Why is life expectancy in England & Wales falling behind?

Between 2011 and 2019, England & Wales saw slower life expectancy gains than other European countries, slipping
down in international rankings. New LCDS research explores what was going on underneath this life expectancy
divergence. The study, published in Population Studies, was led by former LCDS PhD student Antonino Polizzi, with Andrea M. Tilstra, Luyin Zhang, and Jennifer Beam Dowd. It asks which age groups and causes of death drove the widening life expectancy gap between England & Wales and 20 other high-income countries.

The numbers are stark. Life expectancy in England & Wales rose just 0.8 years for men and 0.6 for women over
the period, compared to average gains of 1.4 and 0.9 years elsewhere. That was enough to drop England & Wales
from 7th to 10th place for male life expectancy, and from 13th to 17th for female life expectancy.
Using a cause-of-death decomposition, the team traced these losses to three main causes:

● External causes: deaths rose in England & Wales while falling in most comparison countries, hitting
working-age adults hardest.
● Cardiometabolic disease: deaths fell in all countries, but improvements in England & Wales were smaller,
especially at ages 45 and above.
● Dementia: deaths increased in all countries, but rose faster in England & Wales.

Perhaps most striking: all-cause mortality among 15-to-44-year-olds in England & Wales barely improved at all, and
gains for 45-to-64-year-olds were modest at best.

“England & Wales did not necessarily experience completely different mortality trends from other high-income
countries, but improvements were often much weaker,” said lead author Polizzi. “The result is that life expectancy
advantages which existed in 2011 narrowed over time, while existing disadvantages grew. Understanding why
progress was slower across several ages and causes of death is essential if England & Wales are to avoid falling
further behind.”

The paper points to several possible drivers: rising obesity, shifting smoking patterns, increased drug deaths, slower
gains in cancer survival, and changes in how dementia gets diagnosed and recorded. It also discusses austerity, cuts
to social protection and local government funding, and slower growth in health spending as plausible contributors,
though the authors are careful to note that pinning down causality will take further comparative research.
Overall, the findings show that there is no simple explanation for the lagging life expectancy of England & Wales.
The trends reflect weakening progress across a range of causes and age groups. But the most notable stagnation is
concentrated under age 65, foreshadowing potential continued adverse trends as these younger cohorts age.

The study, “Why is life expectancy in England & Wales falling behind? A cause-of-death decomposition approach,”
is published in Population Studies.