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Shortchanged: Why British Life Expectancy Is Falling

HARTLEPOOL, England — Britons are no longer living longer than before. Just ask Callum Hills.

His father died of a heart attack last year at age 52. Mr. Hills had found him stricken on the floor in the middle of the night, and today is still haunted by his memory.

“I keep having dreams, and he’s in them,” said Mr. Hills, a thoughtful and articulate 23-year-old.

While attention is riveted on the Brexit turmoil in Westminster, with dire forecasts of possible chaos, food shortages and recession, a dispiriting trend is already visible in struggling towns and cities across the nation.

For the first time in modern history, Britain’s gains in life expectancy have stalled — at 79.2 years for men and 82.9 years for women for the years 2015 to 2017. That is better than the United States, but Britain is slipping down the ranks in Western Europe.

In 1841, life expectancy in Britain was around 40 for men and 42 for women, and its rise through improvements in infant mortality, sanitation, nutrition and medical care became a symbol of progress. In recent times, the figures had generally improved by about three years every decade.

But no longer.

Alcohol and drug abuse, poor diet, obesity, smoking and a lack of exercise have taken their toll, increasing the risks of cancer, heart disease and diabetes. Older people are dying prematurely, their conditions worsened by isolation and depression, experts say.

ImageCreditMary Turner for The New York TimesImageCreditMary Turner for The New York Times

Underlying many of the problems, they say, is the government’s austerity program, which was instituted after the 2008 financial crisis and has eaten away at funding for social programs, transportation and other things that might counter the negative trends.

Things have probably not been helped by the chaos in Parliament over Brexit, which has forestalled efforts to come to grips with the growing problems.

While the rate of improvement in life expectancy had long slowed, “2010 marked a turning point in long-term mortality trend,” according to the King’s Fund, a health research institute. Across the country, mortality rates in the first few months of 2018 were higher than in any quarter since 2009.

Among British cities, Hartlepool (pronounced HART-lee-pool), a proud seafaring and manufacturing town battered by deindustrialization, has suffered one of the largest drops in life expectancy. It has the second-highest stroke rate in its region, its death rate tied to drug abuse recently tripled, and its smoking rates are much higher than the national average. Statistics on deaths from cancer and cardiovascular, liver and respiratory disease are troubling.

The average life expectancy for men in Hartlepool was 76 years and one month from 2015 to 2017, fully a year and a half less than in 2011-13. For women, the figure of 81 years and four months ticked up slightly in the most recent set of statistics, but is still lower than it was in 2011-13 or 2013-15.

In the town’s pockets of poverty, some lives are ending very prematurely. Gemma Sampson, the vicar at St. Aidan’s Church, said that two regular users of the church’s food bank have died since it opened in 2017.

ImageCreditMary Turner for The New York TimesImageCreditMary Turner for The New York Times

One was a 56-year-old man who lay undiscovered in his apartment for six days. The other was a homeless woman who had slept in a parking lot, got help with accommodations but disappeared and was later found dead. She was 43.

Such cases are extreme, but the broader trend has upset long-running assumptions. At the sharp end of this is one of Britain’s most cherished, if creaking, institutions: the National Health Service, which many see as an efficient health care provider, particularly by comparison with the United States.

But some wonder whether it might, inadvertently, be part of the problem. The N.H.S. focuses more resources on acute care than on preventive measures, mental health and early screening for cancer and other conditions. That, said Michael Marmot, professor of epidemiology at University College London and director of its Institute of Health Equity, reinforces a tendency to favor medical procedures over efforts to combat obesity, smoking, and drug and alcohol dependence.

“We need to fund our N.H.S., but let’s also talk about the health of the population,” Professor Marmot said. “The causes of premature death are an unhealthy diet, drinking, lack of exercise, et cetera. But the causes of the causes are the conditions in which people are born, grow, live, work and age.”

Several factors influence life expectancy, including an individual’s genetic makeup, inherited disposition to addiction or conditions like diabetes, and behavior.

But the way families, communities and governments shape or mitigate those tendencies matters, too.

ImageCreditMary Turner for The New York TimesImageCreditMary Turner for The New York Times

The 2010 turning point in mortality statistics coincided with the aftermath of the financial crisis, as Britain reined in public spending.

Danny Dorling, a professor of geography at Oxford University, argues that “the link with austerity is not easy to correlate, but it is incredibly strong.”

