Research and analysis

The Burden of Disease in England compared with 22 peer countries: executive summary

Published 17 January 2020

Applies to England

© Crown copyright 2020

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This publication is available at https://www.gov.uk/government/publications/global-burden-of-disease-for-england-international-comparisons/the-burden-of-disease-in-england-compared-with-22-peer-countries-executive-summary

1. Background

This paper summarises and synthesises data from the Global Burden of Disease (GBD) 2016 programme for England compared with 22 countries (UK, EU and non-EU).

The data within this paper was made available to NHS England when drafting their 10-year plan. These data apply GBD methods to identify the areas where England appears to be falling behind other countries.

This study provides modelled health intelligence, all the data in this paper are taken from Global Burden of Disease Study 2017 (GBD 2017) results (Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2018).

Available on GBD Compare.

2. Aims

This paper aims to answer 3 questions:

  1. “What is the current relative position of England in relation to major disease burdens and international peers?”
  2. “For which diseases and or risk factors is England improving or not improving?”
  3. “For which diseases and risks is England improving at a faster or slower rate than peers compared in the paper?”

3. Results

The data show that England’s health has improved over the last 30 years but improvement in mortality rates have slowed in the last decade. The slowing improvement in mortality is not unique to England and has been seen in 20 of the 22 countries compared.

It is largely due to a slowing in the rate of improvement in cardiovascular disease mortality and to some extent cancer.

England outperforms other UK countries in most areas of disease burden with lower rates of mortality and morbidity (death, illness or disability). Internationally, England outperforms the USA, but lags behind Scandinavian countries, the Netherlands and Spain.

The rankings of the burden of disease have remained stable over the last decade and ischaemic heart disease, lung cancer, stroke and COPD remain the most common causes of death. Deaths from dementia, pancreatic and colon cancer have increased.

The pattern is similar across the comparator countries, however the rate of years of life lost (YLL) in England in 2016 were:

  • 50% higher for ischaemic heart disease than France or Spain
  • 60% higher lung cancer than Finland or Sweden
  • 50% higher for stroke than Austria
  • and more than double for COPD than Finland or France

Major causes of morbidity (disability/illness) have remained stable in England, with the top 4 being back and neck pain, skin diseases, migraine and auditory and visual impairment. This pattern is similar for the comparator countries.

Depression and anxiety remain major sources of morbidity. Morbidity due to falls has increased.

Morbidity due to back and neck pain is second only to Denmark but rates in all countries are relatively similar. Morbidity due to asthma is almost double that of the USA.

There have been notable improvements in mean exposure levels to smoking, high cholesterol and high systolic blood pressure.

In England exposure to major risk factors is generally declining, but England is in the top quartile (in other words, highest level of exposure) to:

  • particulate air pollution
  • high cholesterol
  • diet low in whole grains
  • low levels of physical activity

GBD estimates show England’s alcohol consumption as relatively low compared to peers but has been increasing along with low physical activity rates and high BMI.

Hypertension rates, which have fallen substantially between 1990 and 2010, are levelling off.

See further information on Burden of Disease Study for England.

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