Health inequalities ‘caused 1m early deaths in England in last decade’

Tobi Thomas Health and inequalities correspondent
8 January 2024

Photograph: Christopher Furlong/Getty Images

More than 1 million people in England died prematurely in the decade after 2011 owing to a combination of poverty, austerity and Covid, according to “shocking” research by one of the UK’s leading public health experts.

The figures are revealed in a study by the Institute of Health Equity at University College London led by Sir Michael Marmot. They demonstrate the extent to which stark economic and social inequalities are leading to poorer people dying early from cancer, heart problems and other diseases.

Using Office for National Statistics figures, the report’s author, Prof Peter Goldblatt, looked at the life expectancy of people across England who do not live in the wealthiest 10% of areas.

The report, titled Health Inequalities, Lives Cut Short, found that between 2011 and 2019, 1,062,334 people died earlier than they would have done if they lived in areas where the richest 10% of the population reside. A further 151,615 premature deaths were recorded in 2020, although this number was higher than expected because of the coronavirus pandemic.

Of these deaths, Goldblatt directly attributed 148,000 to austerity measures implemented by the coalition government from 2010 by comparing them with levels seen earlier.

Marmot, who authored a seminal review into health inequalities in the UK in 2010, said the premature deaths and widening inequalities were a “dismal state of affairs”. He urged political leaders to do more to tackle the fact that poorer people were at much higher risk of getting and dying from illnessesthat are closely linked to poverty, poor housing and unemployment.

He said: “One million premature deaths, made dramatically worse by austerity, is a shocking political failure. The worse health of the more deprived 90% of the population, compared to the best-off 10%, means that health inequalities involve the majority of society.

“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.

“Our country has become poor and unhealthy, where a few rich, healthy people live. People care about their health, but it is deteriorating, with their lives shortening, through no fault of their own. Political leaders can choose to prioritise everyone’s health, or not. Currently they are not.”

Related: Risk of dying from cancer in England varies hugely between regions, say scientists

Analysis by Cancer Research UK has estimated that there are 33,000 extra cases of cancer in the UK each year associated with deprivation, while women from England’s poorest areas die on average five years sooner than their wealthier counterparts. During the coronavirus pandemic, people from black and Asian backgrounds were at greater risk of dying from the virus than their white counterparts.

Previous research has shown that policies introduced by Labour governments between 1997 and 2010, which focused on early years and education, were beginning to reduce glaring health inequalities. Much of the action taken flowed from the English health inequalities strategy, a cross-government plan. Studies have found that this particular strategy was associated with a decline in geographical inequalities regarding disparities in life expectancy, which reversed a previously increasing trend.

However, after it ended in 2010, coinciding with the introduction of austerity, health inequalities began to increase again. The institute’s 2020 report Health Equity in England: the Marmot Review 10 Years On found that improvements to life expectancy had stalled, with the greatest slowdown seen in the most deprived areas, and had even declined for women in the poorest 10% of areas.

The study found that during the pandemic, inequality between the least and most disadvantaged 10% of areas contributed to a further 28,000 excess deaths, in comparison with the previous five years.

The report also found that “healthy life years” – which measures the length of time someone lives free of ill health – has worsened in the UK compared with countries in the European Union over recent years. In 2014, men and women in the UK had a higher average number of healthy years than those in the EU. However, by 2017 this had stagnated for men and fallen for women, but had increased by two years for both sexes in the EU.

Wes Streeting, the shadow health secretary, said it would be the next Labour government’s mission to “build a fairer Britain where everyone lives well for longer”.

“The last Labour government not only delivered the shortest NHS waiting lists and highest patient satisfaction in history, we also tackled the social determinants of health and cut health inequalities,” Streeting said. “Fourteen years of Conservative wreckage of Labour’s legacy has left our country with an NHS on its knees, an increasingly unhealthy society, with appalling consequences for people.

“Where you are born, and the circumstances you are born into, shouldn’t decide how long you will live. It will be the mission of the next Labour government to both get our health service back on its feet and to build a fairer Britain where everyone lives well for longer.”

Marmot added that it was time for action and political leadership across the board. “Important as is the NHS – 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. 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. To MPs: if you care about the health of your constituents, you must be appalled by their deteriorating health.”

A Department of Health and Social Care spokesperson said: “We are committed to tackling inequalities in outcomes, experiences and access to healthcare across the NHS. This is a key focus of the NHS long-term plan, under which NHS England has commissioned five new cancer clinical audits to reduce unwarranted variation in treatments and outcomes for patients.”