Life expectancy is a key measure of our success as a society. It has roughly tripled over the course of human history, and we have become used to sustained, year-on-year increases – albeit with significant differences by socioeconomic status. The latest life expectancy projections from the Office for National Statistics are the highest ever with baby boys born in the UK in 2018 expected to live on average to 87.6 years and girls to 90.2 years, taking into account projected changes in mortality patterns over their lifetime. By 2043, cohort life expectancy at birth in the UK is projected to reach 90.4 years for boys and 92.6 years for girls.
While this is good news, there is a caveat. And that is that life expectancy projections for 2043 have been revised downwards – by 2.6 years for boys and 2.7 years for girls– compared with the earlier projections. Between 2006 and 2011, life expectancy increased by 1.6 years for men and 1.3 years for women. But over the subsequent five-year period, the increases were just 0.4 and 0.1 years respectively. Those gains in life expectancy that we are accustomed to are getting smaller and, more worryingly, have even gone into reverse for some people. Seventy-two local authorities across England saw a fall in life expectancy for males; 87 saw a fall for females. While women in the least deprived decile of the total population saw their life expectancy increase by a tenth of a year, those in the most deprived decile saw theirs decline by 0.04 years.
The numbers may be small but they matter. And they herald a worrying shift in the health of the population.
Our gains in longevity have, historically, been the result of improvements in sanitation, followed by widespread use of antibiotics and vaccination programmes. Ever fewer people died in infancy and early childhood and once the dangers of infancy and early childhood had passed, the chance of living to old age increased. As a result, death is largely associated with old age. With increasing longevity has come a shift in patterns of death as people live long enough to develop chronic, degenerative, age-related diseases such as heart disease, cardiovascular disease and cancer. Increases in longevity since this transition are the result of extension of life at the oldest ages.
So what might be causing the slowdown and reversals in life expectancy that we’re currently seeing?
One possibility is that we are approaching the “longevity ceiling”, a supposed maximum life expectancy imposed by our biology. But if so, we would expect to see effects only at the highest ages. But over the period 2011–2016, mortality rates didn’t only worsen for the oldest people—those aged 90+—but also for those aged 10–34 and 40–49. And although mortality rates improved for people aged 50–89, the improvement was much less than that seen over the previous ten years and it is this difference that had the biggest effect on overall life expectancy.
Looking at specific causes of death shows how complex the issue is. Deaths from dementia and Alzheimer’s disease had a large detrimental effect on life expectancy among people aged 65+, while a slowdown in the decline in mortality rates from diseases of the circulatory system have had a detrimental effect for people aged 55+. Among people aged 20–44 there has been a rise in mortality rates from accidental poisoning, mostly related to drugs, as well as an increase in the female suicide rate.
Clearly, there are myriad factors at play, involving not just the health of our oldest people but across the population. So, what has changed?
Some experts point to austerity that has led to diminished job security, cuts to in-work and out-of-work benefits, adverse health behaviours, poor nutrition and inequity in access to high quality health care. This is linked too to the growing inequality in life expectancy that we’re seeing between the most and least deprived areas of England, driven in particular by deaths in children under five years old; respiratory diseases, ischaemic heart disease and some cancers among people of working age; and dementia at older age.
Whatever the reason behind our faltering life expectancy, it is surely a wake-up call. Declines in life expectancy cannot be tolerated in the United Kingdom at the beginning of the 21st century. The Centre for Ageing Better aims to address deprivation among those most in need through our programmes on health, work, connected communities and homes. Through working in partnership with others, we hope to reduce the inequality gap and reverse the recent, troubling life expectancy trends.