April 30, 2015

expert reaction to study forecasting life expectancy changes in England and Wales

Publishing in the Lancet journal, a team of researchers has estimated mortality and life expectancy in England and Wales, reporting that previous measures may have underestimated the expected rise in life expectancy, particularly in men.

Prof. Sir Michael Marmot, Director, UCL Institute of Health Equity, said:

“This study predicts that inequalities in life expectancy are likely to increase by 2030. These inequalities vary with deprivation of district along the social gradient: the more deprived the shorter the predicted life expectancy. There are even bigger variations within district – bigger in deprived districts than in more affluent ones. More deprived communities are more vulnerable to the causes of inequalities in health.

“The implication is that people of higher socioeconomic position will benefit from health and other services for longer than more deprived people. Is this fair?

“A key question that the research did not address is healthy life expectancy. Will people have longer healthy lives, or more sickness?

“We should not see more spending on pensions and health care for people living longer as a problem. It is a SUCCESS! A rich country can afford it. Why not?

“Prediction is just that: prediction. Changes in social policy, for example, could mean that actual life expectancy in 2030 could be bigger or smaller than these predicted gains.

“That said, these predictions may well be more accurate than ONS because they are based on small areas not just national figures.”

Prof. Peter Passmore, Professor of Ageing and Geriatric Medicine, Queen’s University Belfast, said:

“It is always useful to get timely and good estimates of population longevity, which this study provides. These do assist in overall planning. This is a large change in longevity seen in a relatively short time frame and is to be welcomed. It provides further evidence that the gender gap is closing as previously predicted. Perhaps of more importance is how successfully that period of increased longevity actually is in terms of general health and morbidity, which is not measured in this study.

“It is always assumed that increased longevity means more frailty and increased use of health and social services resource. Today there is much more emphasis on the demographic dividend with an emphasis on successful ageing, right across the population. Therefore the implication in particular that better-off social groups who live longer will use more health and social service resource may not be fully correct. That hypothesis requires further research. The inequality findings do need to be taken seriously in terms of policy. The increased longevity and stated pension implications need to be tempered with the recognition that policy has already changed to reflect some of these projections and that those can again be modified – and this report will assist in that debate.

“Increased longevity has previously been ascribed mainly to improvements in social conditions, education, nutrition and better vaccinations and vaccination rates. The role of health services could mostly derive from primary rather than secondary care interventions. This would indeed highlight the importance of local priorities for health and general provision for communities.

“It is extremely important in the broader sense to have national finances in a state which will provide for any further need for enhanced expenditure in health, social care and pension provision.”

‘The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting’ by James E Bennett et al. published in the Lancet on Thursday 30 April 2015. 

Declared interests

Prof. Sir Michael Marmot: “I am employed full time as a professor by UCL. My duty travel is always funded by the sponsor, usually governments, WHO, Universities.”

Prof. Peter Passmore: “I don’t have any interests other than as a geriatrician and one interested in older people in general and how their lot can be improved in any way that’s possible.”