What would it take to halve the gap in healthy life expectancy?

For more than a decade, the nation’s health has stagnated. Life expectancy and healthy life expectancy have seen little improvement, and stark inequalities persist. People in the least affluent areas of England can expect to live around 18 fewer years in good health than those in the most affluent.

The government pledged in its manifesto – and again in the NHS 10-Year Health Plan – to tackle ‘the social determinants of health, halving the gap in healthy life expectancy between the richest and poorest regions in England’.

But what might it take to realise this ambition?

What would need to happen to halve the gap?

Healthy life expectancy is the average number of years a person can expect to live in good health. It is derived from data on how long people live (‘mortality rates’) and the prevalence of ‘self-reported good health’.

In 2022–24, healthy life expectancy in England was estimated at 60.9 years for males and 61.3 years for females – the lowest levels recorded in the past ten years. However, these national averages conceal substantial differences between – and within – regions.

Across local authorities in England, the gap between the highest and lowest levels of healthy life expectancy is 18.4 years for males (between Richmond upon Thames and Blackpool) and 19.1 years for females (between Richmond upon Thames and Hartlepool). Large gaps also exist within regions. In the North West, the difference between the best and worst performing local authorities is 13.6 years for males and 14.2 years for females. Even in regions with relatively high health overall, such as the South East, local disparities remain substantial, with gaps of 10.5 years for males and 10.8 years for females.

Recent Office for National Statistics data show that the midpoint of healthy life expectancy between the best and worst performing regions is around 60 years for males and 60.6 years for females. The latest figures also show that the regional gap for females is widening and has reached its highest level for 10 years. Halving the gap would require all regions below this level to improve to at least 60 years for males and 60.6 years for females. That would require an increase of over 3 years in the North East, and over 2 years in Yorkshire and the Humber. Regions in the South and East of England would not need to improve under this interpretation (Figure 1).

A more ambitious – and arguably fairer – interpretation of the pledge would be to halve the gap between each region and the best performing region (the South East). Under this approach, every region except the best performing would need to improve, benefiting more people overall.

Why self-reported health matters if we are interested in closing the gap 

To understand what drives regional differences in healthy life expectancy, we looked at how self-reported health and mortality contribute to the gap between the North East and the South East.

If people in the North East reported the same levels of good health as those in the South East at each age, healthy life expectancy would rise by 4.2 years for males and 5.9 years for females.

By comparison, if death rates in the North East matched those in the South East, healthy life expectancy would increase by 1.3 years for males and 1.2 years for females.

Taken together, these differences explain almost the entire gap. For males, around 74% of the gap is linked to self-reported health, 23% to mortality, and 3% remains unexplained. For females, self-reported health accounts for 79% of the gap, mortality 16%, with 5% unexplained.

This shows that differences in how people report their health – not just how long they live – is the primary driver of regional variation in healthy life expectancy. Self-reported health captures aspects of life that mortality alone cannot capture, including quality of life related to physical and mental health. While policies addressing both self-reported health and mortality are needed, improving self-reported health is likely to have the biggest effect on narrowing regional gaps.

Self-reported health and deprivation

People living in more deprived areas are much less likely to report good health. Nationally, males in the most deprived decile are around 14 percentage points less likely to say they are in good health than those in the least deprived decile. For females, the gap is around 16 percentage points.

This helps explain regional patterns. The North East has around six times as many residents living in the most deprived decile as the South East, likely contributing to poorer self-reported health and lower healthy life expectancy.

Our Health inequalities in 2040 report suggests that these regional patterns are not explained by diagnosed illness alone. In more deprived areas, people often report worse health even when recorded levels of disease are similar. This likely reflects differences in how manageable health problems are in everyday life – shaped by factors such as job quality, financial security, housing conditions and access to public services.

How to improve self-reported health

Improving self-reported health requires action across the life course – from preventing illness, to managing long-term conditions, to addressing the wider factors that shape health.

Reducing smoking and improving diet and physical activity can delay the onset of illness and improve day-to-day wellbeing. For people living with long-term conditions, better care and support managing their condition is also important.

However, social and economic conditions play a powerful role. Secure work, good-quality housing and supportive local environments all influence physical and mental health. Addressing these wider determinants is essential for sustained improvements in self-reported health and reducing regional inequalities in healthy life expectancy.

The challenge for government

To halve the gap in healthy life expectancy between England’s richest and poorest regions, the government must recognise variation in self‑reported health as the primary driver, explaining over 70% of the difference between the North East and South East.

Deprivation also plays a substantial role. People in poorer areas consistently report worse health, reflecting the cumulative impact of economic and social disadvantage. National ambition therefore needs to be matched by local action, focused on improving the conditions in which people in the most disadvantaged areas live, work and age.