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As inequality rises, life expectancy falls

The pandemic is only part of the story behind the drop in the average age that Britons can expect to live.

By Veena Raleigh

The global death toll during the Covid-19 pandemic was unprecedented in modern times. Recent data from the Office of National Statistics (ONS) illustrates the impact of the devastating loss of life in the UK by enabling us to compare life expectancy before and during the pandemic. But what does this tell us about how long people can expect to live now?

Between 2017-19 and 2020-22, life expectancy fell from 79.3 to 78.6 years (so by 38 weeks) in males and from 83 to 82.6 years (23 weeks) in females. That means UK life expectancy slid back to levels last seen a decade ago. The 2020-22 average disguises the even sharper fall in the single year data for 2020, when life expectancy fell by 1.2 years in males and 1.6 years in females.

But the life expectancy discussed here is not a prediction of how long people will live. It is calculated from mortality rates over a specific period and is an estimate of how long a person would live if those mortality rates remained unchanged. As it doesn’t consider future changes in mortality, a person could live longer if mortality falls. Still, it is the most widely used summary measure of population health internationally, enabling comparisons over time, across countries and between population sub-groups.

Recent ONS data also shows the stark variation in life expectancy between some of the most- and least-deprived areas of England, driven by socio-economic inequalities including in income, education, housing and employment. There is a north-south divide, with the more deprived communities of the north-east and north-west having the lowest life expectancy on average and the more affluent populations of London and the south-east having the highest. Male life expectancy is roughly ten years higher in Hart (South East) than it is in Blackpool (North West), and female life expectancy seven years higher in Kensington and Chelsea (London) than it is in Blaenau Gwent (South-East Wales).

Although Covid-19 was the dominant driver of high death rates during the pandemic, other factors were already slowing improvements in UK life expectancy. Historical background can help to contextualise the figures and assess the outlook for the future. Between 2000 and 2011, life expectancy in the UK increased by 3.5 and 2.6 years in males and females, respectively, continuing the dramatic rises seen in the 19th and 20th centuries. These rapid increases were due to a range of public health measures, such as the control of infectious diseases, the indoor smoking ban, and medical advances in preventing and treating disease.

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However, between 2011 and 2019, life expectancy virtually stalled, increasing by just 0.6 years for males and 0.5 years for females. There are various explanations for these sluggish improvements in pre-pandemic longevity, such as the tight budgetary constraints on public health, the NHS, social care and other public services during the “austerity” period after the 2008 financial crash. This further widened socio-economic and health inequalities. Analyses also show that severe flu seasons had an impact, such as in 2015, as did the slowing down of improvements in mortality rate from big killers such as stroke, heart attacks and other cardiovascular diseases.

Whatever the individual contributions of these factors, the result was that falling life expectancy in the UK during the pandemic came on the heels of a period when population health had seen little improvement. Moreover, the UK also experienced higher excess mortality during the pandemic compared with most high-income countries such as Australia, New Zealand, Japan, Canada, and Scandinavian and western European countries (with the exception of Italy and Spain).

So, what’s the outlook for life expectancy in the UK? There’s a clue in the single-year data within the ONS’s three-year average for 2020-22: life expectancy did recover somewhat in 2021 and 2022 after the sharp fall in 2020. Therefore, it’s likely that life expectancy will rise, barring exceptional events such as a resurgence of Covid or flu, another pandemic or extreme climate change events such as the heatwave of summer 2023.

But there is little ground for optimism that we will see big rises in life expectancy in the medium term. Public health services for disease prevention remain under-funded and population health is in a parlous state. Two thirds of adults and one third of children are overweight or obese and 2.5 million working-age adults are unable to work because of long-term sickness. Mortality rates in young adults aged 20-44 are the highest in ten years, with the exception of 2021. The pressures on an under-resourced and overstretched health and care system have been exacerbated further by the pandemic, with waiting lists nearing eight million. And health inequalities are widening further.

The UK’s international ranking in life expectancy is also in jeopardy. Higher excess mortality in the pandemic was preceded by a decade when the UK’s life expectancy compared poorly with other high-income countries and showed the least improvement, resulting in a downward slide by 2022. The prospect for a dramatic improvement in life expectancy relative to other nations is slim.

Turning this ship around will be enormously challenging but is not impossible. Improving life expectancy in the UK and closing inequality gaps will require a coherent cross-government strategy that promotes healthy lifestyles to prevent disease, identifies and treats illness earlier, and reduces inequalities by improving the health of people in deprived communities.

[See also: Local authorities warn they have “little choice” but to raise council tax]

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