Healthy Life Expectancy (HLE), according to a report published last month (April 2026) by the Health Foundation, demonstrates a stark and accelerating trend: healthy life expectancy across the United Kingdom has fallen by two years over the last decade. Healthy Life Expectancy refers to the average number of years someone can expect to live in good health. It now stands at 60.7 years for men and 60.9 years for women.
Inequalities by social class sit starkly behind that average figure. Those in the most affluent 10% of the population can expect around 20 more years of healthy life expectancy (HLE) than those in the most deprived 10%. For people in deprived areas, HLE often falls below retirement age. The Health Foundation report points to affluent Richmond upon Thames with a Healthy Life Expectancy of 69.3 years for males and 70.3 years for females, which contrasts with deprived areas such as Blackpool where males have an HLE of 50.9 years, and Hartlepool where women have an HLE of 51.2 years
The implications are serious. We are talking about lives that do not reach their full potential. We are talking about families facing the need to provide informal care far earlier than expected. And we are talking about lost productivity alongside rising social care and social welfare costs.
Health inequalities have long been a defining feature of life in global capitalism and in the United Kingdom. In the 1840s, the young Friedrich Engels and Mary Burns, in their ethnographic journeys through a rapidly industrialising Manchester, railed against the substantial differences between the living conditions and health of the working class and those of the affluent bourgeoisie. The extent and underlying causes of health inequalities have since been the focus of numerous landmark reports and research programmes. The classic Black Report of the 1980s, and more recently the Marmot Reviews of 2010 and 2020, have consistently highlighted persistent—and in some cases widening—gaps in life expectancy and HLE.
Why is overall HLE falling? This question has been posed repeatedly, with a range of competing explanations. One influential and widely discussed account is offered by Wilkinson and Pickett, who argue that income inequality is a central causal mechanism: the larger the gap in income, the larger the gap in health outcomes. For example, the USA has high income inequality and high health inequality. Despite all its wealth, American overall health rates are worse than those of not‑so‑wealthy but more equal countries. Typically, Nordic countries such as Norway and Sweden outperform the USA on life expectancy and a range of other—but not all—wellbeing outcomes.
Wilkinson and Pickett’s work provides an insight into how social and economic relationships influence health; they do not go deep enough. As sociologists such as Bambra and Schrecker, as well as Scambler, suggest, we need to go deeper. There is something fundamentally wrong with the economic, political and social basis of our society. Over forty years of neoliberal doctrine has unravelled so many of the social bonds that people need to thrive, let alone survive. British society has become much more fragmented, individualised and unequal. Numerous other writers in this blog have identified the pernicious effects of neoliberalism. Ted Schrecker, for example, has pointed out that decades of rhetorical and ideological Thatcherism lie behind so many of the health problems facing us today. Economies are geared for the accumulation of wealth by a small global elite, which displaces resources away from the common good.
It does not need to be that way.
Ultimately, the poor health and wellbeing of a nation is a political choice. There is nothing natural or normal about inequalities in wealth, income or health. It is not only about direct health and social care policies—though they, of course, matter. It is about a wider approach to politics and what is deemed to be a good society, what is regarded as valuable and where resources are allocated.. The NHS and social care do need urgent and increased funding, though focusing on health and social care alone can be misleading. Those services come into play after people become frail or become ill. We need more than a focus on how to prevent people having unnecessarily poor health in the first place.
It is the totality of policy that matters. Health and social care are but one part of an overall assemblage of policies that determine the health and wellbeing of a nation. We need to think about social policies that create workplace relationships where working‑class people have control over what they do; how we build towns with decent housing; how we respond to the increasing concentration of power among a small number of corporations and the even smaller number of individuals who head those corporations; and how we make life meaningful for people again.
Unless those deeper questions are asked and then effectively answered with policy that directly confronts power and wider social and economic inequalities, the reversal in HLE can be expected to continue.
