England Has potential For Lowest Disease Burden in the World

15 Sep 2015 --- For the first time, a new PHE-led study published in The Lancet ranks the diseases and risk factors that cause death and disability in England compared with other high-income countries. It reveals the nation’s potential to have the lowest total disease burden (years of life lost to death and lived with disability) in the world.

Between 1990 and 2013, life expectancy in England increased by 5.4 years: one of the biggest increases compared with the other EU15+ countries (from 75.9 years in 1990 to 81.3 years in 2013).

This increase was mainly because of falls in the death rate from cardiovascular disease, stroke, chronic obstructive pulmonary disease and some cancers (with progress partly offset by increased death rates from liver disease).

South East England has the lowest disease burden when compared to high-income countries, and England as a whole performs better than the EU15+ † average.

Known potentially preventable risk factors taken together explain 40% of ill health in England. If you examine the impact of specific risks on the overall disease burden, unhealthy diet and tobacco are the two largest contributors ‡ (diet accounts for 10.8% of total disease burden and tobacco 10.7%).

Improvements in life expectancy haven’t been matched by improvements in levels of ill-health. So, as a population we’re living longer but spending more years in ill-health, often with a combination of conditions, some of which would have previously been fatal. For example, with diabetes, the years of life lost to the disease have decreased by 56% but years living with disability have increased by over 75%.

Professor John Newton, Chief Knowledge Officer, Public Health England, says; “The findings show the huge opportunity for preventive public health. If levels of health in the worst performing regions in England matched the best performing ones, England would have one of the lowest burdens of disease of any developed country.” He goes on to say; “we want to live long but be in good health; diet affects everyone differently but if everyone took steps to change their diet for the better the health of the country would improve.”

And even though there have been big falls in premature mortality, the top causes of early deaths in England and in each English region are still heart disease, stroke, lung cancer and chronic obstructive pulmonary disease, which to a greater or lesser extent, are attributable to preventable risk factors.

Dr Adam Briggs, co-author and Wellcome Trust Research Training Fellow, University of Oxford, says, “Life expectancy is increasing across the country but large inequalities still remain. Life expectancy in 2013 for those living in the most deprived areas was still lower than those in less deprived areas enjoyed in 1990. How deprived you are is the key driver of these differences rather than where you live and therefore deprivation and its causes need to be tackled wherever they occur.”

Professor Kevin Fenton, Director of Health and Wellbeing, Public Health England, said; “People are living longer, but they are living longer with disability, which will require more integrated models of care spanning health and social services. The other important implication for health services is that it is likely that up to 40% of its workload is due to potentially preventable risk factors. This reaffirms the importance of people taking positive steps today, liking eating well and stopping smoking, to improve their health in the long term.” This report shows the relative impact of risk factors on the health of the nation, and it is dietary risks and smoking that come out as the two biggest risks overall for both ill health and early death. It is important to remember that dietary risks are largely preventable. With 62% of the adult population being overweight or obese, the majority of us need to reduce the calories we consume. Maintaining a healthy weight will help protect against life-threatening diseases such as type 2 diabetes and heart disease. As a nation we also need to eat more fruit and vegetables, fibre and oily fish but cut back on salt, saturated fat and sugar in the diet. This should form part of a healthy lifestyle which includes being regularly active, reducing your alcohol intake and quitting tobacco."

† The first 15 European Union members apart from the UK (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden), plus Australia, Canada, Norway, and the United States of America [EU15+].

‡ For women in England, tobacco is now the number one risk factor and has overtaken unhealthy diets and high blood pressure since 1990.