What’s Going On With European Life Expectancy?

Last month we asked why life expectancy in the United States has not kept up with other wealthy countries. While European countries have fared better, they have not been immune from the slowdown in life expectancy growth. During the 2010s, the steady increase in life expectancy that we came to expect over the course of the last century faltered in most of Europe. But why? And can we learn anything from those countries that did manage to maintain the existing life expectancy trends? A study published in The Lancet aims to answer those questions.

Comparing Countries: Winners and Losers

Using data from the Global Burden of Diseases study, the largest ever study of global health, disease and injury, researchers compared trends across European countries for life expectancy at birth. This is the number of years that a newborn infant will live on average if they are exposed to the same age-specific death rates as exist at their time of their birth. As expected, gains in life expectancy between 2011 and 2019 were nearly universally slower than between 1990 and 2011, though the actual rates of gain varied between countries. There was only one exception to this rule: Norway, where life expectancy increased at a slightly more rapid pace between 2011 and 2019 than it did in the previous two decades. On average, Norwegians gained 0.03 more years of life per year between 2011 and 2019 than they did between 1990 and 2011.

Though life expectancy gains did slow down, Denmark, Belgium, Sweden and Iceland were among the least affected. The biggest ‘losers’ were UK members, with England specifically suffering the largest slowdown, gaining 0.18 fewer years of life expectancy per year between 2011 and 2019 than between 1990 and 2011.

Explaining The Gap

So, why were some countries able to improve or mostly maintain life expectancy gains while others floundered? As in the case of the US study, the outcomes of the COVID pandemic may provide us with a bit of a clue. When the researchers looked at life expectancy losses during the pandemic, they found that countries that suffered the greatest life expectancy slowdowns between 2011 and 2019 tended to lose the most life expectancy outright during the pandemic, and vice versa.

Another clue comes from looking at risk factors for cardiovascular disease. Reductions in cardiovascular deaths were one of the main drivers for increasing life expectancy prior to the pandemic, and part of this was down to reductions in LDL cholesterol and systolic blood pressure, both major risk factors that had been decreasing prior to 2011. However, after 2011, many countries saw this trend reverse.

The authors suggest that the common factor tying these observations together is better general public health, possibly due to government policy. Countries with resilient, more accessible healthcare services and with strong drives to promote general public health (especially among the least wealthy) not only helped to preserve upward trends in life expectancy, but also resulted in a population that was better able to withstand COVID-19. The authors point to examples such as Norway’s long-standing sugar tax and drive to reduce salt in foods while improving health education, alongside efforts in several countries to improve early detection cancers. By contrast, significant cuts to health and welfare spending are likely to have contributed to life expectancy slowdowns.

The Way Forward

The conclusions of this research might seem obvious, but there’s an important distinction to be made here between life expectancy gains from improving medical treatments for diseases, and life expectancy gains from improved general health and reduced exposure to disease risk factors. Throughout the 20th century, the former has been a very effective way of improving human life expectancy because most chronic diseases of ageing had no effective treatment options, making them death sentences. However, as medicine is able to delay mortality from these diseases for longer and longer, it yields diminishing returns because people increasingly die with multiple age-related diseases at the same time. Even if we were to cure all cancer tomorrow, it has been estimated that life expectancy would only increase by a few years, as many people who die of cancer would have died of something else soon after.

By contrast, reducing one’s exposure to certain risk factors can simultaneously reduce the risk of most age-related diseases. Improved diet and exercise not only extends lifespan, but also maintains quality of life for longer – even if a disease treatment allows you to live a mostly normal life, it is preferable to not get the disease in the first place.