A lost decade: the cost of austerity exposed by independent health review

Ten years on from the original Marmot review, an updated report finds stalling life expectancy and those on lower incomes priced out of decent housing and a healthy diet.

By Samir Jeraj

MANCHESTER, ENGLAND - DECEMBER 04: A children's play area sits next to terraced homes in the Gorton area of Manchester on December 04, 2018 in Manchester, England. A report by the Joseph Rowntree Foundation has claimed that over four million children are now living in poverty in the UK. The state of the nation report, UK Poverty 2018, says that in an average school classroom of 30 pupils, nine are now living in poverty. (Photo by Christopher Furlong/Getty Images)

“England has lost a decade” – those were the words of public health expert Professor Michael Marmot on launching his review of health inequalities, ten years on from the government’s original report.

The influential 2010 Marmot Review – “Fair society, healthy lives” – found a seven-year gap in life expectancy between the richest and poorest parts of England, something that has now widened to over nine years for men and just under eight years for women. The 2010 review looked at what evidence-based strategies would work to reduce health inequalities in England and recommended six areas for government action on children and young people, work, health, sustainability, and prevention.

Reluctant even 18 months ago to be drawn on whether austerity was the cause of stalling standards, Marmot says in the introduction to his latest report, published today, that “austerity will cast a long shadow over the lives of the children born and growing up under its effects”.

These include persistently high rates of child poverty, ethnic and class inequalities in school attainment, school exclusions, and youth crime.

Since the 1890s, peacetime life expectancy in England has risen by about one year every four years. In 2010 that began to slow, and in 2020 it has flatlined – with the most deprived women seeing an actual fall in their life expectancy. According to Marmot, this lack of progress in health is a warning sign that “society has stopped improving”.

The north-south gap has also widened, according to the review. Areas where life expectancy has fallen the furthest are deprived parts of the northeast, whereas the least deprived parts of London saw the greatest rises in life expectancy. The people in so-called “red wall” seats which the Conservatives gained from Labour at the 2019 election had a life expectancy, on average, five years lower than the seats the Conservatives won in 2017.

The review also gives ethnicity a higher profile than it has had before in discussions on health gaps. Marmot highlights that the poverty rate is significantly higher in Pakistani and Bangladeshi communities, and that overall, “45 per cent of minority ethnic children lived in families in poverty after housing costs, compared with 20 percent of children in white British families”.

However, he found that action on inequalities is being held back by a lack of detailed data – something which the report recommends improving.

The problems behind the “stalling” of life expectancy go far beyond the NHS into education, housing, benefits, and employment. On being asked whether he would divert some of the planned government spending on these into other areas, Marmot said he wanted to see both – highlighting that public spending went from 42 per cent of GDP in 2010 to just 35 per cent now.

The analysis in the report concludes that poorer areas suffered the most from cuts under austerity, and that the most deprived people, such as single parents out of work and people living in the poorest areas, also suffered most due to changes to benefits and taxes.

One of the key messages was that healthy choices are made almost impossible for the poorest people. For example, those in the poorest 10 per cent would have to spend 74 per cent of their income to provide a healthy diet, according to NHS guidelines.

The report calls for a national strategy on health inequalities to raise the life expectancy of deprived areas in the north up to the same level as affluent parts of the south – and the funding to make it happen. It also points to examples and case studies where local government has acted to reduce inequalities, such as Manchester, where school attainment for the most deprived children has risen to the level of the least deprived.

“Austerity has taken a significant toll on equity and health and it is likely to continue to do so…” Marmot said. When asked what the impact would be of another “lost decade”, he said England would be more likely to resemble the US in health inequality. There, average life expectancy fell for three years and has only just started to grow again at a very slow rate.

Marmot warned against this path saying, “in an earlier era when we looked at the communist countries of central and Eastern Europe and they were doing very badly and we certainly didn’t want to look like that.” He added, “We’ve got this choice and we have to decide as a society how do we want to invest.”