The nation’s health, as measured by life expectancy, is stagnating due to inequality, unlike other developed countries.
Older women in the most deprived areas of England have seen flatlining or falling life expectancy, while those living in less deprived areas all experienced increases.
To understand this better, the Centre for Progressive Policy (CPP) has analysed the patterns and trends of life expectancy inequalities in England. This research was undertaken as part of CPP’s latest health report, Beyond sticking plasters: An inclusive, whole-systems approach to health and social care.
Through in-depth statistical analysis of publicly available data, CPP argue that rising place-based inequality is driving the overall slowdown in UK health improvements.
CPP analysis finds that:
- For girls born in areas with the highest level of deprivation, life expectancy at birth fell slightly between 2010 and 2016 from 78.9 to 78.8 (-0.13%). Whereas, in areas with the lowest level of deprivation it continued to rise from 85.8 up to 86.2 (+0.5%).
- Women aged 65 and living in the most deprived areas saw their remaining life expectancy stall at 18.6 years, while those living in the least deprived areas experienced a rise from 22.9 to 23.2 years (+1.5%) over the same period.
- Boys born in the most deprived areas have continued to experience increases in life expectancy at birth from 73.7 to 74 (+0.37%). This was still a slower rate of improvement than those living in the least deprived areas – from 82.7 to 83.3 (+0.6%).
- The slowdown in growth of average UK male and female life expectancy since 2010 is among the largest across a selection of advanced economies.
The Department of Health and Social Care’s 2016-2017 Annual Report noted large and growing place-based inequalities based on 15 indicators of public health including (amongst others): healthy life expectancy, under 75 mortality rates for cardiovascular disease and infant mortality.
CPP has found that poor health areas are not catching up – with some places falling further and further behind. For example, Blackburn, Middlesbrough and Hull, who had among the lowest life expectancy for older women in 2010, have continued to see falls since.
Charlotte Alldritt, Director of CPP:
“The creation of health cannot sit within the boundaries of NHS services alone. CPP’s new research has shown beyond doubt that if the agencies looking after someone’s health are fragmented and don’t work together there will be adverse consequences. Place must quickly be recognised as the determining factor of health and CPP will continue to work with multiple agencies to ensure there is greater emphasis on place as a determinant of health.”
Andy Burnham, Mayor of Greater Manchester:
“CPP’s analysis has shown that housing is one of the most important factors in variation in life expectancy. We need to consider radical new ways to narrow this inequality.”
Beyond sticking plasters: An inclusive, whole-systems approach to health and social care calls for a critical goal of health policy to be tackling place-based health inequality if the country’s health as a whole is to improve, and with it help support productivity growth and shared prosperity.
Notes to editors
The English Indices of Deprivation measure relative levels of deprivation across 30,000 small areas in England. Using this data, it is possible to track life expectancy by level of deprivation over time and for specific age groups. While we acknowledge this is not the only important measure of health, life expectancy remains a leading and well-cited indicator and there is good data at a local level. We refer to prior work on other health indicators to reinforce our argument.
For data reasons we focus on the UK when making international comparisons, but then concentrate our analysis on the evolution of life expectancy across local authorities in England.
There are separate English, Scottish, Welsh and Northern Irish Indices of Deprivation which make a joint pan-UK comparison problematic.
The Centre for Progressive Policy (CPP) has embarked on a 12-month inquiry into the future of health and social care in England. Our first report Diagnosis Critical, published in June 2018 identified the link between the underfunding of health services and declining constitutional standards of care. Since then we have undertaken a comprehensive programme of engagement with members of the public, policymakers and politicians across the main parties. This interim report presents research from the inquiry’s first six months and sets the direction for our final report due in May 2019.
Our findings and programme are informed by three overriding principles:
- Good physical and mental health must be a key pillar of any inclusive growth strategy, and this is health in the widest sense of the word, not just healthcare. The NHS plays a significant part in this debate but is not the only delivery mechanism.
- Place must quickly be recognised as the determining factor of health – but before this can happen a common definition of what this means needs to be created.
- The system needs to change; increased funding cannot be used for marginal efficiency gains or merely to help health and care delivery stand still.
Here we set out new research using publicly available data, with key findings including:
- The nation’s health, as measured by life expectancy, is stagnating. Life expectancy among older women in areas situated in the bottom four deciles of deprivation saw flatlining or falling life expectancy. It is likely that rising place-based inequality is driving the overall slowdown in UK health improvements.
