Ground-breaking medical research reveals some of the best countries for longevity and health – but does it also suggest the UK NHS is suffering a terminal illness?
Raj Persaud and Peter Bruggen
The authors, led by Professor Christopher Murray from the Institute for Health Metrics and Evaluation, University of Washington, started their investigation expecting the UK to set a standard for health, that other countries would ‘struggle to match’.
This new study, involving experts from institutions such as the National Cancer Programme, Public Health England and the Universities of Manchester, London and Oxford, used a massive analysis of vast data examining 291 diseases and injuries for 187 countries. Because the study assessed the same set of diseases across nations, it’s a unique opportunity to see how the NHS matches up to other systems in different parts of the world.
The UK was compared in The Lancet paper, entitled ‘UK health performance: ﬁndings of the Global Burden of Disease Study 2010’, with 18 other comparison nations (the original 15 members of the European Union, plus Australia, Canada, Norway and the USA).
The key findings are that the UK performed signiﬁcantly worse than the comparison nations for death rates, Years of Life Lost due to Premature Mortality, and Life Expectancy in 1990, plus its relative position had worsened by 2010.
Years of life lost due to Premature Mortality (YLL) is a statistic used by public health experts. It takes into account the age at which deaths occur, giving greater weight to deaths at a younger age and lower weighting to deaths at older age. YLL is important because a higher Years of Life Lost due to Premature Mortality, means younger people are dying; losing a lot of future life.
In terms of this premature mortality, a worsening position of dropping down the league table in relation to other countries, is most notable in the UK between 1990-2010, for men and women aged 20–54 years.
On death rates per 100,000 people, the UK came in ranked 12th position out of 19 comparison countries in 1990, but this had fallen to 14th place by 2010. The UK’s peer countries are seeing an even stronger decline in mortality in recent years compared to Britain. This statistic is calculated allowing for the age of the population. So a high number here doesn’t simply mean the UK has an older population. Even allowing for the different age breakdown across the comparison nations, the UK does badly.
For Years of Life Lost due to Premature Mortality, the UK position in 1990 was 10th place, but this had fallen to 14th in the league table of comparison countries by 2010. For Life Expectancy at Birth the UK came 12th in 1990 but this had dropped to 14th by 2010.
In terms of comparison countries, Australia comes top of the league table for best performance on death rates and on Life Expectancy at birth in 2010. Sweden achieves best performance on Years of Life Lost due to Premature Mortality, both in 1990 and in 2010.
Sweden spends roughly the same proportion of gross domestic product (GDP) on health as the UK (9%) but while the state finances the vast bulk of health care costs, the patient pays a small fee for prescriptions, consultations and examinations.
In Australia, while the government contributes a large subsidy, the patient pays the remainder of costs themselves or through private insurance.
It’s the universal coverage that the NHS provides, with no expectation for a contribution from the patient (except for some prescription charges), which renders it exceptional.
While there may be some comfort in the fact the UK out-performed the USA in terms of Life Expectancy at Birth (the US came 19th in 2010 while the UK came 14th), it may be sobering to realise we are beaten by theoretically poorer countries such as Spain (4th) and Italy (2nd) in 2010, both of whom have been supposedly teetering on the brink of financial collapse for years now.
Even Greece beat the UK in 2010 on Years of Life Lost due to Premature Mortality.
While the US is worse than the UK on Life Expectancy at Birth, the USA trounces the UK on Years Lived with Disability, which is used to gauge how much disability left by illness is prevalent in a population. With the kinds of chronic disorders like arthritis and dementia more prevalent in Western Countries, this may be a more relevant measure of health than mortality.
The USA came 2nd amongst comparison countries in 2010 in Years Lived with Disability, while the UK came 14th. It’s the poor performance of the UK across a wide spread of different measures of health, which marks out the NHS as seriously struggling to compete on any measure of health.
For Years of Life Lost due to Premature Mortality, in comparison with the European average, the UK does worse in 2010 in ischaemic heart disease, chronic obstructive pulmonary disease, lower respiratory infections, breast cancer, other cardiovascular and circulatory disorders, oesophageal cancer, pre-term birth complications, congenital anomalies and aortic aneurysm.
The study, funded by the Bill and Melinda Gates Foundation, indicates that in the UK thousands are losing their lives prematurely.
For example, Australia boasts an average life expectancy at birth which is now 1.6 years more than the UK. In other words – everyone single one of us here in the UK is potentially losing roughly a year and a half of precious life in comparison with Australians.
The enigma is that there are many reasons to presume the UK NHS system has advantages over other countries.
For example, this study points out nearly complete population registration with the NHS provides for the systematic identiﬁcation of all patients with high blood pressure. Those people at high risk for ischaemic heart disease can be targeted in the UK with preventive measures in a way most other countries cannot.
Yet the UK continues to do worse than the European average on premature mortality due to heart disease.
But there are also risk factors outside of the control of the NHS – such as smoking, obesity, alcohol and drug use – lifestyle and cultural factors, that are causing a massive burden of disease, especially among young people. The NHS has been partly charged in recent years with the task of engaging with patients in order to practice prevention and improve lifestyle choices – yet it appears to be struggling here too.
The British affection for the NHS and deep attachment to it has reached the levels of a secular religion. For all the energy directed into checking up on the staff by the Government and the management, for all the boxes ticked, we still seem to be missing the most obvious targets.
We need to ask more painful questions of the NHS and ourselves. We need to see the connection between lifestyle choices we make, and the burden we place on our precious shared NHS.
If we are to share the NHS successfully with each other, then we have to look after ourselves, and it much better.