Is the UK becoming the ‘sicker man’ of Europe?

The ‘sick man of Europe’, an epithet sometimes applied to the UK in the economic context, is used increasingly to describe the health of its population. The latest data from the Organisation for Economic Cooperation and Development (OECD) shows this epithet is even more fitting than before.¹

Life expectancy: falling behind

In 2023, life expectancy² in the UK (79 years in males and 82.9 years in females) was lower than in almost all comparable countries for males, and the lowest for females. Male life expectancy was more than two years lower than in several peers. Female life expectancy was not just lowest but as much as four years lower than in Japan and Spain. And the difference in life expectancy between the UK and most comparable countries widened between 2019 and 2023. Life expectancy, already low in the decade before the pandemic, fell sharply during it and recovered more slowly afterwards. 

Key markers of health

The UK ranks poorly on life expectancy because of poor performance on several key markers of health. For example, infant mortality is higher than in most comparable countries and about double the rate in Nordic countries and Japan.

Avoidable mortality measures the effectiveness of public health and health care systems in reducing avoidable deaths from disease and injury. This includes deaths that are preventable through effective public health interventions (eg to reduce smoking and obesity) and treatable through timely, effective health care (eg for cardiovascular disease and cancer). The UK has the highest rate of avoidable mortality – both preventable and treatable – more than 60% higher than in Japan, Sweden and Australia.

Cancer is a leading cause of death in OECD countries, including the UK. Although cancer incidence is lower in the UK compared to many peers, cancer mortality is among the highest. Five-year survival rates for breast, cervical, colorectal and lung cancers are also the lowest. For example, the breast cancer survival rate in the UK is 86% compared to 91% in Sweden; and the lung cancer survival rate in the UK is 19% compared to 27% in Norway.  

Cancer exemplifies the problems with the UK’s health system. Early detection, diagnosis and treatment of cancer is critical for improving patient outcomes, yet the UK compares poorly on all, with inequalities all along the cancer patient pathway.

While breast and cervical cancer screening rates are higher than in several peers, only about two-thirds of women in the UK are screened – well below the Nordic countries. People in the UK are treated with chemotherapy and radiotherapy less often, face longer waits for treatment, and older patients are less likely to receive treatment. People living in the most deprived areas have higher cancer incidence, lower rates of early diagnosis, longer waits for treatment and poorer survival compared with people living in the least deprived areas.

Although overall cancer survival is rising, improvements have slowed since 2010, in part due to longer waits for diagnosis and treatment. The Department of Health and Social Care’s forthcoming national cancer plan for England has a mountain to climb.  

The UK fares better on another leading cause of death – mortality from circulatory diseases (of which the biggest components are heart attacks and strokes); it ranks about the middle among peers. However, 30-day survival rates for patients admitted to hospital for a heart attack or stroke, a marker of the quality of health care, are lower relative to most comparable countries.

Why is the UK performing poorly?

Several factors contribute to the UK’s relatively poor standing on international health benchmarks, including a higher prevalence of behavioural risk factors harmful to health. 64% of people say they are living with obesity or are overweight – among the highest compared to selected peers. Although smoking prevalence is lower compared with many peers, a higher proportion report ‘binge’ drinking (almost 40%).

The UK’s health care system also faces chronic, systemic problems. It has been less well-resourced than health systems in many comparable countries for years. Lower per capita health expenditure and fewer doctors, nurses and hospital beds than in many peers illustrate a persistently over-stretched health care system which is reflected in intractably long waiting lists. The UK has the fewest CT, MRI and PET scanners, and the lowest rates of scans, compromising its capacity to deliver timely diagnoses crucial for good patient outcomes.

Health inequalities in the UK are wider than in many comparator countries and have been widening since 2010. There is high prevalence of chronic conditions and people economically inactive due to long-term sickness, and people are spending longer in poor health.

Turning the tide on the UK’s deteriorating population health is a herculean task, which the weak ambitions of the government’s 10 Year Health Plan fall short of fixing. The health challenges facing the country call for much bolder action on prevention than envisaged and a national drive to tackle the social determinants of health and reduce inequalities.