Healthy life expectancy in the UK continues to decline, even as overall life expectancy rises, according to the latest official figures. The data has prompted a leading public health expert to urge the government to focus on preventing dependency, not just funding care.
Prof Devi Sridhar, chair of global public health at the University of Edinburgh, says the prime minister's proposal for a universal, NHS-style social care service is an important discussion. But she argues that real political capital should be spent on policies that help people live longer independently and in good health.
Falling healthy life expectancy
The latest figures from the Office for National Statistics show that in 2022-24, healthy life expectancy at birth was just 60.7 years for men (77% of life) and 60.9 years for women (73%) across the UK, despite life expectancy being 79.1 years for men and 83.0 years for women. In Scotland it is even worse: for 2022-24, healthy life expectancy at birth was 59.1 for men and 59.4 for women, numbers that continue to decline.
The data points to a major problem in ageing societies: a growing number of the years gained in life expectancy are being spent with reduced independence, limited health conditions or in disability. This has huge ramifications for social care, with more older people in poor health meaning more people dependent on loved ones, the private sector and the state for care, and a higher burden on an already struggling NHS.
Prevention and healthy ageing
Sridhar, author of How Not to Die (Too Soon), says healthy ageing is largely about what happens in people's 40s, 50s and 60s. It is about effective prevention and early management of conditions such as type 2 diabetes, hypertension, heart disease and cancer. It is also about diet and the regular movement of the muscles needed to stay functionally independent each day, such as taking stairs, going out to the shops, using the toilet or taking a shower.
It is inextricably linked to the quality of environments, including access to green space, social connection, public transport, housing and employment. Sridhar says the factors that lead to longer, healthier lives are known, and she has written an entire book about the evidence base on population-level health.
Learning from other countries
Some countries have already made healthy ageing a priority. In Japan, the healthy life expectancy extension plan aims to increase years lived well by more than three years by 2040, to at least 75 for men and women. This goal is linked to wider reforms to employment, healthcare and social welfare. Japan has also pioneered community-based integrated care to facilitate older people staying in their own homes and communities for as long as possible.
Singapore has had initiatives for “successful ageing” since 2015, involving health, social welfare, employment and infrastructure. In 2023, the government launched further measures targeting health, housing and transport policy, with the explicit aim of helping older people remain active, socially connected and supported in their communities. Singapore and Japan now lead the global rankings for total life expectancy and for healthy life expectancy.
Burnham has much to learn from their planning, according to Sridhar. Any debate on the future funding and organisation of social care needs to consider not only the financial challenges of providing the best care for an ageing population, but also how to collectively reduce the number of people who reach a point of dependency that could be avoided in the first place.
The success of an ageing society should be measured not only on how it collectively shoulders the burden of dependency, but also on how well it extends the years in which people can live independently and well. If Burnham is serious about the social care agenda, the long-term question is not simply how we will care for people when they become dependent, but how we will create the conditions that allow more people to remain healthy for longer.
