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Contribution of health care and behavioural change to mortality risk

Funded by Legal & General
September 2006 to September 2009

Key contact: Professor Rosalind Raine
Project team: Professors Mel Bartley, John Bunker, Rosalind Raine (UCL); Dr Tarani Chandola (UCL); Drs Richard Mitchell and Catriona Macdonald (Edinburgh University); Professor David Blane (Imperial College, London); Martin Hewitt, Richard Willets (Institute of Actuaries); Joseph Lu (L&G); Professor Richard Wilkinson (Nottingham University); Madhavi Bajekal (ONS).

There is great interest in the contribution of medicine to improvements in population health. McKeown pointed out that most of the fall in infectious mortality occurred before the introduction of antibiotics and immunization and concluded that increases in living standards were probably most important. Critics have argued that he reasoned by exclusion and underestimated the impact of public health interventions, but Mckeown’s main point, namely, that clinical interventions made at best a modest impact has remained largely unchallenged for the period that he studied. The crux of the matter is whether this conclusion can be applied to the period post 1970 when medical technology became more effective and life expectancy at middle age began to increase. Recent estimates suggest that up to half the increase in life expectancy can be attributed to the impact of clinical interventions with behavioural change having a comparable effect.

This research will take forward this area of study in the following ways:

  1. It will extend the emphasis that some authors have placed upon coronary heart disease (CHD) to start from all cause mortality rates and it will then focus on the major causes of death. This will allow us to examine different patterns of decennial change during the period 1970-2005 for different diseases e.g. U-shaped for chronic obstructive pulmonary disease and hump-backed for pneumonia, compared with CHD’s falling mortality rate which accelerated with each decade.
  2. It will focus on the most dramatic contemporary health change, namely the increase since 1970 in life expectancy (LE) at middle age. During most of the 20th Century, LE increased due to falling mortality at younger ages, whereas LE at middle age changed little. But after 1970, LE at middle age increased by more than the rest of the century combined. Between 1981-2000, LE at age 50 (LE50) in England and Wales increased by 3.8 yrs among men and 2.6 yrs among women. The fall in mortality is of similar proportionate size for most causes of death and so it cannot easily be assumed that the cause specific factors for CHD apply with equal force to the other main causes of death.
  3. We will consider the full range of health behaviours (including tobacco smoking, diet, alcohol and exercise), as well as changes in health care and public health.
  4. We will investigate the unexplained gender and social class differences. While female LE 50 has increased steadily between 1901-2001 by about one year per decade, male LE 50 increased by 0.6 years per decade between 1901-1971, and then by 1.8 years per decade between 1971-2001. In addition, while LE 65 for men in social class V increased by 1.8 years between 1972/76 -1997/99, in the same period, LE 65 decreased by 0.1years in women in social class five, but increased by 3.3 years in men and by 1.5 years in women in social class.