How does the UK compare with other countries when it comes to healthy life expectancy? What are the main causes of poor health and how can we avoid them?

People in the UK are living longer but are spending more time in poor health.

That's the verdict of Public Health England, which reports that we’re living longer but spending more years in ill health: about 16 years of ill health for men and 19 years for women.

On average that’s about 63 or 64 years of good health followed by 16 to 19 years of poor health. In practice, however, this varies from person to person, depending on how we choose to live our lives. 

Lifestyle diseases

Lifestyle diseases – including cardiovascular disease (such as heart failure and heart attack), cancer and diabetes– are associated with a lack of exercise, overeating, and with smoking and excessive alcohol consumption. These diseases are significant contributors to poor health and disability.

Dementia

Dementia is another cause of poor health, disability and mortality and it is increasing as more people live longer. According to the House of Commons Library, there are already about 850,000 people in England with dementia  and this number is expected to continue to grow. However, physical and mental activity, a healthy diet and an active social life can all reduce the risk of Alzheimers, the most common type of dementia.

Mental and physical problems

Mental illnesses (such as depression), musculoskeletal problems (such as arthritis) and sight and hearing loss may not be fatal, but they are major causes of poor health and disability as we get older. Together with lifestyle related illnesses they mean that the number of people living with multiple health conditions is growing. 

Pollution

Pollution is also a growing cause of ill health globally. In the UK, for instance, a Royal College of Physicians report estimated that about 40,000 deaths a year are attributable to exposure to outdoor air pollution, caused in particular by vehicle and industrial emissions. The report also points out that 'Air pollution plays a role in many of the major health challenges of our day, and has been linked to cancer, asthma, stroke and heart disease, diabetes, obesity, and changes linked to dementia’.

Years of good health – the UK and other countries

According to the World Health Organisation (WHO), Japan, South Korea, France and Italy are some of the countries with the highest healthy life expectancy i.e. the number of years people live in good health. In another of our articles on the Age Watch website, we look at why people in Japan live longer and how some of the factors mentioned in this article may be responsible for the Japanese staying healthier for longer than most other countries.

Neither the UK nor the US are in the top ten countries for healthy life expectancy. The UK averaged 71.4 years of good health compared with the USA’s 69.1 years but is lower than some of our European neighbours (like France with 72.6 years). If the UK could delay the onset of ill health by three and a half years to match Japan’s 74.8 years of healthy life, then not only would all of us and our families benefit but such a delay would also reduce pressure on the NHS.

Socioeconomic factors and the UK’s ‘health divide’

According to an Office for National Statistics (ONS) report on health across the UK, people in England ‘can expect to spend the longest periods in very good or good general health and free from a limiting persistent illness or disability’. In contrast, the shortest periods of good health are in Scotland and Northern Ireland.

The ONS also reported that these health divisions are ‘increasing in England and Wales but, on the whole, are falling in Scotland and Northern Ireland’. Experts, for instance, Alan Maryon-Davis, Professor of Public Health at King's College London , attribute these divisions to different lifestyles, saying that there was ‘markedly more smoking, bad diets and drinking in Scotland and Northern Ireland [than in England and Wales]’.

The UK’s health divide seems to reflect how rich or poor we are. In 2020, the ONS reported that men living in the most deprived areas of England can expect to live in good health for 18.9 years less than men from the least deprived areas. The equivalent figure for women is 19.4 years. 

Having spent more than 30 years researching the influence of status on health and longevity, Professor Sir Michael Marmot concludes that social inequality (status) is even more damaging to our health than poverty. The experience of low status and inequality – being low status, feeling low status and being made to feel low status – has a significant and detrimental effect on people’s lives and health.The WHO has also reported on the damaging health effects of social inequality and concluded that the lower an individual’s socio-economic position, the higher their risk of being in poor health.

Conclusions 

• People are living longer but are spending more years in poor health.
• Lifestyle diseases resulting from smoking, alcohol consumption, unhealthy diets and a lack of exercise are significant contributors to poor health and disability in later life.
• As people live longer they are also more vulnerable to dementia, arthritis, sight and hearing loss.
• In the UK, on average, we experience three and a half fewer years of good health compared with Japan.
• Social inequality seems to be a major factor affecting health. The rich usually enjoying significantly more years of good health than the poor.
• Governments and businesses need to act to reduce social inequality and its impact on our health. 

If we’re living longer but spending more of those years in poor health or with a disability, then that’s bad news not only for us as individuals but also for our health services and government. So, we need to follow a healthier lifestyle ourselves and also to press the government and businesses to help make healthy options the easy options for ordinary people. You can find out more in our separate report How can we stay healthy longer?

Reviewed and updated April 2020. Next review due March 2023.