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Why is Healthy Life Expectancy in decline?
by Chris Yuill May 6, 2026Healthy Life Expectancy (HLE), according to a report published last month (April 2026) by the Health Foundation, demonstrates a stark and accelerating trend: healthy life expectancy across the United Kingdom has fallen by two years over the last decade. Healthy Life Expectancy refers to the average number of years someone can expect to live in good health. It now stands at 60.7 years for men and 60.9 years for women.
Inequalities by social class sit starkly behind that average figure. Those in the most affluent 10% of the population can expect around 20 more years of healthy life expectancy (HLE) than those in the most deprived 10%. For people in deprived areas, HLE often falls below retirement age. The Health Foundation report points to affluent Richmond upon Thames with a Healthy Life Expectancy of 69.3 years for males and 70.3 years for females, which contrasts with deprived areas such as Blackpool where males have an HLE of 50.9 years, and Hartlepool where women have an HLE of 51.2 years
The implications are serious. We are talking about lives that do not reach their full potential. We are talking about families facing the need to provide informal care far earlier than expected. And we are talking about lost productivity alongside rising social care and social welfare costs.
Health inequalities have long been a defining feature of life in global capitalism and in the United Kingdom. In the 1840s, the young Friedrich Engels and Mary Burns, in their ethnographic journeys through a rapidly industrialising Manchester, railed against the substantial differences between the living conditions and health of the working class and those of the affluent bourgeoisie. The extent and underlying causes of health inequalities have since been the focus of numerous landmark reports and research programmes. The classic Black Report of the 1980s, and more recently the Marmot Reviews of 2010 and 2020, have consistently highlighted persistent—and in some cases widening—gaps in life expectancy and HLE.
Why is overall HLE falling? This question has been posed repeatedly, with a range of competing explanations. One influential and widely discussed account is offered by Wilkinson and Pickett, who argue that income inequality is a central causal mechanism: the larger the gap in income, the larger the gap in health outcomes. For example, the USA has high income inequality and high health inequality. Despite all its wealth, American overall health rates are worse than those of not‑so‑wealthy but more equal countries. Typically, Nordic countries such as Norway and Sweden outperform the USA on life expectancy and a range of other—but not all—wellbeing outcomes.
Wilkinson and Pickett’s work provides an insight into how social and economic relationships influence health; they do not go deep enough. As sociologists such as Bambra and Schrecker, as well as Scambler, suggest, we need to go deeper. There is something fundamentally wrong with the economic, political and social basis of our society. Over forty years of neoliberal doctrine has unravelled so many of the social bonds that people need to thrive, let alone survive. British society has become much more fragmented, individualised and unequal. Numerous other writers in this blog have identified the pernicious effects of neoliberalism. Ted Schrecker, for example, has pointed out that decades of rhetorical and ideological Thatcherism lie behind so many of the health problems facing us today. Economies are geared for the accumulation of wealth by a small global elite, which displaces resources away from the common good.
It does not need to be that way.
Ultimately, the poor health and wellbeing of a nation is a political choice. There is nothing natural or normal about inequalities in wealth, income or health. It is not only about direct health and social care policies—though they, of course, matter. It is about a wider approach to politics and what is deemed to be a good society, what is regarded as valuable and where resources are allocated.. The NHS and social care do need urgent and increased funding, though focusing on health and social care alone can be misleading. Those services come into play after people become frail or become ill. We need more than a focus on how to prevent people having unnecessarily poor health in the first place.
It is the totality of policy that matters. Health and social care are but one part of an overall assemblage of policies that determine the health and wellbeing of a nation. We need to think about social policies that create workplace relationships where working‑class people have control over what they do; how we build towns with decent housing; how we respond to the increasing concentration of power among a small number of corporations and the even smaller number of individuals who head those corporations; and how we make life meaningful for people again.
Unless those deeper questions are asked and then effectively answered with policy that directly confronts power and wider social and economic inequalities, the reversal in HLE can be expected to continue.