A man of sixty-five in the United Kingdom can now expect to live another nineteen years. A woman of sixty-five, another twenty-one. These are extraordinary numbers by any historical measure. They are also, by a margin that ought to disturb us more than it does, not the right numbers to be looking at.

The number that matters is health span, the years lived in genuinely good health. And here the picture is starkly different. The Office for National Statistics reports that women in England live, on average, the final nineteen years of their lives in poor or very poor health. For men the figure is sixteen. The gap between lifespan and health span, the period when a person is alive but not well, has been widening for a generation. It did not appear by accident.

This is the demographic reality that is now arriving in workplaces. The employee in their fifties with a full clinical chart of pre-conditions, none of them yet diagnosed as a single illness, is no longer a minority. The senior leader managing fatigue, brain fog, sleep disturbance and a creeping waistline, while passing every standard health check, is not an outlier. The high-performing director quietly leaving the workforce a decade earlier than planned, because something has gone wrong that no one could quite name, is becoming routine.

Occupational health is meeting this reality first. Often years before primary care does, and almost always before secondary care. Which means the discipline has a question on its hands that nobody else is positioned to answer in quite the same way.

The clinical pattern we are all seeing

What is striking, if we sit in a consulting room and look at this honestly, is how predictable the pattern is. The forties bring rising waist circumference, deteriorating sleep quality, the first hints of insulin resistance, the first mood and cognitive complaints. The fifties bring diagnoses, hypertension, dyslipidaemia, type 2 diabetes, frank depression, early cognitive change. The sixties bring the consequences, cardiovascular events, dementia, osteoporotic fracture, the early-onset cancers that have been rising sharply in the under-fifties for two decades.

These are presented as separate diseases, treated by separate specialists, monitored on separate registries. But most of us, watching this unfold across our careers, can see that it is not separate. It is one biology, expressed through different organ systems on slightly different timelines. The clinical pattern is hiding in plain sight in our consulting rooms.

Why this is our question

The temptation is to see all of this as a problem for the NHS, or for primary care, or for personal lifestyle choice. None of those framings are wrong, exactly. All of them miss the point.

The biology that determines whether a person spends their fifties and sixties accumulating diagnoses, or accumulating capacity, is shaped overwhelmingly during the working years. By the patterns of what we eat, how we sleep and how we move, established and reinforced across two or three decades of working life. By the screening regimes, or absence of them, that an organisation puts around its people. Whether the early signals are caught when they are still genuinely modifiable or missed until they have hardened into chronic disease.

This is our territory. Not by historical convention, but by clinical logic. We are the discipline with access to the workforce in midlife, we meet the early signals first, we hold the relationships with the organisations whose people are at risk. If anyone is positioned to do something about the health span gap, it is us. To help turn the years currently lost to slow decline, into decades of energy, sharpness and capacity.

The question is: what doing something actually looks like! Not in the wellness register, which has had thirty years to demonstrate its limits and largely has. In the clinical register that is our professional home ground. With the published evidence as the starting point, modifiable biology as the substrate, the working population as the cohort that matters.

The health span gap is not nobody’s problem. It is ours, more than it is anyone else’s. Whether we name it as such will shape what occupational health becomes over the next decade.

Watch out for more insight from Robin in the August edition of OH Today