Read: Poor life expectancy rates are a stark illustration of health inequality
Nothing illustrates health inequality more effectively than the huge differences in life expectancy across the country. Put bluntly, where you live can have a direct impact on how long you live. And the figures on healthy life years demonstrate a similar picture.
Despite most communities seeing their life expectancy increase in the years between 2002 and 2010, research by Imperial College London (Life expectancy and risk of death in 6791 communities in England from 2002 to 2019: high-resolution spatiotemporal analysis of civil registration data) has shown that many had already started to see a decrease before the pandemic. In the years between 2014 and 2019, life expectancy went down in almost one in five communities for women and one in nine for men.
There are stark geographical differences. Communities with the lowest life expectancy were typically located in urban areas in the North, including Leeds, Newcastle, Manchester, Liverpool and Blackpool while those with the highest were often based in London and the surrounding home counties. However, even within London and the home counties significant variations can still be seen across small geographical areas.
The comparison between the highest and lowest life expectancies is a bleak one. In 2019 there was a 27-year gap in life expectancy for men, with a man in Kensington and Chelsea expected to live until 95, compared to one in Blackpool who would be just 68. The difference for women was almost 20 years, with a woman in Camden having a life expectancy of 95, compared to a community in Leeds where a woman was expected to live until 75.
The biggest decline for women was a loss of three years in an area of Leeds, from 78.7 to 75.6 years, and for men was of 0.4 years in an area of Blackpool, from 68.7 to 68.3 years. There were also significant reversals in life expectancies over this time for women in a number of communities in Yorkshire and The Humber.
Many of the areas with the worst figures were those already experiencing lower life expectancy, together with high levels of poverty and unemployment and lower educational attainment. They are also, typically, the communities where the pandemic hit hardest, with higher infection and mortality rates, so it is inevitable that life expectancy rates will have deteriorated further. During the first wave, a male living in the most deprived area of England was twice as likely to die from Covid-19 than his equivalent in the least deprived area.
These poor outcomes are similarly highlighted in a recent review by Professor Sir Michael Marmot which looks at health equality 10 years on from his 2010 ground breaking report, Fair Society Healthy Lives. It found that improvements to life expectancy have stalled, with a growing gap between wealthy and deprived areas. Significantly, more people will be spending more of their lives in poor health, with huge implications not only for their individual wellbeing and prosperity but also for our health and social care system and our economy.
Whilst healthy life years is also an important indicator of health inequality, the differences in life expectancy rates brings inequality into sharp focus. The situation demands immediate action for those living in more deprived areas so that they enjoy the same levels of health and wellbeing as those in more affluent areas. That extends beyond healthcare to those areas which can have a direct impact on health, identified by Marmot as: a good start in life for children; fair employment; a good standard of living; sustainable communities; and the ability for everyone to have control over their lives. His review calls on government to act on the evidence that exists for what already works well at a regional level, and to collaborate with those regional bodies who are already successfully addressing health inequalities in their area.
The Levelling Up Goals developed by the Purpose Coalition reflect that approach. They provide a framework to close the gaps that currently exist for many people across all stages of their lives which arise as a result of the conditions in which they start their lives, are educated, work and live. The Coalition is already working in partnership with NHS Trusts across the country to share best practice and to identify what more needs to be done to improve equality and opportunity.
The study by Imperial College is the first of its kind to analyse longevity trends in such detail. The alarming picture it presents of a widening gap between wealthy and less privileged communities is a wake-up call which requires a concerted response by national and regional government, with support from local communities, the voluntary sector and business to address the wide-ranging issues of health inequality. This report should shock us all into acting now.
By Rt Hon Anne Milton