What is happening to life expectancy in the UK?

This content relates to the following topics:

2011 marked a turning point in long-term mortality trends in England, with improvements slowing after decades of steady decline, prompting much debate about the causes. The emergence of Covid-19 in 2020 will have significant implications for life expectancy. In this piece, Veena Raleigh examines trends in life expectancy at birth up to 2019, gender differences, geographical inequalities, how the UK compares with other countries, and possible causes of the slowing mortality improvements in recent years. Veena also assesses how Covid-19 could have an impact on life expectancy in 2020. 

How has life expectancy changed over time?

Mortality has declined steadily 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 42.2 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 mortality rates, increasing life expectancy to 55 years for males and 59 years for females by 1920.

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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 2019 life expectancy in England had increased to 79.9 years for males and 83.6 years for females (these figures are provisional estimates) (see Figure 2).

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The effect on healthy life expectancy

Healthy life expectancy1 has also increased, but not as much as life expectancy, so more years are spent in poor health. Although an English male could expect to live 79.6 years in 2016–18, his average healthy life expectancy was only 63.4 years – ie, he would have spent 16.2 of those years (20 per cent) in ‘not good’ health.

In 2016–18 an English female could expect to live 83.2 years, of which 19.3 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 0.5 more years of good health than men. Rates of disability-free life expectancy are similar to those for healthy life expectancy. Further data on life expectancy, healthy and disability-free life expectancy, including for local areas, is available from the Office for National Statistics.

  • 1. 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 (two 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 has decreased since the 1970s, with mortality falling faster in males than females because of decreases in smoking and mortality from cardiovascular diseases among men. The gender gap in 2019 (see Figure 2) is still nearly double (3.7 years) what it was in 1841 (2 years).

Inequalities in life expectancy

People living in more affluent areas live significantly longer than people living in deprived areas. In 2016–18, males in the least deprived 10 per cent of areas in England could expect to live to 83.4 years, almost a decade longer than males in the 10 per cent most deprived areas (73.9 years). Females in the least deprived 10 per cent of areas in England could expect to live to 86.3 years, compared with 78.6 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 gap in healthy life expectancy at birth is even greater – about 19 years for both males and females. 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 widening as a result of greater gains in life expectancy in least deprived populations. Between 2013–15 and 2016–18, the difference in life expectancy between the most and least deprived areas in England widened by 0.4 years among males and 0.5 years among females. Among females living in the most deprived areas life expectancy fell by 95 days over this period, in contrast to the gain of 80 days among females in the least deprived areas.

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 2016–18, life expectancy for males was lowest in Blackpool and Middlesbrough, and highest in Kensington and Chelsea and Westminster, with a difference of about nine years. For females, life expectancy was lowest in Blackpool and Manchester and highest in Camden and Kensington and Chelsea, with a difference of about seven years. The gap in years lived in good health across local authorities in England is even greater, about 18 years for males and females.

About 14 per cent of the population of England is non-white. Life expectancy data is not available by ethnic group because ethnicity is not recorded at death registration. Using alternative methods of analysing ethnic differences, some evidence suggests most Black, Asian and minority ethnic (BAME) groups have lower mortality than the white population, but that differential has been reversed by the higher mortality among BAME groups from Covid-19.

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.

The slowdown in mortality improvements 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 three 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 2019. The life expectancy gains in 2019 and the fall in mortality in early 2020 are associated with mild 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 495,000 deaths in 2015, about 31,000 more than the preceding five-year average; deaths associated with flu were estimated at about 28,000. Life expectancy fell by 0.2 years over the preceding year in both males and females – unprecedented for decades. As in Europe, most 'excess' deaths occurred early in the year and 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.

The slowdown in life expectancy improvements, and the Office for National Statistics’ announcement that the mortality rate in England in quarter one of 2018 was higher than in any quarter one since 2009, prompted the Department of Health and Social Care to ask Public Health England to undertake a review of mortality trends in England. The review found that improvements in life expectancy 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.

How does the UK compare with other European countries?

In 2018, life expectancy at birth varied by 11.1 years for males and 7.7 years for females across the 28 European Union (EU) countries1 (UK was in the EU then). 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 2018 the UK ranked 10th among the 28 EU countries for male life expectancy and only 17th and below the EU average for female life expectancy (Figures 3 and 4), with Denmark being the only western European country to have lower female life expectancy. For males in the UK, life expectancy was 1.7 years less than the highest seen in the EU (Italy and Sweden) and for females it was 3.2 years shorter than the highest (Spain).

