UCL Press Release, Immediate Release
One million people in England living shorter lives than they should
A new report from the UCL Institute of Health Equity (IHE) has confirmed that a million people in 90% of areas in England lived shorter lives than they should between 2011 and the start of the pandemic.
The number of lives shortened is equivalent in size to the whole of Birmingham (and some), 984.333; or Edinburgh and Glasgow together, 1,056,610; or a third of Wales (3,136,000); or half the population of Northern Ireland (1,885,000).
In contrast to the traditional focus on the health of the poorest, the new report Health Inequalities, Lives Cut Short considers the life expectancy of 90% of the general population who do not live in the 10% of wealthiest areas.
Using several published ONS data sources, the IHE made these calculations from the number of excess deaths (the increase in the number of deaths beyond that would be expected) in the decade from 2011 in England.
Previous research has shown that pre-2010 government policies were beginning to close the health inequalities gap. Such policies included coordinated investment in the early years, education and neighbourhood renewal, as well as healthcare.
However, the new findings from the IHE add weight to its two reviews of health inequalities in 2020 (10 years On Review and COVID-19 Review): that the cumulative impact of regressive funding cuts, associated with austerity, contributed to life expectancy failing to increase, life expectancy falling for women in the 10% of poorest areas, and health inequalities widening.
To contextualise the UK’s downwards health trend, the IHE has additionally analysed European Union data. The IHE has compared healthy life years (number of years a person is expected to continue to live in a healthy condition - also called disability-free life expectancy) in the UK to other European Union countries.
The IHE found that, in 2014, both males and females in the UK had a higher average number of healthy years lived (HYL) than those in the EU. However, by 2017, HLY in the UK had stagnated for men, and fallen for women. In the same period, HLY increased by more than two years in the EU. Consequently, ten EU countries had higher HLY than the UK for males, and 14 had higher HLY than the UK for females.
IHE Director, Professor Sir Michael Marmot, whose work on the social determinants of health spans more than 50 years, and has chaired numerous reviews of health inequalities at global, regional, national and local level, said: “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.”
The report found that of the one million people who died prematurely, 148,000 of them were additional to what might have been expected if the post-2010 austerity measures hadn’t been imposed. Additionally in 2020, during the pandemic, inequality between the least and most disadvantaged 10% of areas contributed further 28,000 excess deaths, when compared to that over the previous five years.
Health equity should be central to all UK Government policies.
As a result, the IHE is calling on the government to put health equity and well-being at the heart of all policies by following the eight ‘Marmot Principles’ (see Editor’s Notes).
“This is a dismal state of affairs”, continued Sir Michael. “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. It’s 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 cases of health inequalities.”
IHE proposes the appointment of an independent Health Equity Commissioner and establishment of a new cabinet-level health equity and well-being cross-departmental committee.
Sir Michael explained: “In the UK the IHE is working with more than 40 local areas, businesses and other sectors who are taking this broader approach. They are doing their best to protect lives and promote health equity with their dwindling and inadequate funds. We know what to do. We are seeing a cultural shift and more action on health inequalities in those areas, where local leaders from different sectors are working together to promote health equity, which is magnificent.
“Ensuring all policies are assessed for their likely impact on equity of health and wellbeing is essential for reducing health inequalities long term. What must happen at the same time, though, is leadership from central government, making reducing health inequalities a central plank of the next government. That means implementing fairer social and economic policies, with health at the heart.”
Case study
The IHE works with more than 40 local authorities across the UK (see Editor’s Notes). The longest local authority partnership is with Coventry, which now calls itself a ‘Marmot City’. Since 2013, the City Council has focused on reducing health inequalities even with relatively high levels of deprivation. IHE analysis of the data shows:
- The number of young people not in employment, education or training (NEET) has almost halved from 6.84 to 3.5% (whereas the England average has dropped less than one percentage point).
- The percentage of people earning less than the living wage has fallen and is lower than the English average.
