Ageing, health and care are complex and contentious concepts and have become inextricably linked in policy debates around the world. Apocalyptic ‘time-bomb’ messages continue to circulate, although they are now often accompanied by the more positive message that population ageing is a cause for celebration. The policy agenda on health and care in the context of ageing societies appears to have been settled and the task at hand is not to seek answers about the best way to respond so as much as to ensure compliance at local, national and international levels to a particular set of principles, consistent with a wider neoliberal economic agenda. Despite the economic crises of recent years, the neoliberal agenda remains firmly in place in the context of policies on health and care.

The World Health Organization estimates that by 2025, 63% of all deaths in the world will be among the over-65s. In high-income countries, the 20th century saw greater increases in life expectancy than in the whole of previous history. According to the Global Forum for Health Research (www.globalforumhealth. org) almost 85% of deaths in high-income countries now occur after the age of 60, compared with 45% in low- to middle-income countries. Trends such as these might be seen as a cause for either celebration or deep anxiety, but in any case warrant serious attention so as to understand their impact on social and cultural life. In countries with established welfare states these trends have taxed the minds of policy makers over recent decades and, allowing for some variations, an agenda for health and care has emerged which has two overarching principles. The first of these is that a focus on the gap between life expectancy and healthy life expectancy is crucial. Accordingly, policies should be focused on the promotion of healthy and active ageing so that independence can continue for as long as possible in later life. The second is that governments should keep a tight rein on spending in health and social care so that when older people begin to fail in their attempts to maintain self-reliance and become dependent on others, the costs of caring for them are contained.