More than 1 million people in England died prematurely in the decade following 2011 due to a combination of poverty, austerity policies and Covid, according to a study by the Institute of Health Equity (IHE) at University College London led by Sir Michael Marmot.

The report – Health Inequalities, Lives Cut Short – found that between 2011 and 2019, 1,062,334 people died earlier than they would have done if they had lived in areas where the richest 10% of the population live. A further 151,615 premature deaths were recorded in 2020, although this number was higher than expected because of the Covid pandemic.

In a change from the usual approach of analysing figures from the most deprived areas of England, the analysis of figures from the Office for National Statistics looked at the people who live outside of the wealthiest 10% of areas in England, in other words the vast majority (90%) of the country.

The effect on public health of living in deprived areas is well known, but the number of early deaths revealed in this report on the vast majority of England  is “shocking” according to Marmot, who noted that:

“Our country has become poor and unhealthy, where a few rich, healthy people live. People care about their health, but it is deteriorating, with their lives shortening, through no fault of their own. Political leaders can choose to prioritise everyone’s health, or not. Currently they are not.”

The researchers note that previous research has shown that pre-2010 government policies were beginning to close the health inequalities gap. These policies included increased investment in services for young children, such as SureStart, education and neighbourhood renewal, as well as healthcare.

The IHE’s work also showed how badly we are doing in comparison with European Union countries, when in 2014 we were doing better.

In a separate recently published analysis by the ONS life expectancy across the UK has been found to have fallen to its lowest level in a decade. Although, the ONS notes, that this was mainly owing to the impact of the coronavirus pandemic, Veena Raleigh, senior fellow at The King’s Fund said:

“Although life expectancy has recovered somewhat since the sharp fall in 2020 when the pandemic struck, it’s not had the bounce-back that might have been expected once the worst of the pandemic was over, pointing to deeper problems with the health of the nation and the resilience of the health care system.”

“As the UK’s relatively high mortality during the pandemic came on the heels of stalling life expectancy in the pre-pandemic decade, the result is a further slide in the UK’s already poor ranking relative to comparable countries by 2022.”

The IHE report adds to conclusions from recent reviews of health inequalities published in 2020 (10 years On Review and COVID-19 Review) that show the cumulative impact of regressive funding cuts, associated with austerity, contributed to life expectancy failing to increase, life expectancy falling for women in the 10% of poorest areas, and health inequalities widening.

We are an unhealthy nation, with people dying early from cancer, heart conditions and a variety of other diseases due to economic and social inequalities. Halting this decline in the health of the nation and reversing it is going to take major political will and broad policies that target social conditions, as Sir Marmot noted:

“Important as is the NHS – publicly funded and free at the point of use – action is needed on the social determinants of health: the conditions in which people are born, grow, live, work and age. These social conditions are the main causes of health inequalities.

“I’m saying to party leaders: make this the central plank of the next government – stop policies harming health and widening health inequalities. To MPs: if you care about the health of your constituents, you must be appalled by their deteriorating health.”

The King’s Fund Veena Raleigh commenting on the life expectancy data noted that “improving life expectancy in the UK will require a coherent cross-government strategy that supports people to make healthy choices, identifies and treats illness earlier, and reduces health inequalities by improving the health of people in deprived communities”.

In some cases there is legislation just ready and waiting to be put in place by a new government.  As is the case with anti-obesity policies, which the current government has postponed several times already. It has also ditched many of the anti-obesity measures in the 2020 national food strategy. Now the 9pm junk food advertising watershed policy and the restrictions on unhealthy buy-one-get-one-free deals policy which are ready and waiting to be put in place, have been shelved until October 2025. They were first planned for 2022, but then delayed to 2023 and 2024.

Then there is the new mental health act, which has been five years in the making, but was not included in the King’s speech in 2023 and so is unlikely to be passed before the election. The new act would reduce the number of people detained with psychiatric conditions and so reduce the pressure on inpatient NHS mental health services.

Important as these legislative moves are, they are not enough to repair the damage done since 2010. What the charities, the medical royal colleges and public health organisations are calling for is a major change in the way Whitehall operates, with the health of the nation and a reduction in health inequality to be the cornerstone of policy making in all departments not just health and social care, but in housing, environment, transport, business and energy.

The Association of Directors of Public Health’s manifesto has called for a new Public Health Act, one that consolidates existing legislation and ensures health and wellbeing is at the heart of policy and funding allocation. The manifesto also calls for a dedicated health inequalities strategy with clearly defined targets and a Health in All Policies approach overseen by a cross government ministerial-level committee in order to achieve health equity.

In addition, it calls for a new Child Poverty Act which commits to ending child poverty in all parts of the UK by 2030.

The health of children is the focus of the September 2023 report – Securing our Healthy Future: Prevention is better than cure – from the Royal College of Paediatrics and Child Health and the Faculty of Public Health, and supported by the 24 members of the Academy of Medical Royal Colleges. It calls for the UK Government to appoint a Cabinet-level Minister for Children and Young People, to ensure the UK Government adopts a ‘child health in all policies’ approach to policy development and coordinate the development of a cross-departmental strategy to improve child health and wellbeing.

Likewise, the Centre for Mental Health’s report – To a Mentally Healthier Nation – called on politicians to adopt a ten-year, cross-government mental health strategy, including policies to target poverty and discrimination, and environmental factors, including housing and pollution, with the aim of improving the nation’s mental health, as well as preventing illness and promoting better health.

What is common to all the reports is that reversing the decline in the nation’s health seen over the past decade of Conservative policies will need not only new policies, but considerable political will to put health and well-being at the centre of government.


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