Q&A: European life expectancy

IHME Collaborator Dr. Nick Steel, shares the latest findings on life expectancy in Europe. Public policies to address risk factors like high cholesterol and blood pressure will be needed to improve population health.

This transcript has been lightly edited for clarity

Why was this research into European life expectancy undertaken?

We undertook this research into European life expectancy because decades of steady improvement in life expectancy in Europe appeared to slow around 2010, 2011, well before the COVID-19 pandemic. And we wanted to know what was causing these changes and, most importantly, the causes of the causes, if you like, the underlying changes in exposure to harmful risks in different European countries. And this is important because it shows what can be done to improve life expectancy again. We wanted to know which countries had done better with life expectancy and what’d they done, and what could other countries that hadn’t done so well learn from that.

And we found that the causes of deaths that were responsible for this were cardiovascular conditions and neoplasms, or cancers. So, basically, heart disease and cancer, and improvements in those conditions had slowed in most countries. And that that was what was underpinning this slowdown, the stalling in life expectancy improvements up until 2019.

What behaviors lie behind the slowing of improvements in cardiovascular disease and cancer?

This stalled life expectancy was linked to the causes of cardiovascular disease and cancer, which are primarily risks from poor diet and physical inactivity, from rising body mass index, or obesity, in plain language, and stalling improvements in more upstream, if you like, more biomedical risk factors we see, like [high] blood pressure and high cholesterol. So those are the well-known risk factors that are driving the problem.

How do you explain the slowing in life expectancy improvements seen since 2011?

So, if we look at the chart, what it’s showing us is life expectancy at birth, for both sexes combined, men and women combined, from 1990 along the horizontal axis, from 1990 up to 2021, by country. And the countries are ordered by their life expectancy in 2019, with Scotland in the top left having the worst life expectancy, and Italy, in the bottom right, having the best life expectancy in 2019. And we chose 2019 just because it was the last life expectancy before the COVID-19 pandemic.

And we can see that I’ve put two vertical lines on these charts. There’s a dotted blue line at 2011, which is the year when, on average, there was a change in trend in improvements in life expectancy for all of these countries, when we put them all in the pot together, as it were. And then in 2019 is the red line.

What I’d like to do is take a couple of examples. And perhaps Scotland, inevitably, is the country up in the top left, that has fared poorly, with Norway, which is, you know, we often look at the Scandinavian nations – they always seem to be doing well on health. And, again, this is no exception – Norway, one of the highest life expectancies in these countries. And it didn’t experience the same dip. So, what we did was we looked at risk factor exposure and at different long-term policies in these countries to try and see if there were any associations or links where we could look at policies and think, this is what governments need to do if they want a life expectancy chart that looks more like Norway and less like Scotland.

These findings do suggest a way forward for countries wanting to get back on track to improve life expectancy. One of the surprising and interesting findings for us was the improvements we’ve seen throughout developed countries, particularly from better management of high cholesterol through statins and other interventions, and better management of blood pressure treatment, which has been a major concern for most of these countries, and very successful too. But these gains from better medical management have not managed to offset the harms that we’re seeing from obesity and poor diet, these more upstream population-based public health risk factors.

What differences between public health in Norway and in Scotland could explain the life expectancy gap?

Some examples of things Norway have done, they’ve had decades-long initiatives on diet. They’ve had a sugar tax since 1922. They’ve worked on salt reduction in food with the industry since the 1980s. They’ve also worked on health care. So they’ve had national policies on cancer diagnosis and treatment activity. They’ve had national guidance on standardized approaches to prevention. And these have been followed with a continued reduction in high blood pressure. So those are some of the things Norway have done.

If we compare Scotland, Scotland has much lower rates of physical activity than Norway. They have stalled reductions in high blood pressure. They’ve had a very light touch to improving food knowledge, which has led to very, very little change in the proportion eating the recommended, you know, famous five portions a day of fruits and vegetables. On top of that, there’s been austerity for 20 years or so. And by austerity, I mean reduced public funding for health and social care. And that has been shown in numerous studies to be linked to raised mortality for a variety of factors.

So, the message is that long-term public policies are needed to reduce those risk factor exposures and improve population health. So I think what this work shows is that prevention is the cornerstone of a healthier society, as we’ve heard a lot and will be hearing again. But here’s some strong evidence that actually supports that idea and shows where, particularly, prevention efforts should be targeted. And I think we particularly need some bold government action to reduce this population exposure to harmful diets and low physical activity, in particular.