Health | The State of Ageing 2022

What does the chart show?

• On average, a girl born today in England can expect to live more than a quarter (26.7%) of her expected 83.1 years of life with illness and disability.*
• A boy born today in England can expect to live more than a fifth (21.5%) of his expected 79.4 years of life with illness and disability.
• A woman who is aged 65 today can expect to spend less than half (47%) of her remaining years in good health. And a man aged 65 today can expect a little more than half (53%) of his remaining years to be in good health.

* Disability-free life expectancy (DFLE) estimates years of life free from any persistent condition that reduces your ability to carry out your usual day-to-day activities. These conditions could include arthritis, hearing or vision impairment or mental health issues.

What does the chart show?

• Between the 2001/03 and the 2011/13 periods, life expectancy at birth increased by 3.1 years for men (from 76.2 to 79.3 years), and by 2.4 years for women (from 80.7 to 83.0 years) in England.
• Although life expectancy continued to increase over subsequent years, the rate of improvement slowed so that men gained just another 6 months and women another 4 months between the 2011/13 and 2017/19 periods.
• Inclusion of 2020 death registration data by the Office for National Statistics shows that, as a result of the COVID-19 pandemic, the period between 2017/19 and 2018/20 shows a decline in life expectancy for both men and women – in fact, there was a significant reduction in male life expectancy at birth of 7.8 weeks in 2018/20 compared with 2015/17.
• The amount of our lives that we can expect to live without disability has also been declining and this is particularly noticeable for women at birth; since the 2006/08 period, the number of years that women can expect to live free of disability has decreased by 3.6 years.  Even since the 2015/17 period, there has been a statistically significant reduction in disability-free life expectancy at birth for women of 1.2 years.
• Of note too is the difference between men and women in years lived without disability, which has been growing since the 2012/14 period when it was approximately the same for both sexes. Prior to 2012/14, women had a higher disability-free life expectancy but since then this trend has reversed: women at birth can now expect a total of 1.5 fewer years without disability than men.

We also know that:

• Life expectancy at age 65 has declined too: at 18.7 years for men and 21.1 years for women, it is about the same as it was in 2014/16.

Life expectancy increased steadily across the 19th and 20th centuries, the result of improvements in hygiene and sanitation, child immunisation programmes and the control of infectious diseases. In 2011, however, improvements in life expectancy started to stall. While the slowdown was also seen in other countries across Europe, it has been most pronounced in the UK. There has been much debate about the causes: Public Health England identified an increase in deaths from flu of older people, slowing improvements in mortality from heart disease and stroke and rising death rates from accidental poisoning among younger adults. Austerity measures and their impact on public spending and services have also been blamed. But with the pandemic, life expectancy trends actually went into reverse. The fall in life expectancy in the year to 2020 is the largest since that seen between 1939 and 1940. 

What does the chart show?

• The proportion of our lives that we spend with disability has increased over time for both men and women:
  • While men at birth could expect to live 18.6% of their lives with disability over the 2006/08 period, this had increased to 21.5% by 2018/20.
  • For women at birth, the proportion of life spent with disability increased from 21.2% to 26.7% over the same period.

​​​​​​​The expansion of years spent with illness and conditions that impair our ability to carry out day-to-day tasks is deeply troubling. And with reported delays in diagnosis and treatment of many health conditions because of the pandemic, there is a risk of a further reduction in disability-free life expectancy over the coming years. The government’s commitment to action on obesity is a welcome step to improve our health but we need comprehensive and radical action across a whole range of areas, to halt the trend in disability-free life expectancy and reverse it.

What does the chart show?

• People living in the least deprived areas (by Index of Multiple Deprivation decile) live longer than those in the most deprived areas, whether measured at birth or age 65:
  • Life expectancy at birth for the men in the least deprived areas (top decile) is 83.5 years, 9.4 years longer than in the most deprived areas; for women, the difference is almost 8 years (86.4 vs 78.7 years).
  • When men in the least deprived areas reach the age of 65, they can expect to live another 21 years, more than 5 years longer than men in the most deprived areas; for women, the difference is also 5 years (23.4 vs 18.4 years).
• The better-off not only live longer but spend more of their longer lives in good health and free of disability:
  • At birth, men and women in the least deprived areas can expect 17 and 16 years more life free of disability, respectively, than those in the most deprived areas.
  • At age 65 men and women in the least deprived areas have twice as many years free of disability ahead of them as those in the most deprived areas  (12.2 vs 6.2 years for men and 12.1 vs 5.9 years for women).
  • That means that, at the age of 65, men in the poorest decile can expect to spend 39% of their remaining life without disability, compared with 58% for those in the wealthiest. The corresponding proportions for women are 32% and 52%, respectively.

