Health inequalities among older people in Great Britain

This thesis aims to describe health inequalities among older people in Britain in the 1980s and 1990s and to assess whether various personal circumstances and experiences contribute towards this variation. Three sources of data are used: the Longitudinal Study; the first Whitehall cohort of male civil servants; and baseline quality of life information from the MRC Trial of the Assessment and Management of Older People in the Community (MRC Study). Housing tenure, car availability, and employment grade are the main socioeconomic measures used, but also social class and income. Findings: People disadvantaged in mid-life socioeconomic circumstances continue to experience increased risks of mortality, insitutionalisation, poor self-reported health and functioning 20-30 years later. Smoking and cardio-respiratory factors in middle age partially accounted for the differentials found in the Whitehall Study. The MRC Study revealed worse prospects for five dimensions of health-related quality of life among people in rented homes compared to owner-occupied ones, even among those who were deemed independent. Symptoms of ill health, and health behaviours accounted for over 40% of the housing tenure differentials in quality of life among these independent people. Being in a deprived or densely-populated area was not as strong a discriminator of quality of life as personal housing-tenure. Finally, people whose socioeconomic circumstances become worse in late middle age have greater risks of poor health outcomes than those who stay advantaged. The findings on benefits of improvements in socioeconomic circumstances are more mixed and complicated by ill health leading to apparent upward socioeconomic mobility. Conclusions: The three studies provide evidence of both long-term implications of socioeconomic position in mid-life and continuing relevance of socioeconomic position in old age. Although personal factors and health symptoms contribute to health inequalities in old age they are also seen as a possible product of socioeconomic position