England's health standards lag behind those of other Western countries

BMJ 2004; 328 doi: (Published 01 January 2004) Cite this as: BMJ 2004;328:10
  1. Mark Gould
  1. London

    It could cost the NHS an extra £30bn ($53bn; €43bn) a year to provide health care in England over the next 20 years, unless large gaps in standards of health between rich and poor people are dealt with, an interim report on future health trends estimates.

    The report, by former banker Derek Wanless, was released with a minimum of publicity in December. It paints a picture of a country that compares unfavourably with other major Western countries in terms of mortality and morbidity from cancer and heart disease. Mr Wanless also found wide variations in life expectancy across the socioeconomic groups.

    Mr Wanless compared England with France, Germany, Sweden, Denmark, Finland, the Netherlands, Australia, and Canada.

    England has the highest infant mortality and relatively high mortality from cancer and coronary heart disease. In 2001 England had 5.5 infant deaths for every 1000 live births, compared with 3.1 in 1000 in Finland.

    Respiratory disease resulted in the deaths of 135 men in every 100 000 people in England, the highest proportion of all the countries, compared with 50 men per 100 000 people in Sweden.

    In his report Mr Wanless describes three scenarios for the NHS of 2020: “slow uptake,” “solid progress,” or “fully engaged.”

    He suggests that under the fully engaged scenario the NHS could save £30bn a year by 2022, spending around £154bn each year. If current poor levels of health and inefficiency persist the annual spend will be £184bn.

    Mr Wanless wants to see more understanding of the wider determinants of health, such as housing, diet, exercise, and employment. And he wants to see what England can learn from the way public health systems are organised and how they work in the other countries he looked at.

    He recommends further analysis of his fully engaged scenario to forecast the biggest risk factors over the next 20 years and which sections of the population would be most at risk. He also wants a “situation analysis” of the way public health is organised in England and how decisions are taken at national and local levels.

    The health secretary, John Reid, agrees with the need to reduce health inequalities and close the gap with other countries. He said, “This report provides a valuable snapshot of the current picture and some useful comparisons with other countries. It will be a key tool in ensuring the extra investment we are putting in to health improvement is well spent.”

    But he added a note of optimism: “It's worthwhile considering recent mortality trends, as shown by WHO figures between 1990 and 1999. They show, for example, that the 18% reduction in UK cancer mortality rates was greater than in the countries examined in Derek Wanless's report. And the 41% reduction in the mortality rate from coronary heart disease in those under 65 is well above the 31% fall in the EU as a whole.”

    Mr Wanless will deliver his final report early this year.

    Securing Good Health for the Whole Population: Population Health Trends is available at

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