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The least wealthy people in society can expect not only to live a shorter life but also to spend more of that shorter life with a limiting long-term illness than wealthier people.

This is caused by the accumulation of all the circumstances of our lives: poverty and financial insecurity, employment, our homes and the places we live all affect physical and mental health directly, and affect behaviours like being physically active, smoking, having a poor diet and drinking too much.

With their greater burden of ill-health, it is the poorest in society who will suffer most from the delays in diagnosis and treatment of health conditions that have resulted from the pandemic. Hence, the coming years may bring not only a further reduction in disability-free life expectancy overall, but a larger gap between the richest and poorest.

What do the charts show?

• The highest life expectancy among boys at birth (for the 2018/20 period) was 80.6 years in the South East, three years more than the 77.6 years seen in the North East. The highest for girls (84.3 years) was in London and the lowest (81.5 years) in the North East.

We also know that:

• Disparities in life expectancy are even starker at the local level than at the regional level:
  • The lowest life expectancy for both men and women at birth is in Blackpool – 74.1 years and 79 years, respectively.
  • For men, the highest is 84.7 years in Westminster, over 10 years more than for men in Blackpool.
  • And for women, the highest is 87.9 years in Kensington and Chelsea, nearly 10 years more than for women in Blackpool.
• There is also a pronounced variation across the country in the amount of life lived in good health and free of disability (2018/20 period):
  • Men born in Blackpool and women born in Kingston upon Hull have the fewest years before the onset of illness and disability – 52.7 and 51.5 years, respectively (estimated at birth).
  • Men in Southwark get the most years – 68.9 - before the onset of disability. For women, it’s 68.8 years in Wandsworth. This difference in years lived before the onset of illness and disability is more than 16 years for men and more than 17 years for women.

A number of factors have been identified as accounting for the observed differences in the health of people living in different parts of the country. These include environmental factors (including working conditions), educational and lifestyle factors and infrastructure challenges (many villages and small towns lack frequent and reliable public transport and high-speed internet). The impact of de-industrialisation has also been mooted as a factor: one study has shown that areas in the North that have experienced a strong transition away from employment in physically demanding occupations have particularly low levels of physical activity. All, however, are ultimately linked to other socioeconomic factors, including levels of wealth: poorer places are simply less healthy.

Regardless of the cause, the data demonstrates the importance of local approaches to health prevention that address the specific issues faced by people in a local area.

What does the chart show?

• Male life expectancy in most English regions is significantly lower in 2018/20 than in 2015/17; the largest falls for men were seen in the North East (3.8 months) and Yorkshire and the Humber (3.7 months). In contrast, life expectancy increased for men in the South West (by 1.3 months) and South East (0.24 months).
• For women, decreases in life expectancy over this period were smaller than for men; the largest decrease (2.3 months) was seen in the West Midlands. Increases were seen in four regions, of which the largest – 4.1 months – occurred in the South West.
• These findings are the result of lower mortality involving COVID-19 in the South West compared with other regions of England and higher mortality among men than women.

​​​​​​​Even before the pandemic, there was pronounced geographic inequality in life expectancy and various measures of health; it is clear that these have been exacerbated by the pandemic.

What does the chart show?

• Musculoskeletal disorders (osteoarthritis, rheumatoid arthritis and other conditions that affect the muscles, joints and skeleton) are the most common long-term, chronic conditions among adults in England.
• They account for 4,967 years lost to disability per 100,000 people in the population aged 50-69 and for 5579 years lost to disability per 100,000 people in the population 70 and over. This accounts for 30% of years spent with disability in people aged 50-69 and for 22% in people aged 70 and over. This is the largest cause of disability in both age groups.
• Sense organ disease (principally hearing and sight) account for 6% of years spent with disability for people aged 50-69. This increases to 12% in people aged 70 and over, the second largest cause of disability in this older age group. 

