A longer life in sickness not in health

Social trends: Medical advances are increasing Britons' life expectancy without reducing risk of illness or disability in old age

LIZ HUNT

Health Editor

British men and women are living longer but their extra years of life may be far from productive, marred by poor health and disability, according to new research.

In contrast to steady increases in life expectancy over the past 20 years, healthy life expectancy - the number of years people can expect to enjoy good health - has stayed the same or risen only slightly.

A report from the Office of Population Censuses & Surveys (OPCS) says that for men aged 65, healthy expectancy remained almost constant between 1976 and 1992 at about seven years. For women aged 65, there was an increase of just one year between 1988 and 1992 from 9 to 10 years.

Karen Dunnell, an OPCS health statistician, said that although men reaching pensionable age can now expect to live until 79 and women to 83, the findings had serious implications for the planning of health and social care. The "extra years of life gained by the elderly are extra years with a disability, not extra years of healthy life", she says.

Overall, the report, "Are we healthier?" in the winter issue of Population Trends, produces conflicting data on changes in the general health of the population over a 20-year period.

There are indications of a decline in mortality from all causes for those aged under 20 and 45 and over. But this is countered by little improvement in mortality from all causes for those aged 20-44.

Deaths from heart disease are falling, while deaths from stroke have declined dramatically. However, there is little change in cancer fatalities overall, despite improvements in deaths from stomach, bladder, pancreatic and rectal cancers in men, and cervical and bowel cancers in women.

Lung cancer deaths in men - which account for a third of all male cancer deaths - have fallen. In women, deaths from the disease appear to be levelling off after increases in recent years related to the fact women took up smoking after men.

Bowel, prostate, and oesophageal cancer deaths in men, and bladder cancer deaths in women, have increased. Breast cancer deaths, after climbing slowly, are declining. This may be because of the increasing use of the drug tamoxifen and possibly because of the wider availability of breast screening.

Widespread improvements in dental health are reported; the number of children with decayed teeth at all ages fell from almost 60 per cent in 1973 to less than 30 per cent in 1993.

The report confirms the growing number of obese people despite health education efforts to change eating habits. In 1980, 6 per cent of men aged 16 to 64 were obese; by 1993, the figure had risen to 13 per cent.

In women, obesity doubled from 8 per cent in 1980 to 16 per cent by 1993. The number of men who are overweight has risen from 33 per cent in 1980 to 43 per cent in 1993. For women, there has been an increase from 24 per cent to 30 per cent.

Other behaviours related to poor health, including smoking and alcohol consumption, also appear resistant to health advice. Among 16- to 19-year-olds whose parents are semi- or unskilled workers, almost 50 per cent of girls and 33 per cent of boys smoke.

In families from skilled backgrounds, 29 per cent of girls smoke and 28 per cent of boys. Where the parents are professional, 21 per cent of boys smoke and 22 per cent of girls are smokers.

Alcohol consumption stabilised in men with the number drinking above the weekly recommended limit of 21 units set at around 27 per cent (1992). But in women, the proportion drinking 14 units rose 2 or 3 per cent between 1984 and 1992 and now stands at 11 per cent.

Ms Dunnell concluded that at a simple level it appears people are healthier because of improving mortality rates and greater life expectancy. "However, surveys of reported and measured health status suggest there is no comparable, general improvement in health."