21.05.2026

Diagnosis of systemic failure

There is a huge gap between the life expectancy of the rich and the poor. When it comes to healthy life expectancy, things are bad and getting worse. However it could be very different, says James Linney

At the end of April, the Health Foundation published an analysis titled ‘Healthy life expectancy trends in the UK: a watershed moment’,¹ using Office for National Statistics data to examine changes in healthy life expectancy over the past decade. The publication prompted a flurry of alarming headlines in the media summarising its findings, which, as we shall see, makes for rather depressing reading. Despite Labour’s manifesto pledge to halve the gap in healthy life expectancy, the report concludes that things are actually getting worse, not better.

‘Healthy life expectancy’ is defined by the Health Foundation as the average number of years a person can expect to live in good health, based on current mortality rates and levels of self-reported good health. This differs from average ‘life expectancy’, which simply measures the number of years a person or group is expected to live, based on mortality rates, birth year and age. The authors argue that healthy life expectancy gives a more comprehensive picture of the nation’s health by considering not just how long people live, but the condition in which they live those years.

Looking solely at life expectancy, the picture appears somewhat less bleak. Over the past two centuries, life expectancy has steadily increased. Between 1805 and 1905, the rise was gradual, with average life expectancy increasing from around 40 years at the beginning of the 19th century to 50 years by its end. There were some medical and sanitation advances during the early years of the industrial revolution, but they were almost exclusively the privilege of the bourgeoise. Despite the explosive growth in the population of the urban working class, workers and their families were virtually without a political voice and were forced to live in severely cramped houses, without sanitation or access to healthcare and forced (from early childhood) to work in terrible, deadly factories - what William Blake described as “dark satanic mills”.

During the 20th century, however, improvements accelerated dramatically, and by 2005 life expectancy had risen to 78.4 years. The reasons for this steep increase were manifold. Scientific advances led to major breakthroughs in medicine, including antibiotics, contraception and treatment for conditions such as high blood pressure and heart disease. Child mortality rates fell sharply with the introduction of immunisations and eventually the near eradication of previously deadly childhood infectious diseases, such as polio and measles.

Yet socio-political changes also played a crucial role in allowing these advances to benefit wider sections of society. The working class began to assert itself politically in the form of mass unions and the Labour Party, while never going beyond a rather tepid reformism, the ruling class was prepared to pay what amounted to Danegeld, the price for the not making revolution. The result was the creation of the National Health Service and the expansion of welfare provisions. Working people could now access treatment for illnesses that had previously amounted to a death sentence: heart disease, diabetes, infectious diseases and hypertension among them.

Stagnant

Since 2005, however, improvements in life expectancy have slowed significantly and have remained more or less stagnant since 2011. Global life expectancy fell between 2019 and 2021 as a consequence of Covid-19, though it has now largely recovered to pre-pandemic levels. In the UK, life expectancy currently stands at 83.0 years for females and 79.1 years for males.

The Health Foundation’s main finding, however, was that despite this relative stability in life expectancy, healthy life expectancy in the UK fell dramatically over the decade from 2012-14 to 2022-24, declining by around two years. Currently, men in the UK can expect an average of 60.7 years of healthy life, while women can expect 60.9 years.

Furthermore, the report states: “Healthy life expectancy has now fallen below the state pension age of 66 years in more than 90% of areas. In more than one in 10 local areas, healthy life expectancy is below 55 years.”

Perhaps most shocking of all, the report found that: “Deep inequalities in healthy life expectancy between affluent and deprived areas have widened. The gap between the most and least deprived deciles in England is now 19.4 years for males and 20.3 years for females.” Thus, while in affluent areas such as Richmond upon Thames both men and women can expect to remain healthy well beyond retirement age, in Blackpool healthy life expectancy for males was only 50.9 years, while in Hartlepool it was as low as 51.2 years for females.

