The NHS is being burdened by the scale of Britain’s health inequalities, reports Sam Bright

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There are two parallel perceptions about Brexit voters living in small towns. The first is that they are nostalgic – yearning for Britain to return to its former glory days – and the second is that they have been ‘left behind’ by the fast pace of technological and economic development over the past two decades.

As James Morrison writes in The Left Behind, Reimagining Britain’s Socially Excluded, the term ‘left behind’ became common currency in the weeks and months following the 2016 Referendum, “primarily as a go-to shorthand for neglected and/or economically ravaged post-industrial communities that had overwhelmingly voted for Brexit”.

These two ideas appear to be in tension. Why would communities supposedly left behind by the modern world yearn to return to an even more distant period of history? 

The answer relates to inequality, which these communities attribute to the economic changes of recent decades. As Robert Zymek and Ben Jones note: “Regional differences in per-worker incomes were about as large in 1901 as they are today. There was a period of regional convergence during the mid-20th Century, but this was reversed during the 1980s and 1990s.”

Yearning for the past is – in an economic sense – a progressive endeavour on the part of many Brexit supporters, as it implies the return to a more regionally-balanced Britain. 

This can be witnessed acutely in the realm of health, with intense regional inequalities leaving some areas of the country with health outcomes reminiscent of a prior era – exacerbating our current NHS crisis. 

The idea that we should cure the chaos launched by Liz Truss by going back to austerity is really frightening

Sir Michael Marmot

Life expectancy – the amount of time that newborn children are expected to live – is a clear indicator of these regional inequalities.

Byline Times compiled the life expectancy statistics of 303 of England’s local authorities (excluding county councils) – finding that, from 2017 to 2019, 35% had a life expectancy for women that fell short of the England-wide average last seen in 2010-12, at the start of the Conservative Party’s current period in office. This was matched by 32% of local authorities in terms of life expectancy for men. 

Even more disturbingly, 11% of local areas in England had a life expectancy for women that was last seen England-wide in 2005-07 – while a handful of areas were still in a different century, with five areas (Manchester, Middlesbrough, Stoke-on-Trent, Kingston-upon-Hull, and Blackpool) performing worse than the life expectancy for women last seen nationwide in 1999-2001, and one (Blackpool) falling short of the England-wide life expectancy logged in 1994-96. Blackpool is likewise the worst performing area for men, with life expectancy in 2017-19 falling short of the national average seen in 1995-97, seven prime ministers ago.


The Legacy of Austerity

What unites these areas of England, in political terms, is their support for Brexit. Of the 30 places with the lowest life expectancy for men from 2017-19, all but three voted in favour of the UK’s departure from the EU, with the average vote standing at 59% and roughly a-third of these 30 areas backing Brexit by 65% or more. 

Economically, meanwhile, these areas are united by their high levels of deprivation. In 2019-20, the average child poverty rate in the UK was 28%. Yet, in these places, the average child poverty rate was 35%, with 18 areas exceeding this figure and none being below 29%. Eight are in the Midlands, with the other 22 in the north of England.

In other words: health outcomes are intimately linked to wider social and economic conditions, with the UK’s high levels of wealth inequality contributing to vast health inequalities.

“In 2023, it’s beyond belief that where you are born in our country still determines your life chances; a postcode lottery dictating your bank balance, the quality of the housing you can live in, food you can afford, the diseases you’re likely to develop, and even how long you will live,” Steve Rotheram, Liverpool’s Labour City Region Mayor, told this newspaper.

These facts have been known for some time. Public health expert Sir Michael Marmot was commissioned by the outgoing New Labour Government to produce a report on UK health inequalities – presenting his evidence in February 2010, months before the Conservatives and Liberal Democrats entered office through the Coalition Government. 

Sir Michael’s findings were stark, suggesting that between 1.3 million and 2.5 million years of life are lost through premature death as a result of health inequalities every year in England. 

