Chronic Illnesses

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• Obesity. England: 29% of adults were obese and 64% overweight or obese in 2022—up from ~15% obese in 1993. United States: adult obesity around 40% in 2021–23, and 23 states now report ≥35% adult obesity. Severe obesity is also rising.
• Diabetes. UK: 5.8 million people now live with diabetes (2023–24 registrations + estimated undiagnosed); GP-recorded type 2 prevalence rose to 7.0% by March 2024. US: 38.4 million (11.6%) have diabetes; total (diagnosed + undiagnosed) prevalence in adults is ~15.8% in 2021–23. Prediabetes affects ~98 million adults.
• Ultra-processed food (UPF – industrially reformulated foods high in additives, sugar, salt, fat). UK: ~57% of calories; US: ~53%–55%, with youth at ~62%. Higher intake is linked to heart disease, diabetes, cancer and earlier death.
• Air pollution burden (PM2.5 – fine particles <2.5 microns that penetrate lungs/bloodstream). In the UK, long-term exposure contributes an effect equivalent to ~30–50k deaths annually. In the US, wildfire smoke and PM2.5 drive excess mortality and cardiometabolic risk.
• Long-term sickness and dependency. UK economic inactivity due to long-term sickness is around 2.7–2.8 million, a record share of the workforce. US disability programmes cover ~7.2 million disabled workers, with ~74.5 million on Social Security overall.
• Polypharmacy (use of many drugs at once). England: 1 in 5 older people take 5+ medicines. US adult polypharmacy nearly doubled since 1999–2000 (to ~17% by 2017–18) and rises steeply with age.
• Screens, sleep, and inactivity. UK adults spend ~4h20m online daily (2024), displacing movement. US adults spend 8+ hours/day with media. One-third of US adults report short sleep (<7h), which increases diabetes risk.

• Dietary pattern (UPFs). UPFs are energy-dense, low-fibre, and engineered with emulsifiers (chemicals that change food texture) and sweeteners (non-caloric sugar substitutes). These alter gut microbiota (bacteria in intestines) and insulin responses. Higher intake correlates with more disease and earlier death.
• Sedentary time (sitting still), screen displacement, and sleep disruption. Long sitting and late light exposure blunt melatonin (sleep hormone) and insulin sensitivity (body’s ability to process sugar). Short sleep raises diabetes risk.
• Air pollution (PM2.5, NOx – nitrogen oxides, ozone – reactive gas). These cause systemic inflammation (whole-body immune activation), damage to blood vessel lining, and worsen cholesterol and insulin resistance.
• Microplastics & “forever chemicals” (PFAS – synthetic substances that don’t break down). Microplastics have been found in blood, placenta and artery plaques. PFAS reduce vaccine response, disrupt thyroid function, and worsen cholesterol.
• Heavy metals (lead, mercury). Even low lead exposure is linked with heart disease deaths. Mercury can raise heart disease risk at higher levels.
• Damp, mould, unsafe housing. Damp and mould increase asthma, respiratory infections, and overall poor lung health. Poor housing and transport design also limit activity.
• Fragmented primary care (disconnected GP/doctor systems). Rising multiple illnesses with weak prevention lead to late diagnoses and unsafe drug combinations.

• Healthcare and pharma markets. NHS prescriptions exceeded 1 billion items and ~£11bn spend in 2023–24. In the US, diabetes alone costs >$400bn/year. These create strong financial incentives for treatment, not prevention.
• Governments. Rising numbers depend on sickness and disability support, creating a politically important dependent audience.

Bottom line: chronic illness is worsening in both countries. It cannot be reversed without tackling dietary environment, physical inactivity, sleep and screen culture, and chemical/air exposures alongside better mental health, prescribing practice, and stronger prevention in primary care.