Abstract
How well is your health system performing? Subjectively, many health systems are slow to recover from the shock of covid-19. Objectively, many indicators point in the same direction, of a struggling health service, but which indicator captures a whole system failure?
Life expectancy, you might argue, is one such measure since it isn't simply a reflection of the performance of the health system. It also captures the wider determinants of health, and is made even more powerful when progress in life expectancy is ranked against other nations.
For many years, the UK enjoyed increases in life expectancy, and generally it still does. But the rate of increase in life expectancy has declined, and is in part explained by widening inequalities for gains in life expectancy.
If that narrative weren't grim enough, the UK's place in international rankings of life expectancy has dropped. 1 Where the UK was once among the leaders, rightly so as a rich nation with an advanced version of universal health coverage, the NHS, now the UK's lowly status in international rankings fits perfectly with the subjective experience of a health and care system unable to cope with the demands being placed upon it.
Furthermore, the full impact of covid-19 on life expectancy isn't yet established. Our understanding of the long term consequences of covid-19 is evolving. New research examines the effects of long covid on organs – and finds a substantial burden. 2 It will be important to understand how these findings influence longer term outcomes.
Some of these answers will come through appreciation of effect sizes in research. But effect sizes are often misunderstood and misapplied. The latest in our excellent series from the James Lind Library about the trustworthiness of evidence from treatment comparisons offers some clarity about how to present and interpret effect sizes. 3
Effect sizes of acts of public duty are hard to measure, such as campaigns against the “addiction industry”, 4 but Nick Black has attempted to quantify the impact James Lambert, a little known apothecary-surgeon, had on medical practice in a new book that we begin to serialise this month. 5 Lambert took on the medical establishment 200 years ago in an unprecedented row over surgical care, which helped make modern health care. The gains, then, were hard fought and are now being squandered.