By Kev Stone, David Dearlove, Ian Hamilton, Jurin Katayama-Flores, Lydia Leon, Michael Murphy, Sarah Vicary, Soazig Clifton

Credit: Charlie Griffiths from Pexels

A good way to follow the health of a nation is to glance at what is known as period life expectancy. This calculates how long a person born today would live if the current death rates remained exactly the same for the rest of their life. This had two major turning points in the UK over the period: a marked slowdown in improvements from around 2011 and a sharp, historically unprecedented fall in 2020 during the COVID-19 pandemic.

The slowdown in improvement from the early 2010s was part of a wider pattern across high-income countries. The UK and the other five largest of these nations, including France, Germany and Italy, experienced similar stagnation, although the UK's was somewhat more persistent.

Contrary to frequent claims that the UK's mortality performance is uniquely poor, its period life expectancy gains were broadly similar to those of these comparator countries and the OECD average between 2000 and 2024. For example, France's period life expectancy increased by an annual average of only four days more per year than the UK's over that time.

Changing life expectancy

The most dramatic disruption occurred with the COVID-19 pandemic. The UK's 179,000 COVID-related deaths in 2020–21 represented the largest mortality shock since World War II. As it turned out, the nation's mortality rate peaked in 2020 and has fallen each year since. By 2024, it had returned to levels close to those in 2019, the lowest ever, and we've seen a similar trend across Western Europe.

The long-term implications of the pandemic remain uncertain, but they are potentially severe and likely to affect all groups of society. Many people have experienced life-changing effects from long COVID. Evidence from earlier pandemics, including the 1918–19 influenza pandemic, also suggests that babies in their mothers' wombs may have experienced long-term negative health effects from exposure to the virus.

Causes of death

Underlying these mortality trends in the UK are shifts in the major causes of death. In 2024, cardiovascular disease (26%), cancer (26%), respiratory disease (12%) and dementia (9%) accounted for three-quarters of deaths in England.

Changes in cause-of-death classification make it difficult to see whether these have changed over the long term. But the early 2000s saw rapid declines in cardiovascular mortality, for instance, driven by improvements in treatment and prevention and reductions in smoking.

However, these gains have slowed, and since 2019, progress in reducing cardiovascular deaths has stalled. This reflects a combination of fewer medical breakthroughs in related chronic diseases such as diabetes and high blood pressure and rising pressures on the health and social care systems.

More generally, changing risk factors will be important for the future. We're smoking much less today, from 26% of adults in 2001 to 11% in 2023, which reduces the scope for further mortality gains from tobacco controls.

In contrast, obesity has become the top lifestyle danger, with the proportion of adults classified as obese in England rising from 20% in 2001 to 30% in 2024. These trends imply a growing future burden of cardiovascular disease, diabetes and certain cancers, with long lag times before the full effects are observed.

This rise in obesity will also contribute to rising levels of nonfatal but disabling conditions. As many as 26% of adults report chronic pain, and half of those report high-impact pain (meaning long-term pain that severely limits your ability to function in daily life). Low back pain is now the leading cause of years lived with disability in the UK, mirroring global trends.

Mental disorders are rising steadily, with common mental health conditions increasing from 17.5% in 2000 to 22.6% in 2023–24 among working-age adults. The rates are higher among younger people: 26% among 16–24-year-olds, compared with 10% among those ages 75 and older.

There also appears to have been an increase in poor health in general. Witness the fact that healthy life expectancy in England increased modestly between 2000–02 and 2017–18 (the last period that did not include the COVID-19 pandemic), but only around half of the additional years gained were spent in good health.

While mortality improvements are likely to resume, they may do so at a slower pace than in the late 20th century. The aging population, rising obesity and worsening health among younger people all pose risks. The prolonged deterioration in U.S. mortality linked to drug-related deaths and "deaths of despair" also illustrates that you certainly can't assume progress will continue. The UK's future health will depend on its ability to address chronic disease, reduce risks like obesity and strengthen its ability to respond to future shocks.

