Healthy Life Expectancy for All

People are living longer due to improvements in health care and a range of other life style improvements such as better nutrition, fewer people working in heavy or dirty industries, falling smoking rates, cleaner air and water and better housing conditions. However, many chronic health conditions are particularly associated with older age, so ensuring a healthier old age is an important concern.

Being in good health is, obviously, closely related to how well people retain their independence throughout their life, and particularly in old age. It will impact on how much formal and informal support and care they need, and will affect their ability to fully participate in their community and contribute to the local economy. Even before the Covid-19 pandemic, significant health inequalities affect the lives of people living in Wales. In 2016-17 and 2018-19, 23% of all people lived in relative income poverty, with 28% of children affected. The wider determinants of health such as housing, education, employment and environment may contribute to less healthy lives and factors such as smoking, poor diet, and a lack of physical activity are also influenced by mental well-being, which can be low if these determinants are poor. The effect of the Covid-19 pandemic has not affected everyone equally in Wales. Those over 65 years old have been particularly affected, disabled people, males, people from ethnic minorities and those from deprived backgrounds. ^[1]

The impact of staying at home and social distancing during the Covid-19 pandemic has had both a positive and negative impact on health status. The reduced transmission of Covid 19 will have benefited those who are more vulnerable due to its direct negative health effects. However, the lack of social contact has resulted in feelings of isolation and loneliness, worsening of mental well-being for the whole population (such as depression, anger, anxiety and feelings of confusion) and a worsening of mental health conditions. ^[2]

Life expectancy and the gap in life expectancy

For Conwy County Borough as a whole, average healthy life expectancy at birth is 64.9 years for males and 82.8 years for females. For Denbighshire, this is 63.4 years for males and 81.8 years for females.^[3]

Whilst, overall, the number of years spent in good health for males is above the Wales average for Conwy (and is improving, aside from a dip between 2016 to 2018), this is not the case for Denbighshire.^[4]

Published in 2020, “Health Equity in England: The Marmot Review 10 Years on”, suggest that life expectancy in England has slowed dramatically, almost grinding to a halt. Although the report was concerned with England, the report highlights that Wales, Scotland and Northern Ireland are faced with the same concerning issues; showing that life expectancy for men has declined in Wales and Scotland since 2013/15. This is certainly the case for males in Denbighshire.

Life Expectancy at age 65 for males, United Kingdom, 2001-2003 to 2016-2018
	2011-2013	2012-2014	2013-2015	2014-2016	2015-2017	2016-2018
United Kingdom	18.4	18.5	18.5	18.6	18.6	18.7
England	18.5	18.6	18.7	18.8	18.8	18.9
Wales	18.0	18.1	18.1	18.2	18.2	18.2
Isle of Anglesey	18.3	18.6	18.4	18.6	18.7	18.7
Gwynedd	18.7	18.9	18.7	18.6	18.6	18.9
Conwy	18.6	18.7	18.9	19.2	19.4	19.1
Denbighshire	18.0	17.7	17.7	17.7	17.9	17.9
Flintshire	18.1	18.4	18.4	18.5	18.5	18.5
Wrexham	18.2	18.1	18.0	17.9	18.1	18.3

Source: Office for National Statistics. Notes: Figures exclude deaths of non-residents

The review concluded:

“If health has stopped improving, then it’s a sign that society has stopped improving. When a society has large social and economic inequalities there are large inequalities in health. The health of the population is not just a matter of how well the health service is funded and functions, it is linked to the conditions in which people are born, grow, live work and age and inequities in power, money and resources – the social determinants of health.”^[5]

The Public Health Outcomes framework shows the gap in life expectancy at birth between the most and least deprived fifth for males and females.

As well as being determined by age, ill health is also influenced by experience of deprivation, and there is persistent health inequality within the areas. People living in the areas in the most deprived fifth of Conwy County Borough or Denbighshire not only have a shorter lifespan, but also spend less of it in good health compared to those living in the least deprived fifth.

