How bad are life expectancy trends across the UK, and what would it take to get back to previous trends?

Minton, Jon; Fletcher, Eilidh; Ramsay, Julie; Little, Kirsty; McCartney, Gerry

doi:10.1136/jech-2020-213870

Cited by 18 publications

(22 citation statements)

References 13 publications

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“…Constant update and evaluate of population forecasts is a core tenet in public policy decision making, especially in light of substantial changes to recent mortality trends. 37 Our findings help unpack important mechanisms for evaluating the context of policy development and explore whether and how gaps between expectations and reality arise. The significance of our estimated 231 707 excess deaths is clearly underlined in that 91% of local authorities saw an increase in observed deaths.…”

Section: Discussionmentioning

confidence: 92%

Why were there 231 707 more deaths than expected in England between 2010 and 2018? An ecological analysis of mortality records

Darlington‐Pollock

Green

Simpson

2021

Journal of Public Health

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Background Policy responses to the Global Financial Crisis emphasized wide-ranging fiscal austerity measures, many of which have been found to negatively impact health outcomes. This paper investigates change in patterns of mortality at local authority level in England (2010–11 to 2017–18) and the relation with fiscal austerity measures. Methods Data from official local authority administrative records are used to quantify the gap between observed deaths and what was anticipated in the 2010-based subnational population projections. Regression analyses are used to explore the relation between excess deaths, austerity and wider process of population change at local authority level. Results We estimate 231 707 total excess deaths, the majority of which occurred since 2014–15 (89%) across the majority of local authorities (91%). Austerity is positively associated with excess deaths. For working age adults, there is a clear gradient to the impact of austerity, whereas for older adults, the impact is more uniform. Conclusions Fiscal austerity policies contributed to an excess of deaths for older people and widened social inequalities for younger populations. These results call for an end to all austerity measures and require further research into areas with the highest total excess deaths as a priority following the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 92%

Why were there 231 707 more deaths than expected in England between 2010 and 2018? An ecological analysis of mortality records

Darlington‐Pollock

Green

Simpson

2021

Journal of Public Health

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“… 28 Estimates of the extent to which LE has stalled are that by 2018 in Scotland (three-quarters of the way through the study period) LE was 56 and 60 weeks lower than predicted for women and men from trends from 1980, or 67 and 68 weeks lower than predicted for women and men from trends from 1990. 3 We estimated LE reductions of 20 weeks for women and 23 weeks for men over the period, compared with a scenario without the austerity policies. If our estimates are accurate, the tax and welfare reforms could explain about one-third of the gap in LE between what has been observed and what was expected based on previous trends.…”

Section: Discussionmentioning

confidence: 99%

“…1 This stalling presents one the greatest challenges to population health since the 1940s, 2 with the lost gains in LE being similar to the worst case scenario of pandemic COVID-19. 3 4 While a slowdown in improving LE was observed across many high-income countries, it was not seen everywhere, with the UK nations and USA among the worst affected. 1 Various causes for this stalling in the UK have been proposed, including the impact of the cuts and freezes to benefits paid to low-income families and children since 2010/2011.…”

Section: Introductionmentioning

confidence: 99%

The contribution of changes to tax and social security to stalled life expectancy trends in Scotland: a modelling study

Richardson

Taulbut²,

Robinson

et al. 2020

J Epidemiol Community Health

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BackgroundLife expectancy (LE) improvements have stalled, and UK tax and welfare ‘reforms’ have been proposed as a cause. We estimated the effects of tax and welfare reforms from 2010/2011 to 2021/2022 on LE and inequalities in LE in Scotland.MethodsWe applied a published estimate of the cumulative income impact of the reforms to the households within Scottish Index of Multiple Deprivation (SIMD) quintiles. We estimated the impact on LE by applying a rate ratio for the impact of income on mortality rates (by age group, sex and SIMD quintile) and calculating the difference between inflation-only changes in benefits and the reforms.ResultsWe estimated that changes to household income resulting from the reforms would result in an additional 1041 (+3.7%) female deaths and 1013 (+3.8%) male deaths. These deaths represent an estimated reduction of female LE from 81.6 years to 81.2 years (−20 weeks), and male LE from 77.6 years to 77.2 years (−23 weeks). Cuts to benefits and tax credits were modelled to have the most detrimental impact on LE, and these were estimated to be most severe in the most deprived areas. The modelled impact on inequalities in LE was widening of the gap between the most and least deprived 20% of areas by a further 21 weeks for females and 23 weeks for males.InterpretationThis study provides further evidence that austerity, in the form of cuts to social security benefits, is likely to be an important cause of stalled LE across the UK.

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“…37 Prior to the pandemic, improvements in population health in Scotland had faltered since 2012, with a slowdown in the overall progress of reducing mortality and widening of socioeconomic inequalities in mortality. [38][39][40] Proactively building a healthier Scotland with lower levels and milder forms of non-communicable disease will act as an important barrier in reducing any direct or indirect harms from future epidemics or disasters. [41][42][43] List of abbreviations…”

Section: Implications For Policy and Researchmentioning

confidence: 99%

Measuring the direct population impact of COVID-19 in Scotland, 2020: estimating disability-adjusted life years (DALYs) during the first full calendar year

Wyper¹,

Fletcher²,

Grant³

et al. 2021

Preprint

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Background: Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality and can enable comprehensive, and comparable, assessments of direct and indirect health harms due to COVID-19. Our aim was to estimate DALYs directly due to COVID-19 in Scotland, during 2020; and contextualise its population impact relative to other causes of disease and injury.Methods: National deaths and daily case data were used. Deaths were based on underlying and contributory causes recorded on death certificates. We calculated DALYs based on the COVID-19 consensus model and methods outlined by the European Burden of Disease Network. DALYs were presented as a range, using a sensitivity based on Years of Life Lost estimates using: cause-specific; and COVID-19 related deaths. All estimates were for 2020.Findings: In 2020, estimates of COVID-19 DALYs in Scotland ranged from 96,500 to 108,200. Direct COVID-19 DALYs were substantial enough to be framed as the second leading cause of disease and injury, with only ischaemic heart disease having a larger impact on population health. Mortality contributed 98% of total DALYs.Interpretation: The direct population health impact of COVID-19 has been very substantial. Despite unprecedented mitigation efforts, COVID-19 developed from a single identified case in early 2020 to a condition with an impact in Scotland second only to ischaemic heart disease. Periodic estimation of DALYs during 2021, and beyond, will provide indications of the impact of DALYs averted due to the national roll-out of the vaccination programme and other continued mitigation efforts, although new variants may pose significant challenges.

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How bad are life expectancy trends across the UK, and what would it take to get back to previous trends?

Cited by 18 publications

References 13 publications

Why were there 231 707 more deaths than expected in England between 2010 and 2018? An ecological analysis of mortality records

Why were there 231 707 more deaths than expected in England between 2010 and 2018? An ecological analysis of mortality records

The contribution of changes to tax and social security to stalled life expectancy trends in Scotland: a modelling study

Measuring the direct population impact of COVID-19 in Scotland, 2020: estimating disability-adjusted life years (DALYs) during the first full calendar year

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