Poor Health: Why are the British Dying Earlier than Expected?

The UK has fallen to 29th in the global rankings of life expectancy. Matthew Gwyther looks at the economic and social reasons why the country has become the ‘sick man of Europe’ again

The UK has fallen to 29th in the global rankings of life expectancy. Matthew Gwyther looks at the economic and social reasons why the country has become the ‘sick man of Europe’ again

In 1952, when Elizabeth II came to the throne, the UK had one of the longest life expectancies (as measured from birth) in the world, ranking seventh globally behind countries such as Norway, Sweden and Denmark. 

Indeed, for many in Britain, the 1950s were a good time to be alive, as Harold Macmillan observed with his “never had it so good” observation.  The NHS, as part of the Welfare State, had been created in 1948 and there were high hopes that our collective health –  and therefore life expectancy – would improve. 

Although average life expectancy in the UK has increased in absolute terms over recent decades, similar countries have experienced significantly larger increases, according to a new analysis just published in the Journal of the Royal Society of Medicine. 

The researchers, from the University of Oxford and the London School of Hygiene and Tropical Medicine (LSHTM), analysed global rankings in life expectancy between 1952 and 2021. In 1952 we weren’t doing too badly but by 2021, the UK's global ranking had fallen to 29th, seven places lower than Guadeloupe. 

Class and Access

Health is both intensely personal and also deeply political. At one level it’s just us and our body on life’s journey before it finally gives up the ghost, on the other, especially in the Uk, where the NHS is state-provided and free at the point of delivery, it’s largely politically controlled when it comes to funding and how health is dealt out.

Increased morbidity and mortality go hand in hand with poverty. Although it took the Black Report of 1980 (which showed that the death rate for men in social class V was twice that for men in social class I and that gap between the two was increasing, not reducing as was expected) to spell it out, such facts will have been plain to anyone reading Mayhew’s London which was written in 1865.

Similar factors to 19th century London now apply in the UK. The Organisation for Economic Cooperation and Development (OECD) has found recently that the UK is now the second most economically unequal country in Europe after Bulgaria.

If you have less money you don’t eat as well and you’re more likely to smoke but there’s ample evidence that broader social factors, including education, employment status, income level, gender and ethnicity which have a marked influence on how healthy a person is. The lower an individual’s socio-economic position, the higher their risk of poor health.

There is also the problem of access to help and treatment plus the middle class and their sharp elbows. The NHS is a rationed system. Middle-class people benefit more from the NHS than the poor. This was spelt out in a 2003 report written by Julian le Grand, Tony Blair's health policy adviser in the Downing Street policy directorate and Anna Dixon, an adviser to John Reid, the health secretary. (Reid famously was heard to utter “fuck– NOT Health!” when he was appointed by Blair as Secretary  of State – an indication of the daunting nature of the job.) They found that "affluent achievers” from the professional classes were 40% more likely to get a heart bypass than the "have-nots" from lower socio-economic groups, despite much higher mortality from heart disease in the deprived group.

Poorer people were 20% less likely to get a hip replacement, although they were 30% more likely to need one. And at the primary care level in the GP's surgery, social class made a marked difference to the quality of care that patients might expect. Those from the two most affluent social groups got about 10 minutes of the doctor's time, while those from the other five groups averaged just over eight minutes. The former were far more likely to have Googled their condition and be keen to discuss it with a medical professional. 

The Worried Well and Primary Care

So, while we have yet to see the complete effects of the Covid pandemic, it looks as if an average UK life expectancy of 81.77 has halted, even slid back, after years of improvement. 

Quite simply, as our productivity levels stagnate, we’re not getting any richer. Research by the Resolution Foundation has shown quite clearly that fifteen years of wage stagnation has left British workers £11,000 worse off a year.  The growth that led up to the 2008 financial crisis has fallen away. It also found typical UK household incomes have fallen further behind those in Germany. In 2008, the gap was over £500 a year, now it is £4,000.

While all this is going on, we are newly taken with the concept of individual “well-being” which you could crudely define as remaining fit and avoiding getting ill in the first place. 

This is an ancient duality well understood by the Greeks. The goddess Hygeia was a health nurturer and her father Asclepius was a hands-on healer. While Hygeia was worshipped in a preventative manner with the goal of keeping that patron healthy, Asclepius was the hierarchically superior father who was prayed to, for healing, when someone was suffering. He’s muscled with a stern facial expression and the omnipresent snake. Hygeia, his daughter is represented as sensitive, with a faraway look – smooth-skinned, and delicately represented. Those health futurists believe that as the 21st century advances Hygiea will get the upper hand. She is the future. 

Primary care is where the action will be not simply because it is cost-effective and makes consummate sense but because out there in the community is where the locus of sickness is and where its reverse, wellness and health, should and will be. 

However, for the time being, coping with the Worried Well with their Fitbits won’t be so much of a problem. Getting people out of poverty is the greater challenge.   Prevention remains better than cure. When it comes to healthcare in the UK, the current expenditure balance of 80:20 in favour of hospital over primary care is unlikely to remain the same in the future not least because it’s too costly. The direction of travel will not favour the hospital. 

The Effects of Pension Age

Finally, those demographers within HM Treasury may have recently stumbled across a tricky consequence of this lower-than-expected life expectancy among Brits. It was widely expected that an announcement was coming soon about the retirement age and access to a state pension. But ministers have now delayed plans to raise the pension age to 68 in 2037 which had been intended to ease the financial burden to the taxpayer. 

Bear in mind that – while unlikely to promote pitchfork-wielding rioters, as have such pension-age-increasing moves in France –  the elderly don’t like being forced to work longer and are, as always, far more likely to vote Tory. If the average Brit is dying earlier than had been expected then the state doesn’t have to pay out for so long. Hence, the story leaked to the Financial Times on the evening of Tuesday 21 March. 

One unnamed, senior Tory MP warned of the “critical juxtaposition” of scrapping the £1mn lifetime allowance for pension savings while asking ordinary voters to work until 68 for a state pension. Short-sighted optics, indeed. Government insiders denied any link, insisting ministers needed more time to consider falling life expectancy data, which had been skewed by the Covid pandemic, together with new information such as 2021 census data. “They were gung-ho to raise the pension age,” a government insider told the FT. “But they got cold feet.”

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