What is happening to life expectancy in England?

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There have been two turning points in trends in life expectancy in England in the past decade. From 2011 increases in life expectancy slowed after decades of steady improvement, prompting much debate about the causes. Then in 2020, the Covid-19 pandemic was a more significant turning point, causing a sharp fall in life expectancy the magnitude of which has not been seen since World War II.

This article examines trends in life expectancy at birth up to 2020 and the impact of Covid-19 in 2020, gender differences, geographical inequalities, causes of the changing trends since 2011, and how the UK’s life expectancy compares with other countries.

How has life expectancy changed over time?

Mortality has declined since the 19th century, leading to a long-term rise in life expectancy for both males and females (see Figure 1). Males born in 1841 could expect to live to only 40.2 years and females to 42.3 years, mainly because of high mortality rates in infancy and childhood. Improvements in nutrition, hygiene, housing, sanitation, control of infectious diseases and other public health measures have reduced mortality rates, increasing life expectancy to 56 years for males and 59 years for females by 1920.

Figure 1 Life expectancy at birth

The 20th century saw further dramatic improvements in life expectancy resulting from public health measures such as childhood immunisations, the introduction of universal health care, medical advances in treating adult diseases such as heart disease and cancer, and lifestyle changes including a decline in smoking. A century later, by 2019, life expectancy at birth in England had increased to 80 years for males and 83.7 years for females (see Figure 2). However, the Covid-19 pandemic caused life expectancy in 2020 to fall for males to 78.7 years and for females to 82.7 years, the level of a decade ago.

Figure 2: life expectancy at birth

What's the difference in life expectancy between males and females?

Women have always lived longer than men, but the gender gap in 1841 (2 years) was relatively small because of the high prevalence in the 19th century of diseases that killed men and women indiscriminately. In the late 19th and early 20th centuries the gender gap in life expectancy started to widen, peaking at 6.3 years by 1971 (see Figure 1). Reasons for the widening gender gap included poor working conditions and smoking among men in contrast to improved life chances for women, for example, lower risk of dying in labour and from tuberculosis, which affected women more than men.

The gender gap narrowed from the 1970s, to 3.7 years in 2019, with mortality falling faster in males than females because of decreases in smoking and mortality from cardiovascular diseases among men. However, the gender gap widened in 2020 to 4 years because mortality rates from Covid-19 were higher in males than females.

Healthy life expectancy

Healthy life expectancya also increased over time, but not as much as life expectancy, so more years are spent in poor health. Although an English male could expect to live 79.8 years in 2017–19, his average healthy life expectancy was only 63.2 years – ie, he would have spent 16.6 of those years (21 per cent) in ‘not good’ health.

In 2017–19 an English female could expect to live 83.4 years, of which 19.9 years (24 per cent) would have been spent in ‘not good’ health. And although females live an average of 3.6 years longer than males, most of that time (3.3 years) is spent in poor health.

Similarly, disability-free life expectancy is almost two decades shorter than life expectancy, and is higher among males (62.7 years) than females (61.2 years).

  • a. Healthy life expectancy is an estimate of the number of years lived in ‘very good’ or ’good’ general health, based on how individuals perceive their general health. Disability-free life expectancy is an estimate of the number of years lived without a self-reported long-lasting physical or mental health condition that limits daily activities.

Inequalities in life expectancy

People living in more affluent areas live significantly longer than people living in deprived areas. In 2017–19, males in the least deprived 10 per cent of areas in England could expect to live to 83.5 years, almost a decade longer than males in the 10 per cent most deprived areas (74.1 years). Females in the least deprived 10 per cent of areas in England could expect to live to 86.4 years, compared with 78.7 years for females in the most deprived areas, a difference of almost 8 years. Much of this inequality is caused by higher mortality from heart and respiratory disease, and lung cancer in more deprived areas. The male–female difference in life expectancy is greater in more deprived areas: for example, females in the most deprived areas live 4.6 years longer than males, compared with a difference of 2.9 years in the least deprived areas.

The rich–poor gap in healthy life expectancy is even greater – almost two decades – than the gap in life expectancy. Those living in the most deprived areas spend nearly a third of their lives in poor health, compared with only about a sixth for those in the least deprived areas. Males in the most and least deprived areas spent 21.8 and 12.8 years respectively in poor health; for females, the corresponding figures were 27.3 and 15.3 years. Hence, not only do people living in the most deprived areas have the shortest life spans, they also live more years in poor health.

