Diabetes and Dementia 'Are Growing Health Threats': Report

Peter Russell

September 11, 2018

Tomorrow's NHS will need to adapt to an ageing population by concentrating more on keeping people healthy rather than just treating them when they fall ill, health experts have said.

A health audit for England, carried out by Public Health England (PHE), found that although people are living longer, the figures mask a huge discrepancy in life expectancy between rich and poor.

The findings also reveal worrying data that women's health in the UK ranks poorly when compared to other EU countries.

The Health Profile for England report covers major causes of death, trends in mortality, children's health, and current health protection issues. Evidence in the report will be used to help shape the forthcoming NHS long-term plan.

Smoking rates continue to decrease, the report says, but diabetes, dementia, obesity, and mental health issues are rising.

Diabetes, Dementia, Heart Disease and Cancer

The report predicts that the number of people with diabetes will increase by a million – from just under 4 million people in 2017 to almost 5 million in 2035.

Nikki Joule, policy manager at Diabetes UK, commented: "This shocking report tells us that the number of people with diabetes is expected to increase dramatically in coming years, affecting almost 1 in 10 adults in England by 2035. It's vital that we act to curb the rise of type 2 diabetes, and prevent the 12.3 million people in the UK who are at increased risk from developing the condition."

Death rates from dementia and Alzheimer's disease have increased steadily since 2006. Increased awareness of dementia and an NHS policy to encourage GPs to diagnose dementia have led to increased recording on death certificates. That means that, in more recent years, deaths may have been classified as dementia that would not have been in the past, the report said.

In 2016 the most common cause of death in males was heart disease, accounting for 13.6% of deaths. Among females, the most common cause of death was dementia and Alzheimer's disease, accounting for 15.8% of deaths.

The report predicts that mortality rates from dementia and Alzheimer's will continue to increase for both males and females, and that dementia may overtake heart disease as the leading cause of death for males as early as 2020, if heart disease death rates continue to fall.

Sally Copley, director of policy, campaigns and partnerships at the Alzheimer's Society, commented: "We have stressed for a long time that dementia was set to be the 21st century's biggest killer – it has already become so, and what is the stark reality for women is now also set to be the case for men."

Prostate cancer and breast cancer were identified in the report to be among the top 10 leading causes of death for males and females respectively. Both were ranked seventh, the same as in 2015.

Life Expectancy

The report paints a picture of increasing life expectancy over the last few decades.

Provisional figures for 2017 indicate that life expectancy at birth in England has now increased to 79.6 years for males and 83.2 years for females. However, since 2011 the rate of increase in life expectancy has slowed for both sexes.

In 2017, the percentage of the population aged 85 years and over was 2.7 times greater than it was in 1971.

The number of people over 85 years of age is expected to increase substantially in the future from 1.35 million last year to 1.54 million in 2023 – an increase of 14%. Numbers are set for a significant increase in 2031 when 'baby boomers' born after World War II move into this age group, with the number possibly reaching 2.01 million.

Whereas less than a century ago, deaths from infectious diseases were common, long-term, non-communicable diseases, such as dementia and Alzheimer's, cancer, and heart disease, are now the leading causes of death.

The size of the population in older age groups is particularly important, according to the audit, as this group puts additional strain on health and social care services.

Increasing life expectancy has been accompanied by a rise in the number of years people are spending in ill health. In the period 2014 to 2016, males lived 16.2 years in poor health, while females lived 19.3 years in poor health.

Latest data on healthy life expectancy show that it is now 63.3 years for males and 63.9 years for females.

"As a society we are living longer than ever before but as a result of living longer, more of us are living with disabling conditions such as back pain, or hearing and sight loss," report author Justine Fitzpatrick told Medscape News UK. "And as we continue to live longer, we may expect more and more people to be living with these conditions in the future." 

Women's Health

The report identifies that UK women's health compares unfavourably with those in many European countries. 

Among the 28 EU member states in 2016, the UK was ranked 10th highest for male life expectancy but only 17th for female life expectancy.

The female burden of premature death in the UK was 42% higher than for Spain, the country with the lowest burden.

"When we looked at this, there were a whole range of causes," according to Justine Fitzpatrick. "The UK women ranked lower than UK men but I think the greatest difference in ranking were in cancer mortality, where the UK is ranked 8th for males and 27th for females."

Health Inequalities

The report reveals severe inequalities for life expectancy between the most affluent and the most deprived areas.

In 2014 to 2016, this gap accounted for 9.3 years for males and 7.3 years for females.

Heart disease, lung cancer, and long-term lower respiratory diseases account for around a third of the total gap in life expectancy for both sexes, for which smoking and obesity were principle risk factors.

The report found no evidence that inequalities in life expectancy have narrowed in recent years. In fact, inequalities in life expectancy for females have widened since 2001 to 2003.

The detrimental effect of poverty on people's health is highlighted by the stark observation that those living in the most deprived areas spend nearly a third of their lives in poor health compared with only about a sixth of their lives for those in the most affluent areas.

Duncan Selbie, chief executive at PHE, said: "Inequalities in health undermine not only the health of the people but also our economy.

"As we work to develop the NHS long term plan, we must set the ambition high. If done right, with prevention as its centrepiece, the payoff of a healthier society and more sustainable NHS will be huge."

Among the reports other main findings:

  • In the last 7 years, smoking prevalence has dropped by a quarter to 15% and as few as 10% of the population could still be smoking by 2023

  • Low back and neck pain and skin disease (dermatitis, acne and psoriasis) are the two leading causes of morbidity for men and women, with hearing and sight loss also ranking highly for both sexes

  • While most causes of morbidity become more prevalent with age, mental health problems and substance use affects younger adults the most, accounting for more than a third of the disease burden in those aged 15 to 29 years

Professor John Newton, director of health improvement at PHE, said: "Now in its 70th year, demands on the NHS have changed significantly.

"More of us are living longer with painful or disabling conditions, including musculoskeletal problems, skin conditions and sensory loss. While these illnesses often attract less attention than causes of early death such as heart disease and cancer, they have a profound effect on the day to day lives of many people and together they place significant pressure on the NHS.

"The challenge now is for the NHS to respond to this changing landscape and to focus on preventing as well as treating the conditions which are causing the greatest disease burden across our nation."


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: