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There have been two turning points in trends in life expectancy in England this century. From 2011, increases in life expectancy slowed after decades of steady improvement, prompting much debate about the causes. Then, in 2020, the Covid-19 pandemic was a more significant turning point, causing a sharp fall in life expectancy, the magnitude of which has not been seen since World War II. 

This article examines trends in life expectancy at birth up to 2022, the impact of Covid-19 on life expectancy, gender differences and inequalities in life expectancy, causes of the changing trends since 2011, and how life expectancy in the UK compares with other countries.

How has life expectancy changed over time?

Mortality in England and Wales has declined since the 19th century, leading to a long-term rise in life expectancy (see Figure 1). Males born in 1841 could expect to live to only 40.2 years and females to 42.3 years, mainly because of high mortality rates in infancy and childhood. Improvements in nutrition, hygiene, housing, sanitation, control of infectious diseases and other public health measures reduced mortality rates, increasing life expectancy to 56 years for males and 59 years for females by 1920.

The 20th century saw further dramatic improvements in life expectancy resulting from public health measures such as childhood immunisations, the introduction of universal health care, medical advances in treating adult diseases such as heart disease and cancer, and lifestyle changes, including a decline in smoking. By 2019, life expectancy at birth in England had increased to 79.8 years for males and 83.5 years for females (see Figure 2). However, the Covid-19 pandemic caused life expectancy in 2020 to fall sharply – by 1.3 years for males, to 78.5 years, and by 0.9 years for females, to 82.6 years – the same level as about a decade earlier. Life expectancy recovered partially thereafter as the pandemic subsided, rising to 79.3 for males and 83.1 years for females in 2022, although it remained below 2019 pre-pandemic levels.

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What's the difference in life expectancy between males and females?

Females have always lived longer than males, but the gender gap in 1841 (two years) was relatively small because of the high prevalence in the 19th century of diseases that killed both sexes indiscriminately. In the late 19th and early 20th centuries, the gender gap in life expectancy started to widen, peaking at 6.4 years by 1969 (seeFigure 1). Reasons for the widening gender gap included poor working conditions and smoking among males in contrast to improved life chances for females – for example, the lower risk of dying in childbirth and from tuberculosis, which affected women more than men. 

The gender gap narrowed from the 1970s, to 3.7 years in 2019, with mortality falling faster in males than females because of decreases in smoking and mortality from cardiovascular diseases.  However, in 2020 and 2021, the gender gap widened to 4.1 years because mortality rates from Covid-19 were higher in males than females; with the fall in Covid-19 mortality thereafter, the gender gap fell to 3.9 years in 2022.

Healthy life expectancy

For the three aggregated years 2020–22, although male life expectancy was 78.8 years, average healthy male life expectancy was only 62.4 years – ie, 16.4 of those years (21%) would have been spent in poor  health. Female life expectancy was 82.8 years, of which 20.1 years (24%) would have been spent in poor health. Although females live an average of four years longer than males, they spend a higher proportion and more years of their lives in poor health.

Moreover, healthy life expectancy in England in 2020–22 was lower than in 2011–13, when the data series began, falling by 0.8 years in males and 1.2 years in females during that time. So not only has life expectancy stalled, but males and females spend more years in poor health. As there had been minimal change in healthy life expectancy up to 2017–19, it is likely that the Covid-19 pandemic will have contributed to this fall, with delays in care for non-Covid conditions and an increase in long-term sickness following the pandemic being additional contributory factors. 

Similarly, disability-free life expectancy is almost two decades shorter than life expectancy, and is higher among males (61.8 years) than females (60.5 years).

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About one-third of the inequalities in life expectancy between the most and least deprived decile of areas are caused by higher mortality rates from heart and respiratory disease, and lung cancer in the most deprived areas. These conditions are caused largely by risk factors such as smoking and obesity, which are higher among more deprived groups and potentially preventable.

The gender difference in life expectancy is greater in more deprived areas: females live an average of 4.3 years longer than males in the most deprived decile of local authorities, compared with 3.3 years longer in the least deprived decile.

