For the first time in more than 100 years life expectancy has failed to increase across the country, and for the poorest 10% of women it has actually declined, according to a new report from Professor Sir Michael Marmot and the UCL Institute of Health Equity.
10 years on since Professor Sir Marmot first published the Marmot Review, the new report confirms that over the last decade health inequalities have widened overall, and the amount of time people spend in poor health has increased since 2010.
It also shows an increase in the north/south health gap, where the largest decreases were seen in the most deprived 10% of neighborhoods in the North East, and the largest increases in the least deprived 10% of neighborhoods in London.
The 2020 review discounts the theory that the slowdown in life expectancy increase can be solely attributed to severe winters or flu.
The report lays out that more than 80% of the slowdown, between 2011 and 2019, results from influences other than winter-associated mortality.
And the slow-down in life expectancy improvement in the UK is more marked than in most European and other high-income countries, except the USA.
The review highlights that our health is not just a matter of how well the health service is funded and functions, important as that is.
Because health is closely linked to the circumstances in which we are born, grow, live, work and age, large funding cuts, under the banner of austerity, have had an adverse effect. Deprived areas and areas outside London and the South East have experienced larger cuts.
Key findings from the report include:
The more deprived the area, the shorter the life expectancy. This social gradient has become steeper over the last decade, and it is women in the most deprived 10% of areas for whom life expectancy fell from 2010-12 and 2016-18.
- There are marked regional differences in life expectancy, particularly among people living in more deprived areas.
- Mortality rates are increasing for men and women aged 45-49 – perhaps related to so-called ‘deaths of despair’ (suicide, drugs and alcohol abuse) as seen in the USA.
- Child poverty has increased (22% compared to Europe’s lowest of 10% in Norway, Iceland and The Netherlands); children’s and youth centers have closed; funding for education is down.
- There is a housing crisis and a rise in homelessness; people have insufficient money to lead a healthy life; and there are more ignored communities with poor conditions and little reason for hope.
“This damage to the nation’s health need not have happened. It is shocking. The UK has been seen as a world leader in identifying and addressing health inequalities but something dramatic is happening. This report is concerned with England, but in Scotland, Wales and Northern Ireland, the damage to health and wellbeing is similarly unprecedented,” explained Professor Sir Marmot, (Director, UCL Institute of Health Equity).
It also shows an increase in the north/south health gap, where the largest decreases were seen in the most deprived 10% of neighbourhoods in the North East, and the largest increases in the least deprived 10% of neighbourhoods in London.
“Austerity has taken a significant toll on equity and health and it is likely to continue to do so. If you ask me if that is the reason for the worsening health picture, I’d say it is highly likely that it is responsible for the life expectancy flat-lining, people’s health deteriorating and the widening of health inequalities.
“Poverty has a grip on our nation’s health – it limits the options families have available to live a healthy life. Government health policies that focus on individual behaviors are not effective. Something has gone badly wrong. We will be monitoring and reporting on inequalities and health and expect the government to listen.”
Despite the cuts and deteriorating outcomes some local authorities and communities have established effective approaches to tackling health inequalities. The practical evidence about how to reduce inequalities has built significantly since 2010.
There is considerable technical and practical experience about how to reduce health inequalities learned from some local areas, such as Coventry and Greater Manchester, and other countries.
Funding: The report was commissioned by The Health Foundation.
World health statistics 2019 summarizes recent trends and levels in
life expectancy and
causes of death,
and reports on
the health and health-related Sustainable
(SDGs) and associated targets. Where possible, the 2019 report
disaggregates data by WHO region, World
Bank income group, and
sex; it also
discusses differences in health status and access
to preventive and curative services,
particularly in relation to differences between
women. Where possible, it indicates the roles of sex as a biological determinant, and of gender as a social construct, in accounting for the observed differences (Table 1).
