Health prevention: How does the UK compare?

International comparisons of health prevention often rely on a single measure, such as spending or death rates, considered in isolation. Although useful, it can hide important differences in how countries organise and deliver prevention. It can also make it harder to see where change is needed, and which actions are most likely to improve health. To begin to address this, the analysis takes a broader view, integrating evidence on deaths, ill health, risk factors, and how policies are put into practice to build a fuller picture of how prevention is conceptualised, measured and delivered in the UK relative to similar countries.

What the comparison tells us

The headline finding is stark. The UK is among the worst performers on avoidable, preventable and treatable mortality, and its rate of improvement over the past 15 years has been notably slower than in peer nations. The scale of the gap is clear. In 2023, the UK had the second-highest avoidable mortality rate among the comparator countries. Within the UK, Scotland's rate—307 avoidable deaths per 100,000 people under 75—sat just behind the USA at 318, with the UK overall following at 237. At the other end of the scale, Japan had the lowest avoidable mortality rate among the comparators at 158, while Switzerland's rate of 133 was less than half Scotland's.

There is also a varied story within the UK’s own nations:

• Scotland had the highest avoidable, preventable, and treatable mortality rates of the four UK nations, and the highest avoidable cancer mortality rate of any comparator country. 
• England and Wales had the lowest avoidable and preventable mortality rates within the UK.
• Northern Ireland had the lowest treatable mortality rate within the UK. 

Across the UK and its comparators, three conditions account for most of the excess mortality burden. These are cardiovascular disease (CVD), cancers and injuries, including alcohol- and drug-related deaths. In 2023, the UK as a whole had 25 treatable cancer deaths per 100,000 people, compared with 14 in South Korea, 16 in Switzerland and 20 in Australia. Progress on improving avoidable cancer mortality rates has also been slow. Between 2009 and 2023, avoidable cancer mortality in England and Wales fell by around 10 deaths per 100,000, compared with a fall of around 38 per 100,000 in South Korea.

Looking at variation within the UK, Scotland had the highest CVD avoidable mortality within the UK, the highest rates of alcohol-related, drug-related, and suicide preventable mortality within the UK, and the greatest increase in drug-related preventable mortality over the 15-year study period.

The figures on ill health reveal a wider and growing challenge:

• Mental health conditions are the leading cause of non-fatal disease burden across the UK and, on average, across comparator countries. England carries the highest burden (3,562 Years Lived with Disability (YLDs), per 100,000), with Northern Ireland (2,962), Wales (2,962), and Scotland (2,581) all above the comparator average (2,528). Across the UK as a whole, this burden has risen by around 50% since 2009 from 2,290 to 3,462 YLDs per 100,000 in 2023.
• Diabetes and chronic kidney disease have also worsened, though more modestly, rising by around 16% over the same period (from 419 to 486 YLDs per 100,000).

People in the UK are also increasingly exposed to key risk factors for many diseases relative to comparators. Diet is one example. Ultra-processed foods account for 57% of the calories consumed in the UK – similar to the USA at 58%, but well above other comparators with available data, including Australia at 42%, Japan at 38% and South Korea at 26%.

Importantly, this does not reflect an absence of prevention activity or policy tools. There are areas of genuine policy strength in the UK, and areas such as tobacco control and vaccination demonstrate what effective, sustained prevention looks like in practice. In 2023, smoking prevalence was 13.4%, lower than in 10 of the 14 comparator countries, with taxes accounting for 83.7% of the retail price of cigarettes, the second-highest proportion in the comparison. Vaccination coverage tells a similar story. In 2023, 75.5% of UK adults aged 65 and over received an influenza vaccination, the third-highest rate among the countries compared. By age 15, 77% of girls had completed their HPV vaccination course, also the third-highest reported rate. However, this strength is not consistently reflected in the conditions responsible for the greatest share of avoidable ill health.

