 Good afternoon everybody and welcome to our second CLSA Webinar of 2017. We're going to get started at 12 noon and we want to make sure that we have as much time possible for questions after this webinar. My name is Ina Woben. I'm the managing director of the CLSA and I will facilitate and moderate the webinar today. For some of you who have not attended the webinar before after the webinar and the presentation you can type your questions in the chat function and I will present those questions to the speaker at the end to provide answers to your question and if there are multiple questions in advance my apologies if we can't get to all of them but we will follow up on all your questions after the webinar if they're not addressed. So with this I want to introduce Dr. James Nasru who will be speaking today. James is a professor of sociology and the director of the Center of Dynamics of Ethnicity and co-director of the Manchester Institute for Collaborative Research on Aging at the University of Manchester. He is the principal investigator of the FRAIL program an interdisciplinary study of inequalities in later life and as well co-principal investigator of ELSA which is a multidisciplinary panel study of those aged 50 and older. So today in the webinar Dr. James Nasru will be presenting data from the English longitudinal study of aging to empirically examine the influence of socioeconomic and qualities on transitions and outcomes in later life. So with that I'm going to give the floor to James. Okay, I think I can hear myself, is it working okay? Yes, everything is good, we can hear you. Okay good, it's just turning on the microphone and mute button. I was not sure I was working. Thank you very much for the invitation to give this talk. It's a great pleasure to be able to do this and to be able to do it by webinar which means I can sit comfortably in my office in Manchester. Well, comfortably it's raining and have visible weather outside but nevertheless comfortably in my office in Manchester rather than flying over to Canada to give this talk, which is good. As you can see, the title of my talk is Around Inequalities in Later Life and so the focus is on inequality and particularly inequality in relation to class and processes of retirement. Not entirely, I will kind of flag up other dimensions of inequality but here I think the centre of my argument is that socioeconomic inequalities related to class are crucial in terms of understanding experiences in later life. You see, I've switched the subtitle to A View from England that's simply because of space and attractiveness of slides to put in Finding from the English Longitude Study of Aging that have just ruined the layout of my slides so I've shortened it. I just shortened the title more generally. This is not a specific research paper rather it's a collection of various pieces of evidence that I and my colleagues have been marshalling in a range of research papers in order to present this broader argument around class and retirement and inequality in later life. So it's not a simple research paper as such and the structure I'm going to follow is summarised in this slide. So I'll start off with and perhaps concentrate most on this section in relative time compared to the others describing a context for the work that we've been doing. So in effect how policy responses to the aging of our populations have neglected the question of inequality and how and why we should be thinking about aging differently particularly in relation to inequality but also particularly in relation to important cohort shifts and period shifts in how we might think about aging. I'll then say something about health inequalities in later life. You'll see from the talk that I give that when I talk about inequalities I do embrace the various steps of inequality that operate across people's life but I use health inequalities as in effect ultimate marker of the consequences or processes of inequality. So I will say something about the significance of health inequalities in later life and how and why we should concentrate on health inequalities in later life. Then kind of returning to the theme of how aging might or might not be changing and how patterns of inequality might or might not be changing. I'll spend a little bit of time talking about compression and morbidity and whether we are seeing evidence for this and what that means for inequalities in later life. I'll then say something about the process of aging. I'll then say something about the process of aging, age-related transitions and how they relate to inequality and in particular inequalities around well-being. I'll then say something very specific about, I'll say something about the very specific transition of retirement and how that relates to inequalities. Then I'll move to concluding by saying something about the importance of class and how class might operate in later life and then some summary comments about the findings from our research program and what that means for policy. Okay, so let's just start off by discussing an aging world. Here I'm going to say at least in part some things that you will be very familiar with. The arguments, I think anybody doing policy work or research work in the field of aging will be very familiar with these arguments. This is a quote from the Commission on Global Aging which reported in 1999. It gives you some sense of the period over which we have been concerned about the process of demographic aging. Most important I guess from the 1999 perspective is the focus on Japan, Europe and the United States. Canada and other developed countries are ignored of course here but also importantly less developed countries are ignored here and we know that aging is an issue for all countries around the world so it's a global issue. The argument in this quote is this notion of preserving economic security. To preserve economic security in the context of rapid aging unprecedented change we must adapt the social institutions built around it to these new realities and you can see in the blue boxes that I have on this slide the various commentators reporting on the crisis that we're facing and this is almost like the language that we see around global warming, climate change a real sense of a major problem facing societies and the nature of that problem is kind of framed in this way. Again the Commission on Global Aging, sorry I took these points