11 May 2015
Dr Tazeem Bhatia, Nuffield Trust - image

Dr Tazeem Bhatia

Public Health Trainee
Nuffield Trust

We’re used to seeing ongoing incremental rises in life expectancy, with each generation expecting to live longer than the last. 

So, when data published earlier this year by Public Health England showed a drop in life expectancy for women aged 65 years and over, it caused some alarm. Should we be worried? Is this the beginning of a decline in life expectancy? What does this mean about our society? 

Fluctuations like this are seen all the time and most experts would say that it is too early to tell whether this one is significant. But it does raise the question: what else have we been taking for granted about life expectancy?

Is extending life is always a good thing?

Over the last 30 years, life expectancy has increased by 1.2% per year in men and 0.7% per year in women. The general trend upwards is reason for celebration, but the figures give no indication as to whether the extra years gained are healthy, good quality years of life.  

Not only are we living longer, but our general health is improving and we are living in good health for longer.

Healthy life expectancy (HLE) estimates the average lifespan spent in very good or good health, based on self-assessed general health. According to the Office for National Statistics (ONS), girls born in the UK in 2009-2011 will live 66 years (80% of their lives) in good health, while boys will have 64 years of good health (82% of their lives). In England, this represents four more years of good health compared to those born in 2000-2002. 

What about older people?  Women aged 65 and over can expect to live an estimated 12.6 more years in good health and 8.2 years in poor health, while men aged 65 can expect to live an estimated 10.7 more years in good health and 7.3 years in poor health. So, not only are we living longer, but our general health is improving and we are living in good health for longer. Even more cause for celebration. 

How does where you live affect life expectancy?

An improvement in life expectancy and HLE has been seen across the whole UK population, but there is still a significant difference between the rich and the poor. Men from the most deprived areas have an overall life expectancy 9.2 years shorter than men from the least deprived areas. For women, this difference is 6.8 years.

If we look again at HLE, the difference is even greater. Men in the least deprived areas in England can expect to live 19.3 years longer in good health than those in the most deprived areas, and this difference rises to 20.1 years for women. This inequality in HLE is two to three times larger than the gap in life expectancy. So, not only do men and women from deprived areas live shorter lives, but they spend more of their years in poor health (see below). 

Most importantly, the data also show that the female genetic advantage in terms of life expectancy can be overcome in men by social mobility, since men who live in the wealthier areas have higher life expectancy and HLE than women living in the most deprived 10% of areas. 

Can health policy extend life expectancy?

So, what are we doing to address this social injustice? Health inequalities have been known and written about since the influential 1980 Black Report. The previous government set a ten-year target to reduce the gap in life expectancy between the least and most deprived populations by 10%, but unfortunately failed to achieve it. However, a change in the allocation of NHS resources to invest in deprived areas did achieve a modest absolute reduction in mortality from causes amenable to healthcare.  

The real challenge lies in maximising the quality of years gained – for all members of society, not just the most advantaged.

In 2012, the Health and Social Care Act introduced legal duties on the NHS and the wider system to have due regard to inequalities, but the creation of Public Health England and transferral of public health responsibilities to local authorities has moved the onus to tackle inequalities onto them, rather than the NHS. 

The factors that contribute to health inequality, as outlined in the Marmot Review 2010, are widely understood. Recommended solutions include focusing on children’s early years, ill-health prevention and the wider determinants of health. But there is also recognition that there is no quick win to ensuring greater health improvements in the most deprived communities, and that it is these populations that are most at risk in this time of austerity.  

So, where to start? A segmenting tool published by Public Health England can at least be used to help define which areas of health should be prioritised in order to best address the gap in outcomes. For each locality, the tool segments the gap between the most deprived and least deprived by cause of death, for both men and women. In this way, each local authority can see the key diseases driving health inequalities in their population and then focus on improving outcomes in that area, be it circulatory disease, cancer, respiratory disease or any other health condition. 

Life expectancy may be a key measure of the nation’s health, but the real challenge lies in maximising the quality of years gained – for all members of society, not just the most advantaged.

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