The politics of frailty.

The world population is ageing because of falling fertility and improved life expectancy. Knowing this has not helped governments develop sustainable health and care policies because the underlying causes and impacts of population ageing remain poorly understood. Planning using only population age structure does not account for uneven geographical distribution of older people, their health characteristics, functional needs or lived experiences. English National Health Service (NHS) policy has previously focused on arbitrary age segmentation, failing to capture the origins of cumulative disease and functional burden and missing the opportunity to incorporate wider determinants of health into prevention of poor-quality ageing. This is despite growing international evidence that adults living in places with low per capita income and educational attainment experience a higher burden of age-related disease. Lack of a credible ageing narrative and good quality population health data have contributed to a focus on single disease prevention, rather than life course disease aggregation and its personal impacts. However, a fully explicated health and care narrative incorporating frailty does now give some cause for optimism. In 2017, England became the first country to characterise and systematically identify frailty as a long-term treatable health condition. This was coincident with a UK Government's Industrial Strategy targeting societal ageing. In 2019, the English NHS published a funded long-term plan including a major programme focused on ageing well. Policy makers, health leaders and clinicians must not squander these opportunities but instead pursue frailty prevention and intervention to improve the quality of population ageing.