Adding extra years to life and extra life to those years

Our population is ageing. There are currently over 21 million people aged 50 and over in England. This represents 38 per cent of the population, up from 32 percent in 1981 – an increase of 6.8 million people (47 per cent).

Over 10 million people are currently aged 65 and over, making up 18 per cent of the population.

The number of people aged 65-79 is predicted to increase by nearly a third to over 10 million in the next 40 years, while the number of people aged 80 and over – the fastest growing segment of the population – is set to more than double to over 6 million.

Sources: ONS, Principal projection – UK population in age groups, 2021-based interim edition and Population estimates for England and Wales - Office for National Statistics.

This trend will not only continue in the coming years, but it will also actually gather pace. But while the greater longevity is to be welcomed, far too many of those later years are being spent in poor health.

Currently women on average can expect to live another 21 years when they reach 65, while for men it is close to another 19. But only half of those years are spent in good health – or disability-free as it is known.

Although people born today are still expected to live for longer than older cohorts, they are not expected to live for as long as previously thought. People born in 2020 were expected to live to 93 years in 2010-based projections and are now expected to live to just 89 years in 2020-based projections – lower than in 2002-based projections.

Inequalities in life expectancy remain wide and have been entrenched and exacerbated, particularly by the pandemic. The gap in life expectancy between the local authorities with the highest and lowest life expectancy was 7.4 years in 2017–19 and it grew to 8.7 years in 2020–22. On average, people in the most deprived 10 per cent of local areas are expected to live a shorter life than those in the least deprived areas. They are also more likely to spend more of their life in poor health.

In 2021, around one in four adults who were providing unpaid care reported being in “not good health” after adjusting for age, compared with fewer than one in five adults who were not providing any unpaid care; the probability of reporting being in “not good health” was higher for people providing more hours of unpaid care.

That is bad for the individual and bad for the state.

Figures from the Office for National Statistics (ONS) reveal that, in England, healthy life expectancy at birth for a male fell by a year between 2015-17 and 2020-22. Similarly, the period of life lived in good health for a female fell by 1.2 years between 2015-17 and 2020-22. Healthy life expectancy (known as HLE) is defined as the number of years an individual can expect to spend in very good or good general health.

There’s also a sharp difference in healthy life expectancy at birth between English regions. In the Northeast, it was just 57.6 years for males and 59.7 for females in 2020-22. In stark contrast, male healthy life expectancy at birth in the Southeast was 64.6 years and 64.7 years for females.

In 2020, the Covid-19 pandemic was a significant turning point, causing a sharp fall in life expectancy, the magnitude of which has not been seen since World War II. However, regardless of the pandemic, where you live should not dictate how many years of your life are spent in good or very good general health.

Governments often fail to take urgently needed action further upstream, to prevent and tackle the lifestyle behaviours that lead to chronic disease later on. The disorders making the greatest contribution to health such as cardiovascular disease, stroke, chronic obstructive pulmonary diseases and some cancers, are preventable, and so in order to tackle them we must address their associated risk factors. Now more than ever, unhealthy behaviours such as smoking, physical inactivity, drinking too much alcohol and eating an unhealthy diet are in the spotlight.

Local government backs and proactively led on hard-hitting national action on obesity, smoking, alcohol and other major health risks, while tobacco control and tackling obesity remain high on the political agenda. Local government therefore has an opportunity to tackle long-term conditions, turn the tide and to make sure that everyone is able to maintain their health, wellbeing and independence for as long as possible.

We strongly welcome the government’s commitment to halve that gap in healthy life expectancy. Reducing the avoidable differences in health across the population must be a priority.

We are very encouraged by the health mission commitment to establish a mission delivery board to bring together all government departments with an influence over the social determinants of health. The ambition is achievable, it has been done before, through concerted and determined action we can make a huge difference. We are keen to assist the government to tackle the wider determinants that drive health inequality.

Increasing the number of years people live in good health would require action across multiple areas. Secure jobs, adequate incomes, decent housing, and high-quality education all shape our health. Reducing health inequalities is achievable but needs a long-term cross-government approach, with all departments working together to prioritise good health.

If we tackle this head on, we can help ensure that not only do we add extra years to life but extra life to those years.

Councillor David Fothergill 
Chairman 
Community Wellbeing Board