Veena Raleigh: England’s stalling life expectancy—pointers for action?  

The slowdown of life expectancy increases in England is a story of many parts, says Veena Raleigh, but we understand enough to know that action is urgently needed

Longevity is a totemic measure of a nation’s health. Unsurprisingly, the slowdown of life expectancy increases in England after decades of steady improvement has triggered furious speculation about what’s causing it and calls for action. These worrying trends prompted the Department of Health and Social Care to ask Public Health England (PHE) to investigate. Their report has now been published and is a welcome contribution to understanding some of the causes of stalling life expectancy.

We have become used to year on year life expectancy gains. Yet according to the Office for National Statistics, female life expectancy at birth in England increased by a mere 0.1 years during 2011-16 compared with 1.3 years in the preceding five years; the equivalent figures for males were 0.4 and 1.6 years respectively. Moreover, internationally, the UK* doesn’t compare well. Among EU countries, which include several Eastern European countries where life expectancy has historically been lower, the UK ranked 10th for male life expectancy at birth in 2016. Life expectancy for UK females ranked below the EU average at 17th. While life expectancy improvements are also slowing in many European countries, the slowdown has been greatest in the UK and we are slipping further down the leaderboard.

The PHE review covers considerable ground in unpacking mortality trends and what’s driving them. It finds that both sexes, all age groups, and several causes of death have contributed to the slowdown in life expectancy improvements. Decelerating improvements in cardiovascular disease mortality are a major contributor. Winter deaths from flu and other respiratory diseases also play a significant part in some years, most notably in 2015 when a severe flu outbreak caused life expectancy to fall not just in the UK but also in many European countries. The review also finds that deaths from dementia and Alzheimer’s disease are increasing, in part due to changes in diagnostic and death certification practices, and that many people dying from dementia also had flu/pneumonia as a concomitant condition.

Two particularly unwelcome trends highlighted by PHE are widening inequalities between affluent and deprived areas and the rising numbers of young adults dying from accidental poisoning, mainly due to drug misuse.

While PHE’s report provides useful pointers to the drivers of stalling life expectancy, it also prompts many questions. For example, are improvements in cardiovascular disease mortality slowing because of rising obesity and diabetes? Or do they reflect an inevitable slowdown in gains from controlling risk factors such as blood pressure, cholesterol, and smoking now the low hanging fruit has been realised? Why is life expectancy actually falling in the most deprived areas? And are there signs of the UK following in the unhappy footsteps of the US where “deaths of despair,” such as suicides and drug overdoses, are mushrooming among young adults? These questions, and many more, remain unanswered.

The plateau in UK life expectancy correlates with the onset of austerity, and it’s possible that public expenditure cuts accelerated or even precipitated some deaths, especially among frail, older people. Direct and unequivocal proof that austerity has caused loss of life is not easy to obtain. So this conundrum remains unresolved by PHE, but it is clear that other factors are also at play.

PHE’s report is clear that recent mortality trends aren’t driven by one particular demographic group or a single cause. This is a story—as I have said before—of many parts and one that is also playing out beyond English shores. Some of the drivers of stalling life expectancy in the UK are therefore likely to be common to other countries. However, the UK’s weaker performance suggests that there are some UK-specific drivers—widening inequalities could be part of this story.

Although not all the pieces of the mortality jigsaw are in place, we are now better informed about where action is needed. Strategies for reducing CVD mortality should be re-energised and measures taken to reduce the vulnerability of older people to cold, respiratory disease, and other winter killers. Targeted interventions are also needed to address the causes of ill health and the wider determinants of mortality in deprived communities. As set out in the King’s Fund’s recent report, the government should galvanise the efforts of the NHS, local government, and other agencies by creating binding cross-government targets for improving health, backed by a new national strategy to reduce health inequalities.

More work is still needed to understand what is happening. It took too long to get to this point, and we should now build on the momentum. The UK could set a lead here. Thus far little note has been taken elsewhere in Europe of life expectancy improvements slowing up, and PHE’s report could stimulate wider interest.

But there are enough pointers here to trigger action, and action is urgently called for—especially given PHE’s warning that a bad flu outbreak and severe cold spell in the 2018 winter could result in a rise in mortality this year.

*England’s life expectancy figures cannot be compared with data for Europe because of the different methods used, hence the international comparisons relate to the UK.  

Veena Raleigh is a senior fellow at the King’s Fund.

Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.