Hartlepool’s representative in Parliament, Mike Hill, agrees. “There is no doubt that austerity has hit Hartlepool, and that there is a connection with life expectancy,” said Mr. Hill, a member of the opposition Labour Party.

Hartlepool has had to cut around 20 percent of its budget of 100 million pounds, about $120 million, and shed about 500 employees. Local officials say the town has dipped into reserves and increased local property taxes, but acknowledge some cutbacks in programs.

Others see austerity as an aggravating factor in a complex picture of unhealthy lifestyles compounded by poverty, lack of opportunity and hopelessness.

In Hartlepool, the expected life span in the most deprived areas was far shorter than in the most affluent areas — 11.7 years lower for men and 10.2 years lower for women, according to the 2018 local authority health profile.

The food bank at St. Aidan’s Church helps people like Shelene Brown, 38, who said she was unemployed and had no money in the bank with a week to go before the next welfare payment.

Her diet will be what she was given: pasta, bread and some canned produce stuffed into two plastic bags, with no fresh vegetables or fruits.

Slight, with delicate features and dyed red hair, Ms. Brown has battled heroin addiction, and said that at times she has “hit rock bottom.” She added that she suffers from anxiety, depression and asthma attacks that recently landed her in the hospital.

ImageCreditMary Turner for The New York TimesImageCreditMary Turner for The New York Times

Fewer than half of Hartlepool’s residents eat the recommended portions of fruits and vegetables, and fruit consumption ranks among the lowest in England. This partly reflects lifestyle choices: popular fast food meals include options like the “parmo” — breaded, deep-fried chicken covered in béchamel sauce and Parmesan cheese — that pack as much as 2,000 calories.

But healthy food is often more expensive than calorific processed meals. And when times are tough, cheap drink or drugs provide temporary escape, multiplying what Professor Marmot calls “deaths of despair.”

At the help and advice center of the Oxford Road Baptist Church, Ian Jennings, 47, who does not take drugs, is nonetheless never far from their effects.

In the once-respectable street where he was raised and still lives, some houses are now boarded up and he has seen men armed with machetes.

“People have still got a choice to make,” Mr. Jennings said. “They have still got to make that choice but, because there’s no money kicking around, they have nothing to live for, nothing to look forward to. They can’t afford to go downtown to have a drink, so they drink in the house or take drugs.”

As a child, Mr. Jennings remembers eating fresh vegetables from his father’s garden. “I have been trying to get healthier; I do know I am overweight,” he said. “What people will do, because they haven’t got the money, they think I’ll go out and buy fish cake and chips or kebab.”

ImageCreditMary Turner for The New York TimesImageCreditMary Turner for The New York Times

Professor Dorling said that cuts to social care — or even to bus schedules — may also affect life expectancy by leaving older people isolated and depressed.

“Once somebody stops visiting, many old people give up,” he said. “As wages have fallen so much in real terms in Britain, the cost of fuel or train tickets to visit elderly relatives may be having an effect.”

Austerity has also had an effect on younger people. The Belle Vue community sports and youth center has impressive facilities, but after losing about a third of its funding and around half of its full- and part-time staff, it can no longer offer a program for children with behavioral problems. A proposal to encourage and organize sports at 19 local schools has been axed.

“These are the things that keep young people from antisocial behavior,” said Alan Clark, who attended the center as a 5-year-old and is now the chairman of its board of trustees. Under austerity, he added, “the social fabric of the nation is being destroyed.”

Community spirit nonetheless remains strong in Hartlepool, and Mr. Hills was overwhelmed when local people raised more than £2,000 for his father’s funeral.

Mr. Hills looks fit, is a member of a running club, has a job as a youth worker and is trying to give up smoking. But one of his aunts also died prematurely, at 40, and he thinks it would be better to move away.

“I need to leave,” he said, “because I want to live past 50.”

ImageCreditMary Turner for The New York TimesHow Long Can We Live? The Limit Hasn’t Been Reached, Study FindsJune 28, 2018Opinion | The Editorial Board: Fear, Loathing and Fentanyl ExposureApril 4, 2019‘This Is All We Can Afford’: Shrinking Lives in the English CountrysideMay 13, 2019In Britain, Austerity Is Changing EverythingMay 28, 2018


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