An apple a day

Across the world, people are living longer, healthier lives than ever before. Yet in some rich countries, including the UK, progress has stalled or reversed. Policy responses must ensure that jobs, local economies and food systems support good health – and that healthy choices are easier to make.

Newsletter – 16 October 2026

Health is one of the main determinants of our quality of life. It shapes our ability to work, move freely and live without the burden of chronic pain or illness. For over a century, advances in medicine, sanitation and public health have helped people around the world to live longer and healthier lives. Child mortality has plummeted, antibiotics and vaccines have tamed infectious diseases, and improvements in maternal healthcare have made childbirth safer.

But in some of the richest countries in the world, the trend of progress is faltering. In the UK over the period from 2022 to 2024, healthy life expectancy – the number of years that people can expect to spend in good health – fell to 60.9 years for women and 60.6 for men, the lowest levels since reporting began in 2011 (see Figure 1).

Figure 1. Declining healthy life expectancy in the UK, 2011 to 2024

Source: Office for National Statistics (ONS), 2026.

The World Health Organization (WHO) uses a different method to estimate healthy life expectancy, but their data show a broadly similar pattern. In 2000, the UK was ahead of the typical high-income country on healthy life expectancy. Since then, gains have stalled while other countries have kept improving, and by 2023, the UK had slipped below the high-income median (WHO, 2026).

The gap between life expectancy and healthy life expectancy in the UK has also widened, from 10.7 years in 2000 to 12.5 years in 2024. In other words, while we may be living longer on average, the extra years are spent in poor health. This pattern does not hold for all high-income countries. International peers such as Italy and Japan show that some high-income countries maintain higher healthy life expectancy relative to overall life expectancy, suggesting that longer lives do not necessarily mean more years in poor health (see Figure 2).

Figure 2. UK versus high-income peers on healthy life expectancy and life expectancy at birth, 2023

Source: WHO, 2026.

What’s more, this isn’t just a story of ageing populations. A recent review of UK birth cohorts found a ‘generation health drift’: at the same stage of life, younger generations report worse health than earlier ones for obesity, diabetes and mental health. Indeed, 22.2% of British year 6 children (those aged 10-11) were found to be obese in 2024/25, while over 20% of 8-16-year-olds were reported to have a ‘probable’ mental health disorder.

The consequences of this health drift have far-reaching economic and social implications. Beyond putting further strain on the NHS, it directly affects people’s lives and their ability work. Around 16 million working-age adults now live with a long-term health condition, and almost three million are outside the labour market because of long-term sickness.

Obesity and excess weight are estimated to cost the UK economy £31 billion a year in lost productivity, with obese workers around twice as likely to take long-term sick leave. So health is not only a measure of our quality of life: it is also a measure of the quality of our economy.

This week at the Economics Observatory, we have published four new articles on long-term sickness, health and obesity. We explore why health is getting worse in a world of modern medicine, what it means for the economy, whether a new generation of weight-loss drugs could help, and what it would look like to reframe our understanding of prosperity around health.

Too sick to work

The first piece, written by Heather Brown (Lancaster University), examines why health-related economic inactivity is rising in the UK.

The number of people reporting a work-limiting health condition has grown by over 20% in a decade – from 3.2 million to 3.9 million. This means that 6.4% of the total working age population is unable to work due to long-term sickness (see Figure 3).

Figure 3. Share of UK working-age population who are economically inactive due to long-term sickness, 1993 to 2026

Source: ONS Labour Force Survey

Heather finds that there are two main drivers:

First, work-limiting mental health conditions among 16-34-year-olds have risen by 77%.

Second, musculoskeletal conditions, which affect the joints, bones and muscles, have increased by 32% among 50-64-year-olds over the past decade.

For both groups, Heather finds no single obvious cause. Mental health outcomes in young people are likely to be a result of social media, the lasting effects of Covid-19, long NHS mental health waiting lists and less in-person mentoring in a world of remote work. In Heather’s own research, she finds that austerity may have played a part: young people’s mental health fell furthest in areas hit hardest by cuts to local government funding, such as the North East.

For older workers, musculoskeletal conditions may reflect a different combination of pressures. Stress, long NHS waiting lists, prolonged periods of desk-based work, limited access to occupational health support in smaller firms and the physical demands of warehouse work could all have contributed to the rise.

