Inequality must be reduced to improve life expectancy

Life expectancy is falling and Governments must reduce inequality, Dr David Walsh and Dr Gerry Mccartney explain

AS reported recently in The Herald, life expectancy in Scotland has barely changed since 2012. Such a trend has not been seen since the Second World War and represents the biggest public health challenge for generations.

Understanding when and how people die provides important information about the overall health of a population.

Measures of mortality, such as life expectancy and mortality rates, provide a reliable summary of the occurrence of deaths across the whole population.

This helps us understand how the health of the population is changing. Since 2012 the stalling of life expectancy has occurred because the risk of death has changed across all age groups.

The average health of the population of Scotland has improved on most measures since the end of WWII.

However, life expectancy improved more slowly than in most of the rest of Europe during that period, and since the 1980s inequalities in life expectancy and ill-health have increased rapidly, meaning that the improvements have been unevenly shared.

These inequalities have become so large in Scotland that in Europe only Estonia, Lithuania and Latvia have steeper health gradients across their populations. Since 2012, the inequalities in life expectancy have increased further, with life expectancy dropping for those of us living in the most deprived areas.

This is having a particular impact in our cities and on our more deprived urban areas. Life expectancy is worsening rapidly in Dundee and in the poorest areas of Glasgow, Edinburgh and Aberdeen.

The stalling of life expectancy is not just restricted to Scotland. England, Wales, Northern Ireland and the

USA have all seen similar trends in recent years.

However, many other countries, including those with the highest life expectancy in the world such as Japan, have seen continued improvements.

In Scotland we are leading a large programme of research and action to understand and reverse the trends. We now understand the trends are due to changes in almost all causes of death. Some of these specific causes are particularly worrying, such as the rapid rise in drug-related deaths among the generation of people who are now in their 40s and 50s.

The reasons behind these changed trends are becoming clear.

Various international studies have shown that countries which implemented more severe economic “austerity” programmes subsequently experienced worse trends in life expectancy and other measures of health. Within the UK, the scale of austerity has been staggering, with the social security budget alone set to have been cut by £47 billion by 2020/2021.

The Equality and Human Rights Commission has estimated that policies implemented last decade will see real incomes fall by 8% for the poorest tenth of households.

Multiple studies have shown that these cuts to social security benefits, alongside increased conditionality placed on those receiving benefits, are having profound impacts on people’s health.

Other studies have highlighted that cuts to other public services, particularly those provided by local authorities, are also likely to be responsible for these adverse health trends.

Although tragic and unjust, these findings are not a surprise. The links between income, poverty and health have long been understood, evidenced by scientific studies from as far back as the 19th century, and reinforced in more recent times by countless studies including the work of the World Health Organisation’s Commission on the Social Determinants of Health.

Our own work has also shown that the economic policies that are pursued by governments have a big influence on health and health inequalities across populations.

In a wealthy country like ours, it is not right that we are witnessing declining life expectancy and widening inequalities. Behind these statistically-expressed trends lie genuine human tragedies: individual stories of pain, sickness, early death and grief – affecting individuals, their families, friends and communities.

It is the responsibility of governments at all levels to take action to reverse these trends. This means the social security system needs to be reoriented to ensure we all have the income, and security of income, we need.

It is welcome that the UK government has pledged to end austerity, but it is important that the additional spending is channelled towards social security and public services provided by local government and the NHS.

The Scottish Government’s rightsbased approach to social security and plans to reduce poverty are welcome but more could be done to redistribute tax and to boost incomes of the poorest.

It is also important that local government and the NHS are provided with the funding they need to ensure high quality and accessible services are in place at this time of high need.

The First Minister has signalled an intent to have the economy serve the needs of the population rather than the other way around. But action will be needed at the UK level as well as in Scotland if we are to ensure we live long, healthy and equal lives.

The social security budget alone [is] set to have been cut by £47 billion by 2020/2021

Dr Gerry Mccartney is Consultant in Public Health and Head of the Public Health Observatory, NHS Health Scotland, and Dr David Walsh is Public Health Programme Manager at Glasgow Centre for Population Health.