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173 9. Inequalities among Older People in London: The Challenge of Diversity Maria Evandrou Introduction Tackling inequality and reducing poverty are high on the British government’s policy agenda. In 1999, the government published Opportunity for All, outlining its strategy to “eradicate child poverty, provide employment opportunities for all who can work and ensure that older people live secure, active and fulfilling lives.”1 A central part of that strategy is reduction of income inequality and inequalities in health.The 1999 policy document entitled Saving Lives: Our Healthier Nation aimed to improve the health of the nation and in particular that of the most disadvantaged. Targets for reducing inequalities at the national level were announced in February 2001.2 An integral part of the strategy to achieve this goal has been the setting of local targets for reducing health inequalities by the Department of Health.3 Thus, nationally set targets are to be achieved by improvements at the local level. The setting of targets has focused attention on the data needs of measuring and monitoring progress toward achieving these targets, with a concomitant increase in the quantity and quality of data being produced at the local level. This chapter maps inequalities in the socioeconomic circumstances, health status , and access to health and social care services among older people in London. The discussion of inequality among London’s older persons is located within the broader context of inequalities in later life in Britain as a whole. London is younger than Britain as a whole. In 2001, older people constituted just 10 percent of Inner London’s population and 14 percent of Outer London’s population, compared to one in six (17 percent) nationally.4 This reflects both the high concentration of universities and other further education establishments in Inner London and the fact that many older people, particularly from the higher-income groups, choose to move out of London’s urban core upon retirement. Of those who remain in Inner London, many move when they require care. Significant numbers of people aged seventy-five and over leave Inner London to be closer to relatives or move into residential or nursing homes in Outer London and other areas.5 Despite London’s being younger overall, there is a slightly higher proportion of older men and women in the oldest age groups, aged eighty-five and over, in Outer London compared with the national average (13 vs. 12 percent).6 Although London is on average a young city, it is home to more than one million people aged sixty-five and over. Thus, aging in London remains a critical issue. 174 Growing Older inWorld Cities Part III: London As seen in Chapter 8, older people in Inner London are more likely to be living alone than are their counterparts in Outer London or nationally. In 2001, 36 percent of men aged sixty-five and over in Inner London were living alone, compared to just 23 percent in Outer London and 22 percent in England and Wales a whole.7 Family members, both within and outside the household, are a key source of practical and social support. That a higher proportion of London’s older persons live alone may reflect the success of social services within the capital in terms of promoting older people’s independence. However, it may also pose a continuing challenge to local authorities and policy makers in meeting the needs of older people in providing appropriate services and tackling social isolation. London is one of the most diverse capital cities in the world and has the highest concentration of older people from minority ethnic groups in the country.8 It is estimated that more than one hundred languages are spoken in London, and its residents include people from all the countries in the world and from all religious beliefs. London’s distinctive demographic and socioeconomic profile presents both challenges and opportunities to policy makers and for the delivery of health and social care services to older people. For example, London includes neighborhoods that are among both the richest and the most deprived in Britain. It is home to the country’s leading teaching hospitals, yet there is a shortage of general practitioners (GPs) in inner-city areas. Socioeconomic Inequalities in London London contains some of the most affluent and impoverished areas in the country; however, deprivation is concentrated in Inner London. According to an index of income deprivation constructed by the Department for Transport and the Regions, out of 354...

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