Thursday, November 30, 2017

Population grows but a million lives lost

The UK population is projected to increase by 3.6 million (5.5%) over the next 10 years, from an estimated 65.6 million in mid-2016 to 69.2 million in mid-2026. The UK population is projected to pass 70 million by mid-2029 and be 72.9 million in mid-2041.

Over the next 10 years, 46% of UK population growth is projected to result from more births than deaths with 54% resulting from net international migration.

In the 10 years between mid-2016 and mid-2026, will witness:
  • 7.7 million people being born
  • 6.1 million people dying
  • 5.2 million people arriving in the UK
  • 3.2 million people emigrating
The UK’s projected growth of 16% between 2015 and 2040 is well above the EU average. It is also the highest growth rate among the four largest nations in the EU – over the same period France’s population is projected to grow by 10% and Germany’s by 4%, while Italy’s population is projected to see a slight population decline.

There will be an increasing number of older people; the proportion aged 85 and over is projected to double over the next 25 years. In mid-2016 there were 1.6 million people aged 85 and over; by mid-2041 this is projected to double to 3.2 million. The Old Age Dependency Ratio (number of people of pensionable age for every 1,000 of working age) is projected to rise from 305 in mid-2016 to 370 in mid-2041, even with the scheduled increases in State Pension age. If State Pension age were to remain at mid-2016 levels the ratio in mid-2041 would be 442.

In their projections, published in October 2017, statisticians at the Office for National Statistics (ONS) estimated that by 2041, life expectancy for women would be 86.2 years and 83.4 years for men. In both cases, that’s almost a whole year less than had been projected just two years earlier. And the statisticians said life expectancy would only continue to creep upwards in future. Looking further ahead, a further one million earlier deaths are now projected to happen across the UK in the next 40 years by 2058. It means the century of steadily improving life expectancy in the UK is now over.

Life expectancy is most commonly calculated from birth. It is the average number of years a new-born baby can expect to live if the mortality rates pertaining at the time of their birth apply throughout their life.
In 1891, life expectancy for women in England and Wales was 48 years. For men it was 44. By 1901, on average, women lived to 52 and men 48. 1921 saw women living to 60 and men to 56. 30 years later, in 1951 women lived to 72 and men to 66.  In 1971 women lived to 75 and men to 69. 1991 had women living to 79 years and men to 73. 
By 2011, women in England and Wales were living to 83 years and men to 79 years. Since then no improvement. Life expectancy flat-lined. The stagnation in life expectancy is no longer a “blip”. It is the new norm. 
The latest figures for the period 2014 to 2016 were published in September 2017. Women can now expect to live to 83.06 and men to 79.40. For the first time in over a century, the health of people in England and Wales has stopped improving. The situation in Scotland was even worse than that in England and Wales
Life expectancy for women in the UK is now lower than in Austria, Belgium, Cyprus, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, The Netherlands, Norway, Portugal, Slovenia, Spain and Sweden. The league position for men in the UK is comparable. In almost all other of the most affluent countries, apart from the US, people live longer lives than in the UK, often many years longer.
 To calculate the figure of a million lives lost you have to subtract all the future deaths now predicted in the 2017 report, which was based on data from 2016, from those projected two years ago, based on a 2014 projection.
Every year up until at least the year 2084, people across the UK are now expected to die earlier. Already in the 12 months between July 2016 and June 2017, we calculated that an additional 39,307 more people have died than were expected to die under the previous projections. Over a third, or 13,440, of those additional deaths have been among women aged 80 or more who are now dying earlier than was expected. But 7% of these extra deaths in 2016-17 were of people aged between 20 and 60: almost 2,000 more younger men and 1,000 more younger women in this age group have died than would have if progress had not stalled. So whatever is happening is affecting young people too.
The projection that there will be a million extra deaths by 2058 is not due to the fact that there will simply be more people living in the UK in the future. By contrast, the ONS now projects less inward migration. The million extra early deaths are not due to more expected births: the ONS now projects lower birth rates. The extra million early deaths are simply the result of mortality rates either having risen or having stalled in recent years. The ONS now considers that this will have a serious impact on life expectancy in the UK and population numbers for decades to come.
If you are in your forties or fifties and live in the UK this is mostly about you. Almost all of the million people now projected to die earlier than before – well over four-fifths of them – will be people who are currently in this age group: 411,000 women and 404,000 men aged between 40 and 60. Child, infant mortality and still births have also not improved recently 
Whatever has happened it is not a sudden worsening of the healthy behaviour of people in the UK. It is not a sudden rise in obesity or some additional carelessness about looking after ourselves. Neither obesity nor any other human behaviour linked to poor health such as smoking or drinking alcohol has seen a sudden rise. The most likely culprit, by far, is austerity, including the effect of the cuts to social and health care services.
The 2010 Conservative-Liberal Democrat government led to the loss of care support to half a million elderly people by 2013. NHS budgets stalled or fell slightly in the years following 2010-11 and many old-age care homes went bankrupt. There was a rise in fuel-poverty among the old. Sanctions and cuts to disability benefits were introduced, alongside many more aspects of increased economic callousness. By 2016, cuts in welfare spending, especially to older pensioners had been linked to a rise in deaths – initially among elderly women and later older people in general living in poorer areas. Public health experts writing in the British Medical Journal called for an inquiry, but none came. 
 By summer 2017, Michael Marmot’s Institute of Health Equity was linking health services cuts to the rise in dementia deaths and the faltering national life expectancy. Researchers at Liverpool, Oxford, Glasgow and York universities connected some of the stalling in health improvements to delays in discharging patients from hospital due to insufficient older adult social care. Earlier in the year, the Financial Times reported that the deceleration of previous rises in life expectancy was so rapid that it had cut £310 billion from future British pension fund liabilities. And this was just for a few of the larger pension schemes.
On November 16, an article in the British Medical Journal Open concluded that severe public spending cuts in the UK were associated with 120,000 deaths between 2010 and 2017. Just over a third of these occurred between 2012 and 2014 and almost none in 2010 or 2011. The rate of death due to austerity was rising and there was what is called a “dose-response relationship” between cuts and rising mortality. This term, commonly used as part of the evidence needed to establish that a medicine is beneficial, means that as you increase the dose of an intervention the responses to it rise at the same rate. It can also be used to indicate likely causes of harm. In this case it indicated that the more cuts there have been to public health, social services and benefits – particularly for people in old age – the more earlier deaths there have been in the UK. Cuts that prevent visits by social workers to elderly people reduce their chances of being found after a fall at home. Cuts that make it harder to rehouse someone who is currently in a hospital bed back into the community, result in hospital beds not being available for others.
The economist Simon Wren-Lewis who looked into the link between austerity and mortality  explained:
It is one thing for economists like me to say that austerity has cost each household at least £4,000: this can be dismissed with ‘what do economists know’? But when doctors say the policy has led to premature deaths, that is something else.”

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