Healthy life expectancy falls in the UK – and the decline is worse among women

Healthy life expectancy in the UK – the years we can expect to live in good health – has fallen by more than two years over the past decade, according to a new Health Foundation analysis.

The decline has been larger for women than for men – a finding the report says raises “concerns about the worsening trend of women’s health”. Of 21 high-income countries, the UK has fallen from 14th to 20th on this measure over the same period; only the US now ranks lower.

The aggregate matters, but so does the distribution. The gap in healthy life expectancy between the most and least deprived areas of England is now 20.3 years for women.

A girl born today in Hartlepool can expect to live just 51.2 years of good health; in Richmond-upon-Thames, 70.3. Translate that into time spent unwell and women in the poorest areas can expect roughly three decades of life in poor health, against around 13 years for the most affluent. In Wales, female healthy life expectancy fell by 3.7 years over the decade alone.

Why women in particular?

Men in deprived areas suffer too, but not in the same way and not for the same reasons. Three factors compound disproportionately for women.

The first is unpaid care. Women are 29% more likely than men to be unpaid carers, and almost twice as likely to provide 35 hours or more of unpaid care per week. Forty-two per cent of carers say their physical health has suffered as a consequence of providing care, and 74% report stress and anxiety. Caring falls disproportionately on the same low-income women whose paid work is already physically demanding.

That leads to the second reason: the labour market. Some 78% of social care staff are women; women make up around 59% of minimum-wage workers, concentrated in care, cleaning, hospitality and retail. These are the sectors most likely to involve shift work, zero-hour contracts, physically demanding work and exposure to violence, and least likely to offer sick pay or flexibility when long-term illness inevitably arrives.

The third is diagnostic delay and dismissal. Women in the UK now wait an average of nine years for an endometriosis diagnosis, and the waiting list for a gynaecology appointment is now close to a quarter of a million.

Women’s pain is more likely to be reframed as anxiety than properly treated, and just 2% of UK health research funding goes to reproductive health and childbirth, despite maternal mortality sitting at its highest level in 20 years.

A strategy that doesn’t match the scale

This is the context in which health secretary Wes Streeting’s renewed women’s health strategy lands. Launched on April 15 with a pledge to end “medical misogyny” and the “gaslighting” of women, it has been welcomed in principle. But it contains £5 million of additional investment, against the £8 million in the men’s health strategy unveiled in November.

Look closer and the women’s headline figures shrink fast. The £1 million for menstrual education in schools works out at roughly £300 per state secondary, or about two hours of workshops per school year.

The £5 million for a maternity care bundle averages around £42,000 per trust (or the equivalent of one midwife’s annual salary). The £2.6 million for osteoporosis scanners buys roughly 33 machines, two-thirds of them replacing outdated ones. There is no ring-fenced funding for gynaecology, despite the unprecedented backlog.

Funding is not evidence, but it is the clearest policy signal of political priority. It is difficult to see how a 20-year healthy life expectancy gap for women in deprived areas closes on a per-school spend that wouldn’t cover a supply teacher.

What should be done?

Healthy life expectancy is not a measure of behaviour or individual lifestyle choices. It is the measurable end product of the cumulative conditions in which women grow up, work, give birth and grow old. The decline since 2012 maps, with depressing predictability, onto a decade of austerity, rising child poverty and stagnant real wages – pressures that fall hardest on the women already doing most of the unpaid work to hold their households together.

A serious response would ring-fence women’s health funding, match rhetoric on medical misogyny with sustained investment in gynaecology, maternity and reproductive research and recognise, as has been argued for more than 15 years, that the “causes of the causes” sit upstream of the NHS.

The Health Foundation has called this report a watershed. It will only become one if the policy response is built to the scale of the problem.

Philip Broadbent receives funding from The Wellcome Trust 223499/Z/21/Z