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The Research Brief: health inequalities linked to over a million early deaths

Your weekly dose of policy thinking.

By Spotlight

Welcome to the Research Brief, where Spotlight, the New Statesman’s policy section, brings you the pick of recent publications from the think tank, charity and NGO world. See more editions of the Research Brief here.

What are we talking about this week? The effect of health inequalities on life expectancy. “Health inequalities, lives cut short”, published by the University College London’s Institute of Health Equity (IHE), uses Office for National Statistics data on mortality to calculate the excess deaths (the number of people who die beyond the expected level) among the general population who do not live in the 10 per cent of wealthiest areas, using that top wealthiest decile as a baseline.

So, what was uncovered? The figures show that in the period 2011-19, the peak years of austerity, 1,062,334 people died earlier than they would have done if they lived in the areas where the richest 10 per cent of the population reside. In other words, the total number of premature deaths among 90 per cent of the general population during the period is nearly as great as the entire population of Birmingham (around 1.1 million).

Around 148,000 excess deaths are directly attributed to the impact of austerity measures, based upon mortalities in the two years prior to 2011, the researchers note.

Who’s behind the research? Michael Marmot, the director of the IHE at UCL, led the research. He has worked in health inequalities research for more than 50 years, and in 2010 produced a landmark review on the topic for the government, later referring to the period after his report was published as a “lost decade” on progressing on the issue.

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“This is a dismal state of affairs,” said Marmot. “If you needed a case study example of what not to do to reduce health inequalities, the UK provides it. The only other developed country doing worse is the USA, where life expectancy is falling.”

The report’s findings contrast with previous research, which found that the cross-government English inequalities health strategy, introduced by the Blair government, had reduced disparities between the life expectancy of the most and least affluent parts of the country. The strategy was dropped by the Cameron government in 2010. Since then, a 2020 review led by Marmot concluded that life expectancy in England has stalled, years spent in ill health has increased and health inequalities have widened – particularly among women living in deprived areas.

“Our country has become poor and unhealthy, where a few rich, healthy people live,” said Marmot, in light of his latest research. “People care about their health, but it is deteriorating, with their lives shortening, through no fault of their own.”

What other trends did the research uncover? That, unsurprisingly, poorer areas suffered more: 400,649 excess deaths – around two fifths of the overall total – were comprised of people who lived in the most deprived fifth of areas.

The research also uncovered that in the seven most deprived deciles in England, there were more excess deaths for males than females.

What is Marmot calling for? Just like in 2010 when he published his initial review on public health, he is calling for more political and policy action on tackling the wider social determinants of ill health. 

While a lot of healthcare policy focuses on the deteriorating state of the NHS, many working models suggest that clinical care accounts for 20 per cent of health outcomes – while the social, economic and environmental factors that influence it account for 50 per cent.

“Important as the NHS is – 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,” said Marmot. “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.” 

In a sentence? After some progress, health inequalities have stagnated and, in some cases, worsened over the past 13 years – social interventions are urgently needed to improve people’s quality of life, and therefore health.

Read the full report from the UCL Institute of Health Equity here.

If you have a report, briefing paper or a piece of research that you’d like featured in the Research Brief, get in touch at spotlight@newstatesman.co.uk.

[See also: Why we need a new way of thinking about obesity]

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