A landmark review by Professor Michael Marmot reveals that a decade of austerity has aggravated health inequalities, leading to life expectancy stalling for the first time in a century – and even reversing for the most deprived women.
In 2010, Marmot was commissioned by the government to review health inequalities across England. He warned that government policies focusing on the health care system and individual behaviour change approaches were largely ineffective at reducing health inequalities.
He urged the government to recognise that social determinants – the environment in which individuals are born, grow, work, live and age – are predominantly linked to ill health, and that to improve the health of all, action must be taken in relation to these determinants.
Yet, ten years later, Marmot’s new review exposes the government’s critical failure to act. England has suffered an unprecedented drop in health, with people living in poor health for longer and health inequalities widening. Austerity policies are significantly to blame.
The report pinpoints the cuts to funding which have shaped such devastating realities: the closure of children’s centres, declines in education funding, an increase in precarious work, zero hours contracts and a housing affordability crisis have all directly correlated with a rise in child poverty, a spike in homelessness and a reliance on foodbanks. And the consequences of such policies are, on the whole, worse for minority ethnic population groups and people with disabilities.
One case study within the review illustrated how minority ethnic women in particular experience isolation due to language and cultural barriers, which is then accelerated by a lack of culturally specific provision and resources in the community.
‘Intersections between socioeconomic status, ethnicity and racism intensify inequalities in health for ethnic groups’
Tragically, the analysis carried out by the Institute of Health Equity found that half of the minority ethnic groups – mostly black, Asian and mixed ethnic groups – had significantly lower DFLE (disability-free life expectancy) at birth than white British men or women.
For women in particular, healthy life expectancy has declined since 2009-2011. For both men and women, the number of years spent in poor health has increased.
With regard to social determinants, the review found that: ‘Intersections between socioeconomic status, ethnicity and racism intensify inequalities in health for ethnic groups. Some groups, notably individuals identifying as Gypsy or Irish Traveller, and to a lesser extent those identifying as Bangladeshi, Pakistani or Irish, stand out as having poor health across a range of indicators.’
‘Health inequalities are not inevitable and can be significantly reduced… avoidable health inequalities are unfair and putting them right is a matter of social justice.’
What’s more, the review emphasised that the most deprived areas require a greater proportion of their funding from central government grants to local authorities – yet it is these areas where grants have been cut the most.
Such blatant and avoidable systemic oppression cannot be overlooked. One striking note within the review’s foreword stands out among all else: ‘The damage to the nation’s health need not have happened.’
England’s levels of poverty and inequality do not need to be a reality; this is a choice. As the world’s fifth richest country, we ought to be ashamed.
Marmot’s review reiterated a fundamental sentiment from his 2010 review: ‘Health inequalities are not inevitable and can be significantly reduced… avoidable health inequalities are unfair and putting them right is a matter of social justice.
‘There will be those who say that our recommendations cannot be afforded, particularly in the current economic climate. We say that it is inaction that cannot be afforded, for the human and economic costs are too high.’