Life expectancy in the UK is increasing. Across the country as a whole, men aged 65 can expect to live a futher 16.6 years and women a further 19.4 years if mortality rates remain the same as they were in 2005. Women continue to live longer than men, but the gap isdecreasing. In 1986, there was a differences of 4 years between male and femlae life expectancy at age 65 in the UK (13.2 and 17.2 years respectively). By 2005 this had narrowed to 2.8 years.
There are slight variations in life expectancy between the consituent countires of the UK. English men and women have the highest life expectancy at age age 65, at 16.8 and 19.6 years respectively. Scotland, at 15.5 and 18.4 yesrs respectively,has the lowest life expectancy at this age.
There are also more local variations. The southeast, southwest, and east of Englan have the highest life expectancies. Scotland, the northeast and northwest of England have the lowest.
A considerable amount of research has been conducted into regional variations in morbidity in the UK. The purpose of this research is to try to identify patterns of morbidity and the factors that contribute to these patterns with a view to targeting elements of healthcare to combat them. The results are far from clear; variations exist for some apests of morbidity, but not for tohers. The links between factors such as age, income, occupation, education and evironment and types of morbidity are also difficult to establish. They tend to based on speculative association rather than clearly associated casual links:
· Scotland has the highest rates of lung cancer, heart disease, strokes and alcohol and drug-related problems
· Wales has the highest incidence of breast, prostate and bowel cancer
· Northern Ireland has the highest rate of respiratory diseases
· England has the lowest rates for most of these
At regional level within England, a north-south divide in health is evident in some cases but not others. regions in the north have a higher mortality from heart disease, strokes and lung cancer. London has the highest rates for infectious diseases. Alcohol-related problems do not show a regional pattern. There is lottle variation in the incidence of bowel cancer, whereas breast and prostate cancer rates are higher in the south than the north. Age appears to be a factor for some aspects of morbidity. For example, in London heart disease incidence at ages 45-64 is below average, whereas the incidence of strokes for this age group is high.
A central finding of the research is that differences between countries and regions of the UK are less important than the wide differences that exist withn in regions. Urban areas tend to have higher levels of morbidity. Deprivation is often given as the main reason for this, but many areas of deprivation exist in rural parts.
Factors affecting regional variations
Socioeconomic status: In all regions of England babies born to fathers in social class 5 (unskilled and unemplyed) have higher infant mortality rate than those born to fathers in social class 1 (professional and managerial). Men aged 20-64 within social class 5 themsleves have higher mortality rates than those in social class 1. Furthmore, men in this class in the north of England have higher mortality and morbidity than those in the same class in the south of England. It is believed that the explanation for this lies in material deprivation particularly in terms of employment and housing. In addition, people in this social class display different behaviours toward health – more smoking, less uptake of healthcare, lower abilty to maintian health – and there is a cumulative effect of disproportionate numbers if disadvantaged people living in deprived areas. There is little geographic difference in mortality among those in social class 1.
Health-related behaviours: this may affect geographic variations in health. Levels of smoking vary considerably across the countries of the UK and within the regions. It is well known that those of lower economic status are more likely to be heavy smokers, and it is this that drives the pattern of lung cancer by deprivation. Levels of education may also be a factor. Alcohol conumpstion and diet vary only a little between regions and therefore are likely to have limited influecne on patterns of health. Attitudes to health, and in particular to exercise (again a reflection of education), may have an effect, but is far from straightforward to quantify the effects.
Environment: the relationship between the weather and various aspects of health has been studied in great detail. Relationships have been found between:
· Temperature, heart disease and pneumonia, but these are more associated with seasonal variations of temperature than regional variations
· Rainfall and heart disease, which may impact on regional variations
Seasonality of mortality has delined in the UK since the 1960s, possibly due to the increased use of central heating. Air pollution was responsible for high morbidity and mortality from respiratory diseases before this period, and has declined.
Other smaller-scale aspects of the environment have an influence on morbidity. The impact of background radiation may be a factor in some diseases. For example, soome rocks in the southwest of England contian high amounts of radon, and the radioactivity from this is thought to be responsible for higher risk of lung cnacer in the area. Issues of water quality are significant. Hard water is found in the south and east, soft water in the north and west. A consistent relationship has been shown between soft water and high levels of heart disease. Deficiencies and excesses of certain trace elements in water are known to be harmful. Excesses of nickel and cadmium, mercury and lead are hazardous and high concentrations of aluminium in water have been suggested as an explanation for the geographic distribution of Alzheimer disease.
Age, gender and wealth also play a role in the varations in health.