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Geographical differences in healthy life expectancy

DOI: https://doi.org/10.58248/PB67

• Healthy life expectancy (HLE) is the average number of years that somebody can expect to live in good self-reported health. Years lived in poor health reduce quality of life, increase demand on healthcare services, and have wider economic effects, such as reduced ability to work.  
• Significant disparities exist in HLE across England. More deprived areas are more likely to have lower HLE. In 2021–2023, there was a 17.9 year gap in HLE between Blackpool (52.3 years) and Wokingham (70.2 years). The local authority gap in HLE has increased from 14.8 years in 2011–2013 to 17.9 years in 2021–23.  
• The government's 2025 Fit for the future: 10 Year Health Plan includes aims to shift from “treatment to prevention” and from “hospital to community”. The 10 Year Health Plan pledges to improve HLE for all citizens and halve the gap between the richest (South East) and poorest (North East) regions of England. The government will introduce neighbourhood health centres in every community, starting with areas that have the lowest HLE. HLE will also be used as an outcome measure for health and wellbeing in the Local Government Outcomes Framework, to be published in 2025, which sets 15 priority outcomes to measure progress at local government level.  
• Geographical differences in HLE are strongly associated with the prevalence of long-term health conditions, including musculoskeletal, respiratory, and mental health conditions. Health conditions are in turn associated with modifiable risk factors and underpinned by wider determinants of health.  
• Modifiable risk factors include health-related behaviours such as smoking, physical inactivity and poor diet, and their clinical consequences such as high blood pressure, cholesterol and obesity.  
• Interventions to improve modifiable risk factors include government-level interventions such as legislation on the availability, affordability and advertising of health-harming products, such as tobacco and sugary drinks. Local government and healthcare services can intervene by identifying and supporting high-risk individuals, through initiatives such as smoking cessation programmes, educational campaigns and blood pressure checks.  
• Wider determinants of health refer to the living conditions in which people are born, grow, live and work. Wider determinants have significant effects on health. For example, poverty limits access to healthy food, heating, secure housing and social events. The stress of poverty is linked to physical and mental health issues, which can result in greater use of tobacco, alcohol and drugs.  
• To improve HLE, many researchers advocate for a ‘systems approach’ for policy interventions to address wider determinants of health, such as investment into early childhood development, employment, housing, access to green spaces and air quality. 
• Stakeholders recommended collaboration across government departments, devolution to local authorities, effective community engagement and robust measurement of intervention outcomes. They highlighted outcomes from previous initiatives, including England’s 2000–2010 health inequalities strategy. 

This briefing was produced in consultation with experts and stakeholders, who are listed at the end of the briefing PDF. The briefing was co-funded by the Nuffield Foundation. POST would like to thank everyone who contributed their expertise and acted as external reviewers of this briefing.