Understanding changes to life expectancy and inequalities in the UK, Germany, and other high-income countries.

The rate of improvement in life expectancy and mortality slowed considerably in a number of high-income countries from the early 2010s, predating the COVID-19 pandemic by almost a decade. Evidence for different countries, including the separate nations of the United Kingdom (e.g. Scotland and England), shows that this overall 'stalling' of improvement has been driven by markedly worsening mortality rates among poorer populations, thereby considerably widening spatial inequalities. Here we synthesise international data and evidence-with a particular focus on the United Kingdom and Germany-to highlight the common causes of these trends, most notably economic 'austerity' policies that were implemented in the aftermath of the 2007/2008 financial crash. These have demonstrably increased rates of poverty, reduced availability of required social services, and left public services more threadbare, all of which has negatively impacted mental and physical health and mortality. We conclude with a discussion of the economic policy responses required to address this multi-nation population health emergency.