How and why is life expectancy in London different to other English regions?

For two decades before the Covid-19 pandemic London, and many of its boroughs, had the highest gains in life expectancy compared with other regions and local authorities. But this changed after the pandemic.  

How did things change and what explains London’s atypical trends in life expectancy compared with other regions?  

To set the national context: improvements in life expectancy¹ for males and females in England stalled during the pre-pandemic decade. As in most countries globally, life expectancy fell sharply during the pandemic because of exceptionally high mortality from Covid-19; it recovered to pre-pandemic 2019 levels only by 2024. In 2025, life expectancy in England increased to 80 years for males and 83.8 years for females, the highest level recorded. But the pace of these changes varied across the nine English regions, with London in particular showing strikingly different patterns (see Figures 1 and 2). 

There are a number of exceptional features of recent trends in life expectancy in London relative to other regions.  

• London experienced the highest Covid-19 mortality and hence the greatest fall in life expectancy (of 1.3 years in males and 0.8 years in females) during the pandemic (2020–22 compared with 2017–19).  

• This was followed by London experiencing the sharpest bounce back in life expectancy of all regions after the pandemic (2023–25 compared with 2020–22): of 1.6 years in males and 1.3 years in females; such a sharp increase in life expectancy within 3 years is exceptional.    

• In 2023–25 female life expectancy was highest in London and male life expectancy was second highest (after the South East) compared with other English regions.  

• London has also shown exceptional trends over the longer period. Between 2013–15 and a decade later in 2023–25, both male and female Londoners experienced the greatest increase in life expectancy of all regions: 0.7 and 1 years respectively. This contrasts with increases of 0.2 years or less in males and 0.4 years or less in females in the 5 northern regions during this period.    

• London’s life expectancy also showed the largest increase compared with two decades earlier (ie, 2003–05), of 3.9 years for males and 3.6 years for females, over 1 year higher than the increases seen in other regions.    

• These marked regional variations in life expectancy trends have resulted in an almost doubling – to 3 years – of the inequality between London and the North East, where longevity has consistently been the lowest since the start of the 21st century.   

So, what makes London so different?  

The demographic profile of London 

London’s population is younger and more transient compared with other regions. London is also the most ethnically diverse region in England, with almost half its population being non-White. The proportion of people who are not white in several London boroughs is the highest nationally compared with local authorities elsewhere: over 60% in 5 London boroughs, and 22 of London’s 32 boroughs are in the top 10% of areas with the highest proportions nationally. Moreover, most of these London boroughs have high levels of deprivation. Newham and Tower Hamlets exemplify these features, being among the most deprived local areas nationally and with non-white populations of over 60%, and yet also showing some of the largest increases in life expectancy in 2022–24 compared with both 2001–03 and 2012–14. 

But London shares some demographic features in common with other regions eg an ageing population and widening health inequalities. In what ways and why is London’s population healthier than the populations of other regions? 

The health of Londoners 

We compared some key health indicators for London and, for contrast, the North East region with the lowest life expectancy (see Table 1). On all markers, Londoners are healthier than their North Eastern counterparts with, for example, lower rates of overweight/obesity and lower prevalence of and mortality from several chronic diseases. This is despite London’s much greater ethnic diversity (46% non-white compared with 7% in the North East) and the fact that conditions such as diabetes and cardiovascular disease are more prevalent in people from Asian and Black groups.  

It’s pertinent to also examine what’s driving high mortality elsewhere. For example, there’s a marked north–south divide in death rates from major killers: premature mortality from cardiovascular disease and cancer is 19% and 27% respectively higher in the North East compared with London. ‘Deaths of despair’ are fewer in number but often associated with the socio-economic and psychological stress resulting from cumulative economic disadvantage mediated by wider social determinants of health. ‘Deaths of despair’ include suicides and deaths related to drug misuse and alcohol-related diseases, and are symptomatic of underlying drivers that may increase the risk of ill health and death also from other causes, eg, cardiovascular disease. 

London has the lowest rate of suicide of all English regions, and among the lowest (along with the East and South East) death rates related to alcohol and drug poisoning/misuse. Compared to national averages, alcohol-related mortality is similar or lower in all London boroughs, rates of suicide and hospital admission for self-harm are lower in almost all boroughs, and only 3 boroughs have higher death rates from drug misuse. In contrast, the North East has the highest rates of suicide and deaths from alcohol and drug poisoning/misuse. Almost all local authorities in the North East have higher than national average rates for alcohol-related hospital admissions and deaths, deaths from drug misuse and hospital admissions for self-harm; suicide rates are higher than the national average in 8 of the 12 local authorities in the North East.  

