How long can we expect to live in good health?

What are the main causes of ill health? Are they preventable? And which countries have the best record for healthy life expectancy? 

People in the UK are living longer - but spending more time in poor health. That's the verdict of a major study of global health reported in The Lancet in 2015. This concluded people are, 'living longer with diseases,' so went on to argue, 'Health policies must therefore address the causes of ill health.'

Lifestyle related diseases (associated with lack of exercise, overeating, smoking and excessive alcohol consumption) are now significant contributors to poor health and disability – including cardiovascular disease, cancer and diabetes 

Dementia is another cause of poor health, disability and mortality. It is increasing as more people live longer. There are already around 800,000 people with dementia in the UK, according to the House of Commons Library and this number is expected to continue to grow.  

Mental illness (like depression), musculoskeletal problems (like arthritis) and sight and hearing loss may not be fatal but are other major sources of poor health and disability as we get older. This is part of ‘the shift toward more burden coming from diseases and injuries that cause disability rather than mortality.’ That’s according to an analysis of the Global Burden of Disease study by Health Metrics and Evaluation. 

Pollution is also a growing cause of ill health globally. In the UK, for instance, a 2016 report estimated that around 40,000 deaths a year are attributable to exposure to outdoor air pollution. The report also advised, 'Air pollution plays a role in many of the major health challenges of our day, and has been linked to cancer, asthma, stroke and heart disease, diabetes, obesity, and changes linked to dementia.'

Japan, South Korea, France and Italy are some of the countries with the highest healthy life expectancy i.e. the number of years people live in good health. Japan continues to be the healthiest. We consider elsewhere why people in Japan live longer and some of these factors may well also be responsible for their staying healthier longer.  

According to the World Health Organisation (WHO) neither the UK nor the US featured in the top ten countries for healthy life expectancy. Healthy life expectancy in the UK averaged 71.4 years. That was better than the US (69.1 years) but not as high as some of our European neighbours (like France with 72.6 years). And it was three and a half years less of healthy life than enjoyed by people in Japan. If the UK could delay the onset of ill health by three and a half years (like Japan) this would be of great benefit to people and their families and also reduce pressure on the NHS.

There’s a health divide within the UK. That’s according to the Office for National Statistics (ONS). Reporting on health across the UK it noted people in England, ‘can expect to spend the longest periods in very good or good general health and free from a limiting persistent illness or disability. The shortest periods are in Scotland and Northern Ireland.’ 

It also reported, ‘The proportion of life spent in very good or good general health is increasing in England and Wales but, on the whole, falling in Scotland and Northern Ireland.’ Some experts attribute this to different lifestyles. For instance Alan Maryon-Davis, Professor of Public Health at King's College London, said there was, "markedly more smoking, bad diets and drinking in Scotland and Northern Ireland.” 

This health divide seems to reflect how rich or poor we are. In 2016 the Office for National Statistics (ONS) reported, 'In the most deprived areas, males at birth could expect to live 19.0 years less of their lives in “Good” health compared with the least deprived areas. For females, it was 20.2 years less.' 

Professor Sir Michael Marmot argues that social inequality is even more damaging to our health than poverty i.e. that the experience of low status and inequality (e.g. being low status, feeling low status and being made to feel low status) has a significant effect on people’s lives and health.The damaging health effects of social inequality have also been cited in a WHO (World Health Organisation) report. 

If we’re living longer but more of those years are spent in poor health or with a disability that’s bad news for us individually – and also bad news for health services and governments. 

So what can we do to increase our chances of more years of good health? You can find out more in our separate report - How can we stay healthy longer?

The short answer is to follow a healthy lifestyle and to press the government and businesses to help make healthy options the easy options for ordinary people. 

Conclusions 

  • People are living longer but spending more years in poor health.
  • Lifestyle related diseases (due to smoking, alcohol, unhealthy diet and lack of exercise) are a significant contributor to poor health and disability.
  • As people live longer they are also more vulnerable to dementia, arthritis, sight and hearing loss.
  • Japan, South Korea and France are examples of countries where people enjoy the most years of good health.
  • In the UK on average we experience three and a half fewer years of good health compared with Japan.
  • Social inequality seems to be a major factor – with the rich usually enjoying significantly more years of good health than the poor. 

Michael Baber September 2013, Reviewed and updated by Christiane Hahn February 2017, Next review date January 2020

The importance of 'healthy life expectancy'

BBC

The secrets to a long and healthy life

Golden Ageing