again from the Commission on Global Aging the concern about reduced labour supply as population ages decreased consumption, reducing tax income and what that means for the public purse increased costs of pensions of health and social care programs and again what that means for the public purse enormous pressure to reduce benefits in order to cope with this to raise taxes in order to cope with this and to reduce spending on other public services in order to cope with this and then reforms of pensions and other forms of benefits and increasing reliance on informal care in order to provide good care for older people. As I say this was highlighted very significantly in 1999 and since 1999 but I think it's really over the last decade that we've seen significant policy moves to begin to address the aging of our population and those have really been focused around this question of extending working lives concentrating on people who are leaving work before state pension age and trying to keep them in work and also on extending state pension age or retirement age into later in life. So in the UK we've seen a move to 67 likely to see a move to 68 pretty soon a very rapid move for women from 60 to 67 and a slower move for men from 65 to 67 and as I say likely to move on to 68 and alongside that an active aging policy agenda where the potential of an under-employed older population to do a whole range of things to help support social and civic life is identified as beneficial both to older people themselves and to broader society and so the aspiration is to promote active aging. If you're not working you should be engaged in social activities and the kind of activities you should be engaged in our grandparenting and so on, other care activities or engaged in civic activities such as volunteer the idea to maximize the potential of an aging population and minimize the risks of an aging population. But the other thing that the Commission on Global Aging said and this has been slightly neglected in fact probably entirely neglected in policy discussions is to point towards the way in which what it means to be older is changing so beneath even the daunting physical projections lies a longer term economic, social and cultural dynamic what it would be like to live in societies that are much older than any we have ever known or imagined what would it be like to live in these societies and this is a crucial question how we understand aging what aging means to us in terms of our own personal identities but also how we understand our societies as they become older the place of older people in our societies and the place of younger people how we think about consumption and so on with our population ages and I'll give you two examples of that drawn from the world of art so this is a painting which I spotted in the Manchester Art Gallery a few years back by Walter Sickert drawn 1901 to 04 and the painting caught my eye because it is of an older woman and it contains of course a depth of meaning, emotion and so on in the frailty of the older woman can be seen very clearly but what then struck my eye was the narrative that went alongside it which I've got on the right-hand side of this slide and particularly this statement that contemporary critics found this image shocking at a time when it was thought that the elderly should be treated represented with respect or with sentiments and then Sickertrends a fine line between complete honesty and brutality and what this meant for me when I was looking at this was the way in which what we would consider to be a relatively standard portrayal of an older frail person was seen as shocking at that particular time the way in which we understand ageing now is quite different from the way in which we represent ageing now is quite different from how it was represented in 1901 the ways in which we understand ageing is different and the other more contemporary challenge the ways in which we think about ageing is in this photograph so this is Erwin Olaf who is a baby boomer born in 1959 a late baby boomer and here is a picture of an older woman on an exercise bike challenging asteriotypes of physical activity and ageing but also dressed in a sexual way and presenting herself in a sexual way in underwear made up hair beautifully done and so on and high heels and so challenging a whole set of notions that we might have about ageing that were represented in the previous picture and I've emphasised at the bottom of this slide on the right hand side again what I have on the right hand side is an account of Olaf's work these aren't my words of course these are words of something who understands art unlike me but the bit I've emphasised here vividly captures the essence of contemporary life and here he is trying to capture the essence of how ageing might be being transformed with baby boomer cohort I would argue at least challenging our notions of ageing in a way that reflects the ways in which contemporary older populations are challenging our notions of ageing so the idea of ageing as a kind of fixed notion rather than a notion that has social meaning and social meaning that transforms over time is really important in terms of trying to understand policy responses to ageing and how we might understand the demography and the challenges of the demography of ageing related to this of course is the question of the third age so we have seen an extensive literature on the third age now developed over the last 15 years or so particularly and the baby boomers are potentially reflecting a new generation who are experiencing ageing in a different way because of the ways in which society has transformed and has been transformed by baby boomers so the idea that this is a group of people who are post retirement, post parenting that aren't dependent either financially or physically or health wise they're in a position to be able to contribute to society so engage in volunteering community activities to engage in civic activities and you can see how this is informing some of the policy responses to ageing populations they're also a group of people who being baby boomers are used to consuming and enjoying life engaged in leisure and pleasure and dominating the cultural mainstream so not older people who are marginal to the cultural mainstream not older people who are marginal to consumption but rather at the centre of it and also older people who are engaged in