In terms of uptake of preventive care, Londoners have higher uptake rates for the NHS Health Check² but, in contrast, lower vaccination rates for children and adults, and lower screening rates for cancers of the bowel, breast and cervix.  

Table 1 Selected demographic, health and economic indicators for London and the North East regions

Source: OHID 2026 

Access to health care in London

In terms of access to health care, the picture in London is mixed.  

General practice in London is experiencing particularly severe challenges compared to other parts of England and has the highest average number of patients per GP of all regions. London has seen over a 20% reduction in GP practices in the past 10 years, with the most disadvantaged neighbourhoods and communities often the most disproportionately impacted.   

On the other hand, health care in London is dominated by the generous supply of acute care, including teaching and specialist hospitals, with 32 NHS trusts providing community, secondary and tertiary care to Londoners and people in the South East and beyond. London has the highest intensive care unit bed capacity. Although this may make for easier access to secondary and specialist care, London, as elsewhere in England, has experienced continuing pressures across both emergency and planned care, with rising use of ‘corridor care’ and growing waits in A&E.  

The socio-economic status of Londoners

London is an economic powerhouse, it generates 22% of the UK’s GDP. It provides a stark contrast to the decades of deindustrialisation in northern regions leading to entrenched economic disadvantage and urban decay that have taken their toll on the health of local communities – leading to the long-standing north–south gradient in health inequalities.  

Research shows that socio-economic factors play a major role in geographic inequalities in premature mortality rates, which are highest in local authorities in the North East, the North West and Yorkshire and the Humber, and lowest in London. In contrast, ethnicity accounts for relatively little of the geographical variation. London’s pockets of deprivation notwithstanding, significantly more favourable economic conditions, employment opportunities and working conditions, environmental and living standards in the capital relative to, in particular, communities in northern regions will amplify the geographical disparities. 

Gentrification

Could ‘gentrification’ contribute to the ‘London effect’ in life expectancy? Regeneration and rising property prices have seen some historically poorer neighbourhoods in London become desirable and more affluent, with population churn resulting in people moving into London from less deprived areas and outward movement, especially of families, into outer London boroughs and beyond. Although the pandemic caused a sharp exodus of people from London, this was temporary and London’s population returned to growth in 2021–22. The process of gentrification in London is complex and has changed over time, with amplification in both the level of churn and in its social mobility.  

Further evidence of the impact of gentrification comes from an analysis of life expectancy changes at small area level in London between 2002–19 and their association with house prices. The largest gains in life expectancy occurred where house prices were already high or where they increased the most, especially from low levels, possibly due to an influx of more educated and better-off working age residents.

Conclusion

Likely contributory factors to the buoyant trends in life expectancy in London include its unique economic strengths, gentrification and possibly a generous supply of acute health care services and the ‘healthy migrant’ effect³. They highlight the contrast with regional comparators at the other extreme – specifically the 5 northern regions, the North East and North West in particular – which have seen little or no improvements in life expectancy over the past decade.  

The regional inequalities described here illustrate the scale of the challenge the government faces in achieving the goal in its 10 Year Health Plan for England of increasing healthy life expectancy for everyone, and halving the gap in it between the richest and poorest regions. With healthy life expectancy on a downward trend and inequalities persistently wide, the goal looks increasing unrealistic. The shift from sickness to prevention that the plan aims for has never been more urgent, but it remains an elusive goal as public health budgets and the urgency given to reducing risk factors like obesity and preventing ill health fall well short of the needs of deprived communities.  

Levelling up policies of successive governments have hitherto failed to deliver the economic regeneration required to reverse the adverse impacts of long-standing industrial decline on the health of almost half of England’s population, and should be an urgent priority. Addressing this inequity in the nation’s health is not just a matter of social justice, it would reduce pressures on the NHS and the high economic costs of ill health.     

The factors contributing to London’s atypical life expectancy patterns haven't (to our knowledge) been investigated statistically, except at the ecological level (ie, analysis at the population rather than individual level). A better understanding of what’s driving these demographic changes in London, using linked data across various parameters, could help inform population health improvement strategies in other regions.