The Guardian view on life expectancy stalling: a political choice
In 2010 a government-commissioned review looking at the relationship between health and wealth – only the third officially sanctioned attempt to do so in 30 years – came to the conclusion that life expectancy is linked to social standing and so is the time spent in good health. Lower life expectancies in the UK were not those associated with destitution but rather despair and expectation. Poorer people suffer diseases because of bad diets, a lack of exercise, smoking, poor pay and job insecurity. Its message was twofold. First, government intervention was necessary to ensure that people’s
freedoms were not bad for their health.
Second, the state had a responsibility to assure people’s material security. Tory health secretaries did no more than pay lip service to such ideas. The result has been rising death rates.
The 2010 report, authored by the epidemiologist Sir Michael Marmot, called for national targets on life expectancy, suggesting that policies were put in place to increase the lifetime of a poor person by three years by 2020. That target is not going to be reached. Last month it was confirmed that UK life expectancy has stopped improving for the first time in more than 35 years. In terms of length of life, the UK lags behind other developed nations. Young people are now less likely to live longer than their parents. Ministers initially blamed the figures on flu deaths. A more plausible explanation is the politics of austerity, which had an excessive impact on the poor, the disabled and the elderly. Local councils cannot pay for home visits, cuts have led to rising levels of homelessness, fuel poverty and food bank visits. It is shocking that 18-year-olds with learning disabilities may well not live long enough to draw their pension.
As lives are at stake, the health secretary, Matt Hancock, has managed to be absurdly unoriginal in approaching this. His policy rests substantially on old, failed ideas that personal responsibility and technology can solve the problem. Eating more fruit and salads
is a great idea. But has Mr Hancock wondered what to tell those in the bottom income decile who, if they followed Public Health England’s healthy eating guidelines, would discover that about 70% of their household income had been spent on food? How can they afford to take responsible options – and pay their rent and keep warm? Why fixate on genomics as a preventive measure? A person may be genetically predisposed to a disease. It does not mean they will contract it. Environment swamps such risks. The NHS will get extra money. But last month’s budget saw further cuts of £200m to public health services, which have already seen reductions of £500m since 2014-15.
Mr Hancock’s defence is that Britain has high levels of employment. True, but at what cost to society, when employment cannot support a stable life? Jobs where hours and income fluctuate can wreak havoc with benefits and childcare. They wear workers out mentally. Recent research found that some jobs might be even worse than unemployment for one’s health: people moving into poor-quality work were found to have the highest levels of chronic stress, higher than that recorded by jobless workers.
At the heart of this debate is the government’s refusal to engage with inequality. This is an error borne out of ideology. We know that children from poorer backgrounds are more affected by the rise in childhood obesity. So why allow the number of children living in poverty to breach 5 million by 2022, up from around 4 million at present? It is because a key belief in free-market societies is that they reward the industrious and punish the idle. In this system, individuals must have the freedom to choose – and with that freedom would come responsibility. The market, in this system, would not only improve British society; it would remoralise it. To have faith in such an unfettered model of capitalism is a political choice. When applied to public health, the appalling price appears to be to stall progress in life expectancy.