the self realisation type activity so self fulfilment through having a role having status and having fun and at the core of this baby boomer notion is a generation liberated from the standardised lives of previous cohorts so that instead of making straightforward linear transitions through the life course rather they're disrupting the life course in various ways in this particular instance disrupting the life course in terms of older life in particular ways of course we also see and this is a particularly dominant theme in the UK and perhaps in Europe more generally but also emerging in North America as well this notion of greedy self interested baby boomers so those who took advantage of social welfare post second world war social welfare who are self interested living individualised lives orientates to self satisfaction and also by being a privileged generation generating the risk of intergenerational conflict and this is one of the dominant narratives that we face but what's hidden in the photographs that I've shown you so far and in this presentation of what the third age might be also in discussions of intergenerational conflict is the question of class and so the idea that the opportunity to be a third age to have the resources to be a third age relate very strongly to dimensions of inequality and particularly to socio-economic position and class and you can see this and this is my final slide of introduction you can see this in this comparison of pictures that I have here again drawn from the UK context and the one in right drawn from the Manchester context Manchester is very proud to be an age friendly city one of the first age friendly cities and a whole set of cultural activities organised within the city to try and make it a more age friendly place that place is good to grow older in and one of the things that we've done in the neighbourhood is something we've done I think probably from around 2005 and continuing to do is to hold festivals and cultural activities around the older population and here we have this image of this kind of vibrant young looking baby boomer again out enjoying life contrasted with the image on the left which again is an old image from 2005 when discussions around extending state pension age to 67 were in full flow and a picture of an old woman frail woman walking with a frame coupled with a story that was about older people having to work to the age of 67 before they got state pension and I think what we have here in these contrasting models I think these two pictures do reflect contrasting models of ageing that we have in these pictures is not just age and age difference but we also have class and class difference and I'll try to illustrate that now with the more empirical parts of my presentation so I'll move on to the second part of my talk which is about the significance of health inequalities in later life and here I will show you, those of you who have done stuff on socioeconomic inequalities I'll show you stuff that you may well be familiar with but my focus here really is on socioeconomic inequalities in later life, not socioeconomic inequalities more broadly and the first slide I'll show you is from the English Longitudinal Study of Ageing sorry I should have said I'm not going to introduce the English Longitudinal Study of Ageing you had a brief introduction to it from at the beginning of the presentation but I won't describe it but if you do have questions on it I'll be very happy to talk about its design and so on so this is survival rates in the English Longitudinal Study of Ageing stratified by wealth of people age 50 plus and what we have here is a six year period and the proportion of people who remain alive over that six year period and you can see for women the top line is the richest fifth of people the bottom line is the poorest fifth of people with the other three lines being the other three quintiles in order and after six years you can see that just over 96% of women were alive at the end of those six years in the richest quintile whereas for the poorest quintile that number was closer to 84% so I don't know if you can see my point a bit it's now at the 84% for the poorest and now at the approximately 96% for the richest a massive gap and you can see exactly the same for men on the right hand side of the chart very stratified by wealth differences in survival rates with large gaps between the richest and poorest quintiles and remember these are quintiles of the population so these aren't absolute measures these are relative quintiles of the population which I think makes these differences more significant and if you do a survival model where you take into account things like health behaviors pre-existing chronic conditions education and class then these wealth differences are still very large as you can see from the number right at the bottom of the chart 1.7 a hazard ratio of 1.7 but this is significant differences in survival in mid-life onwards and these differences exist into the oldest ages so this is what this chart attempts to show you so what I have here are cross-sectional data showing the association between fair or poor self-reported health rather than good or excellent self-reported health and wealth men on the left this time women on the right and on the left of each of those are younger people age 50 to 59 older people age 75 plus and you can see for each group a clear gradient from the richest quintile on the left-hand side of each of these blocks to the poorest quintile on the right-hand side of each of these blocks what is important here is that the data for those age 50 to 59 is very well known but to remember that these inequalities are present in the oldest age groups as well and some of the other work we've done shows that in fact these are an underestimates of the inequality in later life because they don't account for mortality differences if you model in mortality differences into this these slopes become much steeper older ages but nevertheless older ages we still see these inequalities and just to show you the size of the difference between the different wealth groups these red circles show you that the level of health for the poorest three quintiles sorry for the richest three quintiles for both men and women in the 70 plus age group so the first three bars in the 70 plus age groups is equivalent to the health level in fact probably better than the level of health