Paying the highest price: Austerity will accelerate area