Dame Sally Davies reports on the health of Baby Boomers: and it’s pretty shocking stuff

The Chief Medical Officer of England has released a report into the health of Baby Boomers. This is the group of people born between 1945 and 1965. I’m one of them, maybe you are too.

We are living longer but are not really in better health. A huge burden of cardiovascular disease and cancers would be reduced if we looked after ourselves better by not smoking, eating better, keeping slim,  exercising, and drinking less.

Obesity and diabetes are increasing markedly through all classes of society. Obesity, particularly central obesity, is increasing. By waist size alone 80% of us are obese!

Liver cancer is now making an impact on deaths. 

Diseases that don’t kill but make you unfit to work and miserable include musculo-skeletal problems, visual and hearing loss. These are having a considerable effect.

Smoking is reducing but more than 6 out of ten smokers say that they have NEVER been advised to stop smoking by a doctor or nurse in their entire lives. Dame Sally thinks this is shocking. I think these smokers have shockingly bad memories.

Men are drinking less than 20 years ago but women are drinking more. The new guideline is less than 14 units a week for everyone.

One thing we are doing less of is physical activity and exercise. This is down from even just ten years ago with two thirds of Baby Boomers doing less than 30 minutes of exercise in the last month.

 

Here is a large chunk of the report:

Physical health

A key finding is that whilst life expectancy in 2013 increased compared with that of men and women in the same age group in 1990, overall morbidity remained unchanged. This means that we live longer but our health and well-being has not actually improved.

The data report substantially decreased death rates from each of the leading causes of disease in both male and female adults aged 50–69 years in 2013 compared with people who were in the same age group in 1990. These declines in mortality are success stories.

In particular, mortality rates from ischaemic heart disease (IHD) fell by over three- quarters in 50–70 year-olds during this time. Nevertheless, the fact that it still remains the leading cause of mortality in this age group is indicative of another issue; the leading risk factors for premature mortality in this group are IHD risk factors that are all modifiable, the top three being smoking, poor diet and high body mass index. The cancer types (oesophageal cancer in men, uterine cancer and liver cancer) that thwart the downward trend in premature mortality from cancer also have associations with modifiable risk factors such as alcohol and obesity.

In terms of morbidity, risk factors responsible for a remarkable 45% of disease burden in 50–69 year-olds in 2013 were again modifiable, with the leading three risks for both men and women being poor diet, tobacco consumption and high body mass index (BMI). The implication of this is huge: a large proportion of the disease burden in Baby Boomers is amenable to prevention.

Perhaps most striking is the case of diabetes. Morbidity from diabetes rose by 97% among men and 57% among women aged 50–69 years between 1990 and 2013. Although this definition includes both type 1 and type 2 diabetes, the attributable risk from factors including obesity, diet and low physical activity rose by 70%. There is a deprivation inequality in diabetes, as there is with all the leading causes of morbidity and indeed life expectancy. However, with diabetes the gap is decreasing, showing that this is an increasing problem regardless of social stratum. Interestingly, compared with tobacco consumption, which is strongly socially stratified, body mass index is now less socially stratified in terms of the size of the attributable burden of risk factors. These data suggest that it is extremely important that we strive to reduce inequalities in the health of Baby Boomers. In addition, weight and obesity must be addressed across the board.

Despite the fact that tobacco consumption in adults overall is decreasing, it remains an important risk factor in this group, remaining the leading risk factor for premature mortality and the second leading cause of total disease burden. Socioeconomic inequalities in tobacco consumption and related illnesses are well recognised and exemplified in this group. However, an additional inequality is the fact that the decline in premature mortality from lung cancer in women is less than half that in men.

Several issues highlighted in my previous surveillance reports hold true for Baby Boomers. My concerns, as Chief Medical Officer, about the increase in premature mortality in England due to liver disease in England (compared with mortality figures for our European counterparts) have been echoed by the trend in premature mortality from liver cancer in this age group. My calls for more robust systems for surveillance of high burden diseases, such as musculoskeletal disease, and sensory (visual and hearing) impairment, which impact more on quality of life and productivity than on premature mortality, are strengthened. Sensory impairment is the second highest cause of morbidity in this age group in men and the fifth in women. Yet needs are likely to be unmet, given the considerably lower prevalence of hearing aid use compared with the estimated prevalence of objective hearing loss. Musculoskeletal disease has again been highlighted as having a lack of high-quality routine information at a national level. However, we do know that the burden is high, demonstrated by the tripling in the rate of elective admissions for back pain and primary knee replacement in 50–70 year old adults between 1995/96 and 2013/14.

Datasets on oral health are also limited. While the improved oral health of Baby Boomers compared with that of their predecessors is a considerable triumph, it is important that we have sufficient data to inform the provision of services given that, counterintuitively, this success may mean that demand increases.

