The case for prevention is no longer just moral – it is economic
4 min read
The UK has developed a curious talent in recent years: we are living longer, but not better.
Over the past decade, the number of years we can expect to spend in good health has gone into reverse. This is not a marginal wobble but a broad-based decline affecting almost every corner of the country. In new Health Foundation analysis, we find that in one in ten local authority areas in Britain, healthy life expectancy has fallen below 55. That is more than a decade short of the state pension age and a quietly damning indictment of the state of our nation.
This is also a tale of the deep inequalities that scar the UK. Health inequalities are not merely persistent; they are widening. The gap between the most affluent and most deprived areas now stretches to around 20 years. A woman in Richmond upon Thames can expect roughly 70 healthy years. In Hartlepool, she might be fortunate to reach 51. That is not a gap; it is a chasm. Internationally, the UK has slipped down the rankings, and we are now languishing near the bottom, with only the US performing worse out of the 21 high-income countries we looked at.
So what is going on? Life expectancy itself — the blunt measure of mortality — has largely flatlined. The more revealing figure, healthy life expectancy, combines mortality with self-reported ill health. It is here that the change has occurred. The British, it seems, are feeling increasingly unwell.
There are two broad possibilities for this. The first is that we are simply more willing to admit it. Stigma around mental and physical illness has diminished. Awareness has improved. Diagnoses come earlier and more often. Expectations of what constitutes “good health” may have risen, while tolerance for discomfort has fallen. The modern citizen is, perhaps, less stoical and more self-aware.
The second is less comforting: people are genuinely getting sicker and feeling it. The evidence suggests this cannot be dismissed. Reports of mental ill health among younger people have risen sharply, particularly anxiety and depression, alongside increased diagnoses of ADHD and autism. There is a growing overlap between ill health and those not in education, employment or training. More people are leaving the workforce due to health conditions or require support to remain in it. The welfare bill for health-related benefits is climbing steadily, while NHS mental health services labour under a formidable backlog.
Yet here lies one of the more striking features of the debate: a policy blind spot. The NHS commands attention, funding battles and political theatre. So too does the life sciences sector, with its promises of innovation, commercial potential, and personalised medicine. But the underlying health of the population — and the conditions that make people ill in the first place — receive comparatively little sustained focus.
The drivers of poor health are neither mysterious nor new. Poverty and chronic stress. Insecure or poor-quality work. Inadequate housing. A food environment saturated with cheap, unhealthy options. Educational disadvantage. Air pollution. Tobacco, alcohol and drugs. Governments occasionally stir themselves to action — the legislation on tobacco and vaping passed last week being a recent example — but such efforts are sporadic. More often, policy is tentative, constrained by fears of “nanny statism”, the lobbying of commercial interests and a political culture attuned to short-term returns.
This is no longer tenable. The argument for prevention has traditionally been framed in moral or fiscal terms: helping people live better lives, or easing pressure on the NHS. Increasingly, it is an economic argument. A country with a shrinking pool of healthy workers is not one that will prosper, particularly as the population ages. If there were ever a case for sustained, cross-government action — the sort that outlives ministerial churn and electoral cycles — this is it.
Our health is deteriorating in ways that are measurable, consequential and, in large part, preventable. The question is whether we are content to observe this trend or inclined to do something about it by building a healthier UK. The answer will say rather a lot about the kind of country we intend to be.
Jennifer Dixon is the Chief Executive of The Health Foundation
