Study reveals UK's declining health performance compared to other high income countries over past 20 years

March 4, 2013

Six decades of universal free health care, the introduction of widespread public health initiatives (e.g., tobacco control, cancer screening, and immunization), and substantial increases in health expenditure have failed to improve the UK's health outcomes or longevity ranking against the average of 14 other original members of the European Union, Australia, Canada, Norway, and the USA (EU15+) over the past 20 years.

The startling findings, published Online First in The Lancet, reveal that despite life expectancy increasing by 4.2 years over the last two decades, the UK's pace of decline in premature mortality has persistently and significantly fallen behind the average of EU15+, and concerted action is urgently needed.

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), Chris Murray, from the Institute for Metrics and Evaluation, University of Washington, USA, and colleagues analysed patterns of ill health and death in the UK, calculated the contribution of preventable risk factors, and ranked the UK compared with a group of high-income countries with similar levels of in 1990 and 2010. Only in men older than 55 years has the UK experienced significantly faster drops in death rates compared with other nations over the last 20 years. The UK ranking in premature for adults aged 20 years has worsened substantially. This is in part because of dramatic increases in drug and alcohol use disorders, which were ranked as two of the least important causes of death in this age group in 1990 (ranked 32nd and 43rd respectively), rising to sixth and 18th place in 2010.

Overall, the eight leading causes of death in the UK have changed remarkably little in the last 20 years, with ischaemic heart disease, (COPD), stroke, lung cancer, and remaining in the top five.

By comparison, there has been a startling increase in the contribution of Alzheimer's disease (increase of +137%; rising from a rank of 24th to 10th), cirrhosis (+65%; 14th to 9th), and drug use disorders (+577%; 64th to 21st).

In 2010, the UK had significantly lower premature mortality from diabetes, road injuries, liver cancer, and chronic kidney diseases than the average for EU15+. However, it has not kept pace with other nations (and still has death rates significantly above the average of EU15+) for ischaemic heart disease, COPD, lower respiratory tract infections, breast cancer, other heart and circulatory disorders, oesophageal cancer, congenital abnormalities, preterm birth complications, and aortic aneurysm.

What is more, disability is causing a much greater proportion of the burden of disease as people are living longer, but spending these later years with more health problems compared to 20 years ago. In 2010, mental and behavioural disorders (predominantly depression, anxiety, drug and alcohol use, schizophrenia, and bipolar disorder), and musculoskeletal disorders (mainly lower back pain and falls) were responsible for more than half of all years lived with disability in the UK.

Explanations for the UK's worsening relative performance confirm the harmful effects of tobacco smoking (that remains the nation's leading risk factor for ill-health responsible for 11.8% of the disease burden in 2010), followed by the rising burden of high blood pressure (9%) and obesity (high body mass index; 8.6%). Also important are risk factors involving poor diet and low physical inactivity, which collectively account for 14.3% of disease burden, and the increasing effect of alcohol. The findings are released as UK Health Secretary Jeremy Hunt launches a new strategy to tackle premature mortality and cardiovascular diseases.

According to Murray, "Further progress in from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities. The growing burden of disability, particularly from mental disorders, substance use, musculoskeletal disorders, and falls deserves an integrated and strategic response." Writing in a linked Comment, Edmund Jessop from the UK Faculty of Public Health in London, UK points out, "The UK has done very well in the past 20 years in many areas. As Murray and colleagues show, mortality has reduced and several aspects of diet have improved, with drops in disability-adjusted life-years for all dietary risk factors examined. The UK has stronger than does any other country in Europe, and we continue to enjoy some of the safest roads in Europe."

But he cautions, "There is still plenty of room for bold action by politicians and the body politic: plain packaging for cigarettes, minimum pricing for alcohol, banning of trans fats, improved control of hypertension, and attention to psychiatric disorders. Alternatively, the UK can continue to languish at the bottom of European league tables."

In an Editorial accompanying the publication, Dr Richard Horton, Editor in Chief of The Lancet, describes the study as "an independent scientific report card on decades of NHS reorganisations that have often had more to do with political ideology than sound evidence." He adds that, "The GBD results do not by themselves offer definitive prescriptions for the predicaments they describe. And they do not provide a simple verdict on the performance of the UK health system. But they do offer a quantitative means to monitor measures of health and disease and to enable more rational review and discussion of health priorities. This work is an important step forward for health policy."

Explore further: Mental illness the largest contributor to disability worldwide

More information: … (13)60188-9/abstract

Related Stories

Mental illness the largest contributor to disability worldwide

December 14, 2012
Mental illness is the largest contributor to disability, according to a report card on the world's health, The Global Burden of Disease 2010 (GBD 2010). The seven papers and two commentaries that make up the report will be ...

We're living longer but with more disability

December 14, 2012
The Global Burden of Disease Study 2010 (GBD 2010), has found people around the world are living longer but often with many years of compromised health.

Blood pressure, smoking and alcohol: The health risks with the biggest global burden

December 13, 2012
Over 9 million people died as a consequence of high blood pressure in 2010, making it the health risk factor with the greatest toll worldwide, say experts.

Mortality gap for people with serious mental illness is increasing

September 14, 2011
(Medical Xpress) -- People with serious mental illnesses in England are not seeing the improvement in death rates the rest of the population is experiencing, a study led by Oxford University has found.

Cancer death rates over a third higher in men than women

January 29, 2013
Men are over 35 per cent more likely to die from cancer than women in the UK, according to a new report released today .

Study finds years living with disease, injury increasing globally

December 13, 2012
No matter where they live, how much education they have, or what their incomes are, people have very similar perceptions on the impact of diseases and injuries.

Recommended for you

One in 4 women and 1 in 6 men aged 65+ will be physically disabled in Europe by 2047

October 23, 2017
By 2047 one in four women and one in six men aged 65 and above is expected to be living with a physical disability that will severely restrict everyday activities, reveals an analysis published in the online journal BMJ Open.

Protein regulates vitamin A metabolic pathways, prevents inflammation

October 23, 2017
A team of researchers from Case Western Reserve University School of Medicine have discovered how uncontrolled vitamin A metabolism in the gut can cause harmful inflammation. The discovery links diet to inflammatory diseases, ...

New insights into controversial diagnosis of adolescent chronic fatigue

October 23, 2017
Crucial new research could provide some clarity around the controversy surrounding the diagnosis and treatment of chronic fatigue syndrome (CFS) in adolescents. The research by the Murdoch Children's Research Institute published ...

Do boys really have a testosterone spurt at age four?

October 23, 2017
The idea that four-year-old boys have a spurt of testosterone is often used to explain challenging behaviour at this age.

Our laws don't do enough to protect our health data

October 23, 2017
Have you ever wondered why your computer often shows you ads that seem tailor-made for your interests? The answer is big data. By combing through extremely large datasets, analysts can reveal patterns in your behavior.

New prevention exercise programme to reduce rugby injuries

October 23, 2017
A new dynamic 20-minute exercise programme, performed by rugby players before training and pre-match, could dramatically reduce injuries in the sport according to a benchmark study published today (Sunday 22 October).


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.