Chris Whitty demonstrates how people who live longer do not necessarily spend more time in ill health
This chart, showing data about the age and health of females in the most and least deprived areas of England, contains several key points for public policy.
 Inequality in life expectancy and healthy life expectancy at birth for females in the most and least deprived areas in England, 2018 to 2020 (Office for National Statistics) |
The total bar length represents lifespan, the blue section time spent in good health, and the orange time in self-reported ill health. The data for males are similar but men die on average slightly younger.
The first point is that it is wrong to assume that an older population inevitably means a population with more time in ill health. Those who live in the least affluent areas, it is widely recognised, die on average at a much younger age. However, those who live in the most affluent areas both live longer and have around a decade less time in ill health compared to those in the least affluent areas – so the group who live longest have the least time in ill health.
The second point is that once people start to experience ill health (the orange part of the bar) they are likely to start to need medical and – in time, potentially social – care. In a period when the loss of people from the workforce to ill health is receiving renewed policy interest, the least affluent on average have ill health well before the national retirement age of 66 years. In contrast, those in affluent areas on average start to suffer from significant ill health well after it.
The most important message is that this can be changed by policy choices. Preventive measures which reduce premature mortality also reduce the period of disease and allow people to maintain independence. The factors which lead to those living in less affluent areas having much longer periods in ill health, often starting before retirement age, are well known and many can be changed. These include active and passive smoking, air pollution, obesity, excess alcohol and limited exercise. All of these are amenable to policy options which have a strong evidence-base showing their effectiveness. It is a choice to take, or not to take, the policy options which would lead to those in the poorer areas having shorter and later periods in ill health.
