Women in the poorest parts of the north are no longer living as long after ten years of austerity hit their areas hardest, a blistering new report has warned the Prime Minister - concluding: “England is faltering.”
Health expert Sir Michael Marmot says overall life expectancy in this country has slowed down to an extent not seen for over a century, arguing damage to health in the last ten years has been ‘unprecedented’ and pointing to rises in child poverty, the closure of hundreds of Surestart centres, unequal council cuts and a growing wage gap, all of which are believed to help determine people’s health.
The north has borne the brunt of that, he finds, in a scathing assessment that describes a ‘shocking’ rise in regional and economic health inequality that ‘need not have happened’.
Warning that the past decade of government not only ignored previous detailed recommendations aimed at tackling that divide - both between the north and south and the rich and poor - he finds national leadership has actively gone ‘in the wrong direction’.
“Put simply, if health has stopped improving it is a sign that society has stopped improving,” he concludes.
Funding must now be focused on the poorest areas that have seen the biggest cuts, the report says, including in the North, adding that another ten years of inaction would 'risk losing a generation'.
Sir Michael had originally been commissioned at the end of the last Labour government to respond to cross-party concerns over health inequalities in this country, a review that then reported back in 2010.
The coalition at the time accepted most of his recommendations, but in a searing and detailed ‘ten years on’ report, he finds they were in many respects ignored and, in other ways, the government effectively did the opposite.
It lays bare growing divides that have since seen women’s life expectancy in deprived areas outside London - particularly in the North East - flip into reverse, while male life expectancy has all but stalled.
He argues such dramatic changes are usually only seen in countries that have seen a ‘catastrophic’ economic or political shock, such as in former parts of the USSR following the break-up of the Soviet Union.
While he says it is not possible to categorically know whether these changes have been caused directly by austerity, he argues such a link ‘is entirely plausible’ due to the way that policy has played out.
That applies ‘from rising child poverty and the closure of children’s centres, to declines in education funding, an increase in precarious work and zero hours contracts, to a housing affordability crisis and a rise in homelessness, to people with insufficient money to lead a healthy life and resorting to food banks in large numbers, to ignored communities with poor conditions and little reason for hope’, he says, adding: “Austerity will cast a long shadow over the lives of the children born and growing up under its effects.”
After he and a team of other academics assessed ten years of relevant data, the latest Marmot review finds ‘there has been a slowdown in life expectancy of a duration not witnessed in England for 120 years’, one that has not been seen in other European countries or most other developed nations in the Western world.
The health of the population as a whole has ‘deteriorated’, it finds, but notes the gap is widening between North and South, and particularly between the North East and South East.
“England is faltering,” he writes.
“From the beginning of the 20th Century, England experienced continuous improvements in life expectancy, but from 2011 these improvements slowed dramatically, almost grinding to a halt.
“For part of the decade 2010-2020, life expectancy actually fell in the most deprived communities outside London for women and in some regions for men. For men and women everywhere, the time spent in poor health is increasing.
“This is shocking. In the United Kingdom, as in other countries, we are used to life expectancy and health improving year on year. It is what we have come to expect.
“The UK has been seen as a world leader in identifying and addressing health inequalities but something dramatic is happening. This report is concerned with England, but in Scotland, Wales and Northern Ireland the damage to health and wellbeing is similarly unprecedented.
“Put simply, if health has stopped improving it is a sign that society has stopped improving.”
The report looks initially at changes in life expectancy across England, including how many years people are now living in good health.
For women in the most deprived areas everywhere apart from London, life expectancy has gone backwards. Women in the country’s poorest neighbourhoods now live four months less than a decade ago, on average, while in the richest districts they are living six months longer.
The biggest fall in female life expectancy came in the poorest parts of the North East.
For men, there have been ‘negligible’ increases overall and a decline in the poorest parts of the North East, Yorkshire and the Humber, the East Midlands and the East of England.
It finds that the overall improvements that had been taking place up to 2010 have ‘slowed since then’ for both genders, ‘with the slowdown greatest in more deprived areas of the country’
“There are growing regional inequalities in life expectancy,” it finds.
