Executive summary

How long people live is a core marker of social progress, reflecting a range of social and economic factors from living conditions to timely access to appropriate health care. Throughout the 20th century, the UK saw significant increases in life expectancy. Of people born in 1905, only 62% lived to 60 compared with 89% of those born in 1955. For people born today, 96% can be expected to live to 60.

Life expectancy is a statistical measure of the average number of years that a person is expected to live informed by, among other things, mortality rates. Mortality rates continued to improve during the 2000s – the average fall was 26 deaths per 100,000 population. Since 2011 these improvements have all but stalled, slowing to an average annual fall of just under 2 deaths per 100,000 population in the last decade. For certain groups of the population mortality rates are deteriorating.

Given the social and political importance of these trends and their implications for life expectancy, the Health Foundation commissioned a research team from the London School of Economics and the Vienna Institute of Demography to carry out a comprehensive literature review and analysis of trends, and how they compared with what is happening in other countries.

The slowing improvements in life expectancy are not unique to the UK – and are seen in other socioeconomically comparable countries across Europe. However, the UK already has a lower life expectancy than many comparable countries – particularly for women – making any reduction in improvement especially worrying.

As in other similar countries, mortality and life expectancy figures largely reflect what is happening with older age groups, where most deaths occur. It is therefore important to look beyond the headline figures at subgroups of the population to pick up atypical trends that merit attention. The research found that while there has been a change in the trend in mortality for all population groups, since 2011 certain sections of the UK population have fared particularly badly.

  • People living in the most affluent areas have experienced slower improvements in life expectancy since 2011. For people living in the most deprived areas improvements in life expectancy have stalled for men and decreased for women. This is widening inequalities.
  • Women have experienced a greater slowdown in mortality improvements than men and for women aged over 85 mortality rates actually increased between 2011 and 2016.
  • Although the slowdown in mortality rate improvements has happened in all UK countries, Scotland continues to have notably higher mortality rates (in absolute terms) for both men and women than the other UK countries.
  • When compared internationally, the UK has seen similar changes in mortality for the older population. However, relative to our closest comparators, outcomes for under 50s are worse. There has been no improvement since 2011 for the younger (under 50) population as a whole and mortality has actually increased for 45–49 year olds.

Put simply, this analysis shows that there is no single driver of the current slowdown in mortality rate improvements. This means there will be no single solution.

As most deaths are among the 80-plus population, variations in mortality rates among the oldest can have a big effect on life expectancy estimates. This has led to inconclusive debate focusing on the impact of flu or austerity through constraints in social care or NHS budgets.

However, the longevity of today’s oldest generations largely reflects the experiences over their entire lives. While health care is particularly important in later life, it is a wider mix of factors – better incomes and living conditions, changing habits and medical advances – that has led to many of the improvements in life expectancy. These are large, long-term population-level effects. So, to understand what is happening to life expectancy now it is necessary to look at the past.

Advances in public health and health care in the last century drove big improvements in life expectancy: eradication of many infectious diseases in the 1950s and 1960s, reductions in smoking rates from the mid-1970s, advances in treatment of heart disease in the 1990s and, more recently, better at diagnosing and treating cancer. A consequence of having already achieved large gains in life expectancy is that it is becoming increasingly difficult to achieve further big improvements.

Future life expectancy will be shaped by the lifetime experiences of the population today. The strongest influences on people’s health are the social, economic, environmental and commercial conditions of people’s lives – the ‘wider determinants’ of health. The complex and interrelated nature of these determinants of health makes measuring the impact of any single one on mortality challenging.

Current trends that are likely to affect future life expectancy are the widening mortality rates associated with people’s socioeconomic status – particularly among young people – and wider indicators of poor health such as rising levels of childhood obesity, the latter being worse for children living in the most deprived areas.

Across most indicators of health there is a clear relationship with socioeconomic circumstances. Life expectancy is a prominent example of this. While the difference in life expectancy between the richest and poorest people in the UK narrowed during the 2000s, it has widened since 2011. The growing gap in life expectancy between rich and poor is a consequence of improvements in life expectancy completely stalling for the poorest people in the population, while it continues to increase for the richest people, albeit at a slower rate than before 2011.

What action is needed to address the slowdown?

The current UK mortality trends are very concerning. The slowdown is widespread among comparable high-income countries, but has been more rapid and sizeable in the UK than elsewhere. Furthermore, younger adults are generally continuing to see improvements in comparable European countries, in the UK this is not the case.

As the drivers of these trends are multiple, highly complex and interrelated, halting the current slowdown or stalling in life-expectancy improvements – and reducing the wide socioeconomic and geographical inequalities in life expectancy – will require a whole-government approach to the wider determinants of health.

If UK national and local governments are serious about addressing the situation, particularly for the most affected and most vulnerable groups, there needs to be greater political and policy attention on trends in health, mortality and their implications for life expectancy.

This demands two areas of action.

An independent body with responsibility for:

  • providing regular and consistent analysis of the factors that influence mortality in different population groups, and the complex interrelationships between these
  • regular and consistent independent tracking of future opportunities and risks to people’s health in order to understand what is likely to influence mortality trends in the future
  • public reporting of these trends on a regular basis, in an accessible and understandable format.

A whole-government approach to:

  • policymaking and action that takes a long-term view and is informed by the understanding of the influences on current and future mortality
  • actions at local and national level that are aligned and sufficiently resourced.

No government wants to see the life expectancy of its population fall on its watch. However, the risk of this happening is very real – particularly within specific subgroups of the population. This can only be prevented through coordinated, wide-ranging, long-term action, led from the centre of government.

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