What does the chart show?

• The prevalence of musculoskeletal conditions increases rapidly with age, from more than a quarter of people aged 55-64 to more than a half (52.4%) of people aged 85 and over.
• There has been a small increase in the prevalence of musculoskeletal conditions in people aged 85 and over since 2018. However, in younger age groups, the prevalence has declined slightly.

​​​​​​​Musculoskeletal conditions are a major cause of disability, and a common reason for people to stop working. For women in particular, mid-life is a critical period for musculoskeletal health. Menopause – which has a detrimental effect on bone, cartilage and muscle mass – causes the higher prevalence of these conditions seen in women than in men. However, the risk is further exacerbated by health behaviours, notably smoking and alcohol consumption, both of which can weaken bones.

What does the chart show?

• For every common long-term chronic condition, there is huge variation in prevalence by wealth – with a much higher prevalence in the poorest compared with the richest people in society. For example:
  • People aged 50-69 who are finding it difficult to get by are twice as likely to have arthritis as those living comfortably (36% vs 18%).
  • They are almost three time as likely to have cardiovascular disease (11% vs 4%) and four times as likely to have diabetes (25% vs 7%) and depression (40% vs 10%).
• Among people aged 50-69 who are finding it difficult to get by, the most common conditions are depression and arthritis, experienced by 40% and 36%, respectively.
• Among people aged 50-69 who are living comfortably, the most common conditions are arthritis (18%), followed by asthma (10%) and depression (10%).

What do the charts show?

• In 2020, the proportion of people aged 50-64 with three or more long-term health conditions ranged from 9% in East Yorkshire and Northern Lincolnshire to almost a quarter (24%) in Tees Valley and Durham.
• Of 30 regions, 17 saw an increase between 2019 and 2020 in the proportion of people aged 50-64 with three or more long-term health conditions.
• The biggest increase (5 percentage points) was in Lincolnshire, followed by Northumberland and Tyne and Wear, and Cheshire (both with 4-percentage-point increases between 2019 and 2020).
• East Yorkshire and Northern Lincolnshire saw the biggest drop between 2019 and 2020 (from 18% to 9%) in the proportion of people aged 50-64 with three or more long-term health conditions.

What do the charts show?

• There is a large variation in the prevalence of long-term physical or mental health conditions, disabilities or illnesses by ethnicity. Among people aged 55-64, this varies from 46% of Chinese people to 73% of African people (White and Black); among people aged 65-74, it varies from 65% of Chinese people to 80% of Bangladeshi and Caribbean people.
• There is also variation by ethnic group in the extent to which those long-term conditions reduce people’s ability to go about their daily activities. In both age groups (55-64 and 65-74), Pakistani and Bangladeshi people are the most likely to be limited by their long-term conditions, while Caribbean people are the least likely.

These figures are consistent with research examining ethnic health inequalities, which found the worst rates of self-rated health among people from Pakistani and Bangladeshi backgrounds. The inequality emerges when people are in their thirties and gradually gets larger with age. This divergence is largely explained by two factors: experiences of racism and racial discrimination, which impact health through the physical and mental stress they produce, and differences in socioeconomic status, which shape all the wider determinants of health, including access to education, work, homes and the places we live. But the two are not entirely separate: socioeconomic status is itself shaped by discriminatory attitudes.  

The data we have presented demonstrates inequalities in multiple measures of health by level of wealth, ethnicity and geography, although these are inter-dependent and intersecting. Health inequalities are not just bad for individuals – they harm our society and economy as a whole. A recent analysis of ‘left behind’ neighbourhoods – those places across England with the lowest life expectancy, the worst health (including outcomes from COVID-19), and the highest rates of smoking, drinking and poor diet – found that they have nearly twice the proportion of people out of work due to sickness as the England average. As a consequence, the productivity of these places is significantly smaller – resulting in a gap of £124.1 billion in Gross Value Added between local authorities that contain left behind neighbourhoods and the rest of the country. Of this gap in productivity, 36% is ascribed to health inequalities, and the analysis finds that eradicating these health inequalities could generate an additional £29.8 billion a year.

