The United Kingdom of Great Britain and Northern Ireland, commonly referred to as the United Kingdom, consists of the isle of Great Britain and the north-eastern section of the isle of Ireland (Fig1.1). These islands are separated from Scandinavia to the east by the North Sea, and from the European continent to the south by the English Channel; to the west is the Atlantic Ocean. Great Britain comprises England, Scotland and Wales; these three plus Northern Ireland make up the United Kingdom (Cylus et al., 2015).
Fig1.1
From 1995 to 2020 the population of the United Kingdom increased by 12.2%, rising from 58.0 million to 65.1 million (Table1.1). Population growth peaked at around 0.8% per annum in the early 2010s and has since decreased to 0.6% per annum in 2020. This increase has been driven by a level of immigration that exceeds levels of emigration, combined with a birth rate that continues to outweigh the death rate. The birth rate has exceeded the death rate every year since 1976 with the exception of the calendar year 2020, when, due to over 90 000 registered deaths attributed to COVID-19, the number of deaths exceeded the number of births recorded (ONS, 2021b). The fertility rate in the United Kingdom peaked at around 1.9 births per woman in 2010 and has been declining since to levels previously seen in the early 2000s (Table1.1). The share of the population over the age of 65 years has been increasing, reaching 18.7% in 2020, which is now above the share of the population aged 0–14 years (17.7%), which was falling until 2010, and has been stagnant since. The share of population over the age 65 years is expected to continue to increase, with projections indicating this will reach one in four people (23.9%) by 2039 (ONS, 2021f).
Table1.1
Around 84.3% of the United Kingdom’s population lives in England, with a population of 56.6 million in 2020, followed in size by Scotland, with 5.5 million (8.1%), Wales, with 3.2 million (4.7%) and Northern Ireland, with 1.9 million (2.8%) (ONS, 2021g). The population density for the United Kingdom as a whole was 275.0 people per square kilometre in 2019 (Table1.1). This is significantly above the average population density for EU27 countries, which was 109.0 people per square kilometre in the same year (European Commission, 2021). However, this varies significantly between the United Kingdom’s constituent countries, at 432 people per square kilometre in England, 70 people per square kilometre in Scotland, 152 people per square kilometre in Wales and 137 people per square kilometre in Northern Ireland (ONS, 2020d). There has been an ongoing trend towards greater urbanization of the population, with the proportion of the population in urban areas in the United Kingdom increasing from 78.4% in 1995 to 83.9% in 2020 (Table1.1). This is above the average for EU27 countries, which was 75.0% in the same year (World Bank, 2021). This creates complexities in delivering health services for many rural areas, which have low levels of population densities, and a higher proportion of older patients with more complex health care needs. In particular, Mid and North West Wales and Scottish Highlands have more remote populations, which are increasingly reliant upon air ambulance and telemedicine services.