Rise in life expectancy is marred by widening inequality gap

BMJ 2012; 344 doi: (Published 15 February 2012) Cite this as: BMJ 2012;344:e1141
  1. Ingrid Torjesen
  1. 1London

Life expectancy in England as a whole is continuing to rise, but the gap in life expectancy between the richest and poorest groups of society is widening, show figures published this week.

The figures, from the Institute of Health Equity at University College London, show that life expectancy rose by 0.3 years for men and for women between 2007-8 and 2008-9. However, inequalities in life expectancy increased among men in 104 of 150 local authorities and among women in 92 local authorities.

The biggest difference in life expectancy in men was in the London borough of Westminster, where the difference between the richest and poorest men was 16.9 years, while the London borough of Hackney had the lowest difference, at 3.1 years. Inequalities in women’s life expectancy were not quite as marked.

Michael Marmot, director of the Institute of Health Equity, said, “When there is this much variation within local authorities there is much that can be done.”

The key to tackling health inequalities, concluded Professor Marmot’s Fair Society, Healthy Lives review of two years ago, is giving all children the best start in life and then ensuring that they have opportunities to maximise their capabilities (BMJ 2010;340:c818, doi:10.1136/bmj.c818).

Although the proportion of children achieving a good level of development at the age of 5 years rose by three percentage points from 56% to 59% between 2010 and 2011, Professor Marmot pointed out that England is still lagging massively behind countries such as Finland, Poland, Sweden, and the Netherlands.

Although England had some of the best educational achievements and best universities in Europe, it lagged behind Europe in other ways, he said. “We have got these huge inequalities, which mean we are failing our children on a grand scale—and it matters to their health, it matters to their wellbeing, it matters to the productivity of the country, and it matters to the sort of society we want.”

Professor Marmot explained that development and poverty in early childhood had a huge effect on a person’s voyage through the education system and whether they ended up “not in employment, education, or training.”

He presented figures showing a 0.3% fall in the percentage of 16-19 year olds not in employment, education, or training between the quarter ending January 2010 and that ending January 2011, but he added that above the age of 19 the proportion had been rising and that this “blights their futures and hence their subsequent health.”

The way to avoid not being in employment, education, or training was to invest in early childhood development and make sure that education and training were available, Professor Marmot said, and he expressed “deep concern” that services for children such as Sure Start were being cut by local authorities in their bid to make efficiency savings. One of the best policy trends in Britain had been the focus on early childhood development, he said.

He admitted that the evaluation of the effectiveness of Sure Start had been “ambiguous” but added: “The experts that have been advising us are absolutely unequivocal that the evidence shows overwhelmingly that we understand the drivers of early child development. If Sure Start performed in a very mixed way, then the response should not be to throw it out but to learn from the best and build.”

The Marmot review called for “proportionate universalism” in which universal approaches improved the health of all. Professor Marmot said: “We believe that universal approaches are the right approaches precisely because of the people in the middle who are not doing as well as the people above them.”

He argued against the removal of universal benefits such as child benefit. “The middle are a really important part of this, and if they are being squeezed it is likely to retard the improvement in their health that has been happening over time.”

The new figures show that the largest rise in inequality in life expectancy of men was 1.5 years in the London borough of Merton and the largest among women was two years in Middlesbrough. The largest decrease among men was 1.9 years in Tower Hamlets, London, and that for women was 1.1 years in Kensington and Chelsea, London.


Cite this as: BMJ 2012;344:e1141