The discussion in this text has spanned a range of issues of relevance to understanding health and care in ageing societies. At the outset, attention was drawn to the overarching policy principles that shape policies and practices in health and care: first, the focus on the gap between life expectancy and healthy life expectancy so as to maintain health and independence, and second, the need for a tight rein on public spending on health and social care services so that the cost of older people's eventual dependency on services is contained. The discussion has covered a wide range of policies and practices in which these two principles can be seen to operate and which shape experiences of ageing, health and care. This concluding chapter identifies the key issues that have arisen and discusses the value of an ethics-of-care approach as an explanatory framework.

Demographic trends and patterns undoubtedly affect the ways in which ageing, health and care are perceived, but the impact of political and economic interests on these perceptions is powerful. In spite of the evidence of a double burden of morbidity in low- and middle-income countries, differences in the speed at which populations are ageing and the lack of welfare infrastructures in those countries, it is the experience of ageing in high-income countries that has dominated the picture. The idea of the compression of morbidity, despite its uncertainty, occupies an important place in the policy process and, coupled with an individualistic focus on the determinants of health, has reinforced a health policy message that is highly moralistic in tone.

The influence of this policy message is evident in policies on health in later life, which repeatedly present health in ageing as something within the control of individual older people. The ‘mind over matter’ message of the WHO's health advice to older people stands in stark contrast to the evidence that the WHO has produced on the socioeconomic determinants of health. The intention is not to suggest that individual behavioural factors are unimportant, but to point to the need to understand better how they interact with socioeconomic factors throughout the lifecourse.