That is the bleak message of Professor Sir Michael Marmot in his major new report on health inequality. Entitled ‘Health Equity in England: the Marmot Review 10 Years On’, it assesses lack of progress in the last decade, since his review in 2010 entitled ‘Fair Society, Healthy Lives’.
Since 2010 life expectancy has stalled: this has not happened since at least 1900. If health has stopped improving it is a sign that society has stopped improving.
This damage to health has been largely unnecessary.
Health is closely linked to the conditions in which people are born, live, work and age, and inequities in power, money and resources.
He repeats the well-understood expectation that, “The more deprived the area, the shorter the life expectancy”, but finds that inequalities in life expectancy have increased. “Among women in the most deprived areas, life expectancy fell between 2010/12 and 2016-18.” For both men and women, he continues, the largest decreases in life expectancy were seen in the most deprived 10% of neighbourhoods in the North-East, and the largest increases in the least deprived 10% of neighbourhoods in London.
He notes that widespread and deep funding cuts have been made in the last ten years in most areas of public spending, Government spending as a percentage of GDP declined by 7 percentage points between 2009/10 and 2018/19, from 42% to 35%, and cuts in local authority spending have been “hugely significant. Spending on social protection and education, both vital for health, have declined the most – by 1.5% of GDP.”
But it is not just the impact of overall cuts: it is how and where they have fallen that has impacted most on inequalities. The cuts over the period have been regressive and inequitable – they have been greatest in areas where need is highest and conditions generally worse. It is likely that the cuts have harmed health and contributed to widening health inequalities.
The original Marmot review considered several areas relating to healthy living which the new report revisits to see if there have been improvements. Aims stated included that every child should be given the best possible start in life, that everyone should be able to have a healthy standard of living, and that everyone should be able to maximise their capabilities and have control over their lives. There should be fair employment and good work for all. The new report also gives a stronger focus to regional inequalities, and a greater emphasis is placed on poverty. noting that the poorest people will require more investment and support over the next decade just to get them back to where they were in 2010.
For none of these areas does Sir Michael appear to feel satisfaction. He notes that the number of families with children who do not reach the minimum income standard has mounted, as have the rates of child poverty since 2010, with over four million children affected. Seeming to echo the UN Rapporteur Philip Alston’s April 2019 report, he cites the implementation of Universal Credit having pushed many people further into poverty and debt. On employment, he states that though employment rates have increased since 2010, there has also been an increase in poor quality work including part-time insecure employment, and that in-work poverty rates and stress caused by work have all mounted.
Although taking some comfort from the present government’s new commitments to spending, he concludes that the governments in the past decade have not prioritised health inequalities, sets out a clear agenda as to how they must be tackled, and calls on the government to take action on this as a matter of urgency.
Liberal Democrats must surely embrace this report’s analysis and conclusions, and demand the appropriate response from the present government, as part of an on-going campaign for social justice and a new social contract to be accepted between government and people.
* Katharine Pindar is a long-standing member of the Lib Dems and an activist in the West Cumbrian constituency of Copeland and Workington.