In addition to the economic cost of productivity losses, the 2010 Marmot Review estimated that health inequality in England accounts for lost taxes and higher welfare payments of about £20 billion to £32 billion per year and additional NHS healthcare costs of more than £5.5 billion, although the latter figure has been revised upwards to £12.5 billion in the Marmot Review 10 Years On.

What does the chart show?

• Wellbeing* scores are higher in people aged 70 and over than in people aged 50-69, regardless of the state of their health.
• However, in each age group, people with no long-term health conditions have the highest wellbeing, and wellbeing steadily declines as the impact of long-term conditions on daily life increases.

* Wellbeing was measured using the CASP-12 scale (CASP stands for Control, Autonomy, Self-Realization and Pleasure), which comprises 12 questions that together enable assessment of wellbeing and quality of life for people aged 50 or above. The total score can range from 0 to 36, with a higher value denoting better wellbeing.

What does the chart show?

• Between May 2020 and May 2021, just over six in ten adults (27.8 million) managed 150 or more minutes of activity a week.
• Up to the age of 54, there is little variation with age in the proportion of adults who are active or fairly active (78.8% of people aged 16-24 and 76.5% of those aged 45-54). But, after that age, levels of activity decline – although, still, almost 70% of people aged 65-74 are active or fairly active.
• From age 75, the decline in activity levels is pronounced: there is an increase of 16 percentage points at the age of 75 in the proportion of people who are inactive, and another increase of almost 23 percentage points at the age of 85.  

Although genetics, and – for women – events such as the menopause, play a part in the advent of many of the chronic conditions that people in all wealth groups experience from mid-life onwards, a host of modifiable risk factors – notably, smoking, diet, alcohol consumption and physical activity – are extremely important. The role of these external risk factors on the development of health conditions has led the World Health Organization to state that, ‘the major causes of chronic diseases are known, and if these risk factors were eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would be prevented; over 40% of cancer would be prevented’.

Physical activity can help to prevent and delay many diseases and conditions that affect us as we age. We know, for example, that inactive people are at increased risk of developing a painful musculoskeletal condition and that excess weight increases the risk of back pain or of developing osteoarthritis and other musculoskeletal conditions. We also know that regular physical activity reduces the risk of: hip and knee osteoarthritis pain by 6%; depression by up to 30%; and falls by 76%.

Physical activity also helps us maintain functional ability, independence and quality of life as we grow older. But the time and ability we have to be physically active is not equally distributed across the population.

What does the chart show?

• Up to the pandemic, activity levels had been improving with time in all age groups over 55.
• The proportion of people aged 55-64 and 65-74 who do more than 150 minutes of activity per week has stayed constant across the pandemic, with 62% and 59% of people in these age groups active during the May 2020 to May 2021 period.
• At the same time, the proportion of people in these age group who are inactive increased slightly – from 25.8% to 26.6% of people aged 55-64 and from 28.7% to 30.5% of those aged 65-74.
• However, gains in activity levels in the over 75s have been lost: the proportion of people aged 75-84 who are inactive increased from 42.6% pre-pandemic to 46.6%, while that of people aged 85 and over increased from 66.1% to 69.2%.

The reduction in physical activity levels caused by shielding and stay-at-home guidelines means that many older people have experienced physical deconditioning during the pandemic. As a result, one in four people aged 60 and over are less able to do everyday activities. For example, 1.45 million people aged 60 and over who previously had no trouble walking short distances outside now find it difficult to do so. Given the role of physical activity in maintaining good health and preventing the onset of chronic health conditions, this is extremely worrying and has led us to call for public health agencies across the UK to launch a national post-pandemic resilience programme to not only return older people to their pre-pandemic physical activity levels, but encourage greater long-term levels of activity. 

What does the chart show?

• Whereas fewer than one in five (18%) people aged 55-74 who live in the least deprived 10% of neighbourhoods are inactive, this proportion increases steadily with level of deprivation, reaching more than two in five (41%) in the most deprived. That is, people in this age group in the poorest neighbourhoods are more than twice as likely to be physically inactive as those in the wealthiest.

