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. By 2019, life expectancy at birth in England had increased to 79.9 years for males and 83.6 years for females (see Figure 2). However, the Covid-19 pandemic caused life expectancy in 2020 to fall to 78.6 years for males and to 82.6 years for females, 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. 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 – i.e, 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 female 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).

  • aHealthy 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.

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 gap in healthy life expectancy between most- and least-deprived areas 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 the south of the country on average living longer and with more years in good health than those living further north. For example, in 2018–20, life expectancy for males was about eight years lower and for females about seven years lower in Blackpool, Middlesbrough, Manchester and Liverpool than in Westminster, Kensington and Chelsea and Camden. 

Some population groups have significantly shorter life expectancy than the general population. For example, men and women who are homeless at or around the time of their death live 31 years and 38 years fewer than the average respectively. People with learning disabilities also have shorter lives than the average, by 23 years among men and 27 years among women.

About 14 per cent of the population of England is non-white. Ethnicity is not currently recorded at death registration but, following the disproportionate impact of Covid-19 on ethnic minority communities, the government has said ethnicity recording will be introduced in England (Scotland introduced it in 2012). However, by linking death records to 2011 census records to derive ethnicity, the ONS has recently produced life expectancy estimates by ethnicity for England and Wales for the first time. The data shows that, despite their higher levels of deprivation, male and female life expectancy in 2011–14 was higher in ethnic minority groups than in the white and mixed groups (see Figures 3 and 4). This may be due in part to the ‘healthy migrant effect’, whereby people who migrate tend to be in good health, and lower rates of smoking and alcohol consumption in ethnic minority groups, which may mitigate some impacts of socio-economic disadvantage. Most ethnic minority groups also have lower mortality than the white group from cancer, dementia and several other leading causes of death.

Use the arrows to explore differences in life expectancy by ethnic group for males and females.

Figure 3 Life expectancy by ethnic group, males
Figure 4 Life expectancy by ethnic group, females

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 most-deprived decile of areas (from 74.3 to 72.4 years) compared with 1 year in the least-deprived decile (from 83.6 to 82.6); for females in the most-deprived areas it fell by 1.6 years (from 78.9 to 77.3) compared with 1 year in the least-deprived (86.8 to 85.8). As a result, the gap in life expectancy between the richest and the poorest areas have 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.

Mortality data for some other groups also shows inequalities, which in turn will have an impact on life expectancy. For example:

  • learning disabilities: mortality from Covid-19 is about 1.5 times higher among people with a learning disability or self-reported disability compared with those without a disability
  • ethnicity: although most ethnic minority groups had lower overall mortality than the white population in the decade before the pandemic, that differential was reversed between January 2020 and March 2021 in some groups (Pakistani and Bangladeshi men and women, and Black Caribbean men) because of their higher mortality from Covid-19. The ONS has not yet analysed the pandemic’s impact on ethnic differences in life expectancy.

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

In the 100 years to 2010–12, life expectancy increased by nearly 3 years every decade...

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 2011–2018 it increased by only 0.5 years for males and 0.2 years for females, virtually flat-lining between 2014–18. However, between 2018–19 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 2019. The life expectancy gains in 2019 and the and the fall in mortality in early 2020 were associated with mild influenza (flu) seasons and lower winter mortality.

In the pre-pandemic decade, 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.

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.

While a slowdown in improvements in life expectancy between 2010 and 2019 was seen in many European countries, 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

However, the slowdown in life expectancy improvements between 2011 and 2019 was nothing compared with what was to follow. The Covid-19 pandemic caused 75,000 excess deaths in England and Wales 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 46,000 excess deaths between January and mid-November 2021, 10 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.

How does the UK compare with other European countries?

This section focuses on comparisons between the UK and selected European and other high-income countriesb in the Organisation for Economic Co-operation and Development (OECD). Within Europe, we focus mainly on western European countries as they are more comparable to the UK on economic measures than eastern European countries, where life expectancy has historically been lower. Selected eastern European countries are included as examples of the differences in health status across Europe.

In pre-pandemic 2019, life expectancy at birth varied by 11.2 years for males and 9.4 years for females across OECD countries. Male life expectancy in the UK was below that of several western European and other high-income countries, while female life expectancy was below that of all these comparator countries (see Figures 5 and 6). The exception is the US, where male and female life expectancy has historically been lower than in other high-income countries; and contrary to the trend in most developed nations, life expectancy in the US fell between 2014–17 due to drug-related deaths in particular, but also deaths by suicide and alcohol-related deaths. For males in the UK, life expectancy in 2019 was 2.5 years lower than the highest seen in the OECD (Switzerland) and for females it was 4.1 years shorter than the highest (Japan).

