5 March 2013 Last updated at 13:20 GMT
UK 'fares badly in European health league table'
By Michelle Roberts
Health editor, BBC News online
The UK is lagging behind progress by similar countries on many indicators for ill-health, research suggests.
Health data over 20 years was compared with figures from 18 other countries in the research published in the Lancet.
Although average life expectancy has risen by four years since 1990, it says the UK needs to increase its strategies for tackling preventable problems such as heart disease and stroke.
Health secretary Jeremy Hunt has said he has a plan to address the lag.
The team of experts from the UK and the University of Washington in Seattle said the UK had a high burden of smoking-related illnesses, and greater priority should be given to reducing lung disease.
There was also a large rise in the number of recorded deaths related to Alzheimer's Disease.
Many deaths happen because the NHS is not good enough at preventing people getting sick or because treatment does not rival that seen elsewhere in Europe, says Mr Hunt who is responsible for health policy in England.
'Take up challenge'
He says up to 30,000 lives a year could be saved if England performed as well as its European neighbours.
Mr Hunt has announced plans to cut the death toll caused by the UK's five avoidable big killers - cancer, heart, stroke, respiratory and liver disease.
The big five avoidable killers
He said: "For too long we have been lagging behind and I want the reformed health system to take up this challenge and turn this shocking underperformance around."
He wants more people to go for regular health checks to spot diseases earlier and he is calling better joining up of NHS services so that patients don't get lost in the system.
In the 20 years from 1990 to 2010 that The Lancet study examined, average life expectancy increased by 4.2 years in the UK to 79.9 years.
But the premature death rate had hardly changed in the UK for both men and women aged 20-54.
Among the leading causes were heart disease, cancers and chronic lung disease.
These are linked to avoidable risk factors such as smoking, high blood pressure and obesity, which are still all too common in the UK, say Chris Murray, from the Institute for Health Metrics and Evaluation, University of Washington, USA, and colleagues who carried out the analysis of global data.
But progress is being made on conditions like diabetes, where the UK appears to be ahead of many of its European neighbours and other high-income countries like the US and Canada.
Prof Murray says the UK also faces fresh challenges, like its growing burden of disability from alcohol use and a 137% rise in deaths linked to Alzheimer's disease.
He and his team also acknowledged that making firm conclusions based on data from different countries was inherently problematic - not all record the same information and each has its own unique issues and policies that made interpretation and comparison difficult.
Leading UK health risk factors
Tobacco smoke (including second-hand smoke)
High blood pressure
Too little exercise
Source: Global Burden of Disease project
Recent figures from the Office for National Statistics suggested people in the UK were living in good health for longer.
But the UK still measures up poorly compared with other countries - it ranked 12 out of the 19 countries in the Lancet study.
Britons have 68.6 years of healthy life, whereas people in top-ranked country, Spain, have 70.9 years of healthy life on average.
In an accompanying editorial in The Lancet, Edmund Jessop from the UK Faculty of Public Health in London said the UK had done very well in many areas of public health - it had stronger tobacco control than any other country in Europe, for example - but there was still "plenty of room for bold action by politicians".
Public Health England, a new division of the Department of Health that will come into being in April 2013 along with the NHS organisational reforms, called the report a wake-up call.
Prof John Newton, chief knowledge officer of Public Health England, said: "Despite some enviable recent success, for example on smoking, we in the UK need to take a hard look at what can be done to help people in the UK achieve the levels of health already enjoyed by other some countries. Central and local government, charities, employers and retail businesses all have a part to play."
John Appleby, chief economist at The King's Fund, said: "Changes in health outcomes take place over many years, if not generations. The UK's health expenditure has increased significantly but has only recently caught up with the EU average so we may not yet be seeing the full effects of this additional spending."
Shadow Health Minister Andrew Gwynne said the findings show how the current government is failing patients and the NHS.
The Lancet, Early Online Publication, 5 March 2013
doi:10.1016/S0140-6736(13)60355-4Cite or Link Using DOI
UK health performance: findings of the Global Burden of Disease Study 2010
Prof Christopher JL Murray MD
The UK has had universal free health care and public health programmes for more than six decades. Several policy initiatives and structural reforms of the health system have been undertaken. Health expenditure has increased substantially since 1990, albeit from relatively low levels compared with other countries. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to examine the patterns of health loss in the UK, the leading preventable risks that explain some of these patterns, and how UK outcomes compare with a set of comparable countries in the European Union and elsewhere in 1990 and 2010.
We used results of GBD 2010 for 1990 and 2010 for the UK and 18 other comparator nations (the original 15 members of the European Union, Australia, Canada, Norway, and the USA; henceforth EU15+). We present analyses of trends and relative performance for mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 259 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to the UK. We assessed the UK's rank for age-standardised YLLs and DALYs for their leading causes compared with EU15+ in 1990 and 2010. We estimated 95% uncertainty intervals (UIs) for all measures.
For both mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010. Life expectancy in the UK increased by 4・2 years (95% UI 4・2?4・3) from 1990 to 2010. However, the UK performed significantly worse than the EU15+ for age-standardised death rates, age-standardised YLL rates, and life expectancy in 1990, and its relative position had worsened by 2010. Although in most age groups, there have been reductions in age-specific mortality, for men aged 30?34 years, mortality rates have hardly changed (reduction of 3・7%, 95% UI 2・7?4・9). In terms of premature mortality, worsening ranks are most notable for men and women aged 20?54 years. For all age groups, the contributions of Alzheimer's disease (increase of 137%, 16?277), cirrhosis (65%, ?15 to 107), and drug use disorders (577%, 71?942) to premature mortality rose from 1990 to 2010. In 2010, compared with EU15+, the UK had significantly lower rates of age-standardised YLLs for road injury, diabetes, liver cancer, and chronic kidney disease, but significantly greater rates for ischaemic heart disease, chronic obstructive pulmonary disease, lower respiratory infections, breast cancer, other cardiovascular and circulatory disorders, oesophageal cancer, preterm birth complications, congenital anomalies, and aortic aneurysm. Because YLDs per person by age and sex have not changed substantially from 1990 to 2010 but age-specific mortality has been falling, the importance of chronic disability is rising. The major causes of YLDs in 2010 were mental and behavioural disorders (including substance abuse; 21・5% [95 UI 17・2?26・3] of YLDs), and musculoskeletal disorders (30・5% [25・5?35・7]). The leading risk factor in the UK was tobacco (11・8% [10・5?13・3] of DALYs), followed by increased blood pressure (9・0 % [7・5?10・5]), and high body-mass index (8・6% [7・4?9・8]). Diet and physical inactivity accounted for 14・3% (95% UI 12・8?15・9) of UK DALYs in 2010.
The performance of the UK in terms of premature mortality is persistently and significantly below the mean of EU15+ and requires additional concerted action. Further progress in premature mortality from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities. The growing burden of disability, particularly from mental disorders, substance use, musculoskeletal disorders, and falls deserves an integrated and strategic response.
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