Socio-economic inequalities in life expectancy were widening before the Covid-19 pandemic, which has exacerbated inequalities further because of its disproportionate impact on deprived groups. Another notable feature is that life expectancy in the most deprived areas has fallen over the past decade, and was falling even before the pandemic. Between 2011–13 and 2020–22, males and females in the most deprived decile of local authorities saw their meagre pre-pandemic gains in life expectancy wiped out by the pandemic, with life expectancy falling by almost a year; in contrast, in the least deprived decile of local authorities, the larger pre-pandemic gains in life expectancy more than offset the smaller falls in life expectancy during the pandemic, so that life expectancy in 2020–22 was higher than in 2011–13 by about 0.3 years.

Geographical inequalities

The deprivation divide in life expectancy and healthy life expectancy reflects a persistent north–south divide in England, with people in the more affluent south having longer life expectancy on average and with more years in good health than those living in the more deprived northern regions.

Life expectancy in 2020–22 was lowest in the North East and North West followed by Yorkshire and the Humber, and West and East Midlands, and highest in the South East, South West, London and the East. The gap in life expectancy between the highest (South East) and lowest (North East) regions was three years. The north–south divide in longevity has widened over the past decade.

The life expectancy gap was significantly wider for local areas within these regions. For example, in 2020–22, life expectancy was lowest in Blackpool (North West), one of the most deprived areas in England, and highest in Hart (South East), one of the least deprived areas; the gap in life expectancy between these areas was 10.3 years for males and 7.1 years for females, having widened from 8.4 and 5.6 years respectively in 2011–13.

As with life expectancy, there are wide geographical inequalities in healthy life expectancy in England. In 2020-22, healthy life expectancy in the North East was almost seven years shorter for males and six years shorter for females compared with the South East. People living in northern regions also spend higher proportions of their shorter lives in poor health.   

Ethnic inequalities

About 18% (11 million people) of the population of England and Wales is non-white, a rise from 14% in 2011. Ethnicity is not currently recorded at death registration, but following the disproportionate impact of Covid-19 on ethnic minority communities, the government has said that ethnicity recording will be introduced in England. However, by linking death records to 2011 census records to derive ethnicity, the Office for National Statistics (ONS) produced life expectancy estimates by ethnicity for England and Wales for 2011–14 for the first time.

The ONS data showed that despite higher levels of deprivation, male and female life expectancy in 2011–14 was higher for ethnic minority groups than for the white and mixed groups (see Figures 5 and 6). The pandemic had a disproportionate impact on ethnic minority groups, who experienced higher Covid-19 mortality rates than the white British group. Covid-19 mortality rates declined in all ethnic groups over the course of the pandemic, and by 2022 rates for ethnic minority groups were no longer higher than for the white British group. Although data on ethnic differences in life expectancy is not available for recent years, ONS data shows that, as in the pre-pandemic period, from 21 March 2021 to 31 January 2023, mortality rates from all causes of death were again lower for ethnic minority groups than for the white British group, despite their higher Covid-19 mortality earlier during the pandemic.

Lower mortality rates (resulting in higher life expectancy) for ethnic minority groups relative to the white British group may be due in part to the ‘healthy migrant effect’(whereby people who migrate tend to be in good health) and lower rates of smokingand alcohol consumption in ethnic minority groups, which may mitigate some impacts of socio-economic disadvantage. Compared with the white British group, most ethnic minority groups have lower mortality from cancer, dementia and several other leading causes of death, although mortality rates for some individual conditions (such as heart disease and diabetes) are highest in some ethnic minority groups.

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Inequalities among other groups

Some population groups have a significantly shorter life expectancy than the general population, for example:

• Life expectancy in people with serious mental illness is 15–20 years shorter than the average for the general population; this disparity is largely due to preventable physical illnesses.

• Men and women who are homeless at or around the time of their death live 31 years and 38 years fewer (respectively) than the average.

• People with learning disabilities have significantly shorter lives than people in the general population;  the median age at death of males and females with a learning disability is 20 and 23 years younger respectively than males and females in the general population.