Socio-economic inequalities in life expectancy are widening as a result of greater gains in life expectancy in the least deprived populations. Males and females living in the least deprived areas of England saw a significant increase in life expectancy between 2014–16 and 2017–19; in the most deprived areas no significant changes were observed.

While mortality has declined everywhere, there is a persistent north–south divide in life expectancy and healthy life expectancy, with people in southern regions on average living longer and with more years in good health than those living further north. For example, in 2017–19, life expectancy for males was about eight years lower and for females about seven years lower in Blackpool, Middlesbrough, Manchester and Liverpool than in Kensington and Chelsea, Camden, and Westminster. The gap in years lived in good health across local authorities in England was even greater, about 17 years.

Some population groups have significantly shorter life expectancy than the general population. For example, homeless males and females live 31 years and 38 years fewer years respectively than males and females on average. People with learning disabilities also have shorter lives than the average, by 23 years among males and 27 years among females.

About 14 per cent of the population of England is non-white. Life expectancy data is not yet available by ethnic group because ethnicity is not currently recorded at death registration but, following the disproportionate impact of Covid-19 on ethnic minority communities, the government has said it will be introduced in England (Scotland introduced it in 2012).

Covid-19 and inequalities in mortality

Mortality from Covid-19 has had an unequal impact on different population sub-groups and exacerbated inequalities. Between 2019 and 2020 life expectancy in males fell by almost 2 years in the poorest decile of areas (from 74.3 to 72.4 years) compared with 1 year in the richest decile (from 83.6 to 82.6); for females in the poorest areas it fell by 1.6 years (from 78.9 to 77.3) compared with 1 year in the richest (86.8 to 85.8). As a result, the gap in life expectancy between the richest and the poorest areas widened in 2020 to 10.2 years for males and 8.5 years for females, compared with 9.3 and 7.9 years respectively in 2019. 

Although 2020 life expectancy data isn’t yet available for all population sub-groups, mortality data for other groups also shows inequalities which in turn will impact on life expectancy. For example:

How and why did trends in life expectancy change after 2011?

2011 marked a turning point in long-term mortality trends, with improvements tailing off after decades of steady decline. In the 100 years to 2010–12, life expectancy increased by nearly 3 years every decade, but between 2011 and 2019 it increased by only 0.8 years for males and 0.6 years for females, having virtually flat-lined between 2014–18. However,  in 2019 life expectancy increased by 0.3 years in males and 0.4 years in females and in January–March 2020, before the Covid-19 pandemic took effect, mortality was again at the lower level seen in 2019The life expectancy gains in 2019 and the fall in mortality in early 2020 were associated with mild influenza (flu) seasons and troughs in winter mortality.  

One year deserves special mention – 2015, when life expectancy fell across virtually all of Europe. In England there were an estimated 28,000 deaths associated with flu and life expectancy fell by 0.2 years in both males and females – unprecedented for decades until the Covid-19 pandemic in 2020. As in Europe, most ‘excess’ deaths in 2015 occurred among older people, with deaths from respiratory disease (including flu and pneumonia) being a key contributor to the largest annual rise in deaths since the 1960s.

A review of mortality trends in England to 2017 found that improvements in life expectancy since 2010 had slowed in most areas of England and among all socio-economic groups, but the slowdown was greater among the most deprived groups and inequalities had widened. Slowing mortality improvements among people aged 50 years and over played a significant role.

The reasons for the post-2011 slowdown in life expectancy improvements are unclear and have been hotly debated.

Several studies attributed both the 2015 fall in life expectancy and the slowdown in mortality improvements after 2011 to the consequences of austerity-driven constraints on health, social care and other public spending and their impact on services.1-6 Others acknowledge that austerity could have had negative consequences on the quality of care, resulting in some excess deaths, but they suggest that statistical associations don't prove causality and there could be other explanations. For example, the growing complexity of medical conditions in an ageing population, and the contribution of decelerating improvements in cardiovascular disease (CVD) mortality and periodic bad flu seasons to the decelerating mortality improvements seen in many high-income countries.7-10 Moreover, some European countries that didn’t adopt austerity policies also experienced slowdowns in life expectancy improvements (eg, Germany and Sweden), while life expectancy increased in others that introduced severe austerity measures (eg, Spain, Ireland, Greece).11

Public Health England’s review identified some of the factors contributing to slowing improvements in life expectancy to 2017: increasing numbers of older people vulnerable to flu and other winter risks, slowing improvements in mortality from heart disease and stroke, widening inequalities and rising death rates from accidental poisoning among younger adults (mainly due to drug misuse). It noted that the slowdown occurred across much of the population, at a time when health and social care services faced increasing demand and unprecedented financial pressures.

