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Improvements in life expectancy at birth observed before the COVID-19 epidemic had slowed considerably in most OECD countries in recent years. Longevity gains fell on average 25%, when comparing the period between 2012 and 2017 to a decade earlier. One reason behind this is that cardiovascular disease (CVD) mortality improvements are now substantially lower than what they used to be in some countries. CVD is a major killer in OECD societies, causing many preventable deaths and large social inequalities. CVD mortality improvements recorded a reduction of over 50% in the United States, Italy, the Netherlands, Austria, Ireland, and Canada since 2010, relative to the prior decade. The same can be said for men in Portugal and women in Israel and Iceland.

Several reasons underpin this trend. For a start, the prevalence of underlying lifestyle risk factors that cause CVD is rising. Rising trends in obesity and diabetes are estimated to offset the mortality reductions attributed to favourable changes in smoking. OECD estimates that overweight-related diseases will reduce life expectancy by nearly three years by 2050, without further policy action. Furthermore, newly emerging risk factors are contributing to higher CVD mortality, like drug overdose and air pollution. Severe influenza outbreaks in some recent winters, as in 2014-15, could also have impacted on CVD mortality, as influenza and pneumonia can trigger cardiovascular events like heart attacks, and in turn, individuals with CVD may be more susceptible to dying from influenza or pneumonia.

The decelerating improvement in CVD mortality is a major cause for concern with implications for policy and research. First, these trends send a warning call for further action in primary prevention, early detection and secondary prevention. Health systems must better balance priorities between prevention – now accounting for less than 3% of total health spending – and treatment. Policies focussed on prevention that stimulate lifestyle changes need to be a priority universally, but health systems must also do better at delivering more cost-effective early detection and diagnosis. Some 40 to 72% of avoidable deaths are attributable to risk factors such as smoking, blood pressure and cholesterol levels, while 23 to 55% are linked to access to acute care and secondary prevention.

Second, it remains urgent to address the large inequalities in CVD prevalence and mortality that penalise the most disadvantaged subgroups of the population. Reducing the unequal burden of CVD is likely to require a combination of targeted policies that go well beyond the health sector, such as housing, employment, and environmental policies, alongside strategies to improve diets, and reduce smoking and alcohol intake among these population groups. A move towards structural population-level prevention, such as fiscal and regulatory measures, can be effective and help to free resources to invest in other pressing areas, like the interface between health and social care. This would further help reduce inequalities, and tackle the pressures on health systems exerted by population ageing. Better understanding of which combination of strategies can offer the best overall approach for tackling the challenge of CVD in our populations over time is therefore an urgent research priority to support policy decisions.

Third, there is a pressing need to improve the underpinning data and monitoring processes, making health data infrastructures more fit-for-purpose for understanding these trends. Data to support timely and effective monitoring of CVD mortality and morbidity is lacking, and the same applies for monitoring of risk factors for CVD such as overweight, blood pressure, smoking, air pollution, and drug abuse. More efforts must be made to optimise the use of existing data systems through linkage of epidemiological surveillance, clinical and administrative datasets, including primary and hospital care records, clinical data and death records. This will be particularly critical in the current COVID-19 epidemic where people with CVD are amongst the population subgroups with the highest mortality risk.

The King’s Fund and the OECD joined forces to raise awareness about the magnitude of these challenges and the need for an urgent policy response to address CVD mortality. This publication is the result of this collaboration. Based on discussions that took place in a joint workshop at OECD in Paris, it presents the evidence on trends in CVD mortality, and their contribution to the slowdown in improvements in life expectancy in some OECD countries. The workshop showed that there is still a long road to be travelled to better understand why we see these trends, and what action is needed to reverse them. Our hope is that this publication will help to shed some lights and support better policies in the future.


Stefano Scarpetta,

Director, Employment, Labour and Social Affairs,



Richard Murray,

Chief Executive,

The King’s Fund

This report was produced in 2019, prior to the onset of the COVID-19 pandemic. The findings were designed to provide a meaningful interpretation of mortality trends prior to this pandemic. The COVID-19 pandemic could have an impact on life expectancy trends in 2020. The issues discussed in this report will nonetheless be relevant in the longer term when the effects of the pandemic subside.

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