ANALYSIS
life expectancy in men has been declining since 2016-18, with increased mortality in those aged 30-39 years making the greatest contribution. 28 Of particular concern is the “ appalling decline ” in both physical and mental health of children aged <5 years, detailed in the 2024 report from the Academy of Medical Sciences. The report described children as being “ betrayed ” by a failure to be provided with a healthy start in life. 2930 The accompanying statistics include that infant mortality increased between 2014 and 2017, with the UK ranking 30th out of 49 OECD (Organisation for Economic Cooperation and Development) countries; child vaccination levels are currently below WHO coverage targets; and a quarter of all children aged 5 years are affected by preventable tooth decay, the main reason for hospital admissions in children aged 6-10 years. These problems are entirely preventable and disproportionately affect the most deprived communities. Figures 2 and 3 show that infant and child death rates increased between 2020 and 2023, with infant deaths almost three times as high for black/black British babies than white babies, and marked regional inequalities in child deaths. 31 Similar trends have been seen in the rates of stillbirths, with increasing rates linked to worsening areas of deprivation and ethnic groups. 32 Other inequalities in early child development exist: cognitive, linguistic, emotional, and behavioural. 14 These inequalities are important because they are correlated with behavioural problems in children and predict the subsequent development of health inequalities. Another marker of poor health in children in the UK is height. In 1985, the height of boys and girls aged 5 years in the UK was lower than in 68 other countries. Height in children aged 5 years increased more slowly in the UK than in many other countries. By 2019, in the UK, boys ranked 102 and girls ranked 96. The average height of children aged 5 years fell from 2015 onwards, suggesting that austerity, which began in 2010, might have had an effect. 33
one million lives were cut short between 2011 and the start of the pandemic in 90% of areas in England. 20 Figure 1, from the Marmot Review 10 Years On, shows how deprivation and region overlap, with regional differences greater in the most deprived group (divided by deciles) than in the least deprived group. 14 In every region outside of London, life expectancy has fallen in the most deprived group. Acknowledging the overlap and intersections in the groups affected is important. Those living in the most deprived areas are often affected by multiple factors, such as structural racism and the consequences of the climate emergency, and are often more likely to lack the resources to mitigate the subsequent health consequences.
Fig 1 | Life expectancy at birth by sex for the least and most deprived groups in each region, England, 2010-12 and 2016-18 14
Fig 2 | Estimated infant death rate per 1000 live births by ethnic group 31
Health is deteriorating from the cradle to the grave Older women were among the first groups to have an unprecedented fall in life expectancy. 1521 Older people have been particularly affected because of a greater reliance on a functioning health and social care system. The golden generation, those born between 1925 and 1934, saw remarkable improvements in mortality throughout their lifetimes, 22 but the remainder of their lives were cut short since 2010. 23 Over time, in more and more groups, health has worsened and lives have been shortened, 12 13 including a rise in deaths of despair in middle age, reflecting the US experience, of deaths from suicide and from causes related to alcohol and drugs. 24 These findings are reflected across Scotland, 25-27 and in Northern Ireland,
the bmj | BMJ 2024;385:e079389 | doi: 10.1136/bmj-2024-079389
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