New research shows that social participation is just as important for improving the health of older people as medical intervention.
Today's public policy agenda is driven by aspirations of active engagement, social inclusion, prevention, opportunity and participation. This agenda specifically highlights older people through such initiatives as Opportunity Age. There have been several studies looking at the relationships between impairments and activity limitations and their impacts on health outcomes.
But there has been little research into the effect of social participation. In terms of UK policy this represents a significant gap. In particular, we have been lacking ways to measure the difference participation makes.
The Medical Research Council has recently begun to bridge this gap. Its Health Services Research Collaboration MOBILE programme has demonstrated that people want to engage in society almost as much as they want to be rid of pain.
MOBILE researchers built on WHO's international classification of functionality, disability and health. The classification is made up of three components - impairment, activity limitation and participation restriction. It recognises human functioning is multifaceted, involving more than just the biological aspects of health.
The researchers aimed to identify the essential ingredients of the three components. They formulated questions corresponding to each and put them to a cohort of older people living with pain and walking difficulties as a result of osteoarthritis.
It is not just that pain hurts. What is also significant is that pain gets in the way of doing things, such as going out, seeing friends and so on. Social participation mattered so much, MOBILE found, that when older people were asked about their health or pain, most spontaneously spoke about their level of participation.
HSRC director Professor Paul Dieppe said: 'We are now acquiring evidence that is likely to show that active social participation really does improve people's health. It's not all just about drugs and surgery.
'Equally important is that we're showing the existing assessment measures are probably masking true treatment effects or making an effect difficult to attribute.'
To treat a painful and disabling condition, it is critical to understand how people respond emotionally. An additional strength of considering participation is that it reinforces the need for interventions to be tailored to individual's needs, providing menus of treatments for people rather than recipes.
Moreover, helping older people participate is considerably less costly than surgical procedures or supporting the 'enforced housebound', quite aside from the misery of being stuck at home. Arranging for someone to go to the shops, to see their friends, to continue some kind of social participation as part of them managing their own health is healthier and cheaper.
MOBILE's findings are good news for older people - more evidence of the benefit of non-medical interventions may encourage health services to offer a broader range of services. In an era of tight finances and accountability, health authorities require evidence that non-medical interventions have a direct and positive impact on the health of older people.
The findings are illuminating in the current policy climate where health and social care bodies are being encouraged to work more closely together. They may also provide some sustenance to the not-for-profit sector when they bid for NHS funding.
The research is useful, too, in light of the World Health Organisation prediction that long term conditions will be the leading cause of disability by 2020. As long-term conditions become more frequent, organisations which plan and deliver primary care will need factor social participation into their services to improve health, and enable the 'patient' to manage their own health condition.
Valerie Lipman is a visiting fellow with the Medical Research Council's Health Services Research Collaboration, University of Bristol.