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English life expectancy up but so are health inequalities

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Life expectancy has increased faster in England than many other developed countries, but inequalities between regions have also grown, according to a major study.

Health in England is improving, but substantial opportunities exist for further reductions in the burden of preventable disease, said the authors of the study from Public Health England.

The gap in mortality rates between men and women has reduced, though “marked” health inequalities between the least deprived and most deprived areas remain, they stated in The Lancet.  

“If the levels of health seen in the best-performing regions could be achieved in the worst, then England could have a level of overall disease burden as low as any country in the industrialised world”

John Newton

The researchers used data to analyse patterns of ill health and death, calculate the contribution of preventable risk factors and rank England compared to 18 other developed countries.

They found life expectancy in England increased by 5.4 years from 75.9 years in 1990 to 81.3 years in 2013 – one of the biggest rises compared with the other countries in the study.

The improvement was mainly because of falls in the death rate from cardiovascular disease, stroke, chronic obstructive pulmonary disease and some cancers, said the researchers.

However, such falls have been offset by increases in death rates from liver disease, drug and alcohol misuse, and neurological conditions.

English men saw the largest gains in national life expectancy during the study period – increasing by 6.4 years to 79.5 years – behind Luxembourg, but on a par with Finland. 

For women, average national life expectancy increased by 4.4 years to 83.2 years, equalling or surpassing all countries except Finland, Germany, Ireland, Luxembourg, and Portugal.

However, the researchers warned that national progress has not been accompanied by improvements in inequalities.

The gap in life expectancy between the most and least deprived regions stayed unchanged for men at 8.2 years and declined by just 0.3 years in women to 6.9 years over the 23 year study period.

Some English regions – the South West, East of England and South East – now have similar or better levels of health than the best-performing developed countries. But other regions – the North East and the North West – ranked among the worst performing nations.

 

North of England map

The degree of health inequality between regions largely follows their relative level of deprivation, the study found, with more deprived populations having a greater burden of diseases.

For example, in 2013, years of life lost to the top causes of death – ischemic heart disease, lung cancer, and chronic obstructive pulmonary disease –largely mirrored levels of deprivation. 

Lead author Professor John Newton, chief knowledge officer at PHE, said: “If the levels of health seen in the best-performing English regions could be achieved in the worst, then England could have a level of overall disease burden as low as any country in the industrialised world.”

The researchers also noted that sickness and chronic disability were causing a much greater proportion of the burden of disease, as people were now living longer with several illnesses.

Low back and neck pain was the leading cause of overall disease burden, with hearing and vision loss and depression also in the top 10.

“If England can make progress with smoking, alcohol, dietary risk factors, physical inactivity, and obesity, it will see massive reductions in disability”

John Newton

For several conditions, although death rates have declined, the health burden has not reduced to the same extent or is even increasing.

For example, while deaths rates from diabetes fell by about 56%, increases in related illness and disability have been substantial – rising by around 75% over the last 23 years.

Professor Newton said: “The country has done a good job preventing premature deaths but this has not been matched by declines in disability and illness, resulting in people living longer with disease.

“If England can make progress with smoking, alcohol, dietary risk factors, physical inactivity, and obesity, it will see massive reductions in disability,” he said, noting that it would require new approaches to support healthy behaviours, modify risk factors and alleviate chronic conditions.

British Heart Foundation medical director Professor Peter Weissberg said: “This study shows how successful the UK has been at reducing deaths from cardiovascular and other diseases through the application of research findings on behaviours such as diet and smoking to improve public health.”

  • The counties in the study were England, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, Australia, Canada, Norway, and the US.
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