No miracles for the social care crisis

Dear Editor

Professor McNally underlines the importance of exercise to prevent poor health (1). While her call is important, I disagree with her reductive proposition of exercise as a “miracle cure for social care.”

There is evidence suggesting exercise interventions prevent disability in hospitalised older adults (2). Exercise is thus one tool to improve health outcomes in older people.

But the crisis in social care is not because of a lack of exercise amongst the population. It is mostly due to the underfunding of carers and their services, due to neoliberal UK policy that must change. Furthermore, such neoliberal thinking tends to put a moralising onus on individuals to stay healthy. So, framing exercise as a panacea distracts away from the need for policy change and could also invite the blaming of people for not doing enough to prevent their ill health (3).

Finally, leading a healthy lifestyle is not just “doing squats” (1). Keeping active requires physical, mental, and social resources that not everyone has equal access to. Thus, while we should promote exercise, we should also stress the need for action against the social determinants of poor health like environmental stressors and loneliness (4).

Social care does not need miracles, but better funding and reasonable policymaking based on sharing responsibility for health promotion, which is not a zero-sum game (5).

References

1 McNally S. Exercise can do wonders for social care. BMJ. 2022 Oct 26;379:o2538. doi: 10.1136/bmj.o2538.
2 Pérez-Zepeda MU, et al. The impact of an exercise intervention on frailty levels in hospitalised older adults: secondary analysis of a randomised controlled trial. Age Ageing. 2022 Feb 2;51(2):afac028. doi: 10.1093/ageing/afac028.
3 Brown RCH. Resisting Moralisation in Health Promotion. Ethical Theory Moral Pract. 2018;21(4):997-1011. doi: 10.1007/s10677-018-9941-3.
4 Daly T. The vital need for action against the social determinants of frailty. Aging Med (Milton). 2022 Feb 1;5(1):73. doi: 10.1002/agm2.12195.
5 Verweij M, Dawson A. Sharing Responsibility: Responsibility for Health Is Not a Zero-Sum Game. Public Health Ethics. 2019 Jul 24;12(2):99-102. doi: 10.1093/phe/phz012.