In 2020 life expectancy fell in all but a handful of OECD countries because of the Covid-19 pandemic, the greatest falls were in Spain, Italy, Belgium, the US and the UK (and some eastern European countries) (see Figures 5 and 6).c The exceptions were Denmark, Finland, Norway and Japan, which, the pandemic notwithstanding, experienced small increases in life expectancy. For western European countries such as Spain, Italy, Belgium and the UK, the last time such a large loss of life was observed in a single year was during World War II.

Use the arrows to explore life expectancy at birth for males and females in selected OECD countries.

Figure 5 Life expectancy at birth, males
Figure 6 Life expectancy at birth, females

Figures 7 and 8 show that, whereas male life expectancy in the UK in the preceding decade was about average compared to most western European and other high-income countries, female life expectancy in the UK was among the lowest compared with peers – again with the exception of the US, which was lower still. 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 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, (women in particular) with life expectancy falling in most European countries (see Figures 7 and 8). European monitoring agencies report that this widespread fall in life expectancy resulted from excess winter mortality associated with flu.

Figures 7 and 8 also illustrate how the pandemic has caused life expectancy in many countries in 2020 to fall to levels of about a decade ago.

Use the arrows to explore life expectancy at birth for males and females in selected OECD countries.

Figure 7 Life expectancy at birth, males
Figure 8 Life expectancy at birth, females

Although life expectancy data for 2021 will not be available until well into 2022, mortality data for 2021 provides some indications. Compared with the 2015–19 average, the excess mortality rate in the UK from January 2020 to June 2021 was higher than in most western European countries except for Spain and Italy; and the UK had the highest excess mortality rate at ages under 65. Many eastern European countries, such as Poland, Bulgaria and Czechia, have experienced the highest excess mortality rates in Europe during the pandemic to date despite their lower life expectancies.

  • bOECD data on life expectancy is used in this section. OECD uses data from Eurostat for EU countries, and from national sources elsewhere. Methodological differences between Eurostat and individual non-EU countries in how life expectancy is calculated could affect the results.
  • cData on life expectancy in 2020 is not available for Australia, Canada, Germany and Ireland.

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 2021, and widen health inequalities further.

The pandemic is still playing out globally, with the timing and scale of resurgences varying between countries. Future trends in mortality are unpredictable, as they depend on many factors including 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. However, current mortality trends don’t bode well for the UK. With the exception of the US, the UK’s pre-pandemic life expectancy was lower than in many comparator countries for males, and the lowest for females, and the UK experienced among the lowest gains in the pre-pandemic decade. The UK has also had a comparatively high loss of life during the pandemic relative to many comparator countries. Improving the UK’s standing in international league tables for life expectancy will be a major challenge.

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  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).
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  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).
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Comments

Mrs Sofia A Matthews

Position
Community support worker retired -73,
Organisation
None
Comment date
27 April 2022

All the questions are complex. I welcomed the scholarship and objectivity in Veena Raleigh's writing I've found epidemiologists eg Wilkinson &Pickett's The Spirit Level" - you'll have to look up date if publication has more informed insights than all ghevtdxrs I read on my sociology degree course combined. I grew up caring for my blind and invalid grandmother at home and I feel closer to the many Asian families who keep up the tradition of family care. At work I met so many "not good health" folk abandoned by their families. Economics plays a part- the extent to which it fosters and facilitates mutual care when you can't pay for private help, makes a difference too. In deprived areas people are less able to helpnthemselves and often don't expect to- education is as important as provision in these cases.

Folashade Janet Ajay

Position
Student,
Organisation
brunnel university
Comment date
14 March 2022

Hi Mr. Raleigh
how do i reference your article please

Employee_2022

Organisation
Job Search Project
Comment date
30 January 2022

We must also be wary of the geographical and distributional aspects that national life expectancy figures hide. Whilst the average life expectancy in Britain continues to rise, particular areas have been badly hit in terms of economic decline as well as health outcomes. Blackpool has the lowest life expectancy in England and there are signs that this is falling. The drivers of this health crisis are likely to be complex: Blackpool has one of the highest rates of obesity, smoking, liver disease and antidepressant subscription rates in the country; it has been hit by austerity but its economic and health decline likely run deeper than this. Understanding these complexities deserve our attention. century. However, it remains true that mortality rate improvements for a very specific cohort of people born between 1923 and 1938, have slowed down in recent years. With the available evidence, it s not possible for anyone to say why health improvements for the golden cohort have slowed. This is something that deserves more attention and research.

Veena Raleigh

Position
Senior Fellow,
Organisation
The King's Fund
Comment date
04 January 2022

Dear Christopher

Many thanks for your comments on my article. Here are some points with reference to the article by Morris et al that you cited (ref below):

1. Morris et al showed that, using their methodology, life expectancy between ages 1 and 80 in Black and Asian males and females was lower than in the White group. They also showed that after adjustment for deprivation, Black males and females continued to have lower life expectancy but life expectancies in Asians were similar to the White group. Asian men and women had the lowest mortality of all groups above age 60.

