What is happening to life expectancy in the UK?

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2010 marked a turning point in long-term mortality trends in the UK, with improvements tailing off after decades of steady decline. In this piece Veena Raleigh looks at how overall life expectancy has changed over time, along with considerations such as the difference in life expectancy between males and females, geographical inequalities, how the UK compares with other countries, and possible factors in the more recent slowdown in mortality improvements in the UK. 

How has life expectancy changed over time?

Mortality rates in England and Wales have declined steadily since the 19th century, leading to a long-term rise in life expectancy1 for both males and females (Figure 1). Males born in 1841 could expect to live to only 40.2 years and females to 42.2 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 reduced these high rates, increasing life expectancy at birth to 55 years for males and 59 years for females by 1920.  

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 (such as in treatment of heart disease and cancer) and lifestyle changes, including a decline in smoking. By 2016 life expectancy at birth had increased to 79.5 years for males and 83.1 years for females (Figure 2).

  • 1. Life expectancy is a summary measure of the mortality of a population. Period life expectancy is the average number of years a person would live from a given age if he or she experienced the prevailing mortality rates in that population throughout his or her lifetime. This measure makes no allowance for any future actual or projected changes in mortality. In practice, a population’s mortality rates are likely to change, so period-based life expectancy does not measure the number of years someone could actually expect to live. A less commonly used measure is cohort life expectancy, which measures the average number of years lived based on past and expected changes in mortality rates for that population group.

The effect on healthy life expectancy

Healthy life expectancy2 has also increased, but not at the same rate as life expectancy, so more years are spent in poor health. Although an English male could expect to live 79.5 years in 2014–16, his average healthy life expectancy was only 63.3 years – ie, he would have spent 16.2 of those years (20 per cent) in ‘not good’ health. 

An English female could expect to live 83.1 years, of which 19.2 years (23 per cent) would have been spent in ‘not good’ health. And although females live an average of 3.6 years longer than males, much of that time is spent in poor health – they experience only 0.6 more years of good health than men. Rates of disability-free life expectancy are similar to those for healthy life expectancy. Although we focus here mainly on overall life expectancy, further data on healthy and disability-free life expectancy, including for local areas, is available from the Office for National Statistics

  • 2. 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 long-lasting physical or mental health condition that limits daily activities.

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

Women have always lived longer than men, but the gender gap in 1841 was relatively small (two years) 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 started to widen, peaking at 6.3 years by 1971 (see Figure 1 – the difference between male and female life expectancy is the gender gap). 

Reasons for the widening gender gap included poor working conditions and rate of smoking for 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 has decreased since the 1970s, although in 2016 it was nearly double (3.6 years) what it was in 1841 (see Figure 2).

Inequalities in life expectancy

People living in more affluent areas live significantly longer than people living in deprived areas. In 2014–16, males living in the least deprived 10 per cent of areas in England and Wales could expect to live almost a decade (9.3 years) longer than males living in the 10 per cent most deprived areas, and for females the gap was 7.4 years. The gap in healthy life expectancy at birth is even greater – about 19 years for both males and females, and 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.  

Socio-economic inequalities in life expectancy are also widening in both sexes, as a result of greater gains in life expectancy in less deprived populations. Between 2011–13 and 2014–16, the difference in life expectancy between the most and least deprived widened by 0.3 years among males and 0.4 years among females, and life expectancy among the most deprived females fell over this period

While mortality rates have declined everywhere over time, there is a persistent north–south divide in life expectancy and healthy life expectancy, with people residing in southern regions of England on average living longer and with fewer years in poor health than those living further north. For example, in 2014–16, life expectancy for males was lowest in Blackpool and Manchester and highest in Kensington and Chelsea and East Dorset, with a difference of about nine years. For females, life expectancy was again lowest in Blackpool and Manchester and highest in Camden and Kensington and Chelsea, with a difference of about seven years.   

The slowdown in mortality improvements after 2010

2010 marked a turning point in long-term mortality trends, with improvements tailing off after decades of steady decline – in both males and females, and at younger and older ages. In the 100 years to 2010–12, life expectancy increased by nearly three years every decade, but between 2011 and 2016 it increased by only 0.4 years for males and 0.2 years for females.

2015 was an exceptional year when life expectancy fell across virtually all of Europe. The age-standardised mortality rate3 in England and Wales in 2015 increased by 3 per cent for males and 5 per cent for females over 2014, leading to a fall in life expectancy. Most of the ‘excess’ deaths occurred early in the year and among people aged 75+. 

Although life expectancy has picked up in 2016 and 2017, the Office for National Statistics announcement that the mortality rate in quarter one of 2018 was higher than in any quarter since 2009 prompted the Department of Health and Social Care to ask Public Health England to undertake a review of mortality trends in England and Wales. 

