The failure of governments to tackle a three-decade rise in preventable diseases such as obesity and type 2 diabetes has fuelled the Covid-19 pandemic and is stalling life expectancy around the world, a comprehensive study has found.

The latest data from the Global Burden of Disease study, published in the Lancet medical journal [1], is from 2019, before Covid, but helps explain the world’s vulnerability to the virus.

In the UK, the editor of the Lancet, Dr Richard Horton, said, the areas where life expectancy was lowest – the north-east, north-west, Yorkshire and Humberside – were the areas hardest hit by Covid. “I don’t think it’s a coincidence,” he said, adding that Covid-19 was not a single pandemic, but “a synthesis of a coronavirus and an epidemic of non-communicable diseases on a background of poverty and inequality.

“It is the interaction of the virus with people living with other diseases – that is the challenge that we face, especially when you factor in the social gradient issue. So I think governments, if they focus only on trying to reduce the prevalence of a virus, this is a strategy that in the long term will fail,” he said.

The UK has a healthy life expectancy of 68.9 years – below many countries in western Europe

Healthy life expectancy
Life expectancy

More people worldwide are experiencing high blood pressure and high blood sugar, are overweight or have high cholesterol, all linked to poor diet and lack of exercise, and all risk factors for disease. There is a rising tide of deaths from cardiovascular disease, particularly in the US and the Caribbean.

The world might be approaching a turning point in life expectancy gains, the authors said. Since 1990, life expectancy has risen steadily, but that has slowed. In the UK, life expectancy has increased, but not as fast as in the rest of Europe, at 5.3 years compared with the European average of 5.7. There is a wide gulf between the richest and poorest areas of the UK, from an average life expectancy in 2019 of 84.5 years in Richmond-upon-Thames to 76.4 years in Blackpool.

More of those years are being lived in poor health. The UK’s healthy life expectancy is the lowest in Europe, tied with Monaco, at 68.9 years. Chronic diseases are now responsible for 88% of the overall disease burden in the UK. The largest contributors to increases in poor health over the past 30 years are diabetes, falls, drug use disorders, lung disease and dementia.

Mortality among under-5s in the UK compares badly with other European countries

Guardian graphic. Source: The Lancet. Note: selected countries shown

Smoking has contributed to 125,000 early deaths in the UK, high blood pressure to 87,000, poor diets to 78,500, high blood sugar to 75,500 and obesity to 56,200.

The emergence of Covid-19 among so many people with chronic illnesses and underlying risks for disease has created “a perfect storm”, said the authors of the study, based in the Institute of Health Metrics and Evaluation (IHME) in Seattle, in the US.

Horton said the study was “the most comprehensive analysis of the state of the world’s preparedness for Covid-19, immediately before the virus. It reveals that the world was acutely vulnerable to a virus that targets older citizens, those living with chronic non-communicable diseases, and those living in societies with pervasive inequalities.

High systolic blood pressure was associated with 10.8m deaths worldwide in 2019

Guardian graphic. Source: The Lancet

“If we are truly to protect our communities from the ravages of this coronavirus, governments must devise national strategies, not only to reduce the prevalence of the virus, but also to more assertively address the burden of chronic disease, and the risk factors for chronic disease,” he said.

Prof Christopher Murray, director of the IHME, said health systems had been slow to adapt to the implications of the rise in long-term chronic, non-communicable diseases. “We’re seeing a shift around the world towards more burden of disease from conditions that cause disability, as opposed to death. It turns out in the era of Covid that many of those conditions are also things that increase the risk of Covid death, so that shift towards disability is also a shift towards vulnerability,” he said.

Looking to the future, he said: “We expect Covid to continue to have its direct effects in 2021 and for those to be quite considerable.” Childhood vaccination rates have gone down because families cannot get to clinics, women are not able to give birth in safe facilities, and people needing treatment for diseases other than Covid are not getting it. The economic effects would be a driver of poor health for three or four years to come, he said.

Sarah Boseley Health editor