2. The authors acknowledge the unavoidable methodological limitations of their analysis, which uses an "ecological" approach ie in the absence of information about the ethnicity of deceased individuals, they used the ONS census data for small geographical areas to ascribe ethnicity to those who died. This is, however, as the authors acknowledge, less satisfactory than using data based on the ethnicity of individuals.

3. The ONS analysis is the most robust to date because it uses national data and self-reported ethnicity for the deceased. While the ONS analysis is also subject to unavoidable methodological constraints, their findings are internally consistent (for example, the cause-specific mortality data fits with other epidemiological evidence) and they align with other research. While the ONS data will have margins of error, they are unlikely to alter the overall patterns.

4. ONS has not yet analysed ethnic differences in life expectancy by deprivation, but I'm aware that they intend to do so.

5. The ONS data shows that ethnic minority groups have higher life expectancies than the White and Mixed groups. As deprivation is generally associated with lower life expectancy, and as ethnic minority groups are more deprived than the White group (although to varying degrees), the impact of adjusting for deprivation would very likely be to increase the life expectancy advantage in ethnic minority groups seen in the ONS data.

I hope this provides clarifications with respect to your queries.

Ref: Morris M, Woods LM, Rachet B. A novel ecological methodology for constructing ethnic-majority life tables in the absence of individual ethnicity information. J Epidemiol Community Health. 2015 Apr;69(4):361-7. doi: 10.1136/jech-2014-204210. Epub 2015 Jan 6. PMID: 25563743; PMCID: PMC4392229.

Christopher Crentsil

Position
BAME Rep on Male Psychology,
Organisation
British Psychological Society
Comment date
02 January 2022

Great & very interesting article.

A question, Morris et. al. (2015) reports quite different findings in their research which sought compare like for like in terms of area deprivation. His research resulted in finding different outcomes to ONS & your report show, effectively showing that amongst Black, Asian and Minority Groups, when accounting for area-deprivation, age and ethnicity proportion, those groups were at the bottom of life expectancy.

For example; black men were noted as 4.2 years behind white men (68 years vs 72.2 years respectively).

Do you have any comment on the relevancy or potential impact of not adjusting for area deprivation?
And, Was this piece of research explored in your analysis?

Thank you, appreciate any response and value this research/analysis.

Reference: A novel ecological methodology for constructing ethnic-majority life tables in the absence of individual ethnicity information. Morris, Melanie, Woods, Laura M., Rachet, Bernard

Ian R, Lawson

Position
Retired physician (UK & USA),
Organisation
Ex- medical school, primary care and LTC of aged persons, etcaged etc
Comment date
23 December 2021

The consequences of a lowering of expectancy of life has a correlation, surely, with a lowering of 'active life' expectancy together with an increased requirement (or societal burden) of LTC services for home-care and institutional care. All this expresses an underlay of worsening of chronic and disabling illnesses (unless we regress to 19th. century concepts, such as that advanced societies like ours have developed problems with some mysterious 'miasma').
If then, there are measurable effects on expectancy of life, total and 'active (as has been shown) with increased demands for services a/m, is this the right time for Parliamentarians to dismiss medical effects as inconsequential and take away the huge LTC segment from the hospital- medical segment and hand over to Local Authorities? This would be to adopt the regressive measures of centuries ago towards a very modern medical-social-epidemiologic phenomenon!
Oh, British electorate - have you gone to sleep, to dream with your Parliamentary representatives!
(Thrown from the peanut gallery of the USA, where we suffer our own delusions, such as being 'numero uno'!)

V Davies

Position
Retired Dietitian,
Organisation
Retired
Comment date
10 December 2021

Re Life expectancy data.

Thoughts on ethnic minorities in UK outliving indigenous whites.

On driving home across the city today, I noticed the long display of vegetables and fruit outside the Eastern European store. As this central city location there have been increases in variety of nationalities moving in, which in turn appears to increase the number of greengrocer outlets and the availability of fresh veg and fruit.
One could argue that the Uk could win the world prize in veg free meals. Consider the multiplicity of favourite dishes that are predominately veg free ( fish and chips, anything with chips, pie and mash, pizza, curries, sausage and mash, macaroni cheese etc etc. )

Observatory nutrition data on vegetable and fruit intakes across these diverse groups could reveal some useful insights. We know that these foods are essential, closely related to health outcomes, yet fail to identify where major improvements could have a big impact at reducing health inequalities. Obvious, but for some reason, omitted from most algorithms and models in this area of inequalities. Areas of high deprivation were known to be ‘food deserts’ back in the 1980s. The work still needs to be done as to why poor whites remain resistant to including plentiful daily veg. Cultural habits, influencers, cooking skills, perceived cost, acceptability, as well as availability still remain unresolved.

richard

Comment date
10 December 2021

What about making 1 hour per day decent hard exercise compulsory for all persons?
this would solve most of the life expectancy challenges. If you can't show on your free strava account 1 hour per day you cannot participate in society? Seems fair and equitable.

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?

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