Heather concludes that there is no single solution to rising health-related economic inactivity. Tackling it will require coordinated action across employers, schools, the NHS and the Department for Work and Pensions. This means not only improving access to treatment, but also preventing work from damaging people’s health and helping those with existing conditions to remain in employment.

A postcode health lottery

Taking a regional view of the UK, Luke Munford, Doriane Mignon (both University of Manchester) and Julija Simpson (Newcastle University) explore how health inequalities shape economic performance.

Geographical health inequality in the UK is substantial. Men living in the most deprived 10% of areas in England can expect 49.8 years in good health, compared with 69.2 years in the least deprived areas – a gap of almost 20 years. For women, the gap is slightly larger (see Figure 4).

Economic outcomes are similarly uneven: productivity in Tower Hamlets in London is almost three times that of Powys in Wales, while economic inactivity ranges from 18.4% in the South East to 25.1% in the North East (ONS, 2026).

Figure 4. UK healthy life expectancy at birth by area deprivation, 2022 to 2024

Source: ONS, 2026.

The authors of this article find that these regional inequalities are closely linked. Many of the health conditions behind regional differences, including obesity-related and musculoskeletal conditions, are more common in deprived areas. Health-related economic inactivity is around 50% higher in the North of England than in the rest of the country, with differences in health explaining more than two-fifths of this gap (Simpson et al, 2025a).

To illustrate the potential scale of the economic consequences, modelled estimates suggest that closing the health gap between the North and the rest of England could generate an additional £18.4 billion in economic output each year, with £6.6 billion linked to mental health alone (Simpson et al, 2025a; Mignon et al, 2026).

Luke, Julija and Doriane also point to policies that could help to address this imbalance. Shorter waiting times for NHS Talking Therapies were associated with a smaller employment gap between people with good and poor mental health, while helping just 5% of sick or disabled recipients of Universal Credit into work could generate around £12 billion in fiscal benefits.

But healthcare alone cannot close the gap. Health is also shaped by incomes, welfare policy and the availability of suitable local jobs, which can vary by more than six-fold for young people across UK labour markets.

The authors argue that reducing health inequalities should be treated as part of regional economic policy, not just health policy. They recognise that causality runs both ways: poor health holds back local economies; while weak economies, low incomes and poor-quality jobs damage health too.

This makes the underlying drivers hard to disentangle, with the evidence reviewed being stronger on who is able to work rather than how productive they are once in work. Nevertheless, health, place and economic performance are closely linked, and effective policies should seek to address these challenges together.

As devolution and regional inequalities move up the UK’s political agenda, more decisions about health, skills and transport are being devolved to local policy-makers. Understanding how health and economic outcomes interact across regions will become increasingly important as local leaders take on new powers and responsibilities.

Changing appetites, changing baskets

Obesity is one of the defining health conditions of modern life. In the United States, over 40% of adults were living with obesity in 2021-23, while obesity costs the NHS around £6.5 billion each year in the UK. A new generation of weight-loss drugs is now being deployed at scale, but how much will they change diets?

Looking across the Atlantic for lessons, our third piece – by Jūra Liaukonytė, Sylvia Hristakeva (both Cornell University) and Leo Feler (Federal Reserve Bank of Chicago) – examines how the rapid rise of GLP-1 weight-loss drugs is changing what households put in their shopping baskets. By July 2024, around one in six US households included a user of medications such as Mounjaro and Ozempic, so even modest changes in household behaviour add up.

Using purchasing data from around 150,000 US households, the authors find that those with at least one GLP-1 user cut their grocery spending by 5.3% in the first six months after starting the drug, equivalent to about $390 (just under £300) a year (see Figure 5). Spending at fast food restaurants, coffee shops and similar outlets falls by 8%. This is unusual, as food habits are typically very hard to change.

Figure 5. How category spending changes after GLP-1 adoption

Source: Hristakeva et al (2025).

GLP-1 households buy fewer items overall, with the biggest falls in crisps and savoury snacks (more than 10%), sweet bakery products (8.8%) and biscuits (6.5%). Yogurt is the only category to show a statistically significant increase. Spending cuts also vary by income with higher-income households (those earning over $125,000) reducing grocery spending by 8.2%, compared with 3.9% for lower-income households.

The study also finds that these changes may not last. About a third of households in the study stopped taking a GLP-1, with their grocery spending returning almost to its original level within six months. Their baskets looked slightly less healthy than before, with spending on sweets and chocolate around 11% higher than before adoption. The authors are careful to note that these are early results, based on higher-income US households at a time of rapid adoption, so effects in the UK may differ.

