Global rankings of life expectancy show that the UK's performance compared with that of the other wealthy advanced countries has been undergoing a decades-long decline.
Although average life expectancy in the UK has increased in absolute terms over recent decades, similar countries have experienced larger increases, according to a new analysis 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. They said that in 1952, when Queen Elizabeth II ascended the throne, the UK had what was then one of the longest life expectancies in the world, at 69.5 years for both sexes.
At that time, just 4 years after the inception of the NHS the UK ranked seventh globally, behind countries such as Norway, Sweden, and Denmark. Yet by 2021, the UK's global ranking had fallen to 29th.
UK in Downwards Ranking Trajectory Since the 1960s
The UK started to slip down the global rankings in the early 1960s, and the trajectory has continued a broadly downward path ever since, with particularly marked falls in the 1970s and 2010s.
When compared with other countries in the G7, anintergovernmental political forum consisting of Canada, France, Germany, Italy, Japan, the UK, and the US which together represent about half of global economic output, the UK has fared worse over the last seven decades than all other G7 countries except the US.
First author Dr Lucinda Hiam, of the University of Oxford, said: "The rankings show that the only G7 country to do worse than the UK is the USA."
'Diminishing Marginal Returns' on Health Investment
The researchers said that the relative decline of the UK portrayed in their analysis was "stark", and the causes of the UK's descent down the life expectancy ranks appeared to have been "decades in the making". It was hard to believe that the UK was facing such "diminishing marginal returns on its investment in health", they said, "while those other countries are at a point in the curve where returns are still much higher".
Whilst admitting that vital registration data has improved immensely in low- and middle-income countries over the time of their analysis, and that the changes in rankings may be partly explained by the remarkable economic progress in the post-war period in countries such as Singapore, Hong Kong, South Korea, and Taiwan, what has happened in the UK is not simply a matter of other regions catching up, they believe. France, for example, started well below the UK and has now surpassed it.
Rising Income Inequalities
They said that in addition to decreasing life expectancy gains, income inequalities rose greatly during the 1980s and have worsened since. Figures from the 38- member intergovernmental Organisation for Economic Co-operation and Development (OECD), which represents about 80% of world trade and investment, showed that "the UK recently became the second most economically unequal country in Europe after Bulgaria", they said.
"Perhaps we should not be surprised to see that inequality reflected in such wide health inequalities and a declining overall position," asserted Dr Hiam.
Co-author Professor Martin McKee, from the LSHTM, said: "While politicians invoke global factors, especially the effects of the pandemic and the invasion of Ukraine, the reality is that, as in the 1950s, the country suffers from major structural and institutional weaknesses."
The rise in income inequality, he said, "also saw an increase in the variation in life expectancy between different social groups. One reason why the overall increase in life expectancy has been so sluggish in the UK is that in recent years it has fallen for poorer groups."
Relative Worsening of Population Health May Signal Political and Economic Problems
Dr Hiam added: "A relative worsening of population health is evidence that all is not well. It has historically been an early sign of severe political and economic problems." The UK may be "at a crossroads", the authors believe, with the cost-of-living crisis meaning that 'business as usual' is no longer an option.
Media headlines such as "A&E delays are 'killing up to 500 people a week'" highlight that, "in the short term, the Government has an acute crisis to address", say the authors. "In the medium term, there is an economic malaise makes it harder to address the short-term problems," they add. But while "the headlines may be now", they add, "the real causes would appear to have been decades in the making".
Meanwhile, current UK life expectancy in 2023 is 81.77years, according to latest figures from the United Nations, and has been increasing by a small but steady 0.15% per year since 2019.
Life Expectancy Increasing for Cohorts From Birth to 65
Latest projected life tables from the Office for National Statistics (ONS) based on figures to January 2022 showed that cohort life expectancy at birth in the UK is projected to increase for babies born in 2045 to reach 90.1 years for men and to 92.6 years for women.
This represents an increase in life expectancy of 2.8 years (3.2%) for men and 2.4 years (2.7%) for women compared with 2020 figures of 87.3 years and 90.2 years, respectively, taking into account projected changes in mortality patterns over their lifetime.
Remaining life expectancy for people aged 65 in 2020 was 19.7 years for men and 22.0 years for women, projected to rise to 21.9 years for males and 24.1 years for females aged 65 years in 2045 – increases of 11.2% and 9.5%, respectively.
Among those born in the UK in 2020, the ONS estimated that 13.6% of men and 19.0% of women were expected to live to at least 100 years of age, and said that this was projected to increase to 20.9% of boys and 27.0% of girls born in 2045.