for the poorest two quintiles in the 50 to 59 year old age group so dramatic differences in health across those groups as well as gradients within the groups so that gives you a kind of illustration of the extent of socioeconomic inequalities in health both in terms of survival and morbidity and we see this for a whole range of health outcomes of course but just to remind you I said it very briefly in my introduction just to remind you of course the socioeconomic position, wealth, education and so on all reflections of class are not the only important indicators of inequality there are others and here I give you a very brief illustration from England in relation to ethnicity and so if you look at the right hand side of this chart I won't go into detail on this chart but if you look at the right hand side of this chart you can see the differences in later life between different ethnic groups are really very very marked Bangladesh represented by the red line Whitingly represented by the black line the size of that gap which that gap has extended across these age groups and for the other ethnic groups ethnic minority groups included here shows in later life ethnic inequalities are really very dramatically in the UK and you can think of other dimensions of inequality that are also important I won't illustrate such as gender and where people live area instead I'm going to move on to talk about compression and mobility and inequality and the question here really is about whether the inequalities that we are seeing might be reducing as a consequence of compression and mobility and the notion of compression and mobility of course is very important to our understanding of ageing and the implications of the ageing of our populations if ageing is being driven by increasing survival rates which of course it is as well as reduced fertility rates but increasing survival rates so if it's being driven by increasing survival rates along with increasing survival rates we also see increasing health and reducing dependency and and therefore reductions in need for health and social care that would be a good news story what would be an even better news story would be of course if that compression and mobility is occurring at a differential rate between richer and poorer people so that the significant mobility that I've just shown you for people is being reduced rapidly so this is what I want to show you and I want to show you this in relation to or whether this is happening is what I want to show you and I want to show you this in terms of frailty so what I have here is not data but a kind of image of what I'm going to be showing you which is slightly complicated so I just show you just guide your way through it so what I have here are two cohorts a cohort that is more distant who became 70 in 2003 and a more recent cohort in red so the blue cohort of the older cohort, the red cohort of the more recent cohort would become 70 in 2010 11 and the red line and the blue line represent the growth in level of frailty as these cohorts get older which of course we would expect to see and if there was no difference if there was no compression and morbidity then we would expect the lines to overlap so at the age of 70 and where there are overlapping lines overlapping ages for these two cohorts as observed they have the same level of frailty and the rate of change in level of frailty within the cohort to be the same so the slope of each of these lines is the same both the slope and the level at a particular age group are the same this of course would not be a particularly good story it would be an okay story we don't see with increasing survival we don't see a compression and morbidity what we would really like to see is this so at the age of 70 the more recent cohort the red line is at a lower level than it than the blue line the more distant cohort lower levels of frailty at the age of 70 for more recent cohorts and also importantly the slope of that line is shallower so the rate of increase in frailty with age is smaller this would imply much lower levels of dependency and morbidity for 70 year olds for more recent cohorts of course we may see something that is not optimistic but something that is pessimistic which is this and here the two lines are in the opposite level so more recent cohorts have higher levels of frailty and increasing rates of frailty in comparison with the more distant cohorts so this is the kind of model that I'm going to show you and this is the actual model so here are the actual data frailty trajectories by cohort so each of these lines is a specific birth cohort observed from a specific age for an 8 year period within the English longitudinal study of aging and confidence in tools around the estimate of the level of frailty in each of these and if you look at the middle part of this graph you can see that the lines overlap and grow at the same rate the suggestion is that the level of frailty is the same for each of these cohorts at a particular age group and will continue to be the same over time but if you look at the right hand side of this graph you see a rather different picture what it seems here is that the more recent cohorts have higher levels of frailty at a particular age point as this blue circle suggests than more distant cohorts more recent cohorts have higher levels of frailty the more distant cohorts suggesting an expansion of morbidity rather than a compression of morbidity this is a really important lesson we haven't replicated this in any other studies yet we may not be able to of course but from the English longitudinal study of aging this is a really important message about the risks of aging populations if you stratify that analysis by wealth you see this and there are two things to say about this chart the first of the two red lines which show that the level of frailty for a relatively young cohort for the poorest third of the population is the same as the level of frailty for a relatively old cohort for the richest third of the population this is the inequality that I've already shown you but importantly this expansion of morbidity the higher lines for the more recent cohorts is occurring in the poorest third of the population and not really in the richest third of the population so expansion of morbidity is strongly related to socio-economic position okay I'm now going to move on and talk about age-related transitions and