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Life expectancy gains in England and Wales among worst in new 23 country comparison study

Risk of death among working age men and women in England and Wales now 20% - 40% higher than average for other high-income countries

The pace of improvement of life expectancy in England and Wales has fallen since 2011, and is among the lowest compared to a large group of other high-income countries, according to new research published in The Lancet Public Health.   

Conducted by a team from the London School of Hygiene & Tropical Medicine and the Max Planck Institute for Demographic Research in Germany, the study compared life expectancy and mortality rates in England and Wales from 1970 to 2016 with that of 22 other high-income countries (table at end of story).

In 2011, life expectancy at birth among men in England and Wales was 79.0 years and for women was 82.9 years. By 2016 it increased by just 0.4 years for men and 0.1 years for women. Only two countries had a smaller improvement for men (Iceland and the USA), and only one for women (Iceland). The median level for the 22 countries increased by 1.0 year for males and 0.7 for females.  

Previous studies have shown that life expectancy improvements in England and Wales have been slowing down since 2011 but this research is the first to look back over many decades. It shows that the recent slowdown is the most substantial seen over the past 45 years. It is also the first to measure the degree to which trends in England and Wales compare with a group of other high-income countries. The researchers were not able to investigate the precise reasons behind these trends.

A slowdown in the rate of increase of life expectancy since 2011 was observed in many of the comparator countries, but the trends in England and Wales between 2011 and 2016 were among the worst. This was a result of a slowing in the decline in mortality rates at every adult age; in young adults, the middle aged and the elderly. These adverse trends were seen among both men and women. 

The most surprising finding of the new study is that that mortality rates among men and women between the ages of 25 and 50 years in England and Wales are now 20% to 40% higher than the average (median) for the 22 other countries studied. This increasing divergence started in the early 2000s and has gradually gathered pace over the years to 2016.

Lead author Professor David Leon from the London School of Hygiene & Tropical Medicine said: “These trends represent a real reversal of the situation in England and Wales in the 1970s and 1980s, when this working-age group had lower mortality than seen elsewhere, almost certainly in part because in this period the UK as a whole had notably low mortality from “external causes such as injuries, poisonings and violence.

“Further work is urgently required to understand what the reasons are for this reversal since 2000, and how far it may be due to adverse trends in injuries, violence and alcohol or drug-related deaths.”

From the early 1970s up until 2010, male life expectancy in England and Wales had followed the average (median) level seen for the group of 22 other countries, rising from 68.9 years in 1970 to 79.4 years in 2016. However, women in England and Wales over this period lagged behind most of the other high-income countries, falling to 18th position by the mid-1980s and to 20th position by 2016, with only Denmark, Scotland, and the USA having lower life-expectancy. In 1970, female life expectancy in England and Wales was 75.2 years, rising to 83.0 years in 2016.  

The researchers were not able to investigate the precise reasons behind these trends. However, it was obvious from the distinctive pattern of mortality that the poor position of females in England and Wales was due in part to women taking up smoking earlier and more intensively than women in most other countries. The effects of this are still evident as they take many decades to manifest and then wear off.

The research was conducted against a background of rising concern about the possible health consequences of austerity policies introduced following the 2008 financial crisis. Previous analyses have focussed upon the negative trends seen in England and Wales among the elderly, suggesting that inadequacies in the social and health care related to government cuts in expenditure may be responsible. The research team noted that the negative trends relative to other high-income countries affected all adult ages and was not restricted to the elderly. This suggests that the explanation might be more complex, although rising socio-economic inequalities in health within the country may well be implicated.

The team also say that the slowdown was not due to reaching a ‘limit of life expectancy’ as there are examples of several countries with appreciably higher life expectancy than seen in the UK, which are continuing to improve at a higher rate.

Author Vladimir Shkolnikov from the Max Planck Institute for Demographic Research in Rostock, Germany commented: “Life expectancy trends in 2011–16 have not slowed down in Italy, Japan, New Zealand, Norway, and Switzerland, although they had higher life expectancies in 2011 than England and Wales. It is also striking that life expectancy continues to rise in highly educated groups in many countries around the world, and these groups have higher life expectancies than any national population. Thus, regardless of what the upper biological limit to longevity might be, people in the UK have a long way to go before they approach any absolute limit.”

Professor Leon said: “We are concerned that the configuration of economic and social forces that have operated since the middle of the 20th century that have enabled the advances in life expectancy seen since the 1950s are not necessarily going to remain.

“Today the world is facing major challenges, from climate change to the disruption of long-established aspects of international collaboration and cooperation, many of which may have a negative impact on future health progress.”

The authors acknowledge limitations of their study, including that at the time of analysis complete and reliable information about which particular causes of death are driving the recent trends was not available.

The study was conducted without special funding.

Publication

David A Leon, Dmitry Jdanov, Vladimir M Shkolnikov. Trends in life expectancy and age-specific mortality in England and Wales, 1970–2016, in comparison with a set of 22 high-income countries: an analysis of vital statistics data. The Lancet Public Health 2019.DOI:

Table showing the change in life expectancy (in years) and rank by country and sex over the period 2011-16. [Negative values are for countries where life expectancy actually declined]

 

Males

   

Females

   

Rank

Country

Change (years)

Rank

Country

Change (years)

1

Norway

1.62

1

Luxembourg

1.57

2

Japan

1.56

2

Japan

1.28

3

Luxembourg

1.41

3

New Zealand

1.17

4

Ireland

1.30

4

Denmark

0.96

5

Denmark

1.25

5

Belgium

0.79

6

Switzerland

1.25

6

Norway

0.72

7

Finland

1.23

7

Spain

0.70

8

New Zealand

1.20

8

Ireland

0.70

9

Austria

1.07

9

Australia

0.61

10

Spain

1.01

10

Italy

0.60

11

Italy

1.01

11

Finland

0.56

12

Belgium

1.00

12

Switzerland

0.54

13

France

0.89

13

Portugal

0.54

14

Australia

0.83

14

Austria

0.49

15

Portugal

0.81

15

Sweden

0.42

16

Sweden

0.78

16

Germany W

0.40

17

Netherlands

0.68

17

France

0.30

18

Germany W

0.62

18

Netherlands

0.26

19

Canada

0.45

19

Scotland

0.24

20

Scotland

0.42

20

USA

0.18

21

England&Wales

0.37

21

Canada

0.16

22

USA

-0.05

22

England & Wales

0.11

23

Iceland

-0.17

23

Iceland

0.01