Improvements in life expectancy in many high-income countries (eg, Europe including the United Kingdom (UK), Australia, Canada, the United States (US)), have slowed markedly in recent years. The King's Fund and the Organisation for Economic Co-operation and Development (the OECD) have been working to understand what’s driving this slowdown, in order to inform efforts by governments to tackle the causes.
While much remains unclear about what is driving this slowdown in many countries, cardiovascular disease (CVD), of which heart disease and stroke are the main components, appears to be an important part of the puzzle. Despite dramatic falls in CVD mortality globally in recent decades (for example, in the UK, the death rate from heart disease halved between 2005–15), it remains a leading cause of death in high-income countries, and is one of the largest contributors to health inequalities. CVD claims 153,000 lives in the UK (one-quarter of all deaths) annually. So, it can have a significant impact on overall life expectancy.
There is evidence now that slowing improvements in CVD mortality are contributing significantly to the slowdown in life expectancy improvements overall in England. CVD morbidity is also a major issue – 6.8 million people in England are living with CVD conditions, and CVD-related health care costs amounted to an estimated £7.4 billion per year.
To examine these issues further in the international context, The King's Fund and the OECD jointly convened an international workshop on trends in CVD mortality, a unique collaboration on an important population health issue. The aim of the workshop was to examine and raise awareness about the slowing improvements in CVD mortality in some OECD countries, including the UK.
Held at the OECD in Paris on 6 November 2019, the workshop was addressed by the following international experts on CVD:
- Ms Susanne Løgstrup, Director of the European Heart Network, Belgium
- Professor Jessica Ho, Assistant Professor of Gerontology and Sociology, University of Southern California, US
- Dr Catherine Johnson, Lead Research Scientist in Cardiovascular Disease, Institute of Health Metrics and Evaluation, University of Washington, US
- Professor Anton Kunst, Professor of Social Epidemiology, Amsterdam UMC, University of Amsterdam, The Netherlands
- Professor Martin O’Flaherty, Professor of Epidemiology, University of Liverpool, UK.
The workshop was attended by representatives from the following 19 OECD countries: Australia, Austria, Denmark, Finland, France, Ireland, Israel, Japan, Korea, Latvia, Luxembourg, Netherlands, Norway, Portugal, Romania, Singapore, Slovenia, Switzerland, and the UK.
The workshop examined trends in CVD mortality in OECD countries, the causes driving any slowdowns, policy options for tackling the slowdown and how national and international monitoring of CVD mortality can be improved.
Some of the trends and common themes discussed (with selective case studies kindly provided by France, Portugal and UK) included:
- CVD is a leading cause of death in many OECD countries and across Europe
- improvements in CVD mortality have slowed or plateaued in several OECD countries, not just the UK but also in the US, Australia, France, Germany, Greece, Spain, Portugal, and some Nordic countries, especially among younger and middle-aged adults
- there are wide socio-economic inequalities in CVD mortality in most European countries, reflecting socio-economic differences in the major CVD risk factors
- many CVD deaths can be prevented, but trends in several risk factors for CVD are going in the wrong direction: while smoking rates overall have fallen, inequalities remain, and cholesterol, blood pressure, low physical activity, blood sugar and diabetes are on the rise in many OECD countries.
The workshop discussion highlighted a number of measures that could be implemented to tackle the slowdown and improve monitoring, including:
- population-level policies, including fiscal and regulatory measures to promote healthy lifestyles, can reduce the burden of CVD; such policies can be cost-effective, have a rapid impact, reduce inequalities, and ease pressures on the health care system
- speakers warned against complacency and the assumption that CVD mortality would continue falling as in the past; if lifestyles don’t improve, the trend of falling heart disease deaths could reverse in the future
- the cost of inaction in tackling the significant burden of CVD can be high, including the indirect costs associated with, for example, the higher levels of dementia and disability that would follow
- several limitations to the data currently available need to be addressed to facilitate timely and effective monitoring that can inform policy development.
Participants agreed on the key need to strengthen preventive measures, but also that improvements in early detection, diagnosis and timely, evidence-based care is important for some countries.
This event was significant because it facilitated national and international dialogue about emerging trends in CVD, a key determinant of population health, and one that impacts directly on life expectancy overall. It also provided a unique opportunity for sharing the experiences of individual countries, and the similarities and divergences. Such international collaboration can promote awareness about and learning from emerging adverse trends in population health that transcend national borders.
Details of the workshop, the proceedings and briefing papers by the authors are available in a joint report from The King’s Fund and the OECD, with links to supplementary material including the speakers' presentations.
The top three causes of premature death in developed countries are closely following those in the USA. They are CVD, Respiratory Diseases(Lung cancer, Asthma COPD), and Iatrogenic Causes (Medical/drug intervention). *
As regards CVD this is primarily associated with diet and obesity, which may be also associated with hypertension due to stress.
Respiratory problems almost invariably are associated or caused by chronic hidden hyperventilation, this is frequently due to the normal response to stress.
Iatrogenic factors, there is a rapidly increasing prescription of drugs and /or self-medication with otc medicines. This is in part due to treating symptoms rather than the underlying causes of the condition. Many other factors are detailed in the referenced book below.
* For references see: How Not To Die by Michael Greger MD ISBN 978-1-4472-8244-0
It is interesting to note that there appears to be an inverse correlation between expenditure on medical care and life expectancy in developed countries. There may be a positive correlation in underdeveloped countries where medical care is lacking.
Life expectancy = 83 - 0.7X (Where X is per capita expenditure on health in '000s $) i.e. USA 78 years (per capita spend $7,000), cf. Japan 83 (per capita spend $2,750) Does this reflect increasingly poor health with increased affluence or increased mortality with an increased medical intervention?