This article discusses the circumstances in which older people die in Britain, focusing on the nature of health and social care interventions. It argues that the social context of ageing, reflected in the policy framework of health and social care, perpetuates a negative view of ageing that is particularly damaging to older people as they approach the end of their lives. Drawing on existing evidence of services in palliative care and care of older people and on recent research findings, it considers the concept of 'tertiary health promotion' and explores this as a useful approach to developing services. It argues that a tertiary prevention approach has particular advantages. First, it enables crucial links to be drawn between individual and collective responsibilities for health and, second, it enables end-of-life care for older people to be understood in the context of their health and well-being over the whole life course.