People in the UK are living longer overall, but they are spending more of those extra years in poor health – a trend that sets the country apart from almost every other comparable high-income nation. While healthy life expectancy has been rising modestly elsewhere (by an average of 0.4 years over the past decade), the UK has seen it fall by two years, dropping from 14th to 20th place in a 21-nation league table. Only the United States performs worse.
The analysis, published by the Health Foundation, shows that between 2012-14 and 2022-24, healthy life expectancy for men in the UK fell from 62.9 years to 60.7 years, and for women from 63.7 years to 60.9 years. The proportion of life spent in good health has also shrunk: from 79% to 77% for men, and from 77% to 73% for women. In 2022-24, healthy life expectancy at birth dropped to its lowest level since the data series began in 2011-13, meaning that in most parts of the UK people now typically enter a period of ill-health before reaching the state pension age of 66.
The decline has been steeper for women, who have lost nearly three years of healthy life compared with just over two for men. That gender gap emerges weeks after the government published its renewed Women’s Health Strategy for England, which promises to improve women’s health and life expectancy. Yet experts at the Nuffield Trust have cast doubt on whether the measures will be enough to reverse the trend.
What is Driving the Decline?
The Health Foundation points to worsening self-reported health as a key factor, since overall life expectancy (excluding the COVID-19 pandemic dip) has remained largely static. The underlying causes are well documented but deeply entrenched. The 2010 Marmot Review – widely regarded as a watershed moment – established a direct link between social inequalities and health outcomes, finding that people in the poorest neighbourhoods die seven years earlier on average and spend 17 more years in ill-health than those in the richest areas.
A decade later, a follow-up report from the same team found that health inequalities had widened and overall health had deteriorated, with life expectancy stalling for the first time since 1900. The review attributed this to austerity and policy decisions made after 2010. The UK, it concluded, had lost its status as a world leader in tackling health inequalities.
The gap between the most and least affluent areas is now stark. In England, healthy life expectancy is 19.4 years lower for men and 20.3 years lower for women in the most deprived decile compared with the least deprived. In those most deprived areas, healthy life expectancy is less than 55 years – meaning many people enter chronic ill-health while still of working age. In Wales, the gap between the most and least deprived areas is 16.9 years for women and 13.4 years for men. In Scotland, women in the least deprived areas have a healthy life expectancy 24.2 years higher than those in the most deprived areas; for men the difference is 24.4 years.
Poverty itself is a direct driver, limiting access to adequate food, clothing, heating and healthcare, and creating stress that damages mental health. But specific lifestyle and environmental factors also play a major role.
Smoking remains the biggest risk factor for avoidable mortality. Although rates have declined overall, they are still higher in areas of lower socioeconomic status. In 2021, Scotland recorded the highest smoking prevalence (15.6%), followed by Northern Ireland (15.5%), Wales (14.6%) and England (13.8%).
Physical inactivity is widespread: more than 20 million adults in the UK fail to meet government guidelines. Women are 36% more likely to be physically inactive than men, and the inactivity gap by deprivation is wide. In 2023-24, 35% of adults in the most deprived areas of England were physically inactive, compared with 15% in the least deprived areas. A sedentary lifestyle is associated with poor health regardless of overall activity levels.
Diet and obesity are also major contributors. The original Marmot Review highlighted poor diet as a usual driver of poor health, and more recent data indicates that 40% of cancers are preventable and linked to poor diet and alcohol. Obesity prevalence is higher in more deprived areas.
Housing conditions further amplify inequalities. Damp, cold, overcrowding and lack of security damage both physical and mental health. Emerging evidence suggests that exposure to multiple poor housing conditions can be as harmful as smoking. Cold housing contributed to an estimated 20% of extra winter deaths in 2015-16, with older renters and Black and minority ethnic communities disproportionately affected.
Beyond these factors, the Health Foundation notes the growing complexity of medical conditions, widening health inequalities, and the lasting impact of austerity as additional drivers of the decline in healthy life expectancy.
Can the Government Turn the Tide?
The Health Foundation has called on ministers to place health on the same level of importance as economic growth and to adopt a new approach that looks beyond the NHS. The think tank argues that without addressing the social determinants of health – where people are born, grow, live, work and age – the decline will continue.
The government’s response has been the renewed Women’s Health Strategy for England, published just weeks before the latest data. It sets out a 10-year vision to improve women’s health and healthcare, with priority areas including listening to women, improving access to gynaecological services, contraception, screening and menopause support, supporting healthier lives through prevention, and boosting research and innovation. Specific initiatives include improving menstrual health education, introducing a menopause question into NHS Health Checks, shifting services into primary and community care, and launching a FemTech challenge to accelerate innovation. The strategy also pledges to halve violence against women and girls within a decade.
However, the Nuffield Trust has expressed deep skepticism about whether these measures can achieve the underlying ambition. To meet the government’s stated goal, healthy life expectancy for women in the most deprived areas would need to improve by 12.8 years – a huge increase. The think tank’s analysis concluded: “While some of the individual actions can reduce ill health and improve the health service experience for women, it seems unlikely the ambition to improve healthy life expectancy can be achieved.”
Even if the strategy is fully delivered, the Nuffield Trust said, the government has not provided evidence that these measures will “turn around” the decline – a verdict that raises serious questions about whether the cornerstone plan for women, who represent more than half the population, has any realistic chance of changing the tide.