A recent report from The King’s Fund that compared health care system performance in the UK with 18 similar countries concluded that overall the UK is neither a leader nor a laggard. However, the UK does compare less well on measures of health status and health outcomes. The latest data from OECD (including for the pandemic years 2020 and 2021)1 in Health at a Glance 2023 can help to unpack why health outcomes are worse in the UK.
For more than a decade, life expectancy, a universally used measure of overall health status, in the UK has compared poorly with that of peers, with the exception of the US. In 2020 life expectancy fell more sharply in the UK, Italy and Spain than in comparator countries as a result of the Covid-19 pandemic, but the UK’s weaker pre-pandemic standing on life expectancy meant it slid even further behind. Data from the Office for National Statistics, due shortly, will show whether the UK experienced the upturn in life expectancy in 2021 seen among comparator countries, and the rate of the UK’s recovery relative to others.
While many wider determinants, such as housing, education and employment, have an impact on health and, therefore, on life expectancy, health care also plays a role. Cardiovascular diseases (CVDs) and cancer are among the leading contributors to overall mortality, and hence life expectancy. How does the UK’s health care system compare in these areas?
In 2020 population-based rates of CVDs and cancer mortality were higher in the UK than in many comparator countries. This could mean that more people develop CVDs and cancer, eg, because the prevalence of behavioural risk factors such as smoking is higher, and/or that they are less likely to survive if they develop these diseases. Both behavioural risk factors and survival rates can be tackled through high-quality public health and health care services. Let’s consider each in turn.
Smoking, excess alcohol consumption and obesity are among the leading (but modifiable) risk factors for CVDs and cancer. Compared with peer countries, in the UK smoking prevalence is lower and alcohol consumption is about middling, but excess alcohol consumption is higher, and levels of overweight/obesity in adults are among the highest (64 per cent in 2021). Hence, the UK urgently needs to implement a range of ambitious public health strategies, such as the Prime Minister’s plans for a ‘smokefree generation’, to reduce the prevalence of these largely preventable diseases.
The UK’s survival rates for CVDs and cancer are also poorer. For example, in 2021 death rates within 30 days of hospital admission for an acute myocardial infarction (heart attack) or a stroke were higher than in most comparator countries. Re-admission and mortality rates within one year of hospital discharge after a heart attack or congestive heart failure, a measure of the quality of integrated care in preventing a relapse of ill health, are also higher. Cancer survival rates also compare poorly. The UK’s survival rates for many leading cancers (eg, lung, breast, colorectal), although improving, have been worse than in many peer countries for years. Screening rates for breast and cervical cancer in the UK are about middle of the range in comparator countries, and diagnosis of cancer at an early stage, when it is more amenable to treatment, is poorer and has remained relatively unchanged over time. Overall, the UK is lagging behind in providing timely and effective health care for those who develop CVDs or cancer.
The UK compares poorly in terms of both preventing and treating CVDs and cancer. This applies more widely also. Compared with peers, the UK has a relatively high rate of avoidable mortality, which includes deaths at ages under 75 years that are preventable through effective public health interventions (eg, deaths from infectious diseases, road accidents), and deaths that are treatable by timely, effective health care services (eg, deaths from heart attack, stroke, breast cancer).
While all comparator countries suffered major losses of life and health during the pandemic, the UK’s weaker pre-pandemic ranking on many key health outcomes has been followed by a surge in post-pandemic morbidity, with about 2.6 million working-age adults not in work due to ill health, with this figure set to rise further. Moreover, mortality rates in 2022 and 2023 (to date) among young adults have been higher than in the preceding decade. Reducing the UK’s high burden of morbidity and mortality calls for a laser-sharp focus on ambitious strategies for tackling the drivers of ill health (eg, the rising prevalence of obesity) and ensuring early diagnosis and timely access to high-quality care. Earlier intervention at every stage to prevent, diagnose and treat ill health is a pre-requisite for ensuring improvements in population health and a sustainable future for the NHS.