New analysis by the Health Foundation, using linked Census data from the Office for National Statistics (ONS), shows that the health of working‑age adults in England declined between 2011 and 2021, with people living in the most deprived areas significantly more likely to experience worsening health.
The findings offer the clearest evidence yet that place, deprivation and employment status have a profound influence on health outcomes over time. They also raise concerns about widening inequalities as the State Pension age rises.
For the first time, the ONS has linked 2011 and 2021 Census data, allowing researchers to track individual changes in self‑reported health over a decade across different social, economic and demographic groups.
The analysis shows stark variations in how health changes over time:
- 84% of adults aged 16–69 remained in good health over the decade.
- Among adults aged 65–69, that figure drops to 65%.
While health naturally declines with age, the rate of decline is strongly linked to deprivation.
Key findings include:
- 18% of working‑age adults in the most deprived areas lost good health over 10 years – far higher than the 13% average.
- People in the poorest communities faced a 40%–70% higher risk of deteriorating health than those in the wealthiest areas, even after adjusting for age, background and other social factors.
- The largest deprivation‑based differences were seen among women.
The effects appear early, with women aged 25–29 in deprived areas having a 70% higher risk of health decline than peers in the least deprived areas; for men, the figure was 69%. Alongside this, among adults aged 55–59, women faced a 57% higher risk, and men 51%.
More people in deprived areas stop reporting good health before reaching the current State Pension age of 66.
With the pension age rising, those in poorer health, who are disproportionately in deprived areas, will spend longer in a less generous working‑age benefits system. According to the Health Foundation, this increases the risk of long‑term poverty among older working‑age adults.
The findings confirm a strong, cumulative link between worklessness, ill‑health and long‑term disadvantage.
The Health Foundation argues that the data strengthens the case for:
- Place‑based prevention and investment in deprived communities
- Stronger employment support and improved access to secure, good‑quality work
- Tackling structural inequalities that underpin poor health
- Ensuring welfare and pension reforms do not disproportionately harm those already in ill‑health
Jo Bibby, Director of Health at the Health Foundation, said:
“Good health allows us to work, enjoy life, and take part in our families and communities. But more working-age people are struggling with their health, and the gap between the most and least healthy is getting wider. This evidence points to the urgency of a more preventative approach.
“Our analysis shows why we need action on the building blocks of health, such as our jobs, our homes, and our income. Strengthening these foundations means focusing on prevention, helping people stay healthy for longer, and supporting them to stay active in work and take an active role in society.”
The analysis provides a rare long‑term perspective on how health changes over time, and underlines that inequalities are avoidable, predictable, and socially patterned.
Image credit: iStock
