indeed in relation to dying too and this is something that we actually want to try and explore during the policy commission: different perspectives in relation to ageing, different perspectives too that may arise within groups that appear on the face of it to be a particular sector of the community but when you actually disaggregate those views within a particular community, they may be very different indeed. How much is being driven by faith? How much is being driven by culture? Or indeed how much is being driven by community and other issues in relation to the UK itself?

Lucy: So we should beware of thinking about ‘oh, this is what people from the Asian sub-continent want’ or ‘this is what Muslims want and need in healthcare’. It’s not going to be that simple, we need to keep complexity in mind.

Jean:  Absolutely, no question.  But we also need to have that dialogue, an ongoing dialogue as well and recognise and try and ensure that this is a real dialogue rather than being seen to tick the boxes that we’ve consulted particular groups and therefore something is OK. Perhaps it’s a way in which we need to frame broader agendas as to the way we actually develop health policy itself too in the community.

Lucy: One thing’s for sure, this is not going to go away and it’s going to affect all of us. I think the estimated cost of health services for a person aged over 85 is three times that of the cost of somebody between 65 and 74 and both those age groups are increasing in number and we’re going to have to deal with that.  So how can people find your event later on today?

Jean: Well, we’re going to be in the Exhibition Meeting Room 2 at 12.30 today at the ACC in Liverpool.

Lucy: So that’s 12.30 till 2 today, Monday 26th September.

Jean:  That’s right.

Lucy: I hope it goes very well and we look forward to hearing the results of the commission in about a year’s time.  Professor Jean McHale, thank you.

Jean: Thanks very much.

Outro VO: This podcast and others in the series are available on the Ideas Lab website: On the website, you can find out how to e-mail us with comments, questions or suggestions for future topics for the podcast. There's also information on the free support Ideas Lab has to offer to TV and radio producers, new media producers and journalists. The interviewer for the Ideas Lab Predictor Podcast was Lucy Vernall, and the producer was Andy Tootell.