Regional differences in health are large and growing There is a 18.6 year gap in male healthy life expectancy at birth between local areas in the UK

The circumstances in which we live – from the support we receive during our early years to our working conditions, housing, education and local communities later in life – have powerful impacts on our health.

A decade on from the original landmark review, Health Equity in England: The Marmot Review 10 Years On shows that not enough progress has been made in addressing unjust and avoidable differences in people’s health and wellbeing.

In the last decade improvements to life expectancy have stalled. There has also been little improvement in the number of years that people can expect to live in good health for men, while it has fallen for women. Below the national average place matters – healthy life expectancy varies depending on where you live.

Where is the gap in healthy life expectancy the biggest?

Blackpool has the lowest healthy life expectancy at birth for men in the UK. Here, boys born in 2016-18 can expect to live 53.3 years in good health, compared to 71.9 years for those born in Richmond-upon-Thames, where healthy life expectancy is highest. This is a gap of 18.6 years.

This disparity in healthy life expectancy is compounded by the difference in overall lifespan between the two areas. Boys born in Blackpool are expected to live eight fewer years overall than boys born in Richmond-upon-Thames, and they are also expected to spend more years in poor health.

How is the gap in healthy life expectancy changing over time?

Differences in healthy life expectancy between local areas are large and growing. In 2009-11, the gap between Blackpool and Richmond-upon-Thames for boys born in that period was 13.9 years – compared to 18.6 years in 2016-18.

It is well known that life expectancy in the UK has stalled since 2011 but there has also been little improvement in healthy life expectancy. Between 2009-11 and 2016-18, the number of years a man can expect to live in good health has risen by only 0.4 years. For women, it has fallen by 0.2 years.

This means that the share of life spent in good health has reduced. In 2009-11, boys born in the UK could expect to live 79.9% of their life in good health but in 2016-18, this proportion decreased to 79.5%.

The map shows that local areas of low healthy life expectancy tend to be clustered: seen in South Wales, Eastern Scotland, Northern Ireland and parts of the north of England. Some of those areas in the North West and North East of England include the ’red wall’ constituencies – the new Conservative seats gained from Labour which tend to have lower than average healthy life expectancy. These areas of poor health have remained consistent over time, with a similar picture of inequalities across England since 2009-11.

What’s the picture in Wales, Scotland and Northern Ireland?

Big gaps in healthy life expectancy exist between areas that border each other, not simply between different regions of the UK. While this is true within regions of England it can also be demonstrated within the other countries of the UK:

• Wales: Blaenau Gwent and Monmouthshire, with a 10.9 year gap in healthy life expectancy.
• Scotland: Glasgow City and East Dunbartonshire, with a 13.6 year gap in healthy life expectancy.
• Northern Ireland: Belfast and Lisburn & Castlereagh, with an 11.0 year gap in healthy life expectancy. 

‘Levelling up’ health and wellbeing

Overall, regional differences in health are large and growing, To ‘level up’ the country as the government aims, it must take action to level up the health and wellbeing of the population. The Marmot Review 10 Years On explores what progress has been made and proposes recommendations for a cross-government health inequalities strategy.