State Pension Age – where are we now?

The UK Parliament has increased the State Pension Age by eight years for women and three years for men, to both reach 66 years by 2020, 67 years by 2027 and 68 years by 2038. We estimate that raising the State Pension Age to 66 years will have added some 760,000 older women and men to the workforce, of whom 76,000 or more will report at least one limiting long-standing illness. Although the numbers are rough and ready estimates, they show this issue affects many of our fellow citizens.

The possible public health implications of these increases in the State Pension Age include:

1. Worsening the health of those already ill (the GAZEL Study found those in poor health improved after retirement).
2. Overwhelming sparse Occupational Health services and adding new demands on Primary Care (most UK workers do not have access to an occupational nurse or physician; in small & medium size companies the proportion could be as low as six per cent).
3. Worsening the crisis in Social Care through loss of informal/unpaid carers (one-in-five of those over 50 are carers, with the need for them predicted to increase).
4. Damaging the NHS and Voluntary Sector through loss of volunteers (volunteers support the NHS, in a ratio of up to one volunteer to six paid workers, and sustain many disease-specific patient support groups).
5. Increasing the mortality rate of those employed in the most demanding occupations (the WHIP-Health Study found 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).

Each of these items is described in greater detail in the MISPA 2020 Report.

The Government’s response

The UK Parliament last debated these issues in 2017. Since then, several new research findings have become available. First, a consensus is forming among actuaries and demographers that the rate of increase in life expectancy is slowing, perhaps to a halt, and that this flat-line may endure for some time. Second, epidemiological evidence is increasingly questioning the assumption that any job is better than no job, with the balance of opinion shifting towards recognition that the health benefits of work are limited to good jobs that offer self-respect and autonomy. Finally, there is near unanimity that any future increase in the State Pension Age should be tied to a more appropriate measure than the previously used life expectancy (you can be alive without being able to work) or the version of healthy life expectancy that involves self-assessed health (disease can be asymptomatic); disability-free life expectancy probably is the best bet.

MISPA’s 2020 Report suggested ways of mitigating these threats to public health within the current legislation. Our recommendations are of two types. First, two strands of research:

1. Identification of evidence-based triage criteria to guide occupational health and general practice in deciding which older employees are most at risk from working longer; in terms of our estimates, how to identify the 76,000 with limiting long-standing illnesses among the additional 760,000 who each year will remain in the workforce. 
2. Replication, or not, of the finding that extending working lives will increase the mortality rate of older employees in the most disadvantaged occupations.

The second type of recommendation involves administrative regulations, which may need to:

1. Be more flexible in the age range 65-68 years to accommodate patterns of relapse and remission in chronic diseases.
2. Accept that paid employment is not the only type of socially necessary work at these ages.
3. Grant exemption from workfare’s conditionality (fitness for work testing) and sanctioning (loss of benefits).

Conclusion

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. Although it is ironic that these are disproportionately the workers officially categorised as essential or key during the Covid-19 pandemic lockdown, they 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.

About MISPA

MISPA (Mitigating Increases in State Pension Age) is an informal grouping of specialists in public health who are concerned about the possible unintended consequences for health and health services of raising the state pension age and wish to contribute to discussions of how to mitigate these.