Britons are living fewer years in good health. New data from the Office for National Statistics, published this week, puts healthy life expectancy in the UK at its lowest level on record. Men born between 2022 and 2024 can expect 60.7 years in good general health — down 1.8 years from the previous period. For women, the figure is 60.9 years, down 2.5 years. Healthy life expectancy fell in 83% of local areas for men and 88% of local areas for women.
The immediate question is what this has to do with the NHS. The deeper question is whether the NHS is the right frame at all.
The Numbers Behind the Headline
The ONS figures are stark. In England, the South East still leads at 63.0 years of healthy life for men and 64.3 for women. The North East sits at the bottom: 57.0 and 56.9 years respectively. That gap — nearly six years of healthy life between regions — has widened. The gap between the best and worst local areas is now 14.7 years for men and 15.8 years for women.
These are not differences in access to hospitals. They are differences in the conditions in which people live. The same pattern appears across Europe. The OECD’s Health at a Glance: Europe 2024 documents that overall life expectancy across EU countries has broadly stabilised, but healthy life expectancy — the years lived without significant limitation or chronic disease — has not kept pace. People are not dying younger. They are becoming unwell earlier and carrying poor health for longer.
The critical insight from both the ONS data and the OECD analysis is consistent: the problem is not primarily medical. It is social.
Where Health Actually Comes From
The research on what determines population health has been stable for decades, even if policy has been slow to act on it. The social determinants of health — housing quality, income security, diet, air quality, access to green space, job conditions, social connection, and early childhood environment — account for a larger share of health outcomes than healthcare access does.
The Health Foundation’s research, cited in the BBC’s coverage of today’s data, is direct: the UK’s healthy life expectancy has fallen by roughly two years over the last decade. NHS waiting times play a role, particularly for conditions that worsen without timely treatment. But the structural drivers — austerity, stagnant wages, rising housing insecurity, cuts to public health budgets — preceded the NHS deterioration and would persist even if waiting lists were cleared tomorrow.
As explored in Europe Was Built for Winter. Now It Has to Survive Summer, the infrastructure people live in directly shapes their physical experience — heat, cold, air quality, movement. That infrastructure is health infrastructure, whether it is designed that way or not.
The City as Health System
The WHO European Healthy Cities Network has been making the same argument for three decades: cities are health systems. The decisions made by urban planners, housing authorities, transport agencies, and park departments shape population health in ways that clinical medicine cannot reach. A walkable neighbourhood improves cardiovascular health. A green space reduces stress and encourages physical activity. A well-ventilated, thermally comfortable home reduces respiratory illness. These are not soft benefits. They are measurable health outcomes.
The contrast between European cities that invest heavily in this framing — Copenhagen’s cycling infrastructure, Vienna’s public housing quality, Barcelona’s superblocks — and those that don’t is legible in health statistics. Healthy life expectancy tracks economic inequality, housing quality, and environmental exposure with remarkable consistency across OECD countries.
The OECD’s comparable data on healthy life expectancy at birth and at 65 shows Sweden, Ireland, and Malta near the top of European rankings for healthy years at birth, while Bulgaria, Latvia, and Slovakia sit at the bottom. The gap is not primarily explained by healthcare system quality. It maps closely onto broader social and economic conditions.
Prevention Is Cheaper Than Treatment
The economic logic is difficult to argue against. Poor health reduces tax revenues, increases demand for social security, raises pressure on healthcare systems, and depresses productivity. The Health Foundation and the OECD both quantify this: the cost of not investing in the social determinants of health is substantially higher, over time, than the cost of addressing them.
The UK government has committed to halving the healthy life expectancy gap and improving healthy life expectancy by five years by 2035. That goal requires not just NHS reform but housing investment, income support, public health spending, and urban design that actively supports physical activity and social connection. As the OECD frames it, the policy shift required is from treating disease to promoting healthy longevity — and that shift happens primarily outside hospital walls.
The Living Light research explored in Light Is No Longer Just Illumination adds a granular layer to this: even lighting design, calibrated to support circadian rhythms and reduce sensory stress, has documented effects on wellbeing. The built environment, at every scale from city planning to interior design, contributes to the conditions in which health is either built or eroded.
Health Is a Policy Choice, Not Just a Medical Outcome
Today’s ONS data arrives on the same day the BBC asks whether the NHS is part of the problem. The honest answer is: partly, for specific conditions where delayed treatment causes lasting harm. But the NHS did not create the housing crisis, wage stagnation, or cuts to local public health budgets that the data also implicates.
Health is built over a lifetime, in the conditions where people live and work. It accumulates through sleep quality, neighbourhood safety, food access, job stress, and social connection in ways that clinical intervention can partially address but cannot replace. The ONS numbers are not primarily a verdict on healthcare. They are a verdict on the quality of ordinary life — and on the policy choices that have shaped it over the past decade.
Key Sources
- BBC / ONS – We Are Living Fewer Years in Good Health: Is the NHS Part of the Problem?
- ONS – Health State Life Expectancies, UK: 2022 to 2024
- House of Commons Library – Inequalities in Life Expectancy
- OECD – Living Longer, Living Healthier? Promoting Healthy Longevity in Europe
- OECD – Healthy Life Expectancy at Birth and at Age 65
- WHO Europe – European Healthy Cities Network
- The Guardian – Findings on Healthy Life Expectancy in UK Shed Light on Its Deteriorating Health
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