Editorial Post Reproductive Health 2015, Vol. 21(4) 135–136 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2053369115619137 prh.sagepub.com

Editorial: Health Gaps Tony Mander BMI Highfield Hospital, Rochdale, UK

The concept of disability-free life expectancy is of fundamental importance.1,2 The variation in disability-free life expectancy between individuals can be up to 28 years and may well be widening. Individual onset of disability can vary from the age of 55, before retirement, to 85 depending on wellrecognised social factors, education, geographical location. The better the education, the longer the lifespan, and the later the onset of disability. This means that higher quality education results in increased longevity and a delayed onset of disability by a factor of seven years. The longer the education the wider this gap. Well-established health-related factors are associated with the onset of disability: Smoking, alcohol abuse, chronic illness and nutritional imbalances. The importance of exercise in childhood is also very poorly understood, for example one in 10 females aged 20 will have osteopenia, partly due to lack of exercise. Why do children not exercise? Again social factors come into play. Sensationalist images and stories reinforced by the popular media of young children abducted, abused or murdered in the past create over-anxious parents who often keep their children at home. So many children are taken to school by their parents every day because of fear of harm. In fact the risk of harm is no more than it ever was 50 or a hundred years ago; indeed, if most children walked to school every day, streets would be safer, the exercise itself being beneficial to the children. Environmental consequences of the school run, in terms of traffic, CO2 consumption are obvious. In subsequent life whilst these children may have healthy strategies to help avoid osteoporosis, they may on the other hand maintain unhealthy habits such as, not exercising, smoking, high alcohol intake and poor dietary habits. In these cases the onset of disability could be much sooner – perhaps up to 20 years earlier. It is clear that the extent of disability-free life is highly dependent on a number of recognised social, educational and health care factors. It is important that those involved in healthcare and especially in making policy are aware of these factors and implement them in public health plans. It is also important that

individual doctors are trained and able to recognise the importance of these policies, and are able to advise and counsel patients and their families in how to stay healthy and disability free. Advice on the menopause and post-reproductive health is important in reducing disability, and enhancing disability -free life expectancy. The recent study by Wilkinson et al.3 illustrates that there is a clear need for commissioned menopause services and education. As well as the Health Gap1 there is an Education Gap3 amongst healthcare professionals around providing advice in these areas; indeed, the gap extends to all areas related to enhancing this disability-free life expectancy. The NICE guidelines on the menopause,4 if fully implemented, should have a positive effect on health care. It is important that the effects of these recommendations are measured. Outcome analysis should especially focus on the known factors involved in generating disability, so that we can measure the effect of avoiding or preventing the onset of disability and its consequent impact on disability-free life expectancy. Will the well-recognised social economic and educational differences be maintained, with, for example, the use of hormone replacement therapy? Will social recommendations have any effect? The recommendations of the British Menopause Society to the coalition government appeared to have been unfortunately ignored.5 Indeed the actions in stopping free swimming for those over 65 have been widely regarded as a backward step. There is a blind spot within the healthcare profession regarding the recognition and timely management of sarcopenia (age-related loss of muscle mass) and its consequences. Sarcopenia is barely mentioned in most medical textbooks and its importance in causing disability is seemingly invisible to most healthcare professionals. Recent evidence suggests sarcopenia had a 2–3 times risk of having a low trauma bone fracture within three years in healthy 65 year olds.

Corresponding author: Tony Mander, BMI Highfield Hospital, Rochdale, OL11 3RB, UK Email: [email protected]

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The reason the very elderly walk with a doddery gait is not so much ‘‘thin bones’’ (osteoporosis) as ‘‘thin muscles’’ (sarcopenia). When the NHS was conceived and began in 1948 there was a philosophy that as people became healthier the demands on the service and the cost would reduce. This did not happen for a variety of reasons. These include new and expensive treatments and medicines, newly discovered illnesses and frequently stated increased life expectancy. However, if the life expectancy is disability free, then the cost should be much less, though widening ‘‘Gaps’’ between social groups must be resolved. If poor, or rather ineffectual, health strategies lead to disability, then costs will increase for healthcare and for other benefits. The founding NHS philosophy of reducing disability, improving health, and reducing cost still holds true.

References 1. Marmot M. The health gap. London: Bloomsbury Publishing, 2015. 2. Mander T. Longevity and healthy ageing – will healthcare be drowned by the grey tsunami or sunk by the demographic iceberg? Post Reprod Health 2014; 20: 8–10. 3. Wilkinson JF, Short HL, Wilkinson S, et al. Commissioning for menopause specialist services: a local perspective: an internet-based survey to assess the potential demand for menopause care in West Cheshire and the skills of local primary care clinicians in this field, with a view to informing future commissioning locally. Post Reprod Health 2015; 21: 98–104. 4. NICE. Guidelines. Menopause: diagnosis and management. London: NICE, 2015. 5. BMS Council modernizing the NHS: observations and recommendations from the British Menopause Society. Menopause Int 2011; 00: 1–3. DOI: 10.1258/ mi.2011.011015.

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Editorial: Health Gaps.

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