A woman drinking from a wine glass with a doughnut in it. Caption on the image says "3 large glasses of wine is like having 3 doughnuts".

Liverpool’s long and winding road to healthy life expectancy

“Liverpool … has become a wonder of the world. It is the New York of Europe, a world city rather than merely British provincial.” – Illustrated London News, 15 May 1886

Liverpool has existed for over 800 years. Established as a borough in 1207 and becoming a city in 1880, Liverpool is part of the fabric of the UK’s cultural, economic, and creative heritage. Birthplace of The Beatles, home to two renowned and successful football teams, host of the world-famous Aintree Grand National, and the instantly recognisable waterfront are some of the things that have put Liverpool firmly on the map. It is also home to the oldest Black African community in the country and the oldest Chinese community in Europe, and this diverse population mix continues today contributing to the city’s vibrancy. After decades of population decline, since the turn of the millennium Liverpool’s population has grown by more than 10%, and there are £14 billion of regeneration projects in the pipeline. Liverpool is clearly an attractive and ambitious city.

However, like all major cities, Liverpool has problems, none more so evident than in the health of its residents. Liverpool is one of the most socio-economically deprived local authorities in the country, and our residents are significantly more likely to engage in unhealthy lifestyle behaviours than those living elsewhere in the country. Combined with a decade of austerity and government funding cuts, these are some of the major contributing factors to poor health and wide health inequalities, not only between Liverpool and the national average, but also within the city itself.

Liverpool’s children are not getting the best start in life, with breastfeeding prevalence, obesity, and school readiness rates all significantly worse than those nationally. With 74,000 smokers, our city has a high smoking prevalence rate. Liverpool also has the second highest rate for emergency hospital admissions in the country and one of the highest rates of hospital admission episodes for alcohol specific conditions.

Within Liverpool itself, there is huge variance across almost all indicators that contribute to poor health outcomes. The difference of 12 years in life expectancy between our most and least deprived wards is shocking. A baby boy born today living in Anfield (the home of Liverpool Football Club) can, on average, expect to have 13 fewer years of life than a baby boy born five miles further south in the same city. Over 140,000 residents aged under 75 years are on a primary care disease register, equating to one in three people, many of whom have co-morbidities. On average, the people of Liverpool can expect to live in good health (healthy life expectancy) for only 58 years – significantly lower than the 63 years nationally. More importantly, there is a wide variation in healthy life expectancy within the city, with a stark and unacceptable gap of 23 years across Liverpool in the number of years people can expect to live in good health.

Some 4,500 of our residents die each year, with 1,800 of these being early deaths (those aged under 75 years). The biggest killers in the city are cancer (30%), cardiovascular disease (CVD) (20%), and respiratory disease (15%) and the premature mortality rates for these diseases are either increasing (in the case of cancer and respiratory) or have plateaued (in the case of CVD). After exponential growth going back to World War II, Liverpool’s life expectancy has been stagnant since 2012.

Around 1,000 early deaths in the city are preventable, and the Public Health team in Liverpool is determined to change these worrying statistics. We commission a range of services that particularly target our most deprived communities and have an in-house social marketing team that uses innovative campaigns to effect behaviour change in children and adults.

We will be working on the Health in All Policies agenda, integrating Public Health across the city council as part of the Mayoral Inclusive Growth Plan, and continuing to work closely with the NHS. It is now clear for all stakeholders in the city that good health and wellbeing are about more than healthcare. The social determinants of health approach defines a ‘healthy person’ not as someone free from disease, but as someone with the opportunity for meaningful work, secure housing, stable relationships, high self-esteem and healthy habits. Understanding health in these terms would highlight lack of employment opportunity and access to affordable housing as a health problem.

Good health is also a product of the decisions we make about what we consume and the way we live our lives. But more importantly, good health is an investment in a vibrant economy, with positive consequences on downstream health and social care costs and broader social and economic impacts.

The most efficient and effective way to improve population health and reduce health inequalities is to address the social determinants of health within the city – to invest upstream and reshape peoples’ physical and social environment to support wellbeing, healthy lifestyles and economic growth. Healthy policy interventions are most equitable, cost saving and, although politically challenging, could achieve substantial and surprisingly rapid reductions in disease. While investments in NHS and social care are always needed, the poor health of Liverpudlians will not be solved solely by investing more in the care system, but by complementing this with upstream intervention to engineer less need for care in the structure of the city. Liverpool needs to become healthier by design.

In times of crisis, Liverpool is a city that historically pulls together. The statistics show that Liverpool is facing a health crisis, which can only be tackled by everyone living and working in the city, not just health professionals. In our effort to ensure Liverpool leaves no one behind, as per one of the sub-themes of the upcoming Symposium, we have begun the Long and Winding Road to Healthy Life Expectancy.

Liverpool City Council's infographic outlining their 'Long and Winding Road to Healthy Life Expectancy' path

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