In England the gap in life expectancy between the most and least deprived areas is around a decade, and in healthy life expectancy about twice that. Those figures are the best-known in the field. The question is the trend behind them. Through the 2010s the gap widened in the United Kingdom, as mortality in the poorest areas stalled or rose while it kept falling elsewhere. The pandemic then hit the same areas hardest. The United States shows the same shape, with larger numbers and a sharper racial dimension. Continental Europe is more varied. Nordic countries have small gaps that are nonetheless growing, and Southern Europe's are smaller still. The measurement is robust, as area deprivation, income and education all give the same ordering. The mechanisms are contested. The pertinent question is how much is behaviour, how much circumstance and how much access to care, and whether the widening reflects austerity, drug deaths or the changing composition of who lives where. The direction is clear. The explanation and the response are not.
The gap shows most sharply at working ages. In the United Kingdom the number out of the labour force because of long-term sickness rose after the pandemic to a record, and claims for disability benefits rose with it. The conditions cited are increasingly mental rather than physical, and the rise is steepest among the young and the most deprived. The pertinent question is whether that reflects more ill health, more recorded ill health, or a change in what the benefit system rewards. Surveys, hospital data and prescribing do not move together. In contrast, working-age mortality in the United States rose before the pandemic, and several European countries show neither pattern. Healthy life expectancy at working ages has stalled or fallen in the United Kingdom, and in the most deprived areas of most countries. Those are the ages affected by rising pension ages. The natural experiments created by pension reforms are only now producing health results by occupation, and those results differ by occupation.