There is a difference of 12 years of healthy life expectancy for males in Denbighshire’s most deprived areas when compared to the least deprived (the widest gap for the whole of Wales), and 6.5 years for women. The gap for men in Conwy is 6.9 years and 5.2 for women.^[6]

Within Conwy County Borough:

Female life expectancies are similar to, or below, the Welsh national average figures at birth and at age 65, except in more affluent areas of the County Borough where life expectancy at birth is 3 years higher.
Male life expectancies at aged 65 are better than the Welsh national average but at birth this is not the case for all areas within the county.
Men born in the most deprived areas have a 8.5 years less life expectancy at birth than those born in more affluent areas of the County, and are estimated to live for 4.2 years less than the Wales average.^[7]

Within Denbighshire:

Female life expectancies are similar to, or below, the Welsh national average figures at birth and at age 65.
Male life expectancies at aged 65 are worse than the Welsh national average but at birth this is not the case for all areas within the county.
Men born in the most deprived areas have a 14.5 years less life expectancy at birth than those born in more affluent areas of the county, and are estimated to live for ten years less than the Wales average.^[8]
Women born in the most deprived areas have a 7.3 years less life expectancy at birth than those born in more affluent areas. ^[9]

Achieving a reduction in health inequalities and maintaining health and well-being throughout life are two of the six strategic themes within the Welsh Government’s public health framework ‘Our Healthy Future’ and remain central to the ‘more equal Wales’ and ‘healthier Wales’ goals laid out in the ‘Well-being of Future Generations (Wales) Act.

Healthy places

Parks, open spaces, playing fields, woodlands, wetlands, road verges, allotments and private gardens are examples of green infrastructure while sustainable drainage systems, swales, wetlands, rivers and canals and their banks, and other water courses are often referred to as blue infrastructure. Access to, and engagement with, this natural environment is associated with positive health outcomes, including improved physical and mental health, and reduced risk of cardiovascular disease and other chronic conditions. Access to recreational infrastructure, such as parks and playgrounds, has been found to be associated with reduced risk of obesity among adolescents and increased physical activity levels. Similarly, park improvements can increase visits /use and physical activity levels of children and older people. Living near and using green spaces, can improve health, regardless of social class. Access to Green Infrastructure can increase social participation among older adults.

Air pollution has a significant effect on public health, and poor air quality is the greatest environmental risk to human health in the UK. Costs to society are estimated at more than £20 billion every year and exposure to air pollution reduces life expectancy and can exacerbate asthma, affect lung function and increase respiratory and cardiovascular hospital admissions and mortality. There is evidence of 2,000 deaths in Wales alone, which amounts to 6% of total deaths (Public Health Wales, 2016a). The effects of air pollution disproportionately affect those in deprived areas. Also see Clean Air Plan for Wales for more information.

27% of people in urban areas of Wales and 18% in rural areas are affected by noise pollution.^[10]

[1] Protecting our Health: Our response in Wales to the first phase of Covid-19: Chief Medical Officer for Wales, Special Report

[2] Source: “A Health Impact Assessment of the staying at Home and Social Distancing Policy in response to the Covid 19 pandemic” Public Health Wales

[3] Public Health Outcomes Framework 2015-17. Note: life expectancy at birth is for babies born in that period, and life expectancy at age 65 is the additional years of life that someone aged 65 would expect to have.

[4] Source: Public Health Wales Observatory, using PHM, MYE and APS (ONS).

[5] Marmot, M., Allen, J., Boyce, T., Goldblatt, P. and Morrison, J. (2020). Health Equity in England: The Marmot Review 10 Years On. https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on

[6] Source: Gap in life expectancy at birth between the most and least deprived fifth, 2015 to 2017. Public Health Wales Observatory, using PHM & MYE (ONS), WHS & WIMD 2014 (WG)

[7] Source: Life expectancy at birth (years), males and females, Conwy MSOAs, 2013 to 2017. Public Health Wales Observatory 2015 to 2017, using PHM and MYE (ONS).

[8] Source: Life expectancy at birth (years), males and females, Denbighshire MSOAs, 2013 to 2017. Public Health Wales Observatory 2015 to 2017, using PHM and MYE (ONS).

[9] Source: Public Health Wales Observatory 2015 to 2017, using PHM and MYE (ONS).

[10] Welsh Government. 2019a. The National Survey for Wales [online]. Available from: https://gov.wales/national-survey-wales-results-viewer

Over time, since 2001, life expectancy is improving for all groups in Conwy County Borough. For Denbighshire, though, while general life expectancy is improving over time, it is improving at a slower rate and less consistently than in Conwy County Borough and when compared to Wales.

Multiple Deprivation in West and South West Rhyl is among the highest in Wales and encompasses worklessness, low incomes, and poor educational outcomes amongst other things. Unfortunately, Rhyl West 1, Rhyl West 2 and Rhyl South West 2 are identified by the Wales Index of Multiple Deprivation as areas of ‘deep-rooted’ deprivation. Areas with ‘deep rooted deprivation’ are those that have remained within the top 50 most deprived – roughly equal to the top 2.6% – small areas in Wales for the last five publications of WIMD ranks.