A slowdown in improvements in life expectancy since 2010 was seen also in many European countries, but it was greatest in the UK. It’s likely that there were several reasons for these trends, some specific to the UK (such as widening inequalities) and some common to the UK and other European countries (such as the swings in flu-related mortality and slowdown in CVD mortality improvements in some countries).11-13 The later uptake of smoking in women compared with men is cited as one explanation for the long-term, relatively small increases in female life expectancy in the UK in recent years, and why it compares poorly with Europe.14

The slowdown in life expectancy improvements between 2011 and 2019 was nothing compared with what was to follow. The Covid-19 pandemic caused 72,000 excess deaths in England in 2020 compared with the 2015–19 average, resulting in the largest annual fall in life expectancy since World War II: a fall of 1.2 years in males and 0.9 years in females. Moreover, there have been more than 28,000 excess deaths between 1 January and 2 April 2021, 20 per cent more than the 2015–19 average for the same period, so life expectancy in 2021 could remain below levels seen in the pre-2020 decade.

Further details about mortality from Covid-19 are available in our explainer, ‘Deaths from Covid-19 (coronavirus): how are they counted and what do they show?’.

How does the UK compare with other European countries?

Life expectancy data for European countriesb is available only to 2019, hence it doesn’t reflect the impact of the Covid-19 pandemic.

In 2019, life expectancy at birth varied by 10.6 years for males and 7.9 years for females across the 28 European Union (EU) countries (the UK did not leave the EU until 2020) (see Figures 3 and 4). Generally, western, northern and southern European countries had higher life expectancies than central and eastern European countries. Women outlive men in all EU countries.

In 2019, male life expectancy in the UK was below that of several western European countries, while female life expectancy was below that of all western European countries and also the EU average. For males in the UK, life expectancy was almost 2 years less than the highest seen in the EU (Sweden) and for females it was more than 3 years shorter than the highest (Spain). 

Figure 3 Life expectancy at birth in the EU, males

Figure 4 Life expectancy at birth in the EU, females

Figures 5 and 6 show that, whereas male life expectancy in the UK in the preceding decade was about average compared to most western European countries, female life expectancy in the UK was consistently the lowest among peers. As in the UK, improvements in life expectancy slowed in many European countries in the decade to 2019. However, the slowdown was greater in the UK than in most other EU countries.

The periodic spikes in excess deaths in some recent winters, especially among older people, show similar patterns across the UK and several European countries, and, according to official agencies are associated with flu and cold spells. In particular, as in the UK, European agencies reported increased mortality in 2015 that disproportionately affected older people, and women in particular. Compared with 2014, in 2015 life expectancy fell in 23 of the 28 EU countries for females and in 16 EU countries for males (see Figures 5 and 6). European monitoring agencies report that this widespread fall in life expectancy resulted from excess winter mortality associated with flu.

Figure 5 Life expectancy at birth for selected EU countries, males

Figure 6 Life expectancy at birth for selected EU countries, females

When 2020 life data becomes available, it is likely (as in the UK) to show a fall in life expectancy in several European countries, as most of them also experienced excess mortality due to the pandemic compared with preceding years. The ONS analysis showed that the UK had the highest excess mortality rate in Europe in the first Covid-19 wave to June 2020, but not in the later months of the year. Excess mortality in the UK in 2020 overall ranked 7th out of 22 European countries,c with only Spain, Belgium and some eastern European countries having even higher rates. Some countries, including Denmark, Norway, Finland, Estonia, experienced no excess mortality in 2020

  • b. Eurostat data on life expectancy in the EU countries from 2005 to 2019 is used in this section. Although the UK did not leave the EU until 2020, UK life expectancy data for 2019 is not available from Eurostat, so ONS data is used instead. Methodological differences in calculating life expectancy between Eurostat and ONS could affect the results, therefore UK life expectancy for 2019 is not strictly comparable with that of other EU countries. However, a comparison of ONS and Eurostat data on life expectancy in the UK for the pre-2019 decade shows the difference is likely to be small (about 0.1 to 0.3). Because the Eurostat data for 2019 doesn’t include UK data, the EU average is shown as EU27 not EU28. UK data is available in the Eurostat database for years preceding 2019.
  • c. Data for some European countries (eg, Republic of Ireland, Germany, Italy) was not available, hence they were not included in the ONS analysis.