well-being and so here I want to do a couple of things the first is to actually show the relationship between age and well-being and second to try and explain that and so this is the pattern that I think many of you will have already seen that you shaped relationship or inverted you if you're measuring positive well-being here I'm measuring negative well-being so depress moves so this is a depression score you shaped relationship in age so as the population heads towards their mid to late 60s their well-being improves and then in their late 60s onwards their well-being deteriorates we show this in a longitudinal model as well as cross section if you look at this by wealth then you actually see the age effect is present for all wealth groups so the poorest group are neatly stratified above the next poorest and the next poorest and the next poorest to the richest so this you shaped relationship is present for each of the wealth what's important here to recognize is that wealth is really important for people's wealth well-being across the life course but it's not explaining this age relationship so what's explaining this age relationship and in fact there's a couple of very simple things so here is the age relationship controlling for gender and differences here is what happens when you control for marital status the line, the sharp rise in the line that happens post 70 becomes much shallower doesn't rise very much this is entirely a consequence of widowhood so spouses dying drives a lot of that rise in negative well-being in later life and this is what happens when you control for health a very positive story for those of us who are heading into 60s 70s 80s your well-being should continue to improve just as long as you maintain your health and your spouse spouse relationship is maintained this of course is not sorry, the two events of deteriorating health and your spouse dying are not randomly distributed in the population these are events that happen to poorer people more often than richer people or earlier ages than richer people so this neat line decreasing over time decreasing over age is something that we can't all aspire to something that none of us in the end will aspire to but nevertheless is something that those of us who are in richer positions are more likely to achieve than those of us in poorer positions having made that point I now want to focus on this particular this particular area a couple of slides this particular decrease in negative well-being so this improvement in well-being that's happening leading up to mid to late 60s and what might be driving that and what might be driving that of course is the transitions around work and retirement and what I want to do here is to show you the implications of extending working lives so does getting people to work for longer in their lives improve their well-being and then the implications of retirement what happens when we retire in relation to our well-being and so can we explain some of that U-shape by looking at transitions out of work I won't show you that slide because I'm not going to go through all of that detail so the first thing I want to do is to show you what happens if you keep on working then here we've attempted to do some causal modelling using propensity score matching so to match people who are equivalent in all characteristics apart from the fact that they continue to work post retirement age and here I show changes in levels of depression levels of self-rated health and levels of cognitive function for those who continue to work post retirement age compared with those who retire and what you can see from the I-bars which show confidence intervals there is no meaningful change there might be a bit of a change in cognitive function but the confidence intervals there are very wide there's no meaningful change for depression and self-rated health it looks like post retirement doesn't impact on your health but there are two types of work that people do post retirement and what I've done here is to contrast those people who work in good quality work compared with those who work in poor quality work people continue to work post retirement either because they enjoy working or because they have to work for money and this is an effect those in low quality work who have to work for money contrast those in good quality work who are enjoying their work continue to feel they have something to contribute and here I show changes in depression score self-rated health and cognitive function again and you can see for cognitive function the bar is a little bit higher but the confidence intervals are impossibly wide for me to make any strong assertion about that but what you can see is that both depression and self-rated health get worse for those in high quality work compared to those in low quality work so it's not working post retirement age that's important it's not working in later life that's important but the kind of jobs that we have and you get a similar message in relation to retirement what I've done here is contrasted retirement roots so compared with people who retire at state pension age who say they've got to 65 or 60 for women for some of these analyses and retired because I've got the state pension and it was time to retire compared with those who retire early because they want to and those who retire early because they have to so one two is because you want to have more time you want to spend time with your grandchildren you want to do leisure activities and so on and have to retire is because you're partners because you've been made redundant those kind of things I've got four outcomes here a bit much to show you I know but four outcomes in relation to well-being and for depression you can see that if you retire voluntarily your depression improves compared with those who retire state pension age and if you retire involuntarily it deteriorates compared with those who retire at state pension age and you can see the same for life satisfaction on the right hand side top although the confidence intervals aren't cross one for those who retire voluntarily you can see the same for quality of life and you can see the same for social participation again though they cross one for those who retire voluntarily so the crucial messages here are that both working and retirement are not uniform experience in later life they are patterned by your class position your argument being that the