European countries need to improve research and monitoring of mortality rates, says OECD

The rate of improvement in life expectancy has slowed across the EU since 2011, but apart from the UK – which has seen the biggest slowdown – there has been little investigation of the underlying causes.

Better monitoring, timely publication of mortality statistics and more research is needed to understand the reasons for this fall, according to an OECD-commissioned report examining trends in life expectancy.

Alongside the UK, the slowdown is most noticeable in France, Germany, Sweden and the Netherlands. But while there has been significant research and public conversation on the matter in the UK, the same cannot be said for elsewhere in western Europe, according to the report’s author Veena Raleigh, senior policy fellow at the King’s Fund think tank in London.

There have been dramatic improvements in life expectancy over recent decades, and given that, “Some slowdown is perhaps not unexpected,” Raleigh said. However, “In some years mortality has actually become quite erratic,” she told Science|Business. “We saw a widespread fall in life expectancy in 2015 across many countries. I think one needs to ask why, in [the era of] modern healthcare systems, that’s happened, and whether that’s something that can be avoided.”

There has been a lot of work done to understand the reasons for the slowdown in life expectancy improvements in the UK, where the issue has become “very political”, Raleigh said. “The most detailed report [was] by Public Health England, to try and unpack this, and I don’t yet see that sort of work being done in other European countries. But I’m hoping that the report for the OECD will trigger some level of interest in other countries.”

The Public Health England report, published at the end of 2018, was commissioned following a considerable slowdown in life expectancy increases since 2011, and two spikes in death rates in the winters of 2014-2015 and 2017-2018, when a virulent strain of flu spread across Europe.

For some age groups, and for some parts of England, improvement has stopped altogether and inequality in life expectancy has widened. Since 2010-12 female life expectancy in the most deprived areas of the country has fallen.

“In the UK, there has been big concern about why mortality improvements have slowed up since 2011,” said Raleigh. “The slowdown has been seen also across many European countries. In France, for instance, female life expectancy hasn’t improved hardly at all over the past five or six years. The Netherlands has also slowed up a lot, as has Germany. But we’re not seeing the same level of concern in these countries. We’re not seeing the same level of interest, debate, investigation,” she said.

“Now of course, in many of these countries, life expectancy is much higher than in the UK, so if you like, they have less of a problem,” said Raleigh. “But equally, they might wonder why this slowdown is occurring.”

Monitoring and research

The 2015 spike in winter mortality highlights the need for more research and better monitoring, according to Raleigh. The European mortality monitoring system, EuroMOMO was signalling that mortality was higher than expected. “But there wasn’t actually a major response from countries, and the full mortality data for 2015 didn’t become available on a pan-European basis until two-plus years later. So it wasn’t until 2017 that people started to say, goodness me, what happened in 2015?” she said.

There are many determinants of mortality and unpicking what is driving the slowdown in improvements in different countries is a “vast and complex” subject. Raleigh argues that Europe needs faster reporting of mortality rates; disaggregated statistics by age, sex, and socioeconomic status; and better monitoring of secondary causes of death. “As you get older populations, you’ve got lots of problems with multimorbidity,” she explained, “a heart attack could have been triggered by a bout of flu.”

There is also a need to make better use of other datasets, for example, those recording hospital admissions. “There’s a lot of data around, and we need to be making much better use of it and doing it quicker,” Raleigh said.

Gap closing between east and west

The slowdown in improvements in life expectancy was greater in western European countries, where life expectancy is higher than in central and eastern Europe, leading the gap between them to narrow.

The EU13 countries in central and eastern Europe have experienced steady improvements in life expectancy since 2005. However, there remain large differences between east and west. In 2016, male life expectancy at birth ranged from 69.5 years in Lithuania to 81 years in Italy, and from 78.5 years in Bulgaria to 86.3 years in Spain, for females.

“East European countries, where life expectancy is lower, on the whole - other than Slovenia - than the rest of the EU countries, have seen faster gains than countries where levels are higher,” said Raleigh. “Male life expectancy tends to be lower than female life expectancy, and therefore is also showing faster increases.”

The fact that there are still “enormous differences” between countries points to the possibility of bringing every country up to the same level. “The UK lags quite a long way behind several other western European countries, especially for female life expectancy. So, it’s a bit early for diminishing returns to be setting in,” said Raleigh.

One reason for the more marked slowdown in female life expectancy is that women live longer and are therefore more likely to be affected by age-related illnesses. The 2015 flu epidemic for example, killed more women because there was no acquired resistance among older people to the particular strain that was circulating.

However, that does not explain differences in female morbidity between countries. “If you look at Japan, which has higher female life expectancy, it continues to improve there,” said Raleigh.

Arguments about austerity are unconvincing

In the UK, some researchers have uncovered evidence indicating the slowdown in life expectancy improvements is due to austerity-era cuts. However, Raleigh is not convinced, because the slowdown has also occurred in countries where budgets were not cut. “If you look across Europe, then the austerity argument doesn’t seem to hold, because Germany and Sweden and the Netherlands have seen the greatest slowdown, and France in women.” One the other hand, countries including Greece which saw far more severe austerity measures “have seen much less [of a slowdown], and have actually seen quite healthy rises in life expectancy,” Raleigh said.

"If it was austerity, you expect to see a general worsening of mortality, increasingly as we move away from 2008,” said Raleigh. Instead, there have been spikes, as in 2015 and 2018. “2014 was a very good year, and mortality fell sharply, and I think that’s because there were far fewer flu deaths in that year.”