Intended for healthcare professionals


Almost a quarter more working adults will have major illness by 2040, experts predict

BMJ 2024; 385 doi: (Published 17 April 2024) Cite this as: BMJ 2024;385:q889
  1. Adrian O’Dowd
  1. London

Rising levels of ill health will take a toll on people’s lives and the economy in the next 15 years, health policy experts have warned. They predict that 23% more adults of working age in England will have a diagnosed major illness by 2040, with 3.7 million people affected, up from three million in 2019.

The Health Foundation think tank makes the prediction in a report on inequalities in major illness in England.1 This follows a report from last year,2 which estimated that the number of people of all ages with major illness in England would increase to 9.3 million in 2040, a rise of 2.6 million from 2019.

Some 80% of the 700 000 workers who will be affected by major illness by 2040 will live in more deprived areas, making existing health inequalities worse and affecting local and regional economies, says the latest report.

A few conditions were contributing to most of the health inequality, including chronic pain, chronic obstructive pulmonary disease, type 2 diabetes, cardiovascular disease, and anxiety and depression—all of which were projected to grow at a faster rate in the most deprived areas, it found. These conditions were also normally managed by GPs or in the community, the report said, making it even more important to invest in primary care and focus on prevention and early intervention.

The authors predicted that, on the basis of current trends, the government would miss the target to improve healthy life expectancy by five years by 2035 and to narrow the gap between the areas with the best and worst health. The stark difference in health due to socioeconomic status was evident, said the authors, who explained that in 2019 some 14.6% of people aged 20-69 had major illness in the most deprived areas—more than double the percentage in the least deprived areas (6.3%)—and that by 2040 the equivalent rates were predicted to become 15.2% and 6.8%, respectively.

Deprived areas

The report said that it was essential for policies to focus on the risk factors for ill health, such as smoking, poor diet, physical inactivity, and harmful alcohol consumption—but that other steps were also needed, such as a long term, cross government approach to tackle underlying causes of ill health, such as poor housing.

Ann Raymond, economist at the Health Foundation’s REAL Centre (research and economic analysis for the long term), said, “The findings from this report clearly demonstrate how people living in more deprived areas develop major illness earlier, live for longer in poor health, and die younger than their counterparts in less deprived areas. These inequalities will remain stubbornly persistent over the next two decades if current trends continue.”

Jo Bibby, the Health Foundation’s director of health, added, “Good health is our most precious asset, and a healthy workforce is the backbone of any thriving economy. Without action, the number of working age people living with major illness is set to increase, particularly in the most deprived areas of the country.”

Saffron Cordery, deputy chief executive of NHS Providers, which represents health organisations, said, “More support and funding for public health services is vital to ensure a healthier population. These findings are worrying but sadly not surprising given the cuts to public health and prevention services over the years.”

A Department of Health and Social Care spokesperson said, “NHS England is working to reduce health inequalities and improve the health outcomes of the poorest 20% of the population, regardless of where they live. Our Back to Work Plan, backed by £2.5bn, is also helping more people into work—including those living with long term health conditions—so everyone can reach their full potential.”


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