- The use of different definitions and boundaries across economic and social policy institutions and public services agencies creates challenges in delivering the place-based coordination and accountability necessary to improve health outcomes. CPP’s new Fragmentation Index shows that people who live in areas where the different bodies responsible for healthcare are geographically misaligned are more likely to end up in hospital and find it harder to be discharged if they do. Specifically, we find:
- For each point a local authority moves down our Fragmentation Index, there will be around 5% more unplanned admissions to hospital.
- If the local authority you live in doesn’t geographically align with the CCG, DTOCs are, on average, 32% higher.
- In a local authority where the different bodies responsible for healthcare do not geographically match-up, there will be around 15% more unplanned admissions to hospital and 30% more people will be delayed in being discharged from hospital.
- The challenge posed by misaligned institutions and structures may be exacerbated by recent NHS policy developments. The emergence of regional teams and regional geographies covering both NHS England and NHS Improvement functions are intended to promote integration, but they may add yet another layer of complexity to already complicated and fragmented local health systems.
- The NHS cannot solve health inequalities in isolation. Employment, education, skills and training, access to better quality housing and other public services are integral to health and the relationship between health, wealth and income inequalities.
- Addressing health inequalities requires cross-departmental action and resourcing as well as improved coordination at a local level. If better health is the goal, then place-based investment and coordination in education, skills and training, increasing access to quality housing and active labour market policies to reduce unemployment and low pay may be just as relevant as more funding for local hospitals and GP surgeries. Cross-departmental strategies in central government do not do enough to make collaborating easier or more effective while funding and accountability incentives are not sufficiently aligned to allow for integrated ‘whole place’ approaches to supporting health at a local level.
- The long-term failure to think holistically about health is having a particularly detrimental impact on adult social care. Adult social care is failing with declining standards, insufficient funding and significant inequality in access and provision. CPP analysis of Care Quality Commission (CQC) data shows that in some local authorities only around half of care homes are rated as good or outstanding when it comes to safety whereas amongst the top 10 local authorities this rises to over 90%. There are even greater variations in terms of the availability of residential care.
- Local differences in care provision help underpin the health inequalities outlined in this report. Our analysis finds that a lower proportion of good or outstanding care homes and a higher number of older people per care home are both strongly related to areas having a higher avoidable mortality rate.
Thomas Hauschildt, Communications Manager, CPP
020 7070 3370
Rachel Shortte, Account Manager, ZPB Associates
07834 523 001
CPP is a new think tank committed to making inclusive economic growth a reality, led by Charlotte Alldritt, former Senior Policy Advisor to Nick Clegg. By working with national and local partners, our aim is to devise effective, pragmatic policy solutions to drive productivity and shared prosperity in the UK. Inclusive growth is one of the most urgent questions facing advanced economies where stagnant real wages are squeezing living standards and wealth is increasingly concentrated.
CPP believes that a new approach to growth is needed, harnessing the best of central and local government to shape the national economic environment and build on the assets and opportunities of place. CPP is independent and impartial. We are not aligned with any political party and are a not-for profit organisation. We are fully funded by Lord David Sainsbury, as part of his work on public policy.
CPP Health and Social Care Advisory Board
Charlotte Alldritt, Director, Centre for Progressive Policy
Siva Anandaciva, Chief Analyst, The King’s Fund
Professor Mike Bewick, former Deputy Medical Director, NHS England and Independent Chair Mid and South Essex STP Joint Committee
Jo Bibby, Director of Health, The Health Foundation
Sir Cyril Chantler, Honorary Fellow and Emeritus Chairman UCL Partners Academic Health Science Partnership
Maureen Dalziel, former Chair, Barking, Havering and Redbridge University Hospitals NHS Trust
Pam Garside, Fellow, Judge Business School, Cambridge University
Sir Ian Gilmore, Professor, University of Liverpool and former President, Royal College of Physicians
Paul Jakimciw, Digital Health Expert
Alex Kafetz, Managing Director, ZPB Associates and Independent Member of the National Information Board
Tim Kelsey, CEO, Australian Digital Health Agency
Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University and Jefferson Health
Professor Peter Kopelman, Vice-Chancellor and Emeritus Professor of Medicine, University of London and former Principal, St George’s
Dame Julie Moore, Professor of Health System at Warwick University
Professor Sir Mike Richards, former Chief Inspector of Hospitals, Care Quality Commission
Professor Sir Terence Stephenson, outgoing Chair, General Medical Council and Nuffield Professor of Child Health, Institute of Child Health, UCL
Geraldine Strathdee, former Clinical Lead for Mental Health, NHS England
Margaret Willcox, Past President, Association of Directors of Adult Social Services