GLP-1s are reshaping demand for food, with an estimated $9 billion fall in US grocery spending and a further $7 billion in restaurant spending. Food manufacturers and restaurant chains are already adapting. Nestlé, for example, has developed products with more protein and fibre, while food outlets adopt smaller portions.

The rise of GLP-1 drugs raises important questions for the food industry, public health and healthcare spending. While the drugs appear to be reshaping shopping habits, it remains unclear whether these changes will last beyond treatment. Their long-term impact on health and the wider economy will depend on who can access them, how long people continue taking them, and how food suppliers adapt to changing demand.

Reframing prosperity

Our final piece takes a different approach to health. Rather than asking how health affects the economy, Tim Jackson (University of Surrey) explores how the economy affects our health – and whether the way it is organised contributes to the very problems that hold it back.

Tim argues that illness is not just shaped by our genetics, choices or healthcare systems, but also by the economic and commercial environments in which we live. Our health depends on factors such as nutrition, income security, housing, working conditions and time to rest. Yet commercial incentives can reward activities that undermine these foundations. In the food industry, for example, companies compete for sales and market share, and they may promote products designed to encourage (over)-consumption rather than provide nutritional value.

In the UK, a recent study found that ultra-processed foods (such as sweet drinks, crisps, cake and some ready meals) account for around 66% of adolescent calorie intake, with consumption highest among deprived households. Concerns over the impact of ultra-processed diets extend beyond obesity, with a growing body of evidence linking their consumption to the rise of early-onset bowel cancer in young people.

Drawing on his research for the Food, Farming and Countryside Commission, Tim estimates that unhealthy diets cost the UK around £298 billion a year. This includes £67 billion in healthcare costs, £20 billion in social care, £18 billion in health- and disability-related welfare payments, £119 billion in lost productivity and £75 billion in diminished quality of life. These costs are not necessarily borne by the companies selling products such as ultra-processed foods. Instead, they are distributed across households, employers, public services and society more broadly.

Tim describes this as a false economy. He estimates that making a diet consistent with the government’s Eatwell Guide affordable to every household would cost around £51 billion a year – far less than the estimated cost of unhealthy diets. Yet for the poorest households, eating healthily remains prohibitively expensive: following the Eatwell Guide would require around 85% of disposable income after housing costs.

Food and diet are just one example of the wider problem. When economic success is measured primarily through GDP, consumption or profit, activities that expand markets can be rewarded even when they damage health. Meanwhile, prevention and care – the benefits of which often emerge over longer periods – risk being undervalued. Tim therefore proposes reframing prosperity around health rather than wealth alone. This would mean treating prevention, care and the conditions that sustain wellbeing as investments in society, rather than simply costs to be managed.

A prosperous economy, Tim concludes, should not merely pay to treat the illnesses it helps to produce: it should also create the conditions in which people can live healthier lives.

Conclusion

An apple a day should keep the doctor away. Yet in some of the richest countries in the world, including the UK, people are spending less of their lives in good health. This week’s series shows that the link between health and the economy runs both ways. Poor health holds the economy back, but the economy also shapes the conditions in which people live. Four lessons stand out:

Poor health holds people back – and economies too. Rising health-related economic inactivity shows how illness can prevent people from working, with consequences for individuals, businesses and the wider economy.

Where you live matters. Regional health inequalities mirror and reinforce economic inequalities, leaving some places facing a particularly difficult cycle of poor health and weak economic performance.

New treatments offer opportunities, but not simple solutions. Weight-loss drugs could change people’s health and spending habits, but their effects also raise questions about access, affordability, sustainability and the wider food system.

Health is shaped by how the economy is organised. If economic conditions and commercial incentives contribute to ill health, treating people once they become sick will only ever address part of the problem. A healthier economy may require us to rethink how we define and pursue prosperity.

The conditions that limit lives today are different from those of a century ago. Modern medicine has made many infectious diseases treatable, but obesity, poor mental health and musculoskeletal conditions are shaped by how people live, work and eat. Treatments, including a new generation of weight-loss drugs, can help to manage these conditions, but they do not change the conditions that produce them.

That is where policy comes in: ensuring that jobs, local economies and food systems support good health, and that healthy choices are affordable and easy to make. An apple a day may not be enough to keep the doctor away, but an economy that makes it easier to afford and choose the apple would be a good start.