As with life expectancy, disability-free life expectancy and the presence of health conditions, there are large socioeconomic inequalities with regards to health behaviours. There are a host of factors that affect a person’s ability to be physically active, including: poor body image, lack of confidence, cost, being uncomfortable in gym environments, and not knowing other people who exercise. Older adults most often report poor health as their primary barrier, although they also mention fear of falling or injury, symptoms of depression and lack of time. Crime and fear of crime, area degradation, lack of green infrastructure, noise and air pollution, cluttered pavements and non-inclusive design are also barriers that prevent people from being more physically active. Many of these factors may be of greater relevance for people of minority ethnic backgrounds because they are more likely to be living in disadvantaged areas, partially explaining their lower participation rates in physical activity. 

What do the charts show?

• For all age groups, walking is a far more common form of active travel than cycling.
• Cycling tends to be more common in younger age groups, with relatively similar proportions of people aged 25-34 (7.4%), 35-44 (6.6%) and 45-54 (6.5%) choosing to cycle as a way of getting around.
• Cycling levels drop off steeply after age 64, with just 2.6% of people aged 65-74, 1.1% of those aged 75-84 and none of those aged 85+ using cyling as a form of active travel.
• In all age groups an increasing proportion of people have been walking for at least 20 minutes three or more times a week since 2002, with a particularly large uptick in 2020 (potentially due to COVID-19 lockdowns).
• Walking at least 20 minutes or more three times a week is particularly prevalent among those aged 50-59 (67%).
• Despite a decline in the proportion of people walking 20 minutes or more at least three times a week as we age (60% of 60-69 year olds and 50% of those aged 70 and over), it still clearly remains an important form of physical activity as we get older.

Travelling actively – that is, by foot or on a bicycle – is an easy and effective way of bringing more physical activity into our everyday lives. Clearly the pandemic – and the accompanying requirements to socially distance and to work from home – led to a sharp increase in levels of walking, which we know is associated with far fewer barriers to access than cycling among older age groups. Our research has found that the factors that shape our active travel behaviours are wide-ranging and include such things as infrastructure, confidence, presence of role models and enjoyment of the outdoors. The factors are so varied that a whole-systems approach – involving the public, private and voluntary sector, local health systems and employers – will be required to tackle the barriers and enact real change. However, we believe that changes in active travel habits brought about by lockdown ‘provide policy makers with a unique opportunity to push at an open door’. 

What do the charts show?

• Rates of overweight or obesity are high in every age group and higher in men than women in all except the youngest age group (16-24).
• The highest rate among men is in 65-74 year olds (81%). For women, the highest rate is in those aged 65 and over (69%).
• Rates of overweight and obesity have increased in every age group between 1993 and 2019. The largest increase (from 58% to 71%) is among people aged 75 and over.

We also know that:

• The proportion of people who have a weight classed as overweight or obese is strongly correlated with wealth: almost half of men and women aged 50 and over in the poorest quintile of the population are overweight or obese compared to one-fifth in the wealthiest.
• The increase in the proportion of people living with obesity has happened mainly among the poorest men. Since 2008/09, the prevalence of obesity among men aged 50 and over in the poorest quintile of the population has increased from 34% to 47%. In contrast, that of men in the wealthiest quintile of the population remained at 23% over the same period.

Obesity is a major risk factor for many conditions which contribute to disability in later life including type 2 diabetes, coronary heart disease, stroke and some types of cancer, such as breast and bowel cancer, as well as associated mental health problems. Obesity has also been identified as a significant risk factor for more severe forms of COVID-19, making addressing levels of obesity among those in mid-life even more urgent.

The poorest people, with the greatest health challenges, are also being exposed to those environments most likely to cause obesity. There is a clear correlation between the availability of fast food outlets and level of area deprivation. The government’s plan to ban junk food ads before the 9pm watershed is laudable, but its impact will be limited if we are surrounded by junk food outlets wherever we go in our neighbourhoods. A recent article by a number of prominent academics said that targeting individuals with weight loss programmes without changing the environments in which they take place, was like ‘treating people for cholera then sending them back to communities supplied with contaminated water’. We need to ensure that we live in places that enable us to live healthy lives.

What does the chart show?

