Improvements in life expectancy in Europe have slowed according to a study published in The Lancet Public Health Journal, with England showing the largest deceleration.

Since 1900 high income countries have enjoyed steady increases in life expectancy. Initially this was thanks to improvements in infant mortality, nutrition, living standards and the control of major infectious diseases, such as tuberculosis and cholera. In recent years, it has been a result of reducing death rates from non-communicable diseases and reducing risk factors for cardiovascular disease (CVD) and cancer, such as smoking and raised blood pressure.

However, according to Changing life expectancy in European countries 1990-2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021, funded by The Gates Foundation, the rate of improvement is slowing, that might impact life expectancy. This slowdown is attributed to population exposure to common risk factors for CVD and cancer, including high BMI, poor diet and low levels of physical activity.

The results

Between 1990 and 2011, all 20 countries studied showed annual improvements in life expectancy of an average of 0.23 years. However, from 2011 to 2019 – apart from in Norway – the rate of improvement fell to an average of 0.15 years. England experienced the largest decline: from 0.25 in 1990 to 2011, to 0.07 between 2011 and 2019.

Countries with the greatest slowdown in life expectancy improvements after 2011 saw some of the largest decreases in actual life expectancy in 2019 to 2021. All countries except Ireland, Iceland, Sweden, Norway, Denmark and Belgium experienced a decline in life expectancy. Greece and England saw the biggest drop as a result of COVID and other respiratory infections.

The countries that have best maintained the life expectancy improvements have done so through reducing mortality from CVD and cancer, by lowering exposure to the major risks factors. The continued improvements in life expectancy in those countries during 2019 to 2021 also indicate they were better prepared to withstand the pandemic.

The explanationThe report points out that the slowing of life expectancy is not because a longevity ceiling has been reached. Government policy has an impact, as does exposure to risk factors, which is also dependent largely on government policy and spending. For example, Belgium, France and Norway have increased capacity for cancer diagnosis and treatment activity in recent years.

Years of austerity have widened inequalities. Among 28 EU countries – including England and Wales – between 1991 and 2013, austerity regimes were associated with an overall 0.7 per cent increase in all-cause mortality. The report notes that a worsening economic position could increase short-term mortality in the most socioeconomically deprived individuals, as well as increasing longer-term exposure to risks, such as poverty, poor diet, food insecurity and poor housing.

Four industry sectors – tobacco, ultra processed food, fossil fuel and alcohol – are responsible for at least a third of global deaths and the power of the commercial sector tends to prevent implementation of policies to mitigate risks. The exception is tobacco, which has seen sustained action to reduce exposure and the report calls for a similar approach to be taken to alcohol usage.

While tobacco usage is decreasing, many other risk factors are increasing across all countries, including high BMI, bad diet, high alcohol use and low rates of physical activity.

Physical activity is estimated to provide a 20 to 30 per cent risk reduction in premature mortality and the incidence of several chronic health conditions. The report notes that sedentary individuals experience substantial health benefits from even a small increase and there is no minimum threshold for benefit. It calls for co-ordinated systematic strategies to achieve improvement in levels of physical activity, including the promotion of active travel.

There is strong evidence that improving diet – with higher levels of whole grains, fruit, fibre, legumes, nuts, seeds, vegetables, milk, calcium, polyunsaturated fats and omega-3 fatty acids – offers scope for large population health gains.

Norway has a long history of fiscal intervention to reduce sugar consumption and this type of approach has been proven to be more effective than a voluntary or educational approach from governments.

Calling on the governments

The global 2007-08 recession led to reduced public spending and since 2010 England has experienced funding cuts in health, social care and welfare, especially in areas of socioeconomic deprivation, which have contributed to the slowing of life expectancy improvement.

The report calls for long-term national and international cross-sectoral strategies involving governments, communities, schools and employers to reverse the slow-down. It calls for more policies that reduce exposure to major risk factors for CVD and cancer – such as harmful diets and low physical activity levels.