Had a good innings? The importance of healthy life expectancy

The latest data on healthy life expectancy (HLE) in England from the ONS provides a detailed look at how long people can expect to live in good health.

“Had a good innings" is a metaphor borrowed from cricket. Just as a cricketer would be praised for a high-scoring innings, a person who has lived many years in good health is seen as having had a "good innings". Healthy life expectancy (HLE) is a crucial measure that estimates the number of years individuals can expect to live in "very good" or "good" health. This measure is based on self-reported health status and provides insight into the quality of life, not just the quantity. This measure is crucial for understanding the overall health and wellbeing of a population.

Over the last 50 years, life expectancy had been rising steadily in most countries of the world and showed little sign of abating. While infectious diseases were the main cause of death, it was reasonable to equate life expectancy increases with better health. However, the rise in importance of chronic diseases as the leading cause of death, along with an ageing population means that life expectancy is an insufficient measure of health and instead we should focus measures that capture the quality of remaining years as well as the quantity.

While there have been improvements over the years, significant challenges remain, particularly in addressing regional disparities. Continued efforts in public health, healthcare access, and socio-economic policies are essential to ensure that all individuals have the opportunity to live long and healthy lives. What does the data tell us?

The latest data on healthy life expectancy (HLE) in England from the ONS provides a detailed look at how long people can expect to live in good health.

Key statistics and insights for 2024

Life expectancy

Overall life expectancy: The life expectancy in England for 2024 is 81.9 years
Males: The life expectancy for males is 79.5 years
Females: The life expectancy for females is 84.3 years

HLE at birth

Males: The HLE at birth for males in England is 61.5 years.
Females: The HLE at birth for females in England is 61.9 years

HLE at age 65

Males: Males aged 65 in England can expect to spend 10.1 years in good health.
Females: Females aged 65 in England can expect to spend 11.2 years in good health

Regional variations

Highest HLE: In 2021 to 2023, the highest HLE at birth was observed in Wokingham, with 69.7 years for males and 70.8 years for females.
Lowest HLE: The lowest HLE at birth was in Blackpool for males (51.7 years) and in Barnsley for females (52.6 years)

Impact of deprivation

Life expectancy gap: Males in the most deprived areas have a life expectancy 9.7 years shorter than those in the least deprived areas. For females, the gap is 7.9 years
HLE gap: The HLE gap is even more pronounced, with males in the most deprived areas having an HLE of 52.3 years compared to 70.9 years in the least deprived areas—a difference of 18.6 years. For females, the gap is 19.3 years, with those in the most deprived areas having an HLE of 51.4 years compared to 70.7 years in the least deprived areas

Trends over time

Decline in HLE: Since the pre-coronavirus (COVID-19) pandemic period (2017 to 2019), HLE at birth has fallen by 1.7 years for males and 1.9 years for females
Regional declines: Most regions experienced a fall in HLE at birth. The largest fall for males was in the North West (31.0 months), while London saw a small improvement (2.2 months). For females, the largest fall was in the South West (32.4 months), with London experiencing the smallest decline (0.7 months)

Local area variations

Largest increase: The local area with the largest increase in male HLE at birth since 2017 to 2019 was Hillingdon, gaining 5.8 years. For females, Hillingdon also saw the largest rise, gaining 6.3 years.
Largest decline: The largest fall in male HLE at birth was in Cheshire West and Chester (5.2 years), while for females, the largest decline was in Peterborough (6.0 years)

Inequalities in healthy life expectancies between local areas in England are much larger than inequalities in life expectancy and are widening. This is likely to be contributing to the slower gains in health expectancies overall.

Over the past decade, HLE in England has seen some fluctuations. Between 2011 and 2019, HLE remained relatively stable. However, the Covid-19 pandemic had a significant impact, leading to a decline in HLE. For instance, HLE at birth fell by 1.7 years for males and 1.9 years for females during the pandemic.

These statistics highlight the ongoing challenges and disparities in healthy life expectancy across different regions and socioeconomic groups in England. Addressing these inequalities remains a critical focus for public health initiatives.

What are the factors Influencing HLE and what can we do to change them?

