MINISTERS admit more work needs to be done as a new report reveals six decades of universal free health care and public initiatives have failed to improve Britain's life expectancy against those of other countries.

Despite life expectancy increasing by 4.2 years over the last two decades, the findings reveal the UK's pace of decline in premature mortality has persistently and significantly fallen behind the average in Europe. The report's authors conclude concerted action is urgently needed.

Only in men older than 55 has the UK experienced significantly faster drops in death rates compared with other nations over the last 20 years.

The research – led by Chris Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington – says the UK ranking in premature mortality rates for adults aged 20–54 years has worsened substantially, partly because of dramatic increases in drug and alcohol disorders.

They were ranked as two of the least important causes of death in this age group in 1990 – 32nd and 43rd respectively – but rose to sixth and 18th place in 2010.

The study, which compared health outcomes against the average of 14 other original members of the European Union plus Australia, Canada, Norway and the USA between 1990 and 2010, found the eight leading causes of death in the UK have changed "remarkably little" in the 20 years, with ischaemic heart disease, chronic obstructive pulmonary disease, stroke, lung cancer, and lower respiratory infections remaining in the top five.

Public health minister Michael Matheson said: "We have seen a general down- ward trend in mortality rates in Scotland in recent years, and overall our health is getting better. However, we realise more work is needed to remove health inequalities and increase life expectancy for all Scots.

"We are taking bold, on- going actions to improve Scotland's health as a nation and to reduce the number of people living with multiple health risks."

"One of the single most important actions people can take to improve their health is to stop smoking, and we are encouraged by the increasing numbers of people using smoking cessation services.

"We believe that a minimum pricing of alcohol will address alcohol misuse in Scotland, and reduce consumption among hazardous and harmful drinkers."

BMA Scotland said the trends in the UK were reflected in Scotland. A spokesman said: "While we are beginning to make progress in reducing deaths from Scotland's 'big three killers' – heart disease, cancer and stroke – there remains much to be done to reduce the premature deaths from these preventable diseases.

"Public health measures such as increasing cancer screening, smokefree legislation and a comprehensive alcohol strategy will have long-term benefits on people's health and help take us on the road to recovery. Scotland has the additional burden of poverty, and an increasing gap in life expectancy of around 28 years for men living in the poorest parts of Scotland compared to their counterparts in the most affluent areas. This has to change.

"Scotland, and the UK may be falling behind in reducing premature mortality but we are confident that there is the political will across the spectrum of the political parties to continue to look to innovative policies to try to reverse this trend."

The report, published today by The Lancet, said there had been a "startling" increase in the contribution of Alzheimer's disease to the number of deaths in Britain over the 20 years to 2010 – an increase of 137%.

It is now the 10th biggest cause of death, up from 24th in 1990.

Explanations for the UK's worsening relative performance confirmed the harmful effects of tobacco smoking.

It remains the nation's leading risk factor for ill-health, responsible for 11.8% of the disease burden in 2010, followed by high blood pressure (9%).

Poor diet and low physical inactivity collectively account for 14.3% of the disease burden.