kind of work you get in later life impacts on your well-being but the kind of work is driven by your class position and the way in which you retire relates to your well-being in later life but the way in which you retire is driven by your class position so I'll come to my concluding sections I'll be another five minutes or so I think and talk about class more explicitly now and the importance of class in later life now obviously I've already made what I believe to be a really strong argument about the importance of class in later life how it relates to health and well-being how it relates to the things that happen to us in later life and more specifically how it relates to our work and retirement experiences in later life and then how all that impacts on our health and well-being what I want to do now is just have a discussion or give you a presentation on how we might understand class in later life and just show you a few things in relation to that so one of the things that colleagues and I have tried to do is to reintroduce class analysis into our understanding of later life and I think over the last few decades classes kind of disappeared and it's disappeared for a number of reasons one is because there is a strong interest in cultural gerontology around cultures of aging and then questions of class have become submerged around questions of cultural practice which of course relate to class and the other is because the kind of inequalities in health literature has largely neglected later life and there are a number of reasons why both these things have happened and one is because when we do empirical research we typically operationalize class with measures of occupation and occasionally with measures of education and so then the focus is inevitably going to be on those of working age and when we do that we kind of theorize class in terms of the impact of labour position on material and psychosocial factors which then impact on relevant health related outcomes and you can think of the work that people like Richard Wilkinson, Michael Marmot and so on in terms of that David Blaine, Mel Bartley where the material circumstances driven by class position may impact on our outcomes but also the psychosocial stresses that relate to our class position might impact on our outcomes and of course the psychosocial focus has been very much on work conditions so control, autonomy and effort, reward in work and how that impacts on health outcomes and on relative social positions or how people position themselves or perceive their position in society on their outcomes and in both cases again the emphasis has been very much on working age populations and of course a lot of this work has also been done on men rather than women so the ways in which the conditions of our life control, autonomy and effort, reward type measures might apply to other dimensions of our life has not really been greatly considered in this empirical work part of my argument which is reflected in the cultures of gerontology type literature is that but also in the kind of traditional sociological literature around class is occupational class and education to actually adequately capture stratification in societies in contemporary societies where consumption and practice are particularly important so the things we do the cultural forms we consume the ways in which we live our life become increasingly important markers of our class position of our status so this of course builds on the work of Bordier and those who are followable with Bordier but basically arguing that markers of social and cultural capital are important and my argument is that this may be particularly important for those post retirement where their occupations may have less direct salience rather the ways in which they live their lives might be much more important in terms of understanding their position in society we tried to empirically investigate that in a fairly complex model that I've kind of graphically illustrated here so the detail of the empirical model that's in this paper is not quite the same as the picture but the picture is what we tried to capture and here we've basically argued that there are three broad but interrelated pathways that impact on health and well-being in later life so that connect class and education to health and well-being in later life and one is the material pathway so wealth, pension leading to material circumstances leading to health and well-being but also operating through social status so our material circumstances influencing our social status the other is the psychosocial pathway which is work and work quality but also social status more directly so a direct relationship with social status impacting on our health and well-being but third and crucial and perhaps empirically very under investigated in studies generally but particularly in studies of later life are the kind of social and cultural dimensions of life and how they relate to class how they relate to material circumstances wealth and pensions and how they relate to social status and to health and well-being and here I'm basically arguing that there are a whole set of operationalized through social connections social roles and participation cultural practices and health behaviors in fact reflects social and cultural character and that these are important in determining health and well-being either through social status or directly and we have some empirical evidence to support this model but I think I would say that this model is at least in part theoretical at the moment but I'll give you just some illustration of how this operates and I'll do that in terms of thinking about social connections and social roles and participation and cultural practice and how these might be summarized in a notion of social detachment so in this slide on the left hand side so the four first blocks of bars are different dimensions of social detachment and how they relate to wealth and what you see that for each of these for the first three of these civic, leisure and cultural there is a very strong wealth gradient in detachment from these domains of social life or social and cultural life. The social networks that's not the case but for an overall measure that measures being detached across these domains there is again a very strong social gradient and on the right hand side sorry a very strong wealth gradient and on the right hand side you can