An ageing population increases pressure on health and social care, welfare payments and pensions in public funded systems. There is no simple measure linking population health to economic disadvantage or the resulting tax burden. We imagine a situation in which local areas are responsible for financing their own public services. We hypothesize a local tax is levied to cover healthcare costs, welfare benefits for those who are sick, and pensions. We partition the costs based on years spent in ill health, disability and pensionable years over the life course using the average costs per person per year for each. We argue that area differences in tax rates provide a summary measure of inequality since a higher tax burden would fall on areas least able to afford it. We show that a one year improvement in healthy life expectancy would add 4.5 months to life expectancy (LE) and 3.4 months to working lives whilst reducing taxes by around 0.5%. We cast doubt on the target to increase health expectancy by five years by 2035; however, were it to be achieved it would add 23 months to LE, 17 months to work expectancy and reduce taxes by 2.4%.

A healthy diet and regular physical activity (PA) are delineated as healthy behaviours. Their implementation is associated with better health outcomes and improved quality of life. There is less evidence of a relationship between dietary patterns (DP) and PA, especially in adults aged ≥ 85. Hence, this cross-sectional study investigates the association between DP and PA in people of this age group, using the data from The Kawasaki Aging and Well-Being Project. Brief-type self-administered diet history questionnaire was used to estimate the intake of fifty-eight types of food. After energy adjustment, principal component analysis was performed to identify DP. PA was measured objectively using an accelerometer and subjectively using a questionnaire validated for this age group. Thousand participants (median age: 86·9 years, men: 49·9 %) were included in the analysis. Three major DP (DP1 ‘various foods’, DP2 ‘red meats and coffee’, DP3 ‘bread and processed meats’) were identified. DP1 ‘various foods’ was similar to DP previously named ‘healthy’ or ‘prudent’ and showed a positive association with PA time (PAT) as measured by accelerometer (B, 6·25; 95 % CI 0·13, 12·37) and relatively shorter sedentary behaviour (SB) time. DP2 ‘red meats and coffee’ and DP3 ‘bread and processed meats’ were negatively associated with PAT and positively associated with SB time. This study observed the relationship between diet and PA behaviours in adults aged ≥ 85, with healthier and more food-diverse DP associated with longer PAT and relatively unhealthy DP with shorter PAT.

Already home to 23% of the global elderly population, China will experience further demographic change in the coming decades. To address the consequences of population ageing, the Chinese government is implementing major social insurance reforms and promotes the development of private insurance markets. We aim to inform these initiatives by developing a new method to project healthy life expectancy (HLE) in different regions. HLE is an important population health measure which is increasingly used in the actuarial literature. Our new approach relies on publicly available data from the Global Burden of Disease Study for life expectancy and HLE for 139 countries. We use the model to estimate HLE at birth in 2015 for 31 province-level regions in China for both males and females. We discuss the implications of our results for planned increases in the retirement age in China and for long-term care insurance pricing.

Rapid population ageing in China has urged the need to understand health transitions of older Chinese to assist the development of social security programmes and financial products aimed at funding long-term care. In this paper, we develop a new flexible approach to modelling health transitions in a multi-state Markov model that allows for age effects, time trends and age-time interactions. The model is implemented in the generalised linear modelling framework. We apply the model to evaluate health transitions of Chinese elderly using individual-level panel data from the Chinese Longitudinal Healthy Longevity Survey for the period 1998–2012. Our results confirm that time trends and age–time interactions are important factors explaining health transitions in addition to the more commonly used age effects. We document that differences in disability and mortality rates continue to persist between urban and rural older Chinese. We also compute life expectancies and healthy life expectancies based on the proposed model as inputs for the development of aged care and financial services for older Chinese.

