Barriers and Breakthroughs: How health trends, mortality and equity intersect

We were delighted to recently host a Female Forum roundtable, with senior female leaders in the pensions industry, titled “Barriers and Breakthroughs: How Health and Longevity inequalities impact pensions schemes.”

The event featured perspectives from LCP’s Health Analytics and Mortality teams to explore:

• trends in worsening of health outcomes between certain population groups;
• what they mean for shaping our view on longevity; and
• why health equity, particularly for women, remains critical to address.

Combining these perspectives enabled us to explore a multi-dimensional view of health outcomes: one grounded in real-world evidence and health system insight, the other in long-term mortality modelling and implications for pension schemes, insurers and policymakers.

A health system under pressure

The UK health system is facing challenges it was never originally designed to handle. An ageing population, rising multimorbidity, backlogs post-COVID, and a drop in hospital productivity are all stretching the NHS to its limits. With the population aged 85+ growing fastest in the UK and 75% of 75-year-olds already managing more than one long-term condition, these pressures are only expected to grow.

The mortality picture

UK mortality improvements stalled around 2010 after decades of steady progress. The pandemic then caused a sharp spike in deaths before 2024 saw record-low death rates.

• Older adults are experiencing modest improvements.
• Working-age adults (20–59) face worsening mortality, driven by “deaths of despair” (suicide, alcohol, drug-related causes).
• Gender dynamics are shifting: the life expectancy gap is narrowing, with men seeing faster improvements, while women face health challenges that often reduce quality of life but don’t always show up in mortality statistics.
  
  

Health Inequalities and the Gender Gap

Much of the roundtable discussion focused on the health inequalities women face. The UK still has a significant gender health gap, with serious implications not just for health outcomes, but also for economic productivity and quality of life.

Women are facing greater access barriers, with LCP’s work with the Royal College of Obstetricians and Gynaecologists (RCOG), finding gynaecology waiting lists have grown faster than any other specialty since the pandemic. Over 750,000 women are currently waiting for care, many in pain, facing fertility challenges. This number is the equivalent to filling Wembley stadium 8 times over.

Women are also more likely to be misdiagnosed, with the British Heart Foundation finding that women are 50% more likely to be misdiagnosed after a heart attack due to historic bias and lack of awareness. Some groups face compounded barriers: our work with Pfizer found that women living in more deprived communities, and black women, face significant inequalities throughout their entire breast cancer care journey.

Health innovation without access?

While medical innovation is flourishing, access remains unequal. The UK lags behind many European peers in availability of newly approved medicines, and within the UK, regional disparities persist. Previous research shows that patients in some areas are three times less likely to receive certain NICE-approved treatments than others.

These gaps reinforce the need to distinguish between equality and equity. A one-size-fits-all approach won’t work when systemic barriers and lived experiences vary so widely.

Insights for pension schemes

Inequalities in health and longevity directly shape pension outcomes.

• Regional gaps in life expectancy are stark, with real financial impacts for schemes.
• Slower mortality improvement mean lower life expectancies which, in turn lowers liabilities – but many Scheme assumptions are already cautious and are assuming little to no improvement over the short term.
• Incorporating real-world health insights can give more accurate estimates, helping trustees and sponsors better understand their long-term obligations.

What’s next?

The Government’s new 10-Year Health Plan includes welcome commitments to tackling health inequalities. But the plan’s limited acknowledgement on women’s health challenges is stark. “Women” and “women’s health” are mentioned just 17 times, compared to 79 mentions of “AI.” We must hope that the plan’s ambitions around neighbourhood care, digital inclusion, and trust will benefit women, provided implementation is bold and intentional.

From the perspective of what pension leaders could do, as the financial world increasingly looks to align with ESG principles, one idea raised in the session was a women’s health-themed Defined Contribution investment fund. This could focus on femtech, female-led companies, and pharmaceuticals tackling women’s health challenges. Could the "S" in ESG finally put women's health front and centre?

Final thoughts

We were reminded during the discussion that health equity isn’t just a health issue, it’s an economic one. McKinsey has estimated that closing the female health gap could boost the global economy by $1 trillion annually. In the UK, menopause-related workplace dropout alone is costing £1.5 billion a year.

One innovative idea raised was to reinvest future DB scheme surpluses (when shared between sponsors and members) into workplace health initiatives – from menopause support to broader wellbeing. This could create long-term value for employers and employees alike.

So perhaps the final question posed at the roundtable is one for us all to reflect on: Are we championing women’s health in our workplaces?