Key health indicators show there is no room for complacency

These reductions in spending come at a time when many indicators of population health are worsening. Even where there has been significant improvement, such as in the case of smoking prevalence, it can vary between local areas and those who still smoke can be the most difficult cases to tackle.

A major issue is the slowing of improvement in life expectancy. The population mortality rate (on which life-expectancy projections are based) was improving relatively rapidly. However, this improvement began to slow around 2010. Figure 7 shows the percentage change in mortality rates (taken as a rolling four-quarter average) since Q1 2001, plotting the historical trend alongside it. There is a clear break in the trend for improvement for men and women from the early 2010s.

Figure 7: Index of change in age-standardised, all-cause mortality rates in England for all ages by gender, 2000–2017

Note: Index is based on a rolling four-quarter average of a rolling, annual, age-standardised mortality rate for all ages and trend from period before break in trend due to slowdown in mortality rate improvement using quarters, Q3 2000 to Q4 2017.

Source: Health Foundation analysis of published data.

The reasons behind this slowdown are not known. Some have suggested it relates to a more severe than usual strain of flu increasing deaths among older people. Others relate the change to the effect of austerity measures. Analysis suggests that there have been a greater number of flu-related deaths in recent years, and that the greatest increase in the number of deaths has been among older women. However, there have also been increasing mortality rates among younger age groups, with no single cause accounting for the change., The slowdown has also been observed across other developed countries, although when the effect occurred differs by country. Disentangling the drivers of this slowdown is the focus of ongoing Health Foundation-funded research.

Regardless of the overall rate of improvement in how long we live, the wide variation across local areas in both total expected years of life, and how many of those years are spent in good health, are cause for concern. Women living in the most-deprived 10% of areas of England are expected to live for 9 fewer years than those from the least-deprived 10% and spend 19 fewer years in good health (Figure 8). Between 2009 and 2016 (the period over which comparisons can be made), there has been little to no improvement in these outcomes. The difference in women’s life expectancy between the most- and least-deprived areas has increased.

Figure 8: Women’s life expectancy and healthy life expectancy in England by decile of index of multiple deprivation (2014–2016)

Note: Estimates shown are life expectancy at birth calculated on a period basis.

Addressing inequalities in health is a huge challenge and questions remain about the pace of future improvements in life expectancy. Although discussing specific approaches to closing those gaps is not the aim of this paper, it seems clear that reducing investment in public health grant activity to improve health is unlikely to help.

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