Annual Report of the Chief Medical Officer 2015, On the State of the Public’s Health, Baby Boomers: Fit for the Future

Chapter 1

Lifestyle factors

The authors of Chapter 5 analyse data concerning Baby Boomers generated from the Health Survey for England 2013 and the English Longitudinal Study of Ageing (ELSA, 2012/13), a wealth of information on adults over 50 years of age. They analyse key factors affecting health such as smoking, alcohol, diet, physical activity and obesity, all of which are modifiable.

Baby Boomers had lower rates of smoking than those of the same age 20 years previously. The extent of the difference between the rates increases with age within the cohort. This is despite data from the physical health chapter which identify tobacco consumption as a leading cause of both mortality and morbidity in Baby Boomers. I find it shocking that, by this stage in their lives, in current and ex-smokers, 66% of baby boomer men and 71% of baby boomer women have never been recommended to stop smoking by a doctor or nurse. There is an unquestionable need for adequate support for smokers trying to quit and this questions whether services are targeting and reaching those who require them. Continued provision of Stop Smoking services is vital. A sustained decrease in the prevalence of smoking risks underestimating the needs of the baby boomer population for these services. They have lived through the height of the tobacco era and continue to experience substantial ill-effects from it. Locally appropriate services are also essential to reduce the resounding socio-economic inequalities and the geographical variation evident in smoking prevalence among Baby Boomers.

The UK Chief Medical Officers published new guidelines on low risk drinking in August 2016. For both men and women the guideline is that to keep health risks from alcohol to a low level it is safest not to drink regularly more than 14 units a week and that for those who drink as much as 14 units per week it is best to spread this evenly over three days or more, and that several drink-free days in the week aid cutting intake. Although in terms of units per week, baby boomer men were drinking less than those in the same age group 20 years earlier, the proportion of men now drinking on five days a week increased with age, with the highest rate of 30% in 65–69 year-olds. Whilst still within the guidance for low risk drinking it is of concern to me that, on average, baby boomer women reported drinking more than women of the same age 20 years previously, with a maximum difference of 3 units per week (from, on average, 4.5 units per week in 1993 to 7.5 units in 2012-13) in women aged 60-64 years

Given the increase in obesity rates seen in recent years, it is of little surprise that overweight and obesity levels were significantly increased in Baby Boomers compared with adults of the same age 20 years earlier. The authors found that nearly half of baby boomer men and over a third of baby boomer women were overweight. Around a startling 75% of men and 80% of women were classified as centrally obese if raised waist circumference (defined as 102cm in men and 88cm in women), a risk factor for diabetes, was used instead of BMI (with 77% of men and 83% of women being classified as obese by 65–69 years of age using this criterion). These statistics are staggering. If these adults are to reduce their current risk and maintain their health through older age, it is critical that this is addressed. I have previously expressed my concern regarding the ‘normalisation’ of overweight and obesity, referring to the increasing difficulty in discerning what is normal from abnormal due to the fact that being either above a healthy weight or obese is now so commonplace. The fact that 1 in five men and nearly half of women classified as having a ‘normal’ BMI were in fact found to be centrally obese is extremely concerning, and underlines the importance of promoting awareness of metabolic risk factors such as increased waist circumference, in addition to BMI.

The UK Chief Medical Officers’ guidelines on physical activity recommend that adults participate in 150 minutes of moderate intensity, aerobic, physical activity every week . Physical activity was found to be low among Baby Boomers. Not only did the authors find that people in their 50s were less active than those of the same age 10 years earlier, they also found that two-thirds of all Baby Boomers in their sample had undertaken no physical activity lasting more than 30 minutes in the past month. Significant geographical, socio-economic and ethnic inequalities exist in physical activity. I was surprised, for instance, to find that rates of inactivity were as high as 80% in Gateshead and Stoke on Trent. Physical activity has benefits in terms of cardiovascular health, mobility, weight management and even cognition. Clearly, this age group could benefit greatly from optimising physical activity levels to maximise their health both currently and in impending ‘older age’.

Lifestyle of older adults in England

Physical activity and weight

1 in 3 OF THOSE AGED 50-70 ARE OBESE according to BMI and this is much worse if you rely on waist circumference.

 

18% women and 19% of men smoke

65-70% who are smokers/ex smokers have never been asked to stop smoking by a doctor or nurse (so they say!)

 

65.6%    of Baby Boomers have not engaged in any moderate physical activity lasting 30 minutes or longer in the  past month

Amongst 50-60 year olds: Men are drinking  approx. 4-5 units a week less than 20 years earlier Women are drinking approx. 2 units a week more than 20 years earlier