It is important to be clear about what an international comparison can and cannot tell us. International comparisons can help to identify broad variation and signal where the UK’s outcomes differ from those of other countries and highlights areas that need closer attention. But because it uses broad, country-level data, it cannot fully explain why those differences exist. More detailed research and analysis is needed to understand where prevention breaks down in practice, how people’s needs and experiences change over their lives, and how outcomes vary by region, age and socioeconomic background.

Why aren’t outcomes better?

Moving beyond the headline comparisons on prevention-related outcomes, the analysis reveals much about the prevention pathway itself – and how this may be driving some of the observed patterns.

Across the UK, gaps are evident throughout the prevention pathway, with the greatest opportunities for improvement concentrated at particular points for the conditions driving the largest burden. In cardiovascular disease, these gaps appear in the detection and control of risk factors such as hypertension and diabetes, conditions that are highly manageable when identified and followed up, but too often are not. In cancer, delays and fragmentation along diagnostic and treatment pathways undermine a screening system that, as the data shows, is otherwise performing well. In mental health, early intervention remains insufficiently integrated with the social determinants that underpin so much of the burden.

Taken together, this points to is less a need for new policy ideas and interventions, and more a need to do better with what we already know works.

Prevention doesn’t happen in isolation

These gaps do not occur in isolation. Although the analysis could not examine how age, where people live and socioeconomic background affect outcomes, wider evidence shows that people facing socioeconomic disadvantage are more likely to experience poor prevention-related outcomes. Differences in access to care and continued support are also shaped by the capacity of local services and how they are organised. Pressures on primary care limit proactive follow-up and long-term support, while people with the greatest health needs are often least likely to receive timely and effective preventive care. Understanding how national ambitions translate into local practice therefore requires attention both to system-level policy and to how its design and implementation interact with inequalities across the UK.

A life-course lens reinforces the same implementation story. Prevention gaps for children and young people, rising mental ill health, and late intervention in long-term conditions in older age are all missed opportunities to reduce disease burden earlier and more equitably. As our policy report on child health sets out, better outcomes depend not only on having effective policies, but on sustained engagement and delivery across different life stages.

Implications for policy and practice

Put simply, the key opportunity for the UK lies in implementation by scaling what works, closing gaps in current approaches, and translating strong intent into population health gains. Many of the right tools already exist; the task is to coordinate, sustain and target their delivery more effectively across healthcare, public health and social policy. The analysis points to four priorities:

Match ambition with delivery and implementation, not just policy design

Effective preventive tools, interventions and policies already exist, but adoption and implementation require the same sustained emphasis as policy development.

Focus on the entire prevention pathway, not just the entry point

Systematic learning from implementation, including where delivery breaks down, from risk identification and diagnosis through treatment and long-term management, and what the UK can learn from other nations.  

Target resource and attention where the burden concentrates

Cardiovascular disease, cancer, and mental health account for a disproportionate share of the UK's avoidable mortality and morbidity gap, with Scotland carrying a particularly high share of that burden, prevention strategy should reflect that concentration.

Strengthen comparative analysis of how prevention is delivered in practice

More granular, patient-level and pathway-based comparisons are needed to understand where and how prevention efforts break down, and to inform more targeted policy responses.

What's next?

The Brown analysis gives us a strong evidence base for the next phase of our work on prevention and early detection. It highlights where further work could have the greatest impact. As part of the next phase of the programme, we are establishing expert groups that bring together people from across research, healthcare, patients, policy, and industry to explore two priority areas in more depth: incentivised prevention and systems alignment; and equitable population impact. As this work develops, we will share further findings and activities. We welcome engagement from people working across prevention and early detection. To find out more or get involved, please contact [email protected].

*United States, Japan, Canada, India, South Korea, Switzerland, Germany, Australia, Singapore, Taiwan, Israel, Ireland, China, France, the Netherlands, New Zealand, Denmark, Latvia, and Brazil (All countries included on the Government’s International Science Partnership Fund (ISPF) non-official development assistance (non-ODA) list.