The extension of life expectancy in the 20th century would be one of the greatest social opportunities in modern Britain.
But while the longevity dividend has delivered valuable health and economic benefits to individuals and societies, it has long since stopped delivering profits: instead of living longer and healthier, we have become an increasingly sick country in which we live longer but in worse health.
Experts say our advanced age is bringing the NHS and the economy to their knees.
Increasingly, authoritative figures are opting for prevention over cure: in July, the Tony Blair Institute for Global Change (TBI) published a major report showing the enormous impact of investment in health prevention on the economy.
“When you have nearly 3 million people unemployed with poor health, it’s pretty clear what the macroeconomic effects are,” said Andrew Scott, who wrote the upcoming TBI report on the economics of longevity. “The real value of preventive health care is in the long run.
“It’s exactly like compound interest. If you start preventive health interventions early, the economic gains are about four times greater than if you start later,” said Scott, author of The Longevity Imperative and co-author of The 100-Year Life.
Long-term illness is the main reason why economic inactivity in the UK rose to a record 9.4 million in February 2024 – or 22.2% of adults aged 16 to 64 – costing the economy £43 billion a year.
And at least 80% of health inequalities outcomes in the UK are driven by chronic but potentially modifiable diseases. Only 9% of men and 16% of women born today can expect to reach retirement age in good health.
The NHS is less well equipped to prevent or treat disease at an early stage.
Prof Sir John Bell, a renowned immunologist, said: “The NHS has done nothing – and by nothing I mean absolutely nothing – to care for people who are obese, even though we know that obesity is probably the single biggest risk factor for cancer, heart disease, stroke and diabetes.”
Although we live in an environment that exposes us to significant risks, it often takes a significant health event – often in the 60s or early 70s – before symptoms of major illness become apparent. By then, it is often too late to reverse the trend.
But because it’s impossible to treat the entire population at age 35, experts say we need to get better at predicting which asymptomatic young people are likely to have problems later in life, using blood tests, family history and genetics.
“We need a prevention service because the NHS can’t deliver it,” said Bell, a trustee of Our Future Health, the UK’s largest ever health research programme to diagnose and treat diseases early – or even prevent them from developing. “It needs to be done in the community, at low cost, with high throughput.”
Prof John Deanfield, who was asked by the government last year to set up a taskforce to identify radical new approaches to preventing heart disease and reducing pressure on the NHS, has had enough of tinkering with the current health system. Instead, he has recommended not a parallel NHS but a pre-NHS.
He envisions a system of one-stop health clinics in offices, football fields, recreational facilities and supermarkets, where people can have their health assessed, treatments prescribed, progress monitored and motivation coached, all without having to go to traditional health care. Ideally, keeping them so healthy that they don’t have to.
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Deanfield is not alone. There is a groundswell of support for the “prevention rather than cure” approach: Dr Charlotte Refsum, director of health policy at the TBI and a former GP, is about to release a new report on prevention.
“The NHS is doing its best, but we’ve got our thinking completely wrong about health spending,” she said. “The health of our workforce is a national asset: it’s our means of production. We should be keeping that asset happy, healthy and working, but what we’re really spending our money on is protecting people in the last year of their lives.
“We need two services,” she said. “The NHS and GPs treating chronic, long-term conditions – and a health prevention service running alongside that.”
The Deanfield taskforce included Sir Keith Mills, the inventor of the Air Miles and Nectar Card loyalty cards.
Mills advocated rewarding people for improvements in their health with free football tickets, gift vouchers, days out, discounts on healthy food in the supermarket or cinema tickets.
“The biggest problem in this preventive space is behavior change,” Mills said. “You can have all the diagnostics and technology you want, but if people aren’t doing what you want them to do, it’s all a waste of time, and in the health space, we’re not incentivizing people to take care of themselves at all right now.”
He also suggested that governments could reward organizations that can demonstrate successful reductions in the blood pressure, weight or cholesterol of their employees, fans or customers – with rewards ranging from official recognition to tax breaks.
“We can’t continue as we are, and the answer is not more doctors and nurses,” he said. “We have to change the way people live.”
Deanfield believes the government will listen this time. “It has become a political imperative because health is now very, very much wealth,” he said.