• The highest rates of smoking are seen in men and women aged 25-34 (18% and 13% of these groups smoke, respectively). Among men, smoking rates decline steadily with age to a low of 7.6% in those aged 65 and over.
• Among women aged between 25 and 64, between 11% and 13% smoke

What does the chart show?

• Smoking rates are highly associated with wealth. More than a quarter of men aged 50 and over (29%) in the poorest quintile of the population smoke, compared with just 4% in the wealthiest.
• Smoking rates in the wealthiest quintile of the population have declined over time. Rates among the wealthiest men and women aged 50 and over have halved from one in ten (10% and 11%, respectively) in 2002/03 to one in 20 (4% and 5%, respectively) in 2018/19.
• There has also been a large decrease in smoking rates among women aged 50 and over in the poorest quintile of the population – from 31% in 2002/03 to 18% in 2018/19.
• However, smoking rates for men aged 50 and over in the poorest quintile of the population decreased by just 5 percentage points over that 16-year period – from 34% in 2002/03 to 29% in 2018/19. That means that almost one-third of the poorest men still smoke.

What do the charts show?

• There is pronounced variation in smoking rates across the country:
  • The highest rates for both men and women aged 55-64 are seen in the North East (17% of men and 14% of women).
  • The lowest rates for men aged 55-64 are in the East Midlands and the South East (both 12%), while the lowest rate for women is in London (9%).

Smoking is the most damaging health behaviour and, although rates have been steadily falling over time, it is still the case that more than one in every ten adults in England smoke. And rates of smoking are higher among the poorest – potentially because smoking reduces stress, which can be brought on by debt and poorly paid and insecure work. In fact, smoking rates for men aged 50 and over in the poorest quintile of the population decreased by just 5 percentage points between 2002/03 and 2018/19 so that, as of 2018/19, almost one-third of the poorest men aged 50 and older still smoked. In addition, people from lower socioeconomic groups who smoke are less likely to succeed in their attempts to stop smoking, even though, on average, all people who smoke make similar numbers of attempts to stop each year. This is because of additional barriers, including stress related to material hardship that has contributed to their smoking habits in the first place, as well as the higher rates of smoking among others in their immediate circles. Of course, the financial cost of a smoking habit only exacerbates hardship: analysis of UK government data carried out for Action on Smoking and Health suggested that smoking has tipped 447,000 households into poverty. 

What does the chart show?

• Risky levels of alcohol consumption are higher in men than women in all age groups.
• The proportion of men who drink at levels that put them at increased or high risk (more than 14 units per week) ranges from almost one in five (19%) 16-24 year olds to almost two in five (39%) 55-74 year olds.
• Among women, the proportion ranges from one in ten of the over 75s to one in five (20%) 55-64 year olds.
• The largest difference between men and women is in the 65-74 age group: 39% of men compared with 17% of women drink at levels that put them at risk in this age group.

Given that alcohol use is the behavioural risk factor that leads to the third highest number of years lost to disability among people aged 50-69 in England, risky levels of alcohol consumption, especially among men, and especially among men aged 45-74 are of concern. 

What do the charts show?

• In 2020/21, there were a total of 280,000 hospital admissions for which the main reason for admission could be attributed to alcohol.
• This is 2% higher than 2018/19 and 8% higher than 2016/17.
• 23% of patients were aged 55-64 and more than half (54%) were aged 55 and over.
• There were twice as many hospital admissions for alcohol-related conditions among people aged 40-64 in the most deprived decile of the population (1,017 per 100,000 population) as in the least deprived (561 per 100,000 population). There were also more among the most deprived compared with the least deprived over 65s (947 vs 700 per 100,000 population).  
• Among the most deprived decile, there were fewer hospital admissions in the over 65s than in the 40-64 age group. However, in the least deprived, there were more hospital admissions in the older than in the younger group.

These observations may be the result of the alcohol harm paradox in which the burden of alcohol harm falls more heavily on individuals from lower socioeconomic backgrounds. The wealthiest are the most likely to be regular drinkers. However, regular drinking is not the same as unsafe or binge drinking: among all people aged 16 and over, more than a third (35%) of those in the least deprived quintile of the population were at increased risk due to their alcohol consumption compared with 15% in the most deprived quintile in 2019.