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“Inequalities in health arise because of inequalities in society – in the conditions in which people are born, grow, live, work, and age,” Sir Michael wrote. “In England, people living in the poorest neighbourhoods will, on average, die seven years earlier than people living in the richest neighbourhoods. Even more disturbing, the average difference in disability-free life expectancy is 17 years. So, people in poorer areas not only die sooner, but they will also spend more of their shorter lives with a disability.”

However, although the Marmot Review was welcomed by David Cameron’s incoming administration, economic circumstances – and therefore health outcomes – have only worsened for the most deprived communities and areas. 

Writing an update to his findings in 2020, Marmot concluded that “England is faltering. 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 men and women everywhere the time spent in poor health is increasing.”

The reason for this, writes Sir Michael, can be directly attributed to austerity, which saw local government budgets cut in half – particularly affecting those who rely on the support of state services.

“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… Austerity will cast a long shadow over the lives of the children born and growing up under its effects,” Marmot’s 2020 report said.


A Failed Economic Model

With a second era of austerity set to be imposed by Rishi Sunak’s Government, combined with the aftermath of the COVID pandemic, there is little hope of an imminent improvement in the health of the nation, either.

As Byline Times has previously reported, England and Wales saw the second-largest fall in life expectancy during the pandemic of any comparable developed country, particularly suffered by the poorest places.

Indeed, people in the most deprived areas of England and Wales were twice as likely to die from COVID after contracting the disease as those living in the least deprived areas.

And so has arrived a winter NHS crisis like no other, with waiting times for emergency and non-emergency treatment now hitting record levels. This is both the cause and the consequence of health inequalities: poor health in stubbornly deprived areas of the country is putting pressure on the NHS, which – due to years of underfunding – cannot cope with the demand. 

Byline Times spoke to Sir Michael Marmot about these extraordinary pressures currently burdening the NHS. He observed that, if the whole of the UK experienced the low NHS admission rates currently only enjoyed by those at the top of the socio-economic scale, “the burden on the healthcare system would be drastically reduced”.

As for the prospect of the Government imposing further austerity measures, in an effort to limit state spending during the cost of living crisis, Sir Michael warned ministers not to repeat the past.

“The idea that we should cure the chaos launched by Liz Truss by going back to austerity is really frightening,” he said. “It might look like ‘grown up’ economics, but austerity did real damage” after 2010.

He observed that, unlike the overwhelming majority of European countries, Britain’s wages did not grow from 2008 onwards, after the financial crash.

“Our economic masters failed on their own terms, and did real damage to the country at the same time,” Sir Michael said. “I say to them: please don’t go back to this failed economic model that stalled growth and failed to improve incomes. A low-income economy is one that won’t recover, and it won’t help to improve health. I’m really worried. [They should] learn something and not repeat the damage.”

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These sentiments are reflected by Steve Rotheram. “Despite the heroic efforts of all NHS staff, the past few years have stretched our public services to their very limits – and exposed many of the deeply entrenched inequalities that exist,” he told Byline Times.

Sickness and death are the symptoms of the austerity-inflicted inequalities suffered by left-behind Britain. For all the rhetoric of the EU Referendum, the UK has spent about 20% less per person on health over the past decade than similar European countries.

As Debbie Abrahams – the Labour MP for Oldham East and Saddleworth who chairs the All-Party Parliamentary Group (APPG) on Health in all Policies – points out, the declining health prospects of the poorest is a situation not shared by other developed economies. “Together with the USA, England has this unenviable position,” she told Byline Times.

And, as the Government attracts more criticism for its “broken” ‘levelling up’ agenda, which has seen a trickle of money directed towards Conservative strongholds, both Abrahams and Rotheram are calling for Sunak’s party to deliver on its promises.

“For all the work this Government claims to be doing to ‘level up’ the country, it means nothing if the most vulnerable in our society are being left behind,” Rotheram said. “If we are serious about addressing health inequality, we must start by targeting resources towards those who need our help the most.”

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