Life expectancy in the UK has improved over the last 20 years, but levels of ill health have not and the UK is now below average compared with 18 other countries on many important indicators. These data are revealed by a special analysis of the high profile Global Burden of Disease Study 2010, published in The Lancet.
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An analysis of the study, which was funded by the Bill & Melinda Gates Foundation, was co-authored by Professor Kevin Fenton, Director of Health and Wellbeing of Public Health England (PHE) and Professor John Newton, Chief Knowledge Officer of PHE, among others. This new body has been established to protect and improve the nation’s health and wellbeing, and to reduce inequalities. PHE will take up its full responsibilities on 1 April, 2013.
The report looked at how the health of the UK compares with 14 other EU countries, Australia, Canada, Norway and the United States. These countries were chosen as comparators with a similar or higher level of health expenditure. Results are presented for 259 diseases and injuries, and 67 risk factors or clusters of risk factors, together with comparable data for years of life lost and disability-adjusted life years between 1990 and 2010.
In the 20 years from 1990 to 2010, life expectancy overall increased by 4.2 years in the UK to 79.9 years. However, improvements in mortality have been very small for some age groups and the UK has performed poorly compared with other countries. Also, some specific causes of death show marked increases, such as Alzheimer’s disease, cirrhosis of the liver, and drug use disorders. The best results are for heart disease mortality where the UK has seen the largest fall in mortality of any of the 19 countries over the period.
Another concern is that levels of disability at specific ages did not improve. This means we are living longer but with an expectation of longer periods of disability. Most other countries share this problem to a greater or lesser degree. The major causes of disability vary by age but include mental and behavioural disorders such as depression, anxiety and schizophrenia, substance abuse including drug and alcohol use, and musculoskeletal disorders, for example lower back pain and osteoarthritis.
The contribution of individual risk factors to the burden of illness and disease in the UK has been quantified. The biggest was for tobacco (12 per cent), followed very closely by high blood pressure and high body-mass (nine per cent each), and then physical inactivity, alcohol and poor diet (five per cent each).
Although the overall picture is one of improvement, there is considerable cause for concern in these figures. Premature mortality has hardly changed in the UK for both men and women in the 20-54 year old age group. The leading causes of death in this group are heart disease and self-harm, but also liver disease, breast cancer and road injury. The number of years of life lost (a measure of the extent of premature mortality) has actually increased in this age group for liver disease (cirrhosis), drug-use disorders and alcohol, cancelling out the benefit of substantial improvements in most cancers and in road deaths.
Across all ages the top eight diseases causing the most years of life lost in the UK remain largely the same as those reported in 1990. In order, these are heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, lower respiratory infections, colorectal cancer, breast cancer and self-harm. Since the last report, years of life lost from drug use disorders have increased nearly six-fold.
Compared with the other 18 countries, the UK does worse for premature mortality (years of life lost) for most conditions and its relative position has worsened since 1990. However, it is not all bad news, the UK’s years of life lost rate is significantly better when compared to the average of all the other countries assessed for road injury, diabetes, liver cancer and chronic kidney disease.
Professor Kevin Fenton, Director of Health and Wellbeing at PHE, said: “This report is both a wake-up call and an opportunity for the UK. While it’s encouraging that overall the health of the UK has improved substantially since the last report the pace of improvement is not enough.
“The creation of PHE and the movement of public health into local authorities are huge transformational opportunities for improving the public’s health, and there could be no better time to do things differently. The results from the study identify where we need to improve and where existing and future resources will need to be realigned to meet the needs of our demographically changing population. To improve public health we need to redress a historic imbalance by focusing more on primary prevention and the promotion of wellbeing in addition to ensuring effective, high quality, and accountable clinical care and rehabilitation services.
“Smoking, high blood pressure, having a high body-mass, physical inactivity and alcohol are five main risk factors for ill-health and many of the major causes of premature death. The finding that poor mental health, substance abuse and musculoskeletal disorders are among the main drivers for disability reinforces the need for the broader health system to intensify efforts in these areas. The reality is that nearly all of these conditions are either preventable or amenable to early intervention, providing opportunities to make a substantial difference in people’s lives, and reduce the tremendous psycho-social and economic burden of poor health on our society.
“Ultimately, in order to really make a difference in improving our nation’s health, concerted action will be required, with individuals, families, local communities, local councils, the NHS and government all taking responsibility and working together towards a healthier population. We already have a range of effective tools for individuals, clinicians, and policymakers to respond to these health challenges. We need to apply and scale-up what we know works. And we need the will to make this happen.”
Professor John Newton, Chief Knowledge Officer at Public Health England, said: “These relatively poor results for mortality and disability in the UK require a response at every level and from all responsible authorities. For example, the data on contribution of different risk factors clearly show the need to redouble our efforts on smoking, high blood pressure and obesity. The NHS must pay more attention to prevention and early intervention but the underlying causes often have little to do with health care.
“This report highlights the potential impact of PHE, an organisation that can take a wide of view of health and its determinants. PHE will continue to report similar data for England on a regular basis, and down to local level, to ensure that national and local resources can be directed towards the areas that need most attention.
“The GBD study only looked at figures for the whole country but within the UK we know we have areas such as the South East and South West that achieve results as good as any of these countries. But there are also areas such as the North West which do as badly as the worst and this is completely unacceptable.
“We should be proud that life expectancy in the UK has increased as much as it has since 1990, but we need to make sure that these extra years are healthy ones. As a society we must look after our vulnerable people better. Poor mental health causes an enormous and increasing burden of disability as does the pain and disability of arthritis, and loss of independence due to poor sight, hearing and incontinence.
“Despite some enviable recent success, for example on smoking, we in the UK need to take a hard look at what can be done to help people in the UK achieve the levels of health already enjoyed by other some countries. Central and Local Government, charities, employers and retail businesses all have a part to play.”
Further Information
- Christopher L J Murray et al. UK health performance: findings of the Global Burden of Disease Study 2010. (2013). The Lancet. For a copy of the report, see: http://press.thelancet.com/UKGBD.pdf. For an copy of the Lancet Editorial, see: http://press.thelancet.com/UKGBDeditorial.pdf.
- Professor John Newton is also honorary Professor of Public Health and Epidemiology at the University of Manchester.
- PHE would like to thank the Global Burden of Disease (GBD) lead researchers and network for their collaboration on this groundbreaking research. Other UK authors included Professor Sir Mike Richards, National Cancer Director and Professor Adrian Davis, Department of Health Chief Scientific Officer’s Lead Advisor on Physiological Diagnostics, Director of NHS Newborn Hearing and Physical Examination Screening Programmes and Professor of Hearing and Communication at UCL.
- The GBD 2010 has involved nearly 500 researchers from more than 300 institutions in 50 countries. In total it has looked at 291 diseases and injuries in 21 regions, for 20 age groups, with an estimation of trends from 1990 to 2010. It also includes an assessment of 67 risk factors. The previous project in 1990 assessed the burden of 107 diseases and injuries and ten selected risk factors for the world and eight major regions over one calendar year.
- The idea for the GBD study was created by a team at Harvard University who developed the ‘Disability Adjusted Life Year’ (DALY) metric that made it possible to combine estimates of mortality and morbidity burden from around the world to enable comparisons to be made.
- Analyses are presented for trends and relative performance for mortality, causes of death, years of life lost, years lived with disability, disability-adjusted life years and healthy life expectancy.
- Mental disorders include: major depression, anxiety, drug use, alcohol use, schizophrenia and bipolar disorder.
- Musculoskeletal disorders include: low back pain, neck pain, other musculoskeletal disorders and osteoarthritis.