Several factors influence HLE, including:

Socioeconomic status: Higher socioeconomic status often correlates with better access to healthcare, healthier lifestyles, and improved living conditions, leading to higher HLE
Lifestyle choices: Diet, exercise, smoking, and alcohol consumption significantly impact HLE. Healthier lifestyle choices generally lead to a higher HLE
Healthcare access: Access to quality healthcare services plays a vital role in maintaining good health and extending HLE
Public health initiatives: Government policies and public health initiatives aimed at reducing health inequalities and promoting healthy living can positively influence HLE
Environmental factors: Clean air, safe drinking water, and healthy living environments contribute to better health outcomes and higher HLE.

Local strategies to improve healthy life expectancy

Councils play a crucial role in improving healthy life expectancy (HLE) by implementing targeted initiatives and policies. Here are some effective strategies they can adopt or working with local system partners:

1. Promote healthy lifestyles

Physical activity: Develop and maintain public parks, walking trails, and recreational facilities to encourage physical activity. Organise community fitness programs and events to promote regular exercise
Healthy eating: Support local food markets and community gardens to increase access to fresh, healthy foods. Implement educational campaigns on nutrition and healthy eating habits
Smoking cessation: Provide resources and support for smoking cessation programs. Implement policies to reduce smoking in public places
Alcohol reduction: Promote responsible drinking through public awareness campaigns and provide support for alcohol reduction programs

2. Enhance healthcare access

Primary care services: Working with NHS partners, communities and the VCSE sector ensure that primary care services are accessible to all residents, especially in deprived areas.
Preventive healthcare: Focus on preventive measures such as vaccinations, health screenings, and early detection of diseases. Encourage regular health check-ups and screenings.

3. Address socioeconomic inequalities

Education and employment: Improve education and employment opportunities to reduce poverty and its associated health risks. Support job training programs and educational initiatives
Affordable housing: Ensure access to safe and affordable housing to improve living conditions. Implement policies to reduce homelessness and housing instability.
Employment: Higher employment rates are strongly correlated with a longer healthy life expectancy.

4. Public Health Campaigns

Awareness programmes: Conduct public health campaigns to raise awareness about the importance of healthy lifestyles and preventive healthcare. Use social media, local events, and community centres to disseminate information
Community engagement: Involve communities in health promotion activities to ensure that interventions are culturally appropriate and effective. Encourage community-led health initiatives

5. Environmental improvements

Clean air and water: Implement policies to reduce pollution and ensure access to clean air and water. Monitor and regulate industrial emissions and waste disposal.
Safe public spaces: Develop and maintain safe public spaces for physical activity and recreation. Ensure that parks and playgrounds are well-maintained and accessible

6. Targeted interventions for high-risk groups

Chronic disease management: Work with partners to provide targeted support for individuals with chronic diseases such as diabetes, heart disease, and respiratory conditions.
Mental health services: Increase access to mental health services and support for individuals experiencing mental health issues. Implement programs to reduce stigma and promote mental wellbeing.

7. Collaboration and partnerships

Multi-sector collaboration: Work with various sectors, including healthcare, education, housing, employers and transportation, to address the social determinants of health. Foster partnerships with non-profit organisations, businesses, and community groups.
Data-driven approaches: Use data and research to identify health disparities and target interventions effectively. Monitor and evaluate the impact of health initiatives to ensure continuous improvement.

The longer a person spends in poor health the more health and care they need. So tackling this is an absolute priority. But how can we encourage healthy ageing? It requires partnership working between local government, the NHS, the voluntary sector and the communities they serve.

There are obvious areas to focus on. As we get older, physical activity levels decline and we become more frail, putting us at greater risk of falls and accidents. Social isolation and loneliness is a factor too, and research has found that it can have serious health effects. In reading the Chief Medical Officer’s 2023 annual report “Health in an Ageing Society” I was struck by the positivity, and the concentration on issues which can improve our quality of life in our later years.

But it is never too late to change. If we tackle this head on we can help ensure that not only do we add extra years to life but extra life to those years.

Councillor David Fothergill
Chairman
LGA Community Wellbeing Board