Where do people live longest in the UK? 

People usually live longer in more affluent areas. That’s the bottom line from statistics published annually by the Office for National Statistics (ONS).

• We can look at men or women, life expectancy at birth or from the age of 65. Whatever we choose the verdict is pretty much the same.
• East Dorset (home to Sandbanks, the millionaire’s peninsula), and other affluent areas, such as Kensington and Chelsea, usually feature in the top ten places for longevity, whatever the measure.
• In each case, average life expectancy is at least 87 for men and 90 for women. 

Where is life expectancy shortest? 

Whatever measure we choose, parts of Scotland have the lowest life expectancy, alongside Manchester and Blackpool in North West England i.e. less affluent parts of the UK. 

In 2017 to 2019, the life expectancy gap between the most and least deprived areas of England was 9.4 years for males and 7.6 years for females. In both cases the gap had increased slightly rather than decreased compared with just a few years earlier.

• Glasgow has a particularly low average life expectancy – just 73.3 years for men and 78.7 for women (from birth).  Studies into the health of Glasgow’s population show greater deprivation than in any other city in Scotland.

• If we consider healthy life expectancy (the number of years people live in good health) the contrast is even greater – with people in the most deprived areas spending 19 more years in poor health, compared with their counterparts in the least deprived areas.
  

The impact of Covid-19

Covid-19 has heightened these differences. For example, in England in February 2021, deaths due to the pandemic were 585.4 per 100,000 people in the most deprived areas, compared with 282 deaths per 100,00 people in the least deprived areas. That means the death rate was twice as high in the most deprived areas.

Why are there such differences in life expectancy? 

• If you’re well off financially you can afford to buy things that might keep you healthy – from fresh fruit and vegetables to gym membership. Whereas if you have a lower income, you are less likely to have enough to spend on these options. 
  

• Professor Sir Michael Marmot’s extensive research for his book Status Syndrome concluded that lower status and less control over our working lives increases stress, offers less opportunity for social participation and therefore increases the risk of illnesses, such as cardiovascular disease. This in turn correlates with how long people tend to live, depending on their occupation. For example, teachers and nurses tend to live longer than plumbers, even though some plumbers may earn more than them, suggesting social status is a factor.  

• Since the 1950’s the decline of heavy industry in the north of England, Scotland, Wales and Northern Ireland has caused a major loss of employment in these areas. For instance, the North East of England has an unemployment rate twice that of the South East of England. This is likely to cause loss of both status and income and to exacerbate stress. 

• There could also be reverse causation. If someone is ill, they are less likely to be able to work, so less likely to be well off. 

• People in deprived areas seem more likely to smoke, abuse alcohol and become obese – all health risks. For example, people living in the most deprived areas of England were more than four times more likely to smoke in 2016 than those living in the least deprived areas.
  

Why do people in deprived areas sometimes spend so much on things that are bad for them? Some studies suggest they may be more stressed due to their situation and see smoking, alcohol and comfort eating as ways of managing that stress. This appears to be supported by the 2014 Health Survey of England – the most recent UK Health Survey to include mental health medication questions. This found that 17% of the poorest women took antidepressants compared with 7% of the richest. 

So should we all move to more affluent areas? 

This isn’t a realistic option, even if we all wanted to. It may not be a wise move either. Moving somewhere where you don’t know anyone can be lonely and isolating.  Studies have shown that loneliness and social isolation increase the risk of mortality in both men and women, even after underlying health problems are taken into account. Some researchers suggest the effect can be as damaging for health as smoking or obesity. 

And living in an affluent area doesn’t guarantee a long life. It just increases the chances that you have the money to be able to follow a healthier lifestyle. 

What can government do?

Levelling up needs to become a practical reality, not just a political soundbite. Here are ten practical suggestions to help improve the chances of people living a long and healthy life across the UK – whatever their postcode:

1. Provide more support for disadvantaged families in the first 1000 days of their children’s lives, as what happens in these early years of life can have long term physical and mental health implications  – meaning interventions such as parenting programmes, visits by community nurses and programmes which encourage children’s language development are likely to prove particularly cost-effective. 

2. Full implementation of the government’s published Childhood Obesity plans, to begin to reduce the obesogenic environment we’ve been living in – combined with additional measures to make healthy food more affordable, accessible and attractive; ‘junk food’ less affordable, accessible and attractive; and physical activity easier and more enjoyable.

3. A significant increase in funding for local public health services, as the front line when it comes to improving the nation’s health. 

4. To ensure a fairer income distribution, all full time adult workers to receive at least a living wage (and part time adult workers pro rata) – while, at the other end of the income spectrum, legislation should be introduced to ensure the remuneration committees of large companies, which decide senior executive pay, should include at least one third staff representatives, to ensure more detailed scrutiny.

5. To help provide the funding to begin levelling up, explore creative approaches to reducing tax avoidance by wealthy companies and individuals in ways that mean they don’t simply then move to lower tax countries – and, as an interim measure, consider a high level of tax on companies and individuals which advertise and provide tax avoidance services.

6. The provision of more good quality, energy-efficient, affordable rental housing needs to be the priority for government housing policy.

7. Post-COVID, Health at Work to be a priority for both government and employers, with an increasing focus on the quality of work as a significant factor influencing health.

8. Government investment in lifelong learning – to allow students held back from educational progress by their background a second chance, as adults, to achieve more of their potential and experience more of the health benefits.

9. Ensure prevention features more strongly in the medical school curriculum and in the continuing professional development of health professionals, that prevention is a more attractive career path for health professionals and that prevention (with a particular focus on the early years) features strongly in Clinical Commissioning Group funding allocations. 

10. Be open to learning from and applying or adapting successful community-based health initiatives from other countries – for example in the case of childhood obesity (which disproportionately affects disadvantaged areas).

What can we do ourselves, wherever we live? 

Fortunately, there are a range of things we can do to increase our chances of living longer, in good health, whatever our postcode. For example: 

• Don’t smoke, don’t binge drink, eat a healthy diet and take regular exercise. Most of us know this is good for our health. What we may not all know is that this could add ten years to our life. 
• Take advantage of any educational opportunities available in our adult life, even if we didn’t do well at school. Actuaries, who advise life insurance companies, know that people who have had more education usually live longer. 
• Maintain and develop strong social networks, with family or friends. Some studies suggest this has a protective effect on health. 
• Volunteer - There are likely to be opportunities to volunteer wherever we live and some studies suggest this can help maintain health and improve life expectancy.

Conclusions 

Health in the UK often seems to be a postcode lottery. However, there are at least 10 things the government can do to begin to truly level up healthy life expectancy and, wherever we live, there are 4 things we can each do ourselves to improve our chances of living a longer and healthier life. 

May 2021