Conclusion

The scale of excess mortality associated with Covid-19 thus far in 2020 and 2021, and evidence that many lives have been cut short, is unprecedented in recent decades. The pandemic isn’t over and the magnitude of its continuing impact on life expectancy in England will depend on associated mortality (caused directly by Covid-19 and indirectly by fewer people seeking or receiving care for other conditions) in the months ahead. These, and the wider socio-economic effects of the Covid-19 pandemic on population health and mortality, could last well beyond 2020 and widen health inequalities further.

Before the Covid-19 pandemic, life expectancy in the UK trailed many western European countries, especially for females, and the UK experienced the lowest improvements in the preceding decade. As in the UK, excess mortality in many European countries is likely to cause a fall in their life expectancies in 2020 as a result of the pandemic, but it isn’t yet possible to estimate the magnitude of the falls, and therefore the impact on the UK’s relative standing. Moreover, the pandemic is still playing out in 2021, with the timing and scale of the resurgence varying between countries. Future trends in mortality are unpredictable, as they depend on the course of the pandemic, governmental responses to them, the roll-out and efficacy of vaccination programmes, and other unforeseeable developments such as the development of new variants of the virus.

  1. Hiam L, Dorling D, Harrison D, McKee M (2017). ‘What caused the spike in mortality in England and Wales in January 2015?’ Journal of the Royal Society of Medicine, vol 110, no 4, pp 131–7, doi: 10.1177/0141076817693600. Available at: http://journals.sagepub.com/doi/abs/10.1177/0141076817693600?journalCode=jrsb (accessed on 23 June 2020).
  2. Hiam L, Dorling D, Harrison D, McKee M (2017). ‘Why has mortality in England and Wales been increasing? An iterative demographic analysis’. Journal of the Royal Society of Medicine,vol 110, no 4, pp 153–62. doi: 10.1177/0141076817693599. Available at: http://journals.sagepub.com/doi/full/10.1177/0141076817693599 (accessed on 23 June 2020).
  3. Loopstra R, McKee M, Katikireddi SV, Taylor-Robinson D, Barr B, Stuckler D (2016). ‘Austerity and old-age mortality in England: a longitudinal cross-local area analysis, 2007–2013’. Journal of the Royal Society of Medicine,vol 109, pp 109–16.Available at: http://journals.sagepub.com/doi/full/10.1177/0141076816632215 (accessed on 23 June 20200.
  4. Hiam L, Harrison D, McKee M, Dorling D (2018). ‘Why is life expectancy in England and Wales “stalling”?’ Journal of Epidemiology and Community Health, vol 72, pp 404–8. Available at: http://jech.bmj.com/content/early/2018/02/20/jech-2017-210401 (accessed on 23 June 2020).
  5. Green MA, Dorling D, Minton J, Pickett KE (2017). ‘Could the rise in mortality rates since 2015 be explained by changes in the number of delayed discharges of NHS patients?’ Journal of Epidemiology and Community Health, vol 71, pp 1068–971. Available at; https://jech.bmj.com/content/jech/71/11/1068(accessed on 23 June 2020).
  6. Watkins J, Wulaningsih W, Da Zhou C, Marshall D, Sylianteng G, Dela Rosa P, Miguel V, Raine R, King L, Maruthappu M (2017). ‘Effects of health and social care spending constraints on mortality in England: a time trend analysis’. BMJ Open. Available at: https://bmjopen.bmj.com/content/7/11/e017722 (accessed on 23 June 2020).
  7. Fordham R, Roland M (2017). ‘Expert reaction to paper on health and social care spending and excess deaths in England’. Blog. Social Media Centre website. Available at: sciencemediacentre.org/expert-reaction-to-paper-on-health-and-social-care-spending-and-excess-deaths-in-england/ (accessed on 23 June 2020).
  8. Steventon A (2017). ‘Can you really link delayed discharge to mortality? The evidence is far from clear’.Blog, The Health Foundation website. Available at: health.org.uk/blog/can-you-really-link-delayed-discharge-mortality-evidence-far-clear
  9. Milne E (2017). ‘Why the “120,000 deaths” claim is unsupportable’. Blog. Available at: https://eugenemilne.com/2017/11/17/why-the-120000-deaths-claim-is-unsupportable/ (accessed on 23 June 2020).
  10. RaleighVS (2018). ‘Stalling life expectancy in the UK’.BMJ, vol 362, k4050. Available at: kingsfund.org.uk/publications/stalling-life-expectancy-uk (accessed on 23 June 2020).
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  14. Leon DA, Jdanov DA, Shkolnikov VM (2019). ‘Trends in life expectancy and age-specific mortality in England and Wales, 1970–2016, in comparison with a set of 22 high-income countries: an analysis of vital statistics data’. Lancet, vol 4, no 11, e575–82.