The analyses presented are not exhaustive; nevertheless, it is hoped that the report will raise awareness of some critical sex and gender differences in health outcomes, highlight the importance of those differences in the attainment of the SDGs, and encourage the roles of sex and gender to be systematically taken into account when collecting data, analysing health situations, formulating policies and designing health programmes.
This overview summarizes the principal findings of the World health statistics 2019 (1).
Definitions of sex and gender
|Sex refers to the biological characteristics that define humans as female or male. These sets of biological characteristics are not mutually exclusive, because there are individuals who are born with physical or biological sex characteristics who do not fit the traditional definitions of female or male (intersex).||Gender refers to the socially constructed norms, roles and relations of and among women, men, boys and girls. Gender also refers to expressions and identities of women, men, boys, girls and gender-diverse people. Gender is inextricable from other social and structural determinants shaping health and equity and can vary across time and place.|
|Sex differences can be observed at the level of chromosomes, gene expression, hormones, immune system and anatomy (e.g. body size, and sexual and reproductive anatomy).||Gender differences and inequalities influence exposure to risk factors, health-seeking and risk-taking behaviours, access to and use of health information; promotive, preventive, curative, rehabilitative and palliative health services; and experience with health care, including in terms of access to and control over resources and power relations.|
|Examples of sex-specific conditions: cervical cancer (women);prostate cancer (men); andX-linked immune regulators may enhance immune responses in female children.||Examples of gender-related factors resulting in differential health outcomes: early pregnancy, including as a result of child marriage, increases girls’ risk of adverse health outcomes;due to the gender-based division of labour, men and women may be exposed to different risks for work- related injuries or illnesses;gender norms related to masculinity promote smoking and alcohol use among men, while gender norms associating smoking with women’s freedom and liberation are being targeted to young women by the tobacco industry;women’s access to health services may be limited by lack of access to and control of household financial resources, caregiving roles, and restrictions on their mobility; whereas men’s use of health services may be influenced by masculinity norms in which seeking health care is not seen as manly; andin addition to gender norms and roles, intersecting discrimination based on gender identity contributes to transgender people experiencing high rates of stigma and discrimination including in health care settings, and a lack of appropriate services responding to their needs.|
Women live longer than men, but the additional years are not always healthy
In 2019, more than 141 million children will be born: 73 million boys and 68 million girls (2). Based on recent mortality risks the boys will live, on average, 69.8 years and the girls 74.2 years – a difference of 4.4 years. Life expectancy at age 60 years is also greater for women than men: 21.9 versus 19.0 years.
Between 2000 and 2016, global life expectancy at birth, for both sexes combined, increased by 5.5 years, from 66.5 to 72.0 years.
The number of years lived in full health – that is, healthy life expectancy (HALE) – also increased over that period, from 58.5 years in 2000 to 63.3 years in 2016 (Fig. 1).
HALE is greater in women than men at birth (64.8 versus 62.0 years) and at age 60 years (16.8 versus 14.8 years). However, the number of equivalent years of full health lost through living in poor health from birth is also greater in women than in men (9.5 versus 7.8 years).
The ratio of the number of men alive to the number of women alive changes through the life-course
Globally, the sex ratio at birth has been in the range of 105– 110 males to every 100 females; however, mortality rates are higher in males, so the ratio changes as the population ages. Thus, in 2016, there were 100 men for every 100 women in the age group 50–54 years, and 95 men for every 100 women in the age group 60–64 years, with the sex ratio falling sharply thereafter (Fig. 2).
Because the incidence of different diseases varies with age, and women live longer than men, some diseases can be more common in women; for example, the lifetime risk for Alzheimer disease is greater in women than in men, partly because more women survive to ages at which the disease most commonly occurs, although in some locations women also appear to be more susceptible to Alzheimer disease (4).
Life expectancy and age of death varies greatly by country income group
Life expectancy at birth in low-income countries (62.7 years) is 18.1 years lower than in high-income countries (80.8 years) (Table 2). In high-income countries, most of the people who die are old; however, in low-income countries almost one in three deaths are of children aged under 5 years (Fig. 4).