On Sunday, the Health Foundation published new analysis of ONS data, finding that between 2012/14 and 2022/24 the average Healthy Life Expectancy (HLE) has dropped by two years. The think tank suggested that poor quality housing, poverty and Covid-19 could be causal factors, and concluded that ‘the UK’s health is declining’. The Guardian described this development as a ‘grim picture’. GB News suggested that this new evidence proved that plans to raise the state pension age are unfair. A spokesperson from NHS Alliance drew a different conclusion, telling the BBC that the fall was evidence that the ‘wider determinants of health’ must be ‘tackled’ and that community support must come ‘closer to home’ (the usual NHS-ese bingo).
It may surprise some readers to find out that while ‘healthy life expectancy’ has indeed declined in this period, life expectancy (LE) has actually marginally increased. According to the ONS, life expectancy at birth for women in 2012-14 was 82.79 years, in 2022-24 it was 83.02 years. For men those numbers are 79.05 and 79.12.
So a modest improvement, but improvement nonetheless. And particularly encouraging is that the small dip in life expectancy at birth during the pandemic (the figures for 2020-22 are 82.57 for women and 78.58 for men) has been reversed.
So why is it that HLE is falling while LE is increasing? Part of the problem is that ‘healthy life expectancy’ depends partially on self-reporting as well as hard metrics on mortality. The main input for how the ONS calculates self-reported health is from the Annual Population Survey which asks people to rate their health on a five-point scale.
The problem with self-reporting is that it relies on perception. How healthy do you feel? Mental disorders are one of the self-reported conditions that the ONS uses to determine someone’s healthy life. The number of people reporting mental health conditions in Britain has been rising for some time, particularly among young people. Between 2012 and 2022 – the decade the Health Foundation uses for its analysis – the proportion of those aged 16- to 34-year-olds reporting a mental health condition more than tripled from 3.8 per cent to 13.3 per cent.
There are many reasons why reporting of mental health problems among young people may be increasing. Some will say it is because we are now more honest and open about our problems, others will say it is because teenagers are using mobile phones too much, or that mental health problems are a form of social contagion spread by the internet. A mixture of all of these things could be true. But when people hear ‘healthy life expectancy’, they think of how long a 70-year-old might be mobile, or able to breathe without assistance, not whether or not a teenager has depression – as serious as that problem is.
Mental health does appear to be driving at least some of the decline. If we break it down on the basis of age we can see that HLE is not declining evenly across the board. UK HLE for 2012/14 to 2022/24 declined by 2.1 years for males aged 5-9, but actually increased by 0.1 years for males aged between 75 and 79. The disparity is sharper for females, with a 2.8-year decline for those aged under one compared with a 0.1-year increase for those aged 75-79. The rise in mental health problems throughout the 2010s has been concentrated among younger people, and those aged over 70 are significantly less likely to report having depression.
So while our perceived health may have declined very slightly, the hard, measurable metrics tell a different story. There are also other causes for optimism on life expectancy. Tobacco use is the main driver for healthy years of life lost, followed by high BMI, high cholesterol and high blood pressure. Over the next 20 or so years we can expect all of these mortality causes to decline. Tobacco smoking has been in decline since 2011 (from 20.2 per cent to 10.6 per cent in 2024) and the radical measures announced during the last government, like the phased smoking ban, should bring this down even more.
For high BMI – which is linked to high cholesterol and blood pressure – some data (relying on surveys) from the United States shows that obesity rates are finally beginning to decline, which is likely to be caused by the rollout of GLP-1 drugs like Ozempic. Over time, as these drugs become cheaper and easier to prescribe at scale on the NHS, we can be fairly sure that we will begin to address this public health emergency.
Excessive fear about the state of the nation’s health will ultimately pave the way for more restrictions on people’s lives. More interference, whether that is taxes on sugary drinks or the banning of ‘unhealthy takeaways’ around hospitals. Are you willing to give up the kebabs because some survey respondents say they feel anxious? Thought not.
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