Although 2016 was a notoriously bad year for celebrity deaths, less famous residents of the UK found 2015 the most dangerous recent year. Long-term trends of better health and longer survival were reversed. Two papers published in the Journal of the Royal Society of Medicine provide evidence that cutbacks to the National Health Service (NHS) represent the most likely explanation. Not surprisingly, the government has hit back at the allegation.
Evidence-based medicine works (it's part of why we love science). All over the world life expectancies are rising as medical researchers find cures or treatments for diseases that used to kill quickly. Yet disturbing exceptions are starting to appear. Lucinda Hiam of the London School of Hygiene and Tropical Medicine reports that 2011 saw the first reversal, but there were slightly fewer deaths in 2013 and 2014 than previous years. In 2015, however, there were 34,000 more deaths than the 2006-2014 average, allowing for the larger and older population in that year.
It was the largest percentage increase in 50 years. Most of the extra deaths were among the elderly, and Hiam has dug more deeply into the data for England and Wales.
January alone accounted for over 10,000 of the extra deaths, compared to the previous decade, supporting the suspicion cold weather played a part. However, Hiam found deaths attributed to influenza, another suggested culprit, did not increase significantly. Instead, there was a sharp increase in dementia being listed as a cause of death, but this may have related to changes in diagnosis, making the causes hard to track.
In an accompanying paper, the same authors compare four explanations for the apparent increased mortality: That it was a result of flawed data rather than a real increase, an outcome of natural disasters, resulted from an epidemic, or a “widespread failure of the health and social care system”.
Hiam concludes that there is no evidence for problems in the data, despite some disruption in the Office of National Statistics at the time, while January 2015 was actually somewhat warmer than the average for the same month over the previous five years. The epidemic possibility got a more detailed exploration, since deaths from influenza are often attributed to secondary causes such as pneumonia.
Nevertheless, the data from 2015 doesn't resemble anything from previous epidemics, and other European nations were not as severely affected.
When deaths are adjusted for population size and ages, 2015 looks like part of a disturbing new trend. Hiam et al/ Journal of the Royal Society of Medicine
On the other hand, NHS statistics are indicative of a badly overstretched system, with ambulance call-out times stretching out dangerously, as did waiting times for emergencies and diagnostic tests. Failure of NHS funding to keep up with population and economic growth looks like an obvious culprit, particularly in the light of previous studies indicating GPs' workloads have increased while welfare cuts have been linked to a rise in suicides.
Nevertheless, the paper states: “We cannot reach a firm conclusion about what has happened, but we can at least point to fruitful lines of further inquiry, as well as discounting some possible explanations.”
Even this qualification was insufficient for the UK Department of Health, whose spokesperson accused the researchers of bias, and suggested the rise was a one-off aberration rather than indicative of a trend.
Hiam was more explicit about blaming funding shortfalls in a statement, saying: “Simply re-organising and consolidating existing urgent care systems or raising the ‘agility’ of the current A&E workforce is unlikely to be sufficient to meet the challenges that high levels of hospitalization of frail elderly people and others who are vulnerable are likely to present in the future.”
The implications of the study stretch beyond the UK. Life expectancy fell in the United States in 2015 for the first time since 1993. It is unclear if the two events are connected, but understanding either of them may help explain the other.