There is conflicting evidence for the effect of BMI on mortality at older ages, and little information on its effect on healthy life expectancy (HLE). Longitudinal data were from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health (n 11 119), over 18 years of follow-up. Self-rated health status was measured at each survey, and BMI was measured at baseline. Multi-state models were fitted to estimate the effect of BMI on total life expectancy (TLE) and HLE. Compared with women of normal weight, overweight women at the age of 75 years had similar TLE but fewer years healthy (−0·79; 95 % CI −1·21, −0·37) and more years unhealthy (0·99; 95 % CI 0·56, 1·42). Obese women at the age of 75 years lived fewer years in total than normal-weight women (−1·09; 95 % CI −1·77, −0·41), and had more unhealthy years (1·46; 95 % CI 0·97, 1·95 years). Underweight women had the lowest TLE and the fewest years of healthy life. Women should aim to enter old age at a normal weight and in good health, as the slight benefit on mortality of being overweight is offset by spending fewer years healthy. All outcomes were better for those who began in good health. The relationship between weight and HLE has important implications for nutrition for older people, particularly maintenance of lean body mass and prevention of obesity. The benefit of weight loss in obese older women remains unclear, but we support the recommendation that weight-loss advice be individualised, as any benefits may not outweigh the risks in healthy obese older adults.

Australian providers of aged care are facing a rapidly ageing population and growth in demand for services. Beyond a sheer increase in consumers and major regulatory changes from Federal Government, many customers are becoming progressively discontented with a medically dominated model of care provision. This period of turbulence presents an opportunity for new entrants and forward-thinking organisations to disrupt the market by designing a more compelling value offering. Under this line of inquiry, the researchers conducted a qualitative content analysis study of over 37 Australian aged care organisations, clustering providers into six business model typologies. The study revealed that providers of aged care are becoming increasingly aware of emerging customer needs, and, in addressing these needs, are seeking to establish innovative models of care provision. This paper therefore presents a future model of care, along with implications for practice and policy.

Ageing is going to be a major problem in Bangladesh given its population size, scarce resources, existing poverty, insufficient health facilities and lack of a social security system. This paper examines how many years older people expect to be in good health, and what are the correlates of self-rated health (SRH). The data used in this study come from 896 older people aged 60 years and above from Rajshahi district in Bangladesh and from United Nations’ projected population figures. Results show that individuals at age 60 expected about 41 per cent of their remaining life to be in good health, while individuals at age 80 expected only 21 per cent of their remaining life to be in good health. Having exercised during the six months prior to the survey was the single most important correlate of SRH (odds ratio=5.49; confidence interval 4.03–7.47; without any adjustment). While rural–urban differentials and some health decline in old age are inevitable, four factors (exercise behaviour, sufficiency of income, physical limitations and facing abusive behaviour) are to a certain extent modifiable and therefore provide the potential for improving SRH and healthy life expectancy in Rajshahi district, Bangladesh.

This Presidential Address is delivered towards the end of the 150th anniversary year of the Faculty of Actuaries, and is timed to coincide with the International Actuarial Association and Groupe Consultatif holding meetings in Edinburgh. It deals with the growing globalisation of the Profession, reviews the key developments arising out of the Morris Review and the implications of current changes. It then moves on to examine communication and the role the Profession can play with the media. A comparison between actuarial practice in life and pensions follows, with suggestions for a closer alignment between pension expectation and pension reality. Comment is made about the prospects for healthy life expectancy. Finally, the relationship between the Faculty and the Institute of Actuaries is debated, and a consultation with Faculty members is launched.

This paper develops a multiple state model to project the number of people with disabilities in the United Kingdom over the next 35 years, thereby identifying implications for demand for long-term care for the elderly in the future.

The model requires three types of data: prevalence rate data, transition rate data and trends data. Recent trends in healthy life expectancy data are used to frame the assumptions made regarding changes in the disability rates of the U.K. population in the future.

Although there will be a large increase in the number of elderly people in the U.K. over the next 35 years, the projections suggest that the implications for the number of elderly people requiring long-term care could be ameliorated by a reduction in the proportion of older people who are severely disabled.