Comments

Quinto

Position
Musicia,
Comment date
13 August 2021

Spain and Italy seems doing much better than U.K. in life expectancy: is this because they have a better health care system?

Kay Tate

Position
Warehouse,
Organisation
Supermarket
Comment date
23 May 2021

If there is such a distinctive difference in age between London
And the northwest ( a considerable difference. Shouldn’t we be lowering retirement age for manual workers in deprived areas bad weather places of the north?

As noted women spend longer with ill health

Could we get
The govt to even consider this?

Norine

Position
Project Manager,
Organisation
BBC
Comment date
21 April 2021

Firstly, I would like to thank you for the data collection. It is insightful and much-needed research.

Unfortunately, the experiences of Black British, Black African, Black Caribbean, White English, White Irish, White Other, Indian, Mixed Race, Pakistani, Bangladeshi are different and could have positive and negative implications on life expectancy.

This area may not have been previously considered to explore in further detail. However, it may have resonate with millions of British citizens who could have negative implications on their life expectancy based on race. If such data were available steps could be taken to reduce/mitigate premature death due to racial implications. Or the data could establish that race does not hold a factor in life expectancy within the UK.

As a British citizen, it's regrettable that I am unable to find this information about myself or my family.

David

Comment date
09 April 2021

Avoidable and premature deaths could be linked to NHS capacity problems, e.g. higher % of over 60s, as well as the capability to diagnose early. Number of disabled people, onset of mobility problems and orthopeadic waiting lists could lead to more premature deaths. Quality of Life indicators suggest that more than 30% of patients are at risk. Urban developments, e.g. sprawling towns and cities (little green spaces, lack of trees) has led to poor air quality and pollution increasing the prevalence of neurological disorders and other diseases, e.g. dementia. Obesity is not a new phenomenon and dates back to the 1970s, with major changes to food production, working practices, housing, and consumer behaviour. There is a much higher prevalence of certain diseases, e.g. insulin resistance, sleep apnea, increasingly the likelihood of premature death. Since the 1970s, use of medicines has increased exponentially, and some medicines have significant side effects, e.g. antipsychotics. Number of people living alone and the quality of housing could be contributing factors to lower life expectancies, e.g. depression, air quality, noise. Consumption of processed foods is higher in poorer areas because access to quality wholesome foods is poor as well as being expensive. Seriously low levels of physical activity in schools and colleges may have a long lasting effect on health and wellbeing. Arguably, life expectancy has reached its peak. If poverty and deprivation is likely to become more prevalent, life expectancy could be on a downward trend.

Andrew Coates

Position
Retired GP,
Comment date
17 December 2020

I looked up life expectancy by ethnic groups in the US and then the UK.
I the US the Asian Americans do best, Latinos do well, Whites in the middle and Blacks do worse.

In the UK I was reminded that we just don’t collect the data! The “BAME” group collects together groups which in the US have better and worse outcomes, so it averages them out.
Isn’t it time to collect the data?!