Eating and drinking habits

David Dearlove, Principal Researcher, Healthy Life Mission, Nesta

Jurin Katayama, Analyst, Healthy Life Mission, Nesta

Lydia Leon, Senior Mission Manager, Healthy Life Mission, Nesta

In 2001, meal deals were a novelty, phones had buttons, and the Food Standards Agency (FSA) was a 1-year-old watchdog. Twenty-five years on, Britain's relationship with food is very different, with big changes in the types of food available and how we buy it, as well as how it is promoted and regulated.

When it comes to how people buy their food, supermarkets still dominate. The retail landscape has been disrupted by the rise of discounters like Aldi and Lidl, whose market share climbed from a mere 3% in 2002 to about 14% by 2021. But given that large supermarkets continue to supply over 80% of our average daily calorie intake, their influence over public health remains profound.

Food bought outside the home has seen large changes. Across Great Britain, the density of fast-food outlets—meaning per person—rose by 36% between 2011 and 2024, outpacing the 17% growth in supermarket density. This supply surge reflects shifting demand—while only a quarter of UK adults ate out once a week or more between 2008 and 2012, in 2021 this rose to more than 60%.

Unfortunately, food prepared outside the home is rarely a healthy choice. Most of these meals exceed the recommended calorie intake for an eating occasion, and about 20% of meals contain more than half the total recommended daily intake.

This physical saturation is mirrored in our digital lives, as ordering food to our door has become easier than ever. When Just Eat launched in 2001, ordering food online was a novelty. Today, platforms such as Just Eat, Deliveroo and Uber Eats connect us to thousands of takeaways at any hour, with their market worth £13.9 billion (2024). Online grocery shopping has also risen, from barely existing in 2001 to now making up around 12% of the grocery market.

Ever more marketing

The way food is bought and promoted has not only gone more digital but is now dominated by pervasive marketing and personalized nudges. Outdoor food and drink advertising, covering everything from billboards to train carriages, has more than tripled in real terms over the past two decades, now accounting for £590 million in advertising spending a year. The rise of apps and loyalty schemes has also expanded the ways customers can be reached, with regular notifications and time-limited "special" deals designed to make us order more often and in larger amounts.

Of the £2.4 billion spent on UK food advertising in 2024, investment in nutritious alternatives remains negligible. For instance, while advertising focusing on fruit and vegetables now accounts for less than 5% of traditional food and nonalcoholic drink advertising budgets, unhealthy foods account for closer to a third.

There has also been a shift in the regulatory landscape. We've seen a gradual move away from voluntary schemes such as Public Health England's calorie, salt and sugar reduction programs toward more interventionist policies, including the 2018 Soft Drinks Industry Levy, which incentivized many manufacturers to reduce sugar content to avoid charges.

Expanding on this, in 2025 the government announced the introduction of the healthy food standard policy. This will require large food businesses, including supermarkets, to report on the healthiness of their sales and meet mandatory targets for improvement. Yet while the regulatory framework is improving, further intervention will be necessary to get the nation to eat more healthily.

Alcohol and drug use

Ian Hamilton, Honorary Fellow (Associate Professor) in Addiction at the University of York

Drugs, like fashion, change over time. Since the millennium, for instance, we have seen a surge in cocaine use. Once regarded as an expensive drug used by the elite, it is now more affordable than ever and more potent, which explains its greater popularity.

This has been facilitated by increased global supply and organized crime groups able to transport and distribute the drug effectively. Unfortunately, rising use has been accompanied by an equally rapid increase in cocaine fatalities, with nearly 1,300 in 2024 in England and Wales alone.

The last 25 years have witnessed the emergence of synthetic drugs, particularly synthetic opiates, which are much more potent than traditional organic opiates such as heroin. Like cocaine, the rise in synthetic drugs has seen an increase in drug-related deaths, with the UK having the highest mortality rate in Europe.

