THEYour health is determined by more than a single virus. This week, a team of Seattle scientists, along with thousands of contributors around the world, gathered 3.5 billion pieces of data to build what they call the global burden of disease. The story this data tells us about Great Britain is alarming. When it comes to some of the most important health measures, the UK’s four countries perform worse than our nearest neighbors. Even without the coronavirus, Britain is Europe’s sick man, woman and child.
The main conclusions of the report are clear. In 2019, life expectancy at birth in the UK was 82.9 years for a woman and 79.2 years for a man (the average for both was 81.1 years). These numbers look good, especially compared to historical numbers. In 1950, for example, the average life expectancy at birth for a British citizen was 68.9 years. The combined effects of economic growth, better education and an improved NHS have made it possible to live 12 years longer. Impressive.
That is until you start to compare the UK with other European countries. When you do this, you find that we have seen increases in life expectancy smaller than the Western European average – 5.3 years versus 5.7 years. Spain and Italy, for example, both had an average life expectancy at birth of 83.1 years in 2019. In France it was 82.9 years, Sweden 82.8 years and 81.2-year-old Germany. The average life expectancy in Western Europe was a year longer than in the UK.
Another important measure is what is called healthy life expectancy – the years of life we spend healthy. The average healthy life expectancy in the UK in 2019 was 68.9 years, which means Britons spend an average of 12.2 years living with some type of disease. And again, when we compare the UK with other European countries, we get bad results.
In fact, Britain has the worst healthy life expectancy of any other European country. We arrive at the bottom of the ranking, alongside Monaco. We have seen a slower improvement in healthy life expectancy (3.6 years) than the Western European average (5.8 years). And the situation for children is just as bad: the UK under-five death rate in 2019 was 4.1 deaths per 1,000 live births – one of the worst performers in Western Europe, just behind Malta. Whichever metric you choose, the health of the UK is worse than that of comparable European countries.
There is a similar pattern at play in all four nations. Scotland has the lowest life expectancy (79.1 years), followed by Northern Ireland (80.3 years), Wales (80.5 years) and England (81 ,Four years). What is going on?
The main causes of poor health in Britain are noncommunicable diseases such as diabetes, chronic respiratory disease and dementia. The global burden of disease shows that deaths from alcohol and drug use have increased 280% and 166% respectively over the past 30 years. And the health of our nation is not uniform across the country. There is an eight year difference in life expectancy between the north and south of the UK. Life expectancy is highest in Richmond (84.5 years) and lowest in Blackpool (76.4 years) – worse than average for China, Turkey, Thailand, Cuba, Chile, Jordan and even the United States.
These differences in life expectancy reflect the inequalities in our country. The 10 lowest expectations in England are for the poorest places in the North West and North East of the country: Blackpool, Middlesbrough, Hull, Liverpool, Hartlepool, Rochdale, St Helens, Sunderland, Blackburn and Manchester. And here we find an interesting and important correlation. Is it a coincidence that the worst life expectancies in England follow the upsurge in the coronavirus? I do not think so.
The pandemic is not the manufacture of a single coronavirus, but the combination of three epidemics: the virus, chronic diseases that make people more vulnerable, and a situation of increasing poverty and inequality. One pandemic is too simple a story to capture this reality. What we are faced with in Britain is a “syndemic” – a synthesis of epidemics.
The reasons we have been so devastated by this virus are reflected in the global burden of disease in 2019, which shows how ill-prepared Britain was for a virus that targets the less healthy in our society. Overcoming this crisis will involve more than just preventing transmission. To protect our communities from the coronavirus, we will need to tackle the underlying diseases that leave people vulnerable and the inequalities that mark our society.
So far, this government has not proposed an adequate strategy for one or the other. Take obesity as an example. After Boris Johnson contracted coronavirus, he vowed to make fighting the disease a priority, conceding that “losing weight, frankly, is one of the ways to lower your own risk of coronavirus.” But the government has so far left the root causes of obesity untouched – the junk food industry, the difficulty in accessing affordable, healthy products and the fact that many poor people do not have time to prepare their food from scratch.
The virus has exposed the inequalities that divide our society. These are disadvantaged areas such as Bolton and Rochdale, where infections are endemic. It is no coincidence that Liverpool, which is at the top of the UK’s most disadvantaged places list, was the first region to be classified as very high risk in Johnson’s recalibrated approach to Covid- 19.
Yet the government remains silent on a plan to reverse or reduce these disparities that have left our citizens so unprotected. Beyond empty platitudes and promises to “level” the country, Johnson rarely, if ever, speaks of inequality. And when he does, Johnson frames the topic in positive terms; in 2013, he quipped that “some measure of inequality is essential for the spirit of envy and to keep pace with the Joneses, which is, like greed, a valuable stimulus to activity. economic”. It is this tolerance for inequality that explains why Britain has such gaping disparities in life expectancy between rich and poor regions, and why the virus has hit these latter places so badly.
At the start of the pandemic, 1.5 million people in England were considered to be at risk of coronavirus high enough to require shielding. The sad truth is that many more people in the UK are at risk than this number suggests. As work at University College London revealed earlier this year, when you include people over 70 and those under 70 but living with chronic conditions such as diabetes or cancer, the actual number of people at risk in the UK is over 8 million people.
This pervasive political indifference to inequality, combined with a decade of cuts to the most basic social protections, has made our nation extremely vulnerable to the arrival of this virus. A national renewal is possible. But only if our government takes the health of its citizens seriously. The signs so far are that this is not the case.
• Richard Horton is a doctor and publishes the Lancet