A health inequalities steering group of senior leaders across Coventry has been set up, involving leaders from local authority, business and the economic sector, health care, education, criminal justice and other public services, and the community and voluntary sector. There has been a significant cultural shift, with partners working together to prioritise health equity by implementing the Marmot Principles.
Now, in Coventry, all policies and services commissioned, from planning, housing and transport to licensing, regulation and procurement, consider the impact on health equity before implementation. Councillor Kamran Caan, portfolio holder for Public Health and Sport at Coventry City Council said: “Since 2013, when I had just started out as Deputy Cabinet Member for Health and Adult Services, our health equity journey has been vast and includes progress in outcomes across health and society in areas including planning, housing and transport. There have been improvements in school readiness at age five, health outcomes, life satisfaction, employment and reductions in crime in priority locations.
“As we move forward the City Council’s ambition remains to ensure more residents of Coventry are fulfilling their ambitions, living healthier lives for longer and living in safer, connected, and sustainable communities. For example, our new Marmot Monitoring Tool will help us to identify any widening health inequalities and where city-wide programmes are improving health equity and making a difference to residents."
Editor’s Notes
All Media Requests: Felicity Porritt E: f.porritt@ucl.ac.uk T: 07739419219
OR Poppy Tombs, UCL Media Relations, E: p.danby@ucl.ac.uk T: 07733307596
About the UCL Institute of Health Equity
The UCL Institute of Health Equity’s mission is nothing less than a fairer, healthier society. All our work is guided by the following eight ‘Marmot Principles’:
1. Give every child the best start in life.
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives.
3. Create fair employment and good work for all.
4. Ensure a healthy standard of living for all.
5. Create and develop healthy and sustainable places and communities.
6. Strengthen the role and impact of ill health prevention.
7. Tackle racism, discrimination and their outcomes.
8. Pursue environmental sustainability and health equity together.
The IHE was established in 2011 and is led by Professor Sir Michael Marmot. The aim at the outset was to develop and support approaches to health equity and build on work that has assessed, measured and implemented approaches to tackle inequalities in health - works such as the ‘WHO Commission on Social Determinants of Health’ and ‘Fair Society Healthy Lives’ (The Marmot Review).
Since 2011, the Institute has led and collaborated on works to address the Social Determinants of Health and improve health equity. In 2020 UCL IHE published The Marmot Review 10 Years on, #Marmot2020, which confirmed an increase in the north/south health gap in England. The largest decreases in health and life expectancy were seen in the most deprived 10% of neighbourhoods in the North-East, and the largest increases in the least deprived 10% of neighbourhoods in London.
Both reviews laid out what would happen if the SDH weren’t addressed to promote health equity. The 2020 report laid bare the health damaging impacts of austerity policies and associated cuts, which led to widening health inequalities across England.
The IHE works globally (with the UN and its institutions, and directly with countries) and nationally across the UK, including local authorities, the NHS, non-governmental organisations (NGOs), businesses and local community & voluntary groups. The aim is to reduce health inequalities by putting health equity at the heart of everything they do.
The IHE has set up a UK-wide Health Equity Network to help organisations and localities share best practice on implementing the evidence on reducing health inequalities.
At local government level, the IHE is working directly with nine areas covering more than 40 local authorities, including Coventry. In these areas reducing health inequalities is a priority and they are taking action to support better health and health equity for their populations, despite health harming national policies, enormous financial cuts and the continuing impacts of austerity policies and the COVID-19 pandemic. All but one was created during or after the COVID-19 pandemic, and more are joining:
1. Coventry, 2013 (1 local authority)
2. Greater Manchester, 2019-21 (10 local authorities)
3. Cheshire and Merseyside, 2021-24 (9 local authorities)
4. Lancashire and Cumbria, 2021-22 (4 local authorities)
5. Luton, 2022 (1 local authority)
6. Waltham Forest, 2022 (1 local authority)
7. Gwent, 2022-23 (5 local authorities)
8. Southwest region, 2023-2025 (counties of Bath, Wiltshire, West Bristol, Somerset, Gloucestershire, Cornwall and Isles of Scilly, Devon and Dorset)
9. Leeds, 2023-2025 (1 local authority)