Another group of synthetic drugs that has emerged is novel psychoactive substances, also known as legal highs, even though they were banned a decade ago. Examples include Spice, a synthetic form of cannabis, and the stimulant referred to as monkey dust.

As with all drugs, the negative consequences of using them are not experienced equally. Those who are vulnerable, poor, homeless or living in the most deprived areas of the UK are more likely to die or suffer poor health from using these drugs. Synthetic drugs have caused havoc and misery in prisons and among rough-sleeping populations.

Drug use in the UK 2000–25

Cannabis remains the most widely used illicit drug in the UK. Adult use has remained stable over the past 25 years. However, this disguises the trend of falling cannabis use among young people (ages 16–24) since 2020.

Alcohol and the internet

Without a doubt, the advent of the internet has directly and indirectly shaped which drugs are widely used and which are not. For example, the data show that since the millennium, young people have shunned alcohol.

This is thought to be due in part to young people not wanting to be seen as intoxicated or behaving badly because of drinking on social media. In parallel, this cohort is more health-conscious and keen to adopt a healthy lifestyle that doesn't include alcohol.

Over the same period, alcohol consumption by adults has remained relatively stable. Older adults are now more likely to drink than their younger counterparts: 84% of those ages 55–64, compared with 65% of those ages 16–24.

Alcohol-related deaths in the UK

The internet has also opened access to drugs through platforms like WhatsApp, Facebook and Telegram. People can simply browse dealer menus via Instagram, for example, or message a Telegram bot and have drugs brought to their door within the hour.

What hasn't changed is drug policy. Successive governments have stuck with the 1971 Misuse of Drugs Act, despite the fact that applying a

50-year-old policy to contemporary patterns of drug use is a terrible mismatch. When this legislation was enacted, many of the most widely used drugs today didn't exist. There is also now a consensus that drug use should be framed by health rather than penal policy.

Yet there is no political appetite for policy change, just the continued mantra of getting tough on drugs by trying to disrupt supply and distribution. In contrast, organized crime is innovative and adaptable.

Sexual behavior

Soazig Clifton, Academic Director for Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal), University College London

By the early 2000s, Britain had experienced decades of social and demographic change dating back to World War II. Marriage rates had fallen, people were having children later and in smaller numbers, and family structures had become more diverse.

These changes were accompanied by increasingly liberal attitudes toward sexuality. Same-sex relationships were becoming more socially accepted. Younger generations were having sex earlier and marrying or cohabiting later than previous generations.

Public concern had also shifted. The widespread fears around HIV/AIDS that had characterized the 1980s and early 1990s were receding. Attention had turned to the UK's rate of teenage pregnancy, which was among the highest in Europe, and rising levels of chlamydia and other sexually transmitted infections.

The best evidence on population trends in sexual behavior comes from Britain's National Surveys of Sexual Attitudes and Lifestyles (Natsal), one of the largest scientific studies of sexual behavior in the world.

Conducted approximately every decade since 1990, Natsal provides representative snapshots of the population, offering a unique window into Britain's changing sex lives.

The most recent published survey, Natsal-3 (2010–12), documented substantial changes in women's sexuality during the 2000s. Women reported higher numbers of sexual partners and more same-sex experiences, with one in six women reporting sexual experience with another woman.

Vaginal and oral sex have remained the core of the heterosexual sexual repertoire since the first survey in 1990. However, the 1990s and 2000s also saw increases in heterosexual anal sex, reported by around one in six people by 2010–12.

Yet despite increasing diversity in sexual behavior, Natsal identified another trend: People were having sex less often. Among 16–44-year-olds in 2010–12, the median frequency of sex was three times per month, compared with four times in the two previous surveys.

Where are we now?

The latest Natsal data, collected between 2022 and 2024, will be published later this year. It will provide the first comprehensive picture of Britain's sex lives after a decade shaped by economic uncertainty, the COVID pandemic and the growing digitization of everyday life. For the first time, Natsal-4 collected data on online sexual activities, including pornography use and sexting, as well as expanding measures of gender to include transgender and nonbinary identities.