“Life expectancy is lower in the North and higher in the South. It is now the lowest in the North East and the highest in London.”
Regional divides are much more marked for poorer people, meanwhile.
“Wealthier areas in the North and South have similar life expectancy to one another, while more deprived areas have lower life expectancy in the North,” it finds. Life expectancy in London has increased faster than anywhere else.
Overall, a man in one of the country’s richest areas can now expect to live 9.5 years longer than a man in the one of the poorest - compared to 9.1 in 2010 - while the gap for women is now 7.7 years, up from 6.8 years a decade ago.
Meanwhile mortality rates - the number of people who die per 100,000 - have increased for middle-aged and younger people, particularly for those aged 45-49.
Women on average now suffer around seven months longer of poor health compared to 2010 and men an extra four months.
The slowdown in life expectancy in the UK between 2011 and 2017 was ‘marked’ compared to other countries, finds the report, concluding that this cannot be put down to outbreaks of winter flu or other seasonal diseases.
“Other countries that have at various times had significant decrease in life expectancy and widening health inequalities have seen these changes happen as a result of catastrophic or severe political, social or economic disruptions,” it finds, pointing to the ‘devastating’ consequences seen in the Soviet Union following the fall of the Iron Curtain.
Child poverty, Surestart and councils
The report goes on to look at some of the trends - particularly austerity - that have taken place in England during the last 10 years, which it argues are ‘likely’ to have driven the widening health divide.
It points in particular to rising child poverty.
“Family circumstances, so vital for development in the early years and for young people, have deteriorated for many since 2010...rates of child poverty have increased,” it says, adding: “This is concerning and will continue to have long-term negative impacts on the lives of affected children and their families.”
There have been ‘significant increases in poverty rates for people in work since 2010, affecting children the most’, it says, arguing that changes to tax and benefits have been ‘regressive’, one cancelling out the other for the poorest in society.
The report is particularly blistering about the unequal way in which government has carried out council cuts.
Those cuts have been ‘hugely significant’, but not fairly applied, it finds.
“It is not just the impact of overall cuts: it is how and where they have fallen which has impacted most on inequalities,” it finds, pointing to Liverpool, Doncaster, Wakefield, Newcastle, Stoke and Hull as having suffered the most.
“The cuts over the period shown have been regressive and inequitable - they have been greatest in areas where need is highest and conditions are generally worse. It is likely that the cuts have harmed health.”
It points in particular to the closure of Surestart Centres - which research has previously shown had improved the rate of hospital admissions for children.
“As family support services, which benefited disadvantaged children most, have gone into decline, equity has become much less of a consideration in funding allocations,” it says. “In the most deprived local authorities, spending on children and young people’s services has fallen almost five times faster than in the least deprived local authorities.”
Pointing to a ‘clear shift away’ from supporting low income families, it says the North East has seen the biggest drop in children’s services funding - 34pc - while the South East saw the smallest, at 22pc.
“The shifts in funding away from more deprived areas, low income families and the North over the past decade have significant implications for health inequalities and for inequalities in a range of other outcomes throughout life,” it finds.
'These areas have been left ignored'
The report also looks at a range of other factors it believes have helped drive the widening health gap, including between the regions.
Average wages are not back where they were in 2010, it notes, even if employment has steadily risen.
“Increasingly work is not a way out of poverty,” it finds.
“Being in poverty and working in poor quality employment have marked effects on physical and mental health, including children in the families concerned.”
Echoing the findings of the UK 2070 commission - also published this week - it also finds that the looming threat of automation is likely to ‘reinforce existing patterns’ of inequality, with the South East and London ‘relatively less likely to be affected’ than areas such as the North.
While the benefits regime of the past decade has sought to ensure people find their way into employment by ‘sanctioning’ them - cutting their benefits - if they don’t look for a job, it says research has shown ‘the majority of jobseekers are keen to work and do not require the threat of sanction’, with those sanctions instead causing ‘further poverty and, in some cases, destitution’.
Despite a drive to create apprenticeships, they are now predominantly being taken up by older, better-off people, it says, a trend that is only likely to ‘widen’ inequalities.
Underlining regional divides further, it notes that average household wealth in the South East is now 2.6 times higher than that in the North East.
