Changing Society Briefing 4: the changing way we die and its’ impact on charities.

Introduction

This is the fourth in the Heyheyjoe briefing series looking at external social, economic, and demographic changes and their impact on charities and non-profit organisations. This one focuses on how people die in UK society. We have death statistics going back 100 years, as well as survival rates for cancer and the big differences in genders and age on the way that we die.

The way people die is changing.

Chart 1 and 2 shows the most common reason for death for each age group, and for men in chart 1 and women in chart 2. Pale green is infectious disease, blue is heart disease, and red is cancer. The other colours are set out in the legend. The changes are stark. For men and women in 1915 infectious disease was the biggest killer across all age groups – witness the pale green dominance in the early years of both charts. 50 years later for men, infectious disease had been replaced by heart disease and road traffic accidents, and for women cancer, heart disease, and road accidents.

By 2015 for men suicide, self-harm and drug misuse were the most common causes of death between the ages of 15 and 45. After that age, cancer and heart disease mix and match. For women cancer is the most common across nearly all age groups except a few years were suicide, self-harm and drugs dominate. Its worth looking at the original chart on the ONS website (reference below chart 2) as each lozenge is interactive. For example over 7243 boys died between the ages of 5 and 9 each year in 1915. In 2015 just 147 boys each year died in this age group.

Death, illness and the differences by age and gender

Up until 1935 the differences between men and women, and by age, were slight. Now they are pronounced. Men are still much more likely to die from heart disease than women. Amongst children, cancer has become the biggest killer, partly because so many other sources of death have been reduced. Even for those with cancer there are differences between men and women: for example men get prostate cancer and women get breast cancer.

Chart 1: main cause of death at different ages amongst men 1915 to 2025

Chart 2: main cause of death at different ages amongst women 1915 to 2025

Source for both charts: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/causesofdeathover100years/2017-09-18

People are living longer with disease, most notably cancer.

Chart 3: Changing cancer survival rates 1971 to 2011.

Chart 3 shows the survival rates for all types of cancer for the forty years between 1971 and 2011. The key thing to notice is how survival rates have improved. In 1971 you had a 50% change of surviving a year after a cancer diagnosis, by 2011 it was 70%. The 5 and 10 year survival rates are even better – in 1971 the 10 year survival rate was 24% and by 2011 it was 50%.

That is good news, but it has ramifications. If people are living longer with cancer, then they are being treated for longer. Death is not a short, swift exit from this mortal coil but a slow descent over many years. There are ramifications for the NHS. A cancer patient needs treatment for 10 years not one, and with an ageing population bringing larger numbers of older people, the demand is compounded. The pressure on the NHS and on social care is only going to increase as the way that people die changes. If everybody dies of the same condition, then less types of expertise are needed. If there are not 4 or 5, but 40 or 50 main ways that people die then more specialist support is needed for each condition, more drug research, more specialist staff, and knowledgable social care staff.Source for chart 3:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61396-9/fulltext

The implications for society and for charities

What do all these changes mean for charities? What does it mean for hospices and the turn-over of beds and patients? What does it mean for cancer support charities if they are needing to give advice to patients over 10 years, rather than a year or two? How will the type of charity change if the way people die goes on changing. Let’s look at each of these issues in turn.

How do hospices and palliative care cope with a slow death?

Bricks and mortar hospices are designed to give people a dignified and comfortable death in the last stages of their life. My mother was in a hospice for just a few weeks before she died. But if improved survival rates mean people dying over years, not weeks or months, then a hospice might find people are needing to stay for much longer. A typical hospice may have 10-20 beds, and if each patient stays 6 months not 6 weeks that is a lot less patients helped.

Will we see the rise of more niche medical and social care charities?

Over the last two decade we have seen the rise of a growing number of niche charities relating to changing patterns of public health. This includes charities that support people with mental health challenges, self-harm issues or suicidal thoughts. There is also a fragmentation of charities in the cancer field. Prostate, ovarian, breast, and bowel are but a few of the types of charities which have seen rapid growth in recent years. If the anti-vaccer movement in the States takes hold over here, will we see new charities to support those with measles or polio or chicken pox? Hopefully not! But the change in patterns of death and medical advances mean that it would be foolish to predict how things will be different in 10 years’ time, let alone 25 years.

Will cancer remain the biggest cause in public affection?

Cancer is one of the causes that people like to give to. Cancer has been top of the nfpResearch ‘favourite causes’ tracking for nearly 20 years now. But it probably wasn’t always this way. 100 years ago, it would surely have been infectious diseases and 50 years ago probably heart disease. So as people die from cancer less, and live with cancer more, will cancer stay top of the giving league table. In 25 years’ time as people live longer and die from a multitude of conditions (co-morbidity as it’s called) will a quick death from cancer not be a scourge, but a blessed relief. Will dementia become the top cause for public support because it tries to tackle the horror of people physically healthy, but unable to remember who  friends and family are?

Joe Saxton

April 2025

This briefing is part of a series looking at the impact of social, economic, technological, and demographic changes on charities and non-profit organizations. We have already published a briefing on the ageing population (briefing no 1) and changing numbers of single people and fertility rates (no 2) and the impact of growing government debt (no 3). In future issues we will look at the impact of digital, the growing cult of the individual, unequal wealth distribution and falling levels of religious conviction on charities. Go to www.heyheyjoe.info for more information.