Other data sources offer clues about what we might find. Natsal-COVID , an online survey conducted during the pandemic, suggested further declines in sexual frequency and potential reductions in behavior associated with sexually transmitted infections (although these comparisons are limited by methodological differences).

Meanwhile, data from the Office for National Statistics show increasing numbers of people identify as LGBTQ+. Research with adolescents in Britain and other European countries has also shown declines in sexual experience. These changes sit alongside broader shifts in young people's lives, including declining rates of smoking and drinking, rising levels of poor mental health and high rates of loneliness, more time online and less time socializing face-to-face.

Whatever Natsal-4 reveals, the picture will probably keep evolving. Societal change and new technologies, including AI, are likely to shape our sexual behavior and intimate relationships in ways we cannot yet predict.

Mental health

Kevin Stone, Associate Dean for Partnerships and Business Development (Health and Social Care), University of South Wales

Sarah Vicary, Professor of Social Work and Mental Health, The Open University

In 2000, care in the community was gaining ground, but provision remained uneven. Although the closure of long-stay psychiatric hospitals had reshaped the system, hospital admission remained a dominant response to people experiencing an acute mental health crisis. Patient voices were also beginning to emerge more strongly against a backdrop of stigma, with growing demands for better-quality care in both primary and secondary services.

Since then, we have seen significant changes in attitudes and responses

to mental health needs. Mental health is no longer seen simply as a private struggle that should be hidden, but increasingly as a public health concern.

Awareness-raising has helped create a culture in which speaking about mental health is more acceptable than it was in 2001 and more actively encouraged everywhere from workplaces to schools to the home. For those with severe diagnoses, the shift away from institutional care before the 1990s toward community-based support has also been clear.

Nonetheless, we are seeing more children and young people reporting adverse childhood experiences, trauma and neglect, all of which can lead to significant mental health needs. We also continue to see high numbers of detentions under mental health legislation involving people in severe mental distress, with a disproportionate impact on men from ethnic minority groups.

Mental health-related absences from work continue to be a problem—stress, depression and anxiety cost 22 million working days in 2024/25. Societal barriers like stigma still prevent many people from discussing their declining mental health or seeking help early, which undermines effective prevention.

The transformation

When it comes to raising awareness, anti-stigma campaigns such as Time to Change, led by Mind and Rethink Mental Illness, alongside World Health Organization initiatives, have contributed to changing behavior and attitudes. World Mental Health Day each October and campaigns led by YoungMinds have helped reinforce this message. The same goes for public figures and people with lived experience, such as Stormzy and Davina McCall.

We have seen the growth of mental health first aiders in the workplace, mental health champions in schools and helplines offering nonjudgmental listening and support.

The principle that mental health should be valued as highly as physical health (known as parity of esteem) has increasingly shaped NHS policy. The NHS commissioners who oversee health services within particular areas have reshaped mental health services to place greater emphasis on community-based support and treatment.

This has included dedicated mental health workers in emergency departments and doctors connecting patients to nonmedical community activities to help improve their outlook (this is known as social prescribing). Access to psychological therapies has also improved and is now recognized through NHS Talking Therapies in GP practices and primary care settings.

The authorities are also giving more attention to societal factors affecting people's mental health. When patients come to GPs with anxiety triggered by things like debt or poor housing, they are expected to refer them to a link worker to help overcome these problems. It's now increasingly recognized that responses to mental health needs should never be about medication alone. There has also been growing recognition of the role played by family members, nearest relatives, friends and unpaid caregivers.

Yet NHS services are still too often forced to respond to crisis rather than prevent it. Funding pressures and workforce shortages have combined with the increased demand for mental health services to place the system under growing strain.

As well as addressing this, the wider challenge is to build a society and system that values prevention, compassion, choice, dignity and timely support. That way, mental health won't just be protected in moments of crisis, but throughout the course of everyday life.