There are, of course, important limitations to the Health Foundation’s analysis, as pointed out in a recent Financial Times article.² The data used to calculate healthy life expectancy relies partly on annual surveys conducted by the Office for National Statistics, introducing a greater degree of subjectivity. Participants are asked to rate their health as ‘very good’, ‘good’, ‘fair’, ‘bad’, or ‘very bad’, as well as answer questions about any chronic illnesses. Surveys inevitably contain an element of participant bias, but this does not render them useless and it still points to a true decline in health relative to previous surveys.

The FT article also argues that much of the decline in healthy life expectancy is driven by worsening mental health among younger people, rather than deteriorating physical health among older people. Yet this does not undermine the legitimacy of the findings. Furthermore, mental and physical health are deeply interconnected and cannot always be neatly separated.

So, despite being aware of these limitations, we can see that the key conclusions from the healthy life expectancy data still stand: that people are increasingly living with chronic illness; that deprivation is strongly associated with poor health; and that the UK is a very unequal place. Though disgraceful, the findings are no big surprise and are entirely consistent with evidence from other sources. It is already well established that deprivation is one of the greatest determinants of both mental and physical ill health, and the inequality gap continues to widen. Even though overall life expectancy has stabilised, those in the poorest areas can still expect to die around a decade earlier than those in the wealthiest.³

Moreover, although modern medicine has reduced mortality, increasing numbers of people are now living with at least one major chronic illness: around 40% of adults⁴ - and this figure is projected to rise significantly by 2040. Combined with an ageing population, this means that more and more people are spending later life in frailty and ill health.

The rising obesity rates are one explanation for the increase in chronic health conditions. Between 1993 and 2022 the proportion of adults in England who are obese rose from 14.9% to 28.9%, while the proportion who were either overweight or obese rose from 52.9% to 63.9%.⁵ Obesity can lead to the development of other chronic illnesses such as type 2 diabetes, musculoskeletal conditions, liver disease and mental health problems.

Ageing

These demographic shifts are happening in the UK at the same time as the NHS has been severely defunded and large parts have been gifted to private healthcare providers - emergency departments are routinely completely overwhelmed and waiting times for basic elective care are now measured in years, not weeks. Mental health provision has been one of the services most severely hit by cuts, with young people especially facing huge gaps in service and unable to access basic support or psychology.

Ageing and the increased risk of illness that comes with it, is of course, a natural process. We rightly mock the billionaire ‘tech bros’ pouring their fortunes into life-extension biotechnology, in the hope that wealth might somehow bribe death itself. Yet the reality for most people today is not simply that they age, but that they become ill prematurely. Biological limits are not the main barrier to healthier lives: rather, it is the system under which we are forced to live.

Most people spend the majority of their waking lives working in environments detrimental to their health, either sitting sedentarily in front of screens for hours on end or performing repetitive manual labour that damages joints and backs. As a result, people lack adequate time for exercise, spending time outdoors in nature, maintaining relationships, preparing and sharing meals, or even getting sufficient rest and sleep. All of which is the perfect storm for creating poor mental and physical health.

Poor-quality and expensive housing is also contributing significantly to ill health and rising morbidity. As an article in The Conversation points out,

When housing is unaffordable, people are forced to make trade-offs: for example, trading affordability for damp or overcrowded homes. They cut back on heating, food, medication, transport and social participation … Poor housing quality directly shapes health. Cold, damp, mould, disrepair, poor ventilation and unsafe homes are directly linked to respiratory illness, cardiovascular risk, mental health problems and reduced wellbeing.⁶

Of course, capitalism has overseen previously unimaginable scientific and technological advances that have helped extend human life. But these advances have occurred not because of capitalism, but despite it. Under capitalism, scientific, medical and technological breakthroughs are rapidly commodified and turned into new opportunities for profit and the accumulation of immense wealth by a tiny minority. The promise of progress for all has always been a hollow lie.

Only the working class can expose and overcome this lie - by providing freedom from wage labour; freely available, high-quality food; housing with space to live, ventilation and adequate heating; and daily access to exercise and green outdoor spaces for all - in other words, a life of both quantity and quality.

These are not utopian demands. They are the bare minimum conditions for a healthy life, yet they have proven entirely unattainable under capitalism.