UK - Politika i društvo

The missing quarter of a million
Britain has endured a decade of early deaths, and the pandemic is not the only reason

In RECENT YEARS Britain has been hit by one health crisis after another. First came the covid­19 pandemic—then backlogs in
health and social care that the coronavirus exacerbated, and a long winter of strikes and overwhelmed emergency departments. But in the background, long before the pandemic hit, an even more disturbing story has been unfolding. Britain has endured a grim decade during which perhaps a quarter of a million people died younger than expected.

By our calculations, that is the number of extra deaths Britain has suffered, compared with similar countries such as France and Denmark. The reason is that, in the early 2010s, life expectancy stalled in Britain compared with long­-run trends and other countries. This slowdown in life expectancy struck all age groups, not just the elderly. And it disproportionately affected the poor. If you travel just 10km (six miles) from the poshest part of Kensington in London to New Cross Gate, life expectancy for men falls by a staggering 18 years, from 92 to 74. The burden these deaths place on the living is not just weighed in grief. When more people are dying and life expectancy is stagnating, a greater number of people are also living in ill health.  Life expectancy in Britain, as in almost all other rich countries, had been rising for nearly two centuries. But something went wrong in the early 2010s. Life expectancy at birth today, at 81, is just eight weeks longer than it was in 2011. In a best-­case scenario, in which the pace of improvement between 1980 and 2011 had been sustained, life expectancy today would have been over 83. By The Economist’s calculations, that is no minor difference: it implies that between 2012 and 2022 approximately 700,000 Britons died sooner than they might have.

Two features make this figure even more worrying. Death comes mostly when people are old. But the slowdown in life expectancy has occurred across all age groups. Mortality rates have stalled for infants, and risen among young adults and the middle­-aged. Death rates for 30­ to 49­-year­olds have steadily increased in Britain since around 2012, in sharp contrast with neighbouring countries.

Although the deaths have been spread across generations, they have not been spread across the income spectrum. Life expectancy has fallen among the poorest in society but risen for the richest. A poor English girl could on average expect to live 6.8 years less than a rich girl in 2011, but 7.7 less in 2017. For boys, the gap increased from 9.1 to 9.5 years over the same period.  

The combined effect of the pandemic and global demographic trends can explain only some of Britain’s missing multitude. Though other rich countries have also experienced slowdowns, Britain has done the worst out of a cohort of its European peers. After stripping out the effects attributable to covid and the broad European slowdown from the toll of 700,000, you are still left with those 250,000 unexplained deaths. Working out what has gone wrong is not easy. In America, where life expectancy has fallen even more sharply in recent years, “deaths of despair” from drugs, alcohol and suicide have done the most harm. The same is true for Scotland, where drug deaths have more than doubled in a decade; Dundee is now the drug­-death capital of Europe. Yet although a similar problem may be brewing in England and Wales, the rate of drug deaths is nearly four times higher in Scotland.

The recent struggles of the National Health Service (NHS) have played their part. Hospital waits of record lengths and a crisis in primary care jeopardise timely treatment. But delays in medical care cannot explain all the extra deaths, especially before the pandemic. Besides, the greatest improvements in life expectancy come not from treatment but from better diagnosis and prevention, and wider prosperity. This is where Britain appears to have fallen short. It could do much better in all three.

First, diagnosis. Poorer Britons are 20% more likely to be diagnosed with cancer at a later stage, when the disease is more
complex and expensive to treat. Having more NHS diagnostic centres would help, as well as cutting the pandemic­-related
backlog. Prescribing more statins for those at risk of heart attack or stroke would be good, too. Both treatments are cheap and cost-­effective, and are recommended. But with around one in 11 NHS posts vacant, it will be tricky to find enough radiologists and general practitioners to make a difference.  

Next, prevention. Individuals bear responsibility for their own decisions but public-­health interventions, from vaccines to
anti­smoking and weight-­loss programmes, can improve things. They also provide good value for money. One study found that it cost nearly four times as much to gain an extra year of good health via clinical interventions than through public-­health programmes. Yet funding for the public­-health grant, which is allocated to local authorities by central government
and amounts to a mere 2% of the NHS budget, has been cut in real terms in recent years.  

Ultimately the greatest improvements will come from raising the living standards of the poor. Their lower life expectancy has many causes, from less money to spend on home insulation or nutritious food, to the stress of financial insecurity. One useful long­-term thing the government can do is help improve the country’s dreadful record on productivity by liberalising planning and devolving fiscal powers to local authorities. Life after life The government should also recognise the role that deprivation plays in health. Reweighting funding formulas to benefit general practitioners in the poorest areas would be a good idea. They care for 10% more patients than practices in the richest areas, but receive 7% less cash. And as Jeremy Hunt, the chancellor of the exchequer, prepares his budget for March 15th, he should recognize how spending cuts show up in other areas. The data show that life expectancy was worst affected in the places with the largest relative declines in housing services and adult social-care spending between 2009 and 2019.

In its covid response, Britain went to extraordinary lengths to prevent its citizens from suffering an early death. The pandemic may be over, but that job is nowhere near complete.