Paul McKeown

Position
Engineer,
Organisation
Government
Comment date
30 October 2020

What I find truly staggering in all of this the 2000 Pound Gorilla in the room called smoking. It simply beggars belief that the statistical changes due to the gradual elimination of smokers and their not so friendly smoke pollution is totally ignored. Credit to the big companies for hiding these facts in plain sight

Martine Matic

Position
Retired community worker,
Comment date
19 January 2020

I to am very interested in the 50’s women, we have seen such massive changes socio/ economic, family dynamics, many no longer living close , grand parents needed for child care and often looking after their elderly parents, but no recognition that this is important and no financial benefits often creating ill health and affects mental health. public health primary and local hospitals , not able to provide holistic health one issue is the care side is so depleted it clogs up the system, and another is it isn’t set up to look at a person as a whole eg you go to gp for a bad back he sends you to one dept who deals with this one issue and later other issues emerged stress, hypothermia malnutrition, mental health each time your going back to the gp, taking up his/her valuable time because if you live on your own or in a family on low pay your put on esa £70 a week your making choices between food and heat So the other health issues will follow, so it needs to be recognised and dealt with at the beginning . The system if care breaks down quickly and a cycle of deprivation sets in. employment law and how older people are viewed with in community and politically there are very few positives being an elder in communities and are seen as a burden often. This is not the case in other societies. Feel we need to look at other societies for positive outcomes. older people could in good health Eg participate in collages university's as advocates and receive free places , as sudo parents grand parents ( I have taken on a young woman with no family and supporting her ) volunteering brilliant for mental health but this could and would be seen as work by dwp and should be actively encouraged with out loosing benefits We are a society based on economics that gives us our worth. the dept dwp needs to be totally overhauled , a living wage needs to be the norm for every one who needs it without all the hoops loops and communities re build from the bottom up so each generation has a place with in it. Carers needs to be better paid, older people’s villages need to be built older people are isolated often And creates health issues , sessions at gyms free for elder people and care should be real and enabling the saddest part of my father dying was his wife Ill her self placed him in a home he was not allowed to leave his room it was horrific he served in the navy and he was made to sit on his bed till he passed and no matter what I said I was ignored my mother who has had dementia since she was 60 and now 87 has been in a home which is bright happy and has so much going on two different kinds of experiences. Im in my early 60’s don’t want my children to look after me if I become really ill although they insist they will, I travel up and down the country doing Nana duties and I’m too waiting for my pension , my generation had a very different life style to the next generation, freedom to play out every one looked after every ones children , women not expected to work full time when they had a family no pension to pay into, and have seen massive changes in women’s rights, and responsibilities , and now we are treated like a burden like we did this to our selves, we are not moving forward we have stalled at the top of the hill and starting to slide backwards , this is not the country I was hoping for yes my children have gone to uni yes I struggled beyond belief to get them there and they earn salaries I could never have had, yes my girls are strong determined women, but the sacrifices have left me physically and mentally at times Ill, I’m a lucky woman but many of my friends or not they have no pensions to live On , substandard accommodation and their life’s are a daily struggle many won’t see old bones and not sure if I will either but things have to change. Policy needs to change health needs to be holistic community needs rebuilding funding needs to be more forthcoming , £ 60 something for caring is a joke but women often give up a job and care for someone for a pittance. older people’s homes should be built with in a community or as a community and staff highly qualified and paid more . Older people’s vast knowledge used voluntary or paid. Extending learning till we die free education for elderly and this government need to recognise this generation did as they were told., And are now being punished for it eg I got divorced when my children where young the judge told me I could not work full time as I had children and therefore I worked part time for years meaning instead of being a manager I had to take a less paid role and live on a lot less pay it would never happen now. Antidotal evidence with show that we have lived with austerity lack of resources and a generation that didn’t have it that good in working class areas, when we come out of the London bubble .

Dena Hunt

Comment date
14 January 2020

I would welcome research into how life expectancy has fallen for 1950s born women denied their state pension, bus pass and winter fuel payment for up to six years with no notice. This particular group of women has been hit hardest in the first wave of raising pension age. Women are losing their homes, suffering real hardship, using foodbanks, having already worked for 40plus years - working longer with serious health issues, struggling with stress & anxiety and committing suicide. Over 3.8 million women are in this position and more than 82 million in this age group have already died pensionless. I feel, in time, statistics will show a massive drop in life expectancy for these women - an issue being ignored by current government.

Janet p

Position
Carer,
Comment date
07 August 2019

Given the specific nature of austerity inflicted upon the poorest and most disabled in the UK, and looking at the timeline in the graph, there is not much room for doubt that the two are consequential.
I do hope that your investigations will not fudge or confuse this link by over weighting a lot of less relevant issues.
There may have been austerity measures in other European countries but these have been targeted in different ways.
Austerity affects population groups in varying ways as we can see by the flourishing of the wealthy at the same time as life expectancy falters overall.

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