The health domain of WIMD measures lack of good health. Of all the WIMD domains, the highest number of areas in Rhyl in the 10% most deprived areas was in this domain; clearly demonstrating the relationship between socio-economic disadvantage and health and well-being.^[1]

Despite overall increases in life expectancy, the gap between the proportion of life expected to be spent in good health in the most and least deprived areas has shown no clear sign of reducing in the last 10 years.

Chronic health conditions have a big impact on healthy life expectancy. We previously noted, in our last assessment of well-being, that the number of people with chronic conditions who were registered with GPs in Conwy County Borough or Denbighshire increased in the five years between 2011 and 2016. We do not have new data for our two areas, in terms of increases but we can see that a significant number of patients are registered with hypertension in particular, higher than the national average.^[2]

[1] Denbighshire County Council (2020). Welsh Index of Multiple Deprivation 2019: Results for Rhyl. Un-published report.

[2] Percentage of patients registered as having a chronic condition, Wales, Betsi Cadwaladr UHB & Conwy & Denbighshire Primary Care Clusters, 2019. Source: QOF

At the Wales level, while estimates vary significantly, prior to the COVID-19 pandemic, life expectancy increases in Wales looked set to continue, although the rate of increase has slowed over the past decade. However, this increase in life expectancy has not translated in to a higher ‘healthy life expectancy’ (the years someone spends in good health), which has decreased slightly in the past decade. This trend is driven, in part, by inequalities faced by those living in the most deprived areas in Wales, who are most likely to report ill health. Ageing populations are also more associated with higher levels of chronic health conditions and ill health. However, older people tend to provide unpaid care and make valuable contributions to local communities.^[1]

Positively, life expectancy is predicted to continue to improve (see our ‘ageing well’ and ‘increasing pressure on health and social services’ topic for more information). If past trends continue, it is predicted that by 2039 those aged 65 and over will make up 33% of the population, whereas those aged under 25 will make up only 23% (currently those aged 65+ make up 23% of the population, and those aged under 25 = 27%).^[2] Because most chronic health conditions are associated with older ages, we can expect the prevalence of chronic illnesses to increase in the same period. Improved life expectancies also mean that people with complex needs are living longer than ever before. As people live longer, the cases of dementia will continue to rise. This could lead to increased demands on health and social care services, and on unpaid carers.

The long term upward trend in the proportion of people who are overweight or obese is also likely to cause a rise in chronic health problems, and this will impact on healthy life expectancies in the future.

Because the rate of improvement in healthy life expectancy has not increased as quickly as overall life expectancy, there is a danger that changes in state pension age will lead to a situation where instead of people retiring there will be more people accessing Universal Credit benefit as they are not well enough to remain in the workforce.

[1] Welsh Government (2021). Future Trends Report Wales. https://gov.wales/sites/default/files/publications/2021-12/future-trends-report-wales-2021-narrative-summary.pdf

[2] Welsh Government 2018-based sub national projections, principal projections

People are concerned about child poverty, and the extent to which the public sector is working to improve the quality of life for people and children in poverty. Child hunger is a particular concern for people and they want to understand the root causes for hunger. People also want to ensure we ask those living in deprived areas to find out what they feel would improve their lives.

Homelessness is seen as a factor in deprivation and so too housing quality. Poor housing has been highlighted by people as having a causal relationship with lower life expectancy.

People would like to see more investment in factors that support young people’s well-being:

Investment in activities for young people e.g. community projects, young people’s exercise classes, youth clubs (so young people have a place to go e.g. make them more attractive with better activities, more publicity so young people know about them)
Support to improve young people’s mental health, specifically following the Covid-19 pandemic
Young people more involved in council decision making
Leisure centre and facility improvements to attract young people e.g. better clubs, classes that are well publicised and targeted to young people.

People identified those with disabilities, including learning difficulties, and older people as people they feel should be supported, in particular to reduce feelings of isolation and loneliness. They thought that there could be ways of building generational links through younger volunteering to support older people.

The need to support healthy lifestyles was also raised, particularly in respect of tackling obesity crisis, through increased leisure opportunities, partnership working and by building on our active travel network.

Years of austerity has adversely affected the social determinants that impact on health in the short, medium and long term and will affect the lives of our children born and growing up under its effects. To what extent are all our communities resilient to negative factors affecting their well-being?

Conwy & Denbighshire Public Services Board

Healthy Life Expectancy for All

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