Population issues Across the EU, people over 65 form 17% of the population (ONS 2002a). The UK had a population of 59.2 million at the last census in 2001. For the first time, people over 60 form a larger part of the population (21%) than children under 16 (20%). There has also been a large increase in the number of people over 85: now 1.1 million, which is 2% of the popula- tion. In England and Wales there are 336 000 people aged 90 and over, and of these nearly 4000 are providing 50 or more hours of care to anoth- er family friend or carer. Older people receive a large proportion of health and social care spending. In 2000, £28 billion were spent on hospital and community care with nearly two-fifths of this spend on people aged 56 and over (ONS 2001). In England and Wales, 5.2 million people provide informal care, including a million who provide more than 50 hours a week and 1.6 mil- lion who are in full-time work. A major public health issue for the next century is the increase in the number of older people in the UK from ethnic minority groups (OPCS 1993). As of 2000, the largest ethnic group was Indian (984 000 people), then Caribbean and African descent (969 000) and Pakistani and Bangladeshi descent (932 000). Initiatives for these groups have tended to focus on physical health, and this together with the traditional stigma of mental illness in some ethnic groups has led to the relative neglect of older people from ethnic minorities (Rait et al. 1996). The term ‘triple jeopardy’ has been used to describe the challenges of racism, ageism and in some cases socio-economic deprivation faced by older people from eth- nic minority backgrounds (Norman 1985). CHAPTER 1 Health, ageing and the context of care 1 KAREN BRYAN AND JANE MAXIM bryan-maxim_01_a_first.qxd 10/31/05 11:43 AM Page 1