In 2013, England performed better than average on a variety of key health outcomes compared with 18 other high-income countries in the European Union, and Australia, Canada, Norway, and the USA (EU15+), according to new research published in The Lancet.
However, the findings also reveal the impact of substantial health disparities within English regions, the significant toll of chronic disabling conditions, and the importance of tackling preventable diseases. It is likely that around 40% of NHS workload is due to potentially preventable risk factors.
Using data from The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013), Professor John Newton from Public Health England, London, UK and colleagues analysed patterns of ill health and death in England, calculated the contribution of preventable risk factors, and ranked England compared to the UK and the EU15+ countries in 1990 and 2013. Estimates were also produced for nine English regions and 45 sub-regional areas defined by level of deprivation (deprivation areas).
Between 1990 and 2013, England achieved one of the largest gains in national life expectancy among men at 6.4 years (to 79.5 years), behind Luxembourg, but on a par with Finland. For women, average national life expectancy increased by a more modest 4.4 years (to 83.2 years), but still equalling or surpassing all EU15+ countries except Finland, Germany, Ireland, Luxembourg, and Portugal.
However, national progress has not been accompanied by improvements in inequalities, and the gap in life expectancy between the most and least deprived regional groups in England has stayed unchanged for men (8.2 years) and declined by just 0.3 years in women (from 7.2 to 6.9 years) since 1990.
"Inequality within regions is greater than it is among them," explains Professor Newton. "In 2013, those living in the most deprived areas still hadn't reached the levels of life-expectancy that less-deprived groups experienced in 1990."
The research shows that improvements in life expectancy in England have been driven by declines in deaths from cardiovascular disease and some cancers. But, increases in death rates from liver disease, drug and alcohol misuse, and neurological conditions -- which are highest in the most-deprived areas -- have diminished these benefits.
"England has done well over the past 23 years in many areas. But there is still plenty of room for bold action to reduce the significant toll of preventable conditions," says Professor Newton. "The country has done a good job preventing premature deaths but this has not been matched by declines in disability and illness, resulting in people living longer with disease. If the levels of health seen in the best-performing English regions could be achieved in the worst, then England could have a level of overall disease burden as low as any country in the industrialised world."
"This analysis demonstrates the enormous importance of measuring disease burden at the subnational level," says Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME), the coordinating center for the Global Burden of Disease study, and a Professor of Global Health at the University of Washington in the USA. "Examining leading causes of death, disability, and health loss only at the national level can obscure key local trends. Decision-makers need the best available evidence to determine the most locally-appropriate solutions to addressing health inequalities."
Other key findings include:
According to Professor Newton, "England has had some success finding solutions for cardiovascular diseases and some cancers, but it has yet to make the same kind of progress with the leading causes of ill health and disability. Health policies must address the causes of ill health, as well as those of premature death, with a particular focus on tackling the effects of deprivation in all regions."
He adds, "If England can make progress with smoking, alcohol, dietary risk factors, physical inactivity, and obesity, it will see massive reductions in disability. This will require new approaches to support healthy behaviours, modify known risk factors, and alleviate the severity of chronic disabling conditions."
Materials provided by The Lancet. Note: Content may be edited for style and length.
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