The evidence is clear and the solutions are there – what is needed is the will to act The Marmot Review 10 Years On
26 February 2020
Living in Britain is increasingly bad for your health. We’ve grown used to living longer than our parents, but since 2010 growth in life expectancy has slowed dramatically. The Marmot Review 10 Years On, published today, shows that in the last decade we have had the weakest growth in life expectancy for over a century. For the most deprived communities outside London it has actually gone into reverse. We know of the unacceptable ‘health gap’ between people living in rich and poor areas – the poorer the area, the worse the health. But since 2010 that gap has widened, and on average we are spending longer in poor health. Something has profoundly damaged our health.
Boris Johnson has acknowledged that many working class voters ‘lent’ their support to the Conservatives. The newly won constituencies in ‘red wall’ areas are at the sharp end of widening health inequalities – well below the national average for life expectancy. To ‘level up’ the country as the government has promised, action must be taken to level up health and wellbeing.
The Marmot Review 10 Years On gives us important clues as to what is driving health inequalities and what should be on the ‘levelling up’ agenda. A striking finding is that while people living in wealthy areas in the north and south of England can expect a similar lifespan, for people living in the most deprived areas there is a 5-year gap in life expectancy between north and south. So, it is not just poverty that matters for health, it is also place – particularly if you live in the north.
In England, the regional inequalities are most stark comparing the North East with London. For men living in the 10% most deprived areas, life expectancy has fallen since 2010 in the North East, Yorkshire and Humber, and the East of England. For women in the most 10% deprived areas life expectancy fell everywhere except London, the West Midlands and North West.
Crucially, The Marmot Review 10 Years On also shows what has happened to key factors that have a powerful impact on health – the so-called ‘wider determinants’ – such as poverty, education, employment, housing and homelessness, and climate change. The authors find that austerity has taken its toll on each of these, from child poverty, declining education funding, and increases in violent crime and precarious employment. Between 2009/10 and 2018/19 public sector spending fell by 7% from 42% of GDP to 35%, and council spending per head fell most sharply in the most deprived areas.
The slowdown in life expectancy since 2010 is seen in many other countries, but is most stark in the UK, USA and the Netherlands. As Marmot and colleagues point out, reduced public sector spending on ‘social protection’, such as early years support for the under-fives and welfare benefits, will surely have contributed to the health damage we now see. But by precisely how much is difficult to quantify. Other, long-term structural changes in the economy, noted recently by Angus Deaton and Anne Case, such as de-industrialisation, global competition, and low-wage chronically insecure work have crushed some families and communities. Other social changes may have contributed too – 2010 coincidentally marked a noticeable uptick in stress and emotional disorders in teenage girls, with links to growing use of social media. But behind the cold aggregate statistics lie hot human stories of despair and rage, of feeling forgotten or frankly ignored. All of which are summing up to warp traditional voting patterns and fan populism.
What to do next? The government has opportunity now to show leadership: the evidence is clear and the solutions are there – what is needed is the will to act. A ‘levelling up’ agenda needs to focus not just on enterprise and productivity-increasing infrastructure, such as bridges, transport and technology, but also on social protection particularly in areas hurting the most. Marmot makes practical suggestions for policies in five areas to tackle the ‘wider determinants’ of health, from improving the availability of children’s centres, to reducing child and in-work poverty.
Above all the plea is for government to develop an explicit strategy to reduce health inequalities: to join the dots on existing efforts, coordinate, scale and boost action, set some manageable targets to reduce health gaps, and publicly report performance against them. Some elements are already in place, but fragmented and underpowered. A strategy would need more cross-government commitment, coordination and consistency of focus over the life of several parliaments. Key ingredients must include empowering local government to make progress, encouraging businesses to contribute more, and investment in prevention. A ‘grand challenge’ to reduce the regional health gap, linked to the industrial strategy, could usefully focus efforts.
As Marmot notes ‘if health has stopped improving it is a sign that society has stopped improving’. What is government for if not to act on that?
This article was originally published in the Times Red Box on 25 February 2020.