Research and analysis

Healthy life expectancy - Mortality Insights

Published 20 December 2024

Average life expectancy in the UK has been increasing over the last couple of centuries which is positive news (figure 1). However, are the ‘extra’ years which people are living being enjoyed in good health? The focus has started to shift to improving ‘healthy life expectancy’ (HLE).

Figure 1

Source: GAD graph based on ONS data

While cohort life expectancy represents the number of years that an individual is expected to live, the Office for National Statistics (ONS) describes HLE as an estimate of lifetime spent in ’very good’ or ’good’ health, based on how individuals perceive their general health.

How do we measure HLE?

HLE is more difficult to calculate than life expectancy as data is not so readily available. Life expectancy for a particular population is typically calculated using actual death data together with census or other population totals. ONS estimates HLE using annual population surveys and census data.

Surveys only look at a sample of population and the data relies on self-reporting of how an individual perceives their general health. This makes HLE figures more open to subjectivity and potentially inconsistent between different sources.

While reliable life expectancy figures date back to the 1840s for the UK, HLE is a newer measure with little data available prior to 2000.

How has HLE changed over time?

According to the most recent data from the ONS male HLE at birth in England for the period 2021 to 2023 is estimated to be 61.5 years. Similar to trends in life expectancy, HLE is higher for females at 61.9 years in England for the same period.

HLE in England remained relatively stable between the 2011 to 2013 data, and the 2017 to 2019 data. Since this pre-coronavirus pandemic period, HLE at birth has fallen in England by 1.7 years for males and 1.9 years for females.

How does HLE relate to life expectancy?

HLE is linked to life expectancy and we would expect that as life expectancy increases HLE would too. However, it is not always the case that both measures change in the same proportions.

Despite the recent fall in overall HLE in England, the proportion of life spent in good health varies between age groups. The data for both men and women over the age of 60 shows increases in the reported proportion of life spent in good health between the 2011 to 2013 and the 2021 to 2023 period. At younger ages the news is not as positive – revealing a decrease in the proportion of life spent in good health between the same two periods.

The Office for Health Improvement and Disparities (OHID) states that changes in self-reported good health prevalence have a larger impact on HLE than changes in mortality rates. The OHID provides a hypothetical example of this using 2017 to 2019 data for males and females at all ages. It states that if self-reported good health were to improve by 2% and mortality rates were to remain constant, then HLE would rise by 1.3 years. Conversely, if mortality rates improved by 2% in all age groups and self-reported health prevalence remains constant, then this rise to HLE would only be 0.1 years for both males and females.

How HLE varies by location?

According to previous ONS data for 2020 to 2022 HLE varies across the UK, with England having the highest HLE for both male and females. This is followed by Northern Ireland, and then Wales. At regional level, the south and east of England have comparatively high HLEs at age 65 when compared to the north of England (figure 2).

HLE data by local area shows that the vast majority of areas had lower HLE at birth in the 2021 to 2023 period compared to the 2017 to 2019 period. The largest fall in HLE at birth was 6.0 years for females in Peterborough. Better news came from Hillingdon where HLE rose the most for both males and females (5.8 and 6.3 years respectively).

Note that figures for Scotland are not included in this data set due to the later timing of the Scotland 2022 Census. Northern Ireland estimates are also not yet available for 2021 to 2023.

Figure 2

Source: GAD graph based on ONS data

International trends

On an international level, the World Health Organisation (WHO) reports that HLE increased by 7% over 2000-2021 to reach 61.9 years. However, the pace of the increase in HLE was slower than the global rise in life expectancy. Singapore and Japan top the global rankings with a HLE at birth averaging 73.7 and 73.4 respectively in 2021. The European Journal of Clinical Nutrition cites Japan’s dietary intake, with less meat and more seafood consumed, as one of the key reasons for the longevity of its population. The rest of the top 20 nations are predominantly European nations, while the UK was placed at 28th out of 185 countries.

What affects HLE?

How people feel about their overall health is key in the determination of HLE. As reported by the OHID in 2023, chronic health conditions and multimorbidity were 2 of the main reasons for self-reported poor health.

Experiencing significant health events such as:

• strokes
• diabetes
• cancers
• musculoskeletal conditions
• respiratory conditions
• digestive issues

…contribute to reporting poor health.

Mental ill-health, poor recent wellbeing and lifestyle factors such as smoking and being overweight were all also identified as being associated with self-reported poor health. Conversely, increased physical activity was reported as a major driver of those self-reporting good health.

Socio-economic factors also play a role in HLEs. Data for 2018 to 2020 shows that in England there is greater inequality in HLE between the most and least deprived areas than the gap in life expectancy. As an example, men living in the UK’s most deprived areas are expected to live less than 75% of their (shorter) lives in good general health, whereas for the least deprived areas this figure was over 80%.

Research in Scotland showed that during the period from 2010 to 2019, the most deprived groups experienced a greater decline in HLE than the least deprived groups.

What could be done to narrow the HLE gap?

Living healthy lives has become a key focus point for governments across the world.

In the UK, the Department of Health and Social Care’s report, HLE was identified as a key measure of assessing the extent to which health is improving and disparities are narrowing.

One of the key missions of the previous government’s Levelling Up the United Kingdom white paper (published February 2022) was to reduce the gap in HLE between local areas where it is highest and lowest by 2030, and to increase HLE by 5 years by 2035. The paper identified poor diet and obesity as being the biggest contributors to ill health.

A House of Lords report on Ageing: Science, Technology and Healthy Living highlights the need for increased government focus on early prevention. These include in areas such as obesity, alcohol consumption and smoking, and a push for increasing levels of physical activity, in order to improve HLE. The report notes that whilst improvements and investments in health technology should boost HLE, this is expected to benefit socio-economic groups with more disposable income first and therefore increase health inequalities. The report suggests that products and services aimed at increasing HLE should be designed to be affordable to ensure that the gap in HLE between socio-economic groups does not widen initially.

The US Department of Health and Human services has set over 350 data-driven national objectives to improve health and wellbeing in its ‘Healthy People 2030’ initiative. Objectives relate to areas such as reducing obesity, binge drinking and smoking and increasing the proportion of people with health insurance, in work and doing sufficient exercise.

Final thoughts

The UK has some catching up to do in terms of HLE when compared to some of its European and worldwide counterparts. Recent trends showing growing inequalities in healthy living between different groups in the population have not been encouraging. As a result, an increasing effort is needed to reduce the proportion of people’s lives spent in poor health.

Healthy lives are likely to be a key talking point when the State Pension Age rises to 67 years in April 2026. The Health Foundation states that between early 2020 and late 2023, an additional 235,000 people aged between 53 and 62 years were out of work due to ill health. This is the demographic set to have a higher State Pension Age.

It’s not just government funding and directives that will play a role in HLEs in the future. As technology gets increasingly ingrained in society, its benefits to older individuals is likely to grow as they become more comfortable with technology over time. Earlier detection and better management of preventable diseases and ailments driven by new technologies should help to increase HLE.