see that a longitudinal assessment of risk of becoming detached is also very strongly graded according to wealth so this is your relative risk of being detached compared to the poorest quintile for the subsequent quintiles and again a very strong gradient with the richest quintile having 20% of the risk of the poorest quintile of becoming detached over time and then of course the extension of this argument would be to show how social detachment relates to health and well-being. I'm going to skip over the next slide which is really just an illustration of how this works in practice so it's a qualitative piece of data and instead say something very briefly again about material conditions and that wealth inequalities are marked in later life it's not something that we can ignore it's not just that these quintiles are all nested very close together in terms of absolute wealth very very different mean wealths across so what I show you here are deciles of the population in terms of wealth and the on the left hand side is the amount of wealth in each of these deciles and on the right so the axis on the left and in the blue numbers on the top are the proportion of total wealth owned by each of these deciles it's important to remember that these are survey data so they exclude the poorest of the richest who don't participate in surveys but nevertheless you can see the two fifths of the wealth is owned by the richest tenth of the population and when you add those three numbers together the top the top 30% of the population and I should know the number I've added it together many times but I don't have it immediately on my head it's about 61 plus 12 it's almost three quarters of the wealth and the bottom fifth of the population almost no wealth at all so conclusions and I'll try and go through these reasonably quickly because I'm conscious of time so here are my concluding comments and I might just kind of semi-read these out there are significant class inequalities that continue into later life and I make the points in this bullet point that we should also be studying ethnic gender and area inequalities where the mechanisms might be different but they're nevertheless very important inequalities they're present for all of the outcomes whether these are health and well-being outcomes or one's approximate or two health and well-being there are important variations by cohort if you remember the stuff I was showing you on frailty with a strong indication of increases in levels of morbidity the very best stability in levels of morbidity across cohorts but likely to be increases in levels of morbidity across cohorts a widening of inequalities and the increases are being driven by the increases the kind of transitions that we go through in later life are really important for later life outcomes so marital status the onset of health and disability retirement, status and root and wealth and all of these are strongly patterned by social class so this is my argument for social class is really very very important determining later life outcomes I tried to show you a little bit of this that the inequalities that we observe operate through complex and interrelated mechanisms and processes that operate over time so material well-being social and cultural capital employment quality and retirement and social status and the availability of and performance of valued roles and identities the thing that I haven't really emphasized that though I only talked about a little bit at the beginning I guess I did emphasize a little bit at the beginning is that we are seeing important cohort and period changes that are reshaping later life and I showed you that in terms of the representation of later life but these have also important implications for inequalities so the way occupational structures are changing the way pension arrangements are changing the time and choices are changing the way marriage choices are changing so the meaning of divorce for example will vary dramatically across cohorts and potentially changes in health across cohorts all of these are patterned by class have implications for class inequalities and they all have implications for policies that need to address aging but these discussions of policy neglect class inequalities and my argument here is that we need to address inequalities in later life and this is my final slide so my argument now is that socio-economic inequalities in later life are an absent topic in policy discussion and development and I think that is true in most developed countries including in the UK where we have a strong focus on inequalities but not on inequalities in later life there is almost no consideration of inequalities in discussion around questions of extending working lives around active aging around pensions and around social care and welfare reform all things are very actively being discussed at the moment almost no interventions to address inequalities in later life and interventions that are focused on later life there is no evaluation of their impact on inequalities instead policy discourse and focus is on empowerment of older people, productivity individualization of risk and responsibility think about that in terms of pensions and so on in the context of welfare retrenchment in contemporary neoliberal responses to discussions around public spending all of these reforms are likely to increase inequalities I would argue in fact when we think about the kind of reforms that we are discussing in relation to aging populations there is a policy space for interventions targeted at reducing inequality and increasing social justice so when we talk about pensions and pension reform when we talk about extending working lives and job quality when we talk about housing and when we talk about the social roles that we would like active older people to be engaged in all of those discussions could be framed by the need to address inequality so that was my final point I will end now but just this final slide which you will see lists a number of colleagues, this of course isn't my work it's a work of a number of colleagues lists a large number of colleagues who helped me develop these ideas and I will close now this is an advert I think for the next session Yes, thank you very much Dr. Nasru that was really an excellent presentation where you very well laid out all the challenges and the results of the research from the ELSA I just want to mention