Our health is determined by far more than a single virus. This week, a team of scientists in Seattle, together with thousands of contributors around the world, assembled 3.5bn pieces of data to construct what they are calling the Global Burden of Disease. The story this data tells us about Britain is alarming. On some of the most important measures of health, the four nations of the United Kingdom perform worse than our nearest neighbours. Even with coronavirus out of the picture, Britain is the sick man, woman and child of Europe.
The headline findings from 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 when compared with historical figures. In 1950, for example, the average life expectancy at birth for a UK citizen was 68.9 years. The combined effects of economic growth, better education and an improved NHS have delivered an extra 12 years of life. Impressive.
That is until you start comparing the UK with other European countries. When you do this, you find we have seen smaller increases in life expectancy than the western European average. 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 Germany 81.2. The western European average life expectancy was a whole one year longer than in the UK.
Another important measure is what’s known as healthy life expectancy – the years of life we spend in good health. The average healthy life expectancy for the UK in 2019 was 68.9 years, meaning that people in the UK spend an average 12.2 years living with some kind of illness. And again, when one compares the UK with other European nations, we perform poorly.
In fact, Britain has the worst healthy life expectancy of any other European country. We come bottom of the league table, alongside Monaco. We’ve 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 equally bad: the under-five mortality rate in the UK in 2019 was 4.1 deaths per 1,000 live births – one of the worst performances in western Europe, second only to Malta. Whatever metric one chooses, the UK’s health performs worse than comparable European nations.
There’s a similar pattern at play across the four nations. Scotland has the lowest life expectancy (79.1 years), followed by Northern Ireland (80.3 years), Wales (80.5 years), and England (81.4 years). What’s going on?
The major causes of Britain’s poor health 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 by 280% and 166% respectively over the past 30 years. And the health of our nation is not uniform across the country. There’s an eight-year difference in life expectancy between the north and the south of the UK. Life expectancy is highest in Richmond (84.5 years) and lowest in Blackpool (76.4 years) – worse than the average for China, Turkey, Thailand, Cuba, Chile, Jordan and even the US.
These differences in life expectancy hold a mirror up to the inequalities across our nation. The lowest 10 expectancies in England skew towards 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 one finds an interesting and important correlation. Is it a coincidence that the worst life expectancies in England track the upsurge in coronavirus? I don’t think so.
The pandemic is not the making of a single coronavirus, but the combination of three epidemics: the virus, the chronic conditions that make people more susceptible to it, and a situation of deepening poverty and inequality. A single pandemic is too simple a narrative to capture this reality. What we’re 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 exposes how poorly Britain was prepared for a virus that targets the least healthy in our society. Overcoming this crisis will involve far more than just preventing transmission. To protect our communities from coronavirus we will need to address the underlying diseases that leave people vulnerable, and the inequalities that scar our society.
This government has so far failed to offer an adequate strategy for either. Take obesity as an example. After Boris Johnson contracted coronavirus, he promised to make tacking this condition a priority, conceding that “losing weight, frankly, is one of the ways you can reduce your own risk from coronavirus”. But the government has so far left the root causes of obesity – the junk food industry, the difficulty of accessing affordable healthy produce, and the fact that many people in poverty lack the time to prepare food from scratch – untouched.
The virus has exposed the inequalities that divide our society. It is deprived areas such as Bolton and Rochdale where infections have been endemic. It’s no accident that Liverpool, which scores high on the list of the UK’s most deprived places, 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 for reversing or reducing these disparities that have left our citizens so unprotected. Beyond empty platitudes and promises to “level up” the country, Johnson rarely if ever talks about inequality. And when he does, Johnson frames the subject in positive terms; in 2013, he famously quipped that “some measure of inequality is essential for the spirit of envy and keeping up with the Joneses that is, like greed, a valuable spur to economic activity”. It’s this tolerance for inequality that explains why Britain has such gaping disparities in life expectancy between rich and poor areas, and why the virus has hurt those latter places so badly.
At the beginning of the pandemic, 1.5 million people in England were deemed at sufficiently high risk of coronavirus to require shielding. The unfortunate truth is that far more people in the UK are at risk than this number suggests. As work from University College London revealed earlier this year, when one includes those over 70 years of age, and those who are under 70 but live with chronic diseases such as diabetes or cancer, the actual number at risk in the UK is more than 8 million people.
This pervasive political indifference to inequality, combined with a decade of cuts to the most basic social protections, has left our nation exquisitely vulnerable to the arrival of this virus. A national revival is possible. But only if our government takes the health of its citizens seriously. The signs so far are that it does not.
• Richard Horton is a doctor and edits the Lancet