  • 3. A rise in the number of deaths does not necessarily mean mortality rates are increasing, it can occur simply because the population is becoming larger and/or getting older, even if mortality rates remain unchanged. The age-standardised mortality rate is a more useful measure of the actual change in mortality levels because it takes into account changes in the size and age structure of the population.

How does the UK compare with other European countries?

Life expectancy at birth in 2016 varied by 11.5 years across the EU for males and by almost 8 years for females. Generally, western and southern European countries had higher life expectancies than central and eastern European countries. Women outlive men in all countries. 

In 2016 the UK ranked 10th among the 28 EU countries for male life expectancy, but only 17th and below the EU average for females (Figures 3 and 4), with Denmark being the only west European country to have lower female life expectancy. For males in the UK, life expectancy was 1.6 years shorter than the highest seen in the EU (Italy) and for females it was 3.3 years shorter than the highest (Spain).  

As in the UK, since 2011 improvements in mortality, and therefore life expectancy, have slowed in many countries in Europe and beyond, and more so in females than males. A recent report shows that compared with 2005–10, during 2011–16 improvements in life expectancy slowed in most of 20 countries examined, including the USA, Canada and Australia; for females the UK showed the greatest slowdown and for males the UK had the second greatest slowdown (after the USA). However, the UK experienced greater improvements than most countries during the earlier period, 2005–10. Some countries (including Japan, Denmark, Italy) did not experience a slow down, with greater improvements in 2011–16 than in the preceding period. 

As in the UK, many EU countries also reported increased mortality in 2015 that again disproportionately affected older people and older women more than older men. Compared with 2014, in 2015 life expectancy at birth fell in 23 of the 28 EU countries for females and in 16 EU countries for males. This suggests that the factors causing the increased deaths in England in 2015 also affected many other countries.

Flu caused excess deaths in some winters in both the UK and in Europe, especially among older people and women, as reported by official agencies, and spikes in winter mortality rates show similar patterns across several European countries.

Why have improvements in life expectancy slowed down?

The reasons for the slowdown in mortality improvements in the UK, and why the slowdown has been greater than in many other countries, are unclear and hotly debated. 

Several studies have attributed both the 2015 fall in life expectancy and the tailing off of mortality improvements after 2010 to the consequences of austerity-driven constraints on health, social care and other public spending and their impact on services [refs 1-6]. These studies are often based on statistical associations, for example, between mortality trends and the slowdown in spending on health and social care, increased waiting times, rising numbers of delayed discharges from hospital and cuts in welfare benefits.   

Others question the methods and findings of the research. While acknowledging that austerity could have had negative consequences on the quality of care, they suggest that the statistical associations don't prove causality and that many other factors, such as the growing complexity of medical conditions in an ageing population, could contribute towards those extra deaths [refs 7-9].    

The recent report by the Office for National Statistics showing that the UK has had the lowest rate of improvement in life expectancy since 2011 among western nations other than the USA has added to claims that austerity is the only credible explanation. Some European countries such as Greece, Spain, Portugal and Ireland also experienced austerity-related cuts in public expenditure after the 2008 recession, and they show less slowing of mortality improvements than the UK. There have been calls for the government to undertake an urgent investigation [refs 10-11], and there is now a review of mortality trends in England and Wales by Public Health England under way.

What do we know?

There are some specific changes impacting on different age groups that we know about. For example, flu has been shown to cause extra deaths, especially among older people, and a slowing in the decline in mortality rates for circulatory diseases (such as heart attack and stroke) since 2011 has been a major factor in slowing mortality improvements for people aged 55 and over in all the UK countries. These different factors, and the effects of other changes occurring concurrently such as falling smoking rates and rising levels of obesity and dementia, need to be estimated and disentangled to understand their contribution to overall life expectancy. We also need to understand why these changes are taking place. Given that many of these trends are occurring also in many other countries, it is important to also learn from them. 

It’s likely that there are several factors contributing to the slowing of improvements in mortality, and hence life expectancy, in this country, but disentangling their effects is complex. For now, the causes of the slowdown in mortality improvements remain unclear but several agencies and researchers are undertaking further investigations to try to understand what's causing it. Given that life expectancy is lower in the UK than in many European countries, especially in females, and that improvements here are weaker, it’s important to establish what's happening, why and what can be done to reverse these trends. 

We’re working with the Health Foundation to investigate mortality trends in the UK and the potential causes for the slowing of mortality improvements. This includes research commissioned by the Health Foundation from the London School of Economics and Political Science, which we will jointly oversee. 

