Does the government’s 10 Year Health Plan measure up to the current state of population health?

Labour’s health mission is to improve health and health equity in England by improving healthy life expectancy overall and halving the gap between regions. It aims to do this by building ‘an NHS fit for the future’. But are the ambitions in the 10 Year Health Plan commensurate with the current state of population health?

One way of contextualising this question is to look at how the UK population’s health compares with that of comparator countries. Life expectancy at birth¹ is used globally as a key summary measure of population health and for comparisons between countries and population sub-groups. In 2023 (the latest data available), life expectancy in the UK² was 79 years in males and 82.9 years in females – among the lowest in all high-income countries other than the United States (see Figures 1a and 1b). This follows slower improvements in life expectancy in the pre-pandemic decade than in comparator countries, relatively sharper falls in life expectancy during the pandemic due to greater excess mortality (exceptions being Italy and Spain in 2020), and a slower recovery to pre-pandemic life expectancy levels after 2021.

Figure 1a

Figure 1b

Wide and widening inequalities in life expectancy in England also contribute to the UK’s poor international standing. In 2020–22, life expectancy in England in the most deprived decile of areas was 10.4 years lower in males and 8.4 years lower in females than in the least deprived areas, the gap having widened significantly from 9 and 6.9 years respectively in 2011–13. Although this partly reflects the more severe impact of Covid-19 on people living in more deprived areas, inequalities in life expectancy were already widening in the years before the pandemic and life expectancy was falling in the most deprived areas. Compared with 2011–13, life expectancy in 2020–22 was 1.3 years lower in males and females in the most deprived areas, whereas it was marginally higher in the least deprived areas (by 0.1 and 0.2 years respectively), despite the pandemic. People living in the most deprived areas, such as Blackpool, have a life expectancy similar to that in Bangladesh and Mexico. In contrast, life expectancy in the least deprived areas is similar to or higher than in high-income countries such as Italy, Australia, Canada and Sweden. On several markers, inequalities in life expectancy are wider in the UK than in comparable countries, curtailing millions of lives prematurely.

Another brake on life expectancy is that mortality rates, from which life expectancy is derived, haven’t shown uniform improvements by age. In spite of the pandemic, by 2024 much of the decline in mortality compared with the average for the preceding decade was driven by people of pensioner ages. In contrast, young and middle-aged adults aged 20–64 experienced little or no improvement in mortality over the previous decade, with males aged 40–59 experiencing higher mortality in 2024 than in 2014. Rising mortality among adults of working ages has been apparent for some years, but this accelerated after the pandemic. These trends will have impeded improvements in life expectancy and are consistent with the sharp increase in work-limiting health conditions among working-age people and economic inactivity due to long-term sickness.

So the launch of the 10 Year Health Plan comes at a time when the sentinel measure of population health – life expectancy – is around the bottom of rankings among comparator countries, the UK compares poorly on other health measures, health inequalities are widening, and the prospects of economic growth are jeopardised by the ailing health of working-age adults. Trends in healthy life expectancy, the measure used to define the government’s health mission, are even worse, having fallen by 1.5 years in males and 2.1 years in females in the decade to 2021–23.

The government’s ambition to have ‘….restarted progress on longevity, healthy life expectancy… and begun narrowing the wide and widening health inequalities’ in 10 years’ time’ seems modest given the urgency demanded by the current state of population health, which shows few signs of an upturn. The health challenges facing the country call for much bolder action on prevention than envisaged in the government’s plan. Primary prevention should not be seen as a long-term process as stated in the plan. Instead, as with Scotland’s 10-year plan, it needs to be centre stage, and public health policies have been shown to deliver positive, cost-effective impacts within five years. An international review provides evidence that specific policies – so-called ‘quick buys’ – to reduce alcohol and tobacco use, unhealthy diets and physical inactivity, which are leading risk factors for deaths from non-infectious diseases such as cardiovascular disease and cancer, have the potential for rapid impacts on health.

Furthermore, a national drive to tackle the root causes of ill health needs to go well beyond a vision for just getting the NHS ‘back on its feet’. But there is little in the 10-year plan about the government’s pre-election mission to tackle the social determinants of health that would reduce inequalities in healthy life expectancy. The need for a range of targets for improving key health outcomes and reducing inequalities, with supporting cross-government strategies for achieving them, ongoing monitoring of progress and accountability for delivery, such as New Labour had during 2000–10, is even more pressing now than it was then.