If we are to welcome the elderly into our communities and support them to stay there for as long as possible, if we are to attend to the social needs of our elderly citizens both inside and out of institutions, then we need both government intervention and funding, along with the community's engagement and help.

When I spoke to a colleague about Joe's report, her face registered surprise. She said, "Is it possible for a death in a nursing home to be premature?" Joe told me, "If it were happening in any other kind of institution, to any other part of the population - workers, say, or children - there'd be an outcry, media, inquiries, swift intervention. The truth is we do not value the last months or years of a person's life. The remaining life of someone old. Particularly if they are in residential care." If we are all just economic units who lift or lean, then very little is "lost" when a nursing home resident or anyone getting on in their years dies prematurely. In fact money might be saved - one less nursing-home bed to fund, and the kids can finally get their hands on the house.

No one wants to go into a nursing home. My patients fear it; families often feel terrible guilt when the time comes: it is thought of as an abandonment. Nursing homes are where we place our bad outcomes, our frail, our no-longer-independents. They are places people go to wait safely to die. The old doubly incontinents. You might have stood up to Stalin, you might still read Tolstoy, but if you're losing it from both the front and back and you're not a two-year-old, you're going to be hidden away. "Don't know the nursing homes, they do a pretty good job," a geriatrician said to me. And most of the time they perform their function: as a holding bay for old people. Most of the time.

Medicine and society have entered into a folie a deaux regarding medicine's importance in gigantic population ills. We believe that genetics and pills and enzymes bring us health. We wait for the dementia cure (the obesity cure, the diabetes cure) rather than changing our society to decrease incidence and severity. We slash social welfare programs and access to GPs and ignore the downstream effect this will have on future generations. To reduce non-communicable disease, the actions we need to take are societal: make it easier for people to move and eat well, strengthen education, promote community participation and meaningful work. Our collective delusion is that we can have all the benefits such a society would bring without the structural supports necessary to bring it into being, that we can attain health by inventing and buying drugs. It is hard to know which is the more utopian vision: magic pills or a society serious about prevention.