to the participants that if you have any questions you can please type them in the chat box and I will present them to Dr. Nasru and while you may be doing that I just wanted to ask you Dr. Nasru you are saying very elegantly that there is a space for intervention that has not been addressed yet so based on your research and your experiences where do you think would be the biggest impact for intervention right now understanding that there is multi-factorism multiple influences on the impact of such interventions you already listed a few such as housing and others but based on your experience where do you feel would be the biggest impact for intervention Yes, so I think the biggest impact is in part where you can get the opportunity to leave a change and in part where you can leave a change that is effective and I think we have lots of opportunities to leave a change around pension reform if we can shift the debate so at the moment the debate is around the kind of individualisation of pension risk at least in Europe and particularly in the UK individualisation of pension risk so pension investment and pension risk and we can see quite clearly I don't need to spell it out how this will amplify inequalities but actually we thought about pension reform so the intention is to reduce the cost of pensions or the relative cost of pensions and if we think about pension reform in a way that redresses income equality post retirement then we could do so in a way that minimises inequality and reduces spend on pensions. Of course those of us who are in very good pension schemes like many academics in the UK would suffer as a consequence but nevertheless that would reduce inequalities in a major way. That's one area I think there are many others of course and I tried to list a few where I thought there was some evidence for action and housing is one of those which I didn't talk about at all but there is some evidence addressing housing poor housing would make a major difference to the lives of poorer older people. Okay great now and I do also know that there's other countries that might have already addressed some of these interventions I think for example in Japan where they are a little bit ahead of the curve. Have you seen any specific actions from in different countries that were effective there and could address these inequalities for example? I'm sorry that's a question that I can't answer without being a little bit invasive because I'm sure there will be. Most of my research where I've looked for evidence I've kind of focused to a large extent and it's been done in the UK policy so I'm making excuses it's been done in the UK policy environment so I've looked for evidence within the UK I don't think there is a huge deal of evidence elsewhere but you can imagine that a good evaluation of some of the things that are happening in Japan as one example would be very useful and also the ways in which later life employment and later life care are being considered differently in different countries might give us some important insights so one of my arguments has always been that we need international studies because we get policy variation and then we can look at policy variation to see whether that gives us clues on how to maximize benefits, minimize inequalities but of course I've made that argument I can't answer that That's okay I just thought to ask you there is one question from Susan McDaniel who says thank you for the very interesting presentation do you have any suggestions on how we can create comparable data from less ideal data Yes there is a set of interesting issues here as people may know the English longitudinal study of aging is a family of studies is part of a family of studies so we also have the founding study the health and retirement survey we have a set of studies actually related to each other across mainland Europe entitled share we have the Charles study in China we have the closest study in Korea and others and of course the Canadian study which I guess the people in this audience are all very familiar with and over time we get increasing amounts of longitudinal data from these studies which then enables us to do some of the kind of things that I've done just to argue the international comparative work is really important so we have done a little bit of work comparing US and UK data which I haven't shown you of course which does point to the importance of trying to understand policy variation around healthcare for example and achieving good outcomes in relation to healthcare if there aren't longitudinal data then I think a lot of my work around ethnicities in this position where there aren't good longitudinal data sets stuck with having to try and develop pseudo cohorts from repeat cross sections and that can work to a certain extent the methodology is complex where you try and basically identify a cohort in one data set and then look at them in a more recent data set and see change over time and then you can compare different cohorts and so on in the kind of way that I did but there's lots of error in that of course and it depends and it requires very careful matching of data so thinking about the ways in which you can use repeat cross sections to do the kind of stuff that we've done using longitudinal data and the other area is increasing availability of administrative data including government data or government generated data across countries that enables us to do some of this kind of work as I understand in Canada you have difficult to access I suppose but nevertheless very rich on data from your statistical government statistical agency which can be used to kind of examine some of these questions Okay, thank you very much and of course there's also the Canadian longitudinal study on aging where there is lots of data available now so I'm shamelessly putting a plug in here for all the attendees to check out our website to see what data we have available We have come to the end of our seminar now Dr. Nazouz, thank you so much for a very well done presentation to us So, again, thank you very much and I also want to remind everybody that our next webinar will be on March 28 which will be presenting data from the Irish longitudinal study on aging by order done to you so we hope you can join us then as well Again, thank you very much everybody and especially thanks to you Dr. Nazouz for your wonderful presentation Thank you, thank you