  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, pp131–7. doi: 10.1177/0141076817693600. Available at: http://journals.sagepub.com/doi/abs/10.1177/0141076817693600?journalCode=jrsb
     
  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, issue 4, pp 153–62 doi: 10.1177/0141076817693599. Available at: http://journals.sagepub.com/doi/full/10.1177/0141076817693599
     
  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
     
  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. Available at: http://jech.bmj.com/content/early/2018/02/20/jech-2017-210401
     
  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, doi:10.1136/jech-2017-209403. Available at: https://jech.bmj.com/content/71/11/1068
     
  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
     
  7. Fordham R, Roland M (2017). ‘Expert reaction to paper on health and social care spending and excess deaths in England’. Blog. Science Media Centre website. Available at: www.sciencemediacentre.org/expert-reaction-to-paper-on-health-and-social-care-spending-and-excess-deaths-in-england
     
  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: www.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
     
  10. Hiam L, Dorling D (2018). ‘Rise in mortality in England and Wales in first seven weeks of 2018’. BMJ, 360, k1090. Available at: www.bmj.com/content/360/bmj.k1090
     
  11. Marmot M (2017). ‘We’ve thrown away a century of progress on life expectancy’. The Times, 11 September. Available at: www.thetimes.co.uk/article/weve-thrown-away-a-century-of-progress-on-life-expectancy-ql6f2bqp8

Comments

pamela ellis

Position
Daughter and Carer,
Organisation
Looking after my mother
Comment date
17 August 2018

I have been shown extreme contempt and have been lied to by York Trust, Scarborough Hospital, PHSO, North Yorkshire Police and the Coroner. All of these are in a conspiracy re my mother's death March 2012. The mortality review not done correctly. I have spent since then investigating my mother's death. I have asked questions about the lies I have been told, about the information I have found out. November 2012 the Admitted Neglect from the Outset after my investigation report. I have never been told why. The neglect was premeditated abject cruelty for which they could not care less! Delay tactics and lies by all of the above. My mother's life to them not worthy of a dog's. I have pleaded with all of them for the truth and dismissed by all. The Coroner could not care this is post mortem report reads nothing like the truth. CQC couldn't care less. 2012 was the worst year of mortality results. Mum only went into hospital for observation A+E changed SECRETLY mum's admission reason and she was denied medical care, lost her teeth, I now believe deliberately so she couldn't eat properly. Friday 23rd March 2012 10am "Eileen desperate to go home" I WAS NOT TOLD YET 3PM had mums clothes with me but a refusal to take her home. Mum was kept a prisoner to drive her to desperation to death.I am now 76 and they have taken my life by refusal to give me the truth of mum's last hours from when I left her looking very well and so pleased to see me. I feel guilty mum was being neglect under my eyes. THEY WILL NOT TELL ME THE TRUTH. INTERNAL INVESTIGATION INTO NORTH YORKSHIRE POLICE LIES TO ME AND THE CORONER CONDONED. WHAT SORT OF LIFE ARE THE ELDERLY LIVING IN. I BELIEVE THERE IS A SYSTEMATIC CULLING OF OUR BELOVED ELDERLY AND THE CRUELTY IS GETTING WORSE. Your report does not relay anything like what family have to endure to their loved ones.

pamela ellis

Position
Daughter and Carer,
Organisation
Love of my mother
Comment date
17 August 2018

I want my comments to you made public. I will spend to my dying day to get justice for my mother by way of truth told to my family and myself. I will be sending a report to Theresa May in the hope she is not just one of the number I have contacted to help me and hope she does not show contempt to me as all the rest of them have done.

pamela ellis

Position
myself,
Organisation
myself experiences
Comment date
17 August 2018

Now aged 76 as I have already commented on and I believe on the nhs OLD PEOPLES' list also for
limited medical treatment. Or was the age 70 re the neglect of callup for breast scan, so this disease would go unnoticed and kill many more people. Varicose veins no-one cares and told wait until you get an ulcer then you can have treatment, this is against Consultants advice.
In Reading,Berkshire our fantastic second hospital in grounds, hydrotherapy pool, heart, stroke etc. hospital, was sold and now we have a very large Tescos, a village of flats and a mosque. How could this happen when we had two hospitals for years and years, with less people,and now the Royal Berkshire Hospital, old and little, we have, which cannot cope. Certain operations at Thatcham and elsewhere.I have not car, so no operation.
People living in Bridlington, where mum lived, have to go to Scarborough Hospital, people limited money have to pay to get to Scarborough. Many situations people have to get to York under their own steam, which is a nightmare of short visit to their loved ones to get back to Bridlington. Bridlington has a decent building hospital, most of it closed down. I have a four week delay to see my own very lovely, unusually very caring doctor, but now trying to get a Doppler test, phoned twice but dates only set for the week whenever, despite my urgency.
If mum had not had me to look after her, even when she could contact a doctor, the system was so complicated even many years ago made life for her impossible.
Everything needs to be sorted in the nhs. No-one at the helm, I am heartbroken at what happened to my mother, NO-ONE CARED, NO-ONE IN CHARGE, NO-ONE TO TELL ME THE TRUTH AND THE CORONER COULD NOT CARE LESS THE POST MORTEM REPORT GIVES THE TRUTH.

