Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Davies of Brixton Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Davies of Brixton (Lab)]

My Lords, it is a pleasure to take part in this debate. We most certainly owe the noble Lord, Lord Patel, and his committee a big vote of thanks for their excellent report. I am only sorry that I was not here to participate.

As an actuary, life expectancy is my subject and I hope that I will be forgiven for emphasising aspects of how the issue is discussed. A crucial distinction, which needs to be understood in such discussions, is that between period and cohort life expectancies. It is not that one is right and the other wrong, but it is important to understand the distinct roles that both play in such discussions.

Period life expectancy is defined as the average number of additional years a person can be expected to live for, if he or she experienced the age-specific mortality rates of a given era in the current time period, for the rest of his or her life. The latest figures from the ONS are based on the experience of people for the three years 2018 to 2020. If you want to compare current mortality experience with that of the past—the experience of 2018 to 2020 with that of 20 years previously—the period life table is the one that you want.

In contrast, cohort life expectancy makes allowances for mortality improvements by combining observed and projected changes in mortality into future years. A cohort refers to a group of people with the same year of birth. For example, if someone is aged 18 in 2018, they were born in 2000 and would therefore be part of the year 2000 birth cohort. It has to be accepted that estimating future changes in mortality is difficult, but to ignore them would be even worse. Over many years, we have seen consistent improvements: people are living longer. However, the report points out that the rate of improvement has slowed in the last decade. While there are no uncontested explanations for this slowdown, I, along with many other practitioners, have no doubt that austerity has played a key role. In any event, this is a subject worthy of further study.

The report also points out the gross differences in life expectancy by social circumstances—one might even say class. But it is not the absolute level that differs by social circumstances; it is the rate of improvement. The wide differences that we see in rates of improvement are as much or more of a cause for concern as the current position. As has been mentioned, we await the levelling-up White Paper and it will be judged by how effective we think it is at addressing these issues. Can the Minister give us any reassurance that this will be a headline in the White Paper?

I come back to period and cohort life expectancies. Period life expectancies are based on solid data: we actually know how many people died in a particular period and what the population was. Cohort life expectancies depend on the exercise of some judgment about what changes in life expectancy are to be expected in future—over a period of many years, in the case of young people. However, if you want to know how long someone is expected to live—so that you could, for example, advise them on how much they need to save for retirement—you really need to use the cohort expectancy. In the same way, if you want to know what the future population will be then you need to adopt the approach of the cohort and build in allowances for potential improvements. This important distinction appears in the report, with footnotes that provide links to a detailed explanation. However, I am disappointed that the report focuses on period life expectancy. Fortunately, that does not affect its key conclusions, but it would be better to have used the more useful figure.

I am running out of time but want to say something about the impact of the Covid-19 pandemic on life expectancy. Quite understandably, given when it was written, the report itself says little. In any event, it is still relatively early days and the pandemic itself is a moving target. What we can be sure about is that it is here to stay. Every death is a tragedy, and the latest estimate from the Covid-19 Actuaries Response Group—I can recommend its website—is that the pandemic has cost 155,000 lives in the UK. It would be natural to assume, therefore, that this has had an adverse effect on life expectancy, particularly next year when more up-to-date data covering the period of the pandemic will be available. However, as is so often the case, it is more complicated than that, particularly when we come to cohort life expectancies. There are many consequences of the pandemic on future mortality, but not all are necessarily negative. For example, the improvements in hygiene, working from home leading to less traffic and pollution, and the mask wearing have clearly had some success—whatever their effects on Covid-19—in controlling influenza and other illnesses. I am sure that I, along with many others, will maintain these behaviours. We wait to see whether there will be the feared rebound, but the long-term effect will probably be positive overall.

There have also been significant improvements in medical science that might have a substantial effect on future mortality. The pandemic has spurred scientific innovation and collaboration from immunology and vaccine science through to new approaches to the collection and processing of health data and the organisation of healthcare. In particular, it has catalysed research and medical advances. RNA therapies are being harnessed to develop vaccines for personalised cancer therapy, infectious and autoimmune diseases and other disorders, not least cystic fibrosis and haemophilia. Work was already under way, but there is no doubt that Covid-19 has brought forward the time when these new treatments will be of value and extend human life.

I mention these positive effects not to make light of a pandemic where every death is a tragedy. However, it sets the Government a higher target: are they prepared to take advantage of these advances and deliver not just for those in the lucky groups who gain from improvements but across the board, focusing on those with fewer social advantages?