“Social mobility in England has stalled,” it adds. “Social mobility is even less likely to occur in many Northern cities and coastal towns.”
Pointing out there are more areas of intense deprivation ‘in the North, Midlands and in southern coastal towns’ including in estates in Manchester, than in the rest of England, it notes: “These areas have been left ignored,” many of them also having suffered the heaviest cuts to local services.
Transport funding has not been shared equally either, it finds, with the wealthiest 10pc of areas receiving ‘almost four times as much public spending on their transport needs’ as the poorest 10pc - also pointing to a £234m cut in bus funding.
“Funding cuts in bus services affects those on low incomes the most,” it adds.
Meanwhile the number of new social houses ‘has not increased to meet need’, while 40pc of private landlords now refuse to take people who claim benefits and one in five refuse to house families.
Adults living in poverty are not necessarily then going to choose healthy lifestyles, it argues, ‘mainly because they are focusing their attention on coping with the short term rather than planning for the future’.
A message to the Prime Minister
The report is scathing of government’s approach in the last ten years, arguing that the issue ‘has not been a priority for national government in England since 2010 and there has been no national strategy’.
“This is despite stalling life expectancy and widening inequalities,” it says, calling national political leadership on the situation since 2010 ‘weak’ and needing to be ‘strengthened urgently’.
Between 2001 and 2012 - when there was a national strategy to cut health inequality - the gap in life expectancy in the richest and poorest areas had begun to narrow, it finds, but after that the pattern flipped into reverse.
And while many areas outside of central government - including councils in Greater Manchester and Coventry, NHS England, the police and other agencies - have tried to implement his recommendations from a decade ago, there has been no further white paper on public health since 2010 and many policies drawn up by ministers have run ‘counter’ to what was required.
“The government has the evidence”, it says of the factors driving the crisis, “but it has not acted on it and certainly not at sufficient scale.”
It adds: “As we have described, more deprived areas and communities, particularly in the North of England, have suffered the most from years of austerity. In some instances, more deprived areas have experienced greater funding cuts than less deprived areas...it is in these areas that resources now need to be invested first and with greater intensity than elsewhere.”
Echoing a call from the UK 2070 Commission this week, which wants regional inequality generally to be tackled at a cross-departmental level, the report says its main recommendation ‘is to the Prime Minister’.
An ‘ambitious and world-leading’ focus on slashing health inequality must now be put at the heart of all policymaking, in an approach that is ‘highly visible’ to the public.
“In England, health is getting worse for people living in more deprived districts and regions, health inequalities are increasing and, for the population as a whole, health is declining,” it says, warning that since the last review, ‘the country has been moving in the wrong direction’
“If we leave this for another 10 years, we risk losing a generation.”
The Marmot review makes a series of recommendations, acknowledging that while they may be expensive, as a society Britain cannot afford not to carry them out.
Otherwise, the health of the nation with suffer further, it argues, while inequality will grow and still cost billions a year in avoidable health and social services expenditure.
Here are some of the key points:
- set up a powerful, Cabinet-level, cross-departmental committee to drive a new national strategy on health equality.
- increase early years spending to the average for nations in the OECD, the international group of 36 developed countries.
- reduce child poverty to the lowest rates in Europe.
- improve availability and quality of early years services everywhere, including children's centres.
- increase pay and qualifications requirements for childcare workers.
- put fairness at the heart of education decisions, including funding.
- increase school achievement to the best in Europe, by cutting educational inequalities.
- invest in prevention services to cut rising levels of school exclusions.
- bring school and further education funding back to 2010 levels.
- remove sanctions reduce 'conditionalities' (the expectations placed on jobseekers) in the benefits system.
- increase the National Living Wage to a 'minimum healthy income' for people in work.
- increase apprenticeships.
- reduce the 'high level' of poor quality and unstable employment.
- redesign Universal Credit.
- place health equality at the heart of policymaking.
- value health and wellbeing in policymaking as much as measures of economic growth.
- review tax and benefits to ensure they are fairer and do not punish the poor.
- invest in the most deprived communities.
- make all new housing carbon neutral by 2030, with more of it either affordable or social.