pamela ellis

Position
daughter/carer,
Organisation
just me
Comment date
17 August 2018

I never get any comments from you or what you do with my information. Even Sir Robert Francis I contacted cannot help and I feel does not want to know the truth what is happening. Or am I correct to say CULLING OF OUR ELDERLY IS SYSTEMATIC IN EVERY COUNTY.

pamela ellis

Position
daugther/carer,
Organisation
Love of my mother
Comment date
17 August 2018

Mum was 92 with shortterm memory. We had a good life, I kept mum smart as she always was and wanted to be. Everyday was active which she loved. Everyday was looked forward to by her. Despite the fact she lost the reason to look after herself, and remember what happened a few minutes before or where we had been for the day, mum remained sociable, loved going out, yet did not have a clue re the date, month etc. I could read certain interesting info from newspapers and leave it by her and she could ask me many times, what is this about, could not remember to take her tablets etc. I believe the changing of mums tablets she had been on for years Atenolol to Amlodipine together with Simvastin was not good and twice the doctors and hosp asked for compatibility but both times ignored, I later found out could have had something to do with mum's harsh cough and intermittent heart pains she only went into hospital for observation for. I have a list of lies told to my by the hospital, phso, police and refusal by Coroner. The CEO of York Trust is a disgrace as he tried to bully me by telling me the case was closed when he fully knew the truth about mum's death had not been revealed. I am not a strong person, but they will never use their miserable cruel tactics of bullying and lying to break me, no matter how I am suffering, the sleepless nights, no life, the cost to the nhs they are causing by their disgusting disgraceful behaviour.

smurphy

Position
Digital Communications Assistant,
Organisation
The King's Fund
Comment date
17 August 2018

Hi Pamela,

I’m very sorry to hear about your experiences and your concerns about the care your mother received. The King’s Fund are not able to comment on individual cases, however as we’ve previously advised there are a number of organisations that may be able to offer you help and support regarding this.

Along with the Patient Advice and Liaison Service at your local hospital and your local Healthwatch who we understand you have already been in touch with, there is:

The Patients Association, who are independent charity that provides specialist information and advice. They can be contacted via their helpline 020 8423 8999 or by email at helpline@patients-association.com.

There is also the Parliamentary and Health Service Ombudsman who may be able to offer you advice regarding your complaint: https://www.ombudsman.org.uk/

I hope the above information is useful to you.

Kind regards,
Sarah

Nick Mann

Position
GP,
Organisation
NHS
Comment date
19 August 2018

Life Expectancy (mean average) is not the appropriate measure to compare years lived in 1840 and now. In 1840, LE was disproportionately skewed by high death rates among children.

The average age of adult deaths has only increased by approximately 15yrs, not 40yrs, since 1840. Much smaller gains for adults than we give ourselves credit for.
LE and modal average have become aligned since 1970s as perinatal/child mortality rates have more or less plateaued.
Isn't it therefore more appropriate to be using modal average to compare historical trends?

Although causality is difficult to establish, the 120,000 extra deaths in UK 2010-15 (BMJ) - not due to ageing population, flu, or cold weather - occurred mainly in >65's and care home residents.
To my mind, this says something very clearly about changes in social care and NHS since 2010.

Neil Bendel

Position
Public Health Specialist (Health Intelligence),
Organisation
Manchester City Council
Comment date
05 September 2018

I'd be interested to know if this work is going to look at local variations in the 'slow down' of life expectancy. Is life expectancy slowing down in some areas more than others and, if so, why? Is the growth in life expectancy growth slower in more deprived areas or in particular types of area (e.g. urban/rural areas, coastal communities etc.)? This would help to identify if there are specific local factors in play as well as national drivers and which have had the biggest impact.

smurphy

Position
Digital Communications Assistant,
Organisation
The King's Fund
Comment date
05 September 2018

Hi Neil,

Thank you for getting in touch. Our project will look at life expectancy in local areas but not until phase 2 which takes us to Spring 2019. In the meantime, you may be interested to see some ONS reports on this, if you haven't seen them already:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare…

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare…

I hope that helps. If you have any further questions, please do not hesitate to get in touch.

Kind regards,
Sarah

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