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As in the UK, improvements in mortality, and therefore life expectancy, have slowed in many European countries in recent years. However, the slowdown has been greater in 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, especially women. 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.

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  • 1. Data on life expectancy that is comparable to European countries is available for UK, not England and Wales or England

Why have improvements in life expectancy slowed down?

The reasons for these trends 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. [ref 1–6] These studies were 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 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 the large numbers of extra deaths. 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. 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). [ref 11]

Public Health England’s review identified some of the factors contributing to slowing improvements in life expectancy: 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 in mortality improvements is occurring across much of the population, at a time when health and social care services have been facing increasing demand and unprecedented financial pressures.

The slowdown in improvements in life expectancy seen in the UK has also been seen also in many European countries, but it has been greatest in the UK. It’s likely that there are several reasons for the current 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). [ref 11–13]

What impact will Covid-19 have on life expectancy?

After a mild 2020 winter and flu season with low mortality, the first deaths from Covid-19 occurred in early March 2020 and the numbers increased sharply thereafter. Between week ending 13 March 2020 and 12 June 2020, there were 48,218 deaths in England and Wales attributed to Covid-19, and 59,138 'excess' deaths overall (ie, the difference between the number of deaths in 2020 compared with the average for the same period in the previous five years). Covid-19 thus accounted for 82 per cent of overall excess deaths during this period; the remaining 10,920 deaths resulted from a combination of undiagnosed Covid-19 deaths and non-Covid deaths resulting from other causes because of, eg, reduced uptake of health care for potentially life-threatening conditions, causing an increase in deaths from other causes. To give an idea of scale – Covid-19 is now the third leading cause of death, causing more deaths in about three months than the numbers who die in a year from heart disease or lung cancer or stroke.

Predicting the impact of Covid-19 on life expectancy is difficult for several reasons including, for example, the following.

  • The large numbers of deaths that Covid-19 has caused, or hastened, among people with pre-existing conditions and frail older people may be counter-balanced by fewer deaths in future. However, this will not become clear for a while and is not a certainty: For example, men and women in England aged 75 can expect to live another 12 years and 13 years respectively, and at age 85 it’s 6 years and 7 years respectively. So, deaths even at older ages can shorten lives by several years.
  • Some excess deaths could be offset by fewer deaths from, eg, air pollution and transport accidents.
  • Finally, the pandemic isn’t over and much depends on its impact (directly and indirectly on deaths from other causes) on mortality in the months ahead. 

The scale of excess mortality associated with Covid-19 thus far, and evidence that many lives have been cut short (eg, almost 11 per cent of Covid-19 deaths were among people aged under 65 years), is unprecedented in recent decades. The wider socio-economic impacts of the pandemic could also have an adverse impact on health and mortality overall, particularly among more deprived and minority ethnic groups who already experience disproportionately higher mortality from Covid-19. The overall impact that this pandemic is likely to have on life expectancy in 2020 will become clearer in due course.

As the number of deaths associated with Covid-19 in the UK is among the highest in Europe and as the UK already trails many European countries in terms of life expectancy, we could see UK slide further down life expectancy league tables. Some of the direct and indirect effects of the Covid-19 pandemic on population health and mortality in the UK could last beyond 2020.

  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: www.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: 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/ (accessed on 23 June 2020).
  10. Raleigh VS (2018). ‘Stalling life expectancy in the UK’. BMJ 2018; 362. doi: https://doi.org/10.1136/bmj.k4050..Available at: www.kingsfund.org.uk/publications/stalling-life-expectancy-uk (accessed on 23 June 2020).
  11. Raleigh V (2019), Trends in life expectancy in EU and other OECD countries: Why are improvements slowing? OECD Health Working Papers, 108. Paris: OECD Publishing, Available at: https://doi.org/10.1787/223159ab-en (accessed on 23 June 2020).
  12. EUROMOMO (2020). Euromomo website. Available at: www.euromomo.eu/ (accessed on 23 June 2020).
  13. OECD, The King's Fund (2020). Is cardiovascular disease slowing improvements in life expectancy?: OECD and The King's Fund Workshop Proceedings. Paris: OECD Publishing. Available at:  https://doi.org/10.1787/47a04a11-en (accessed on 23 June 2020).

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

Judy Abrahams

Position
Retired,
Comment date
12 January 2019

I am 70 years old and have just spent a year of my life waiting on pain with greatly reduced mobility for a hip replacement . The NHS is under funded. Teresa May and her friends can easily afford private health care. What can we expect.

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