What is happening to life expectancy in the UK?

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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

Maria Emilia

Comment date
29 January 2019

I have just come across your comments about your mother by chance whilst trying to find out information about the reasons why life expectancy for older women aged over 85 is falling, which I believe is unique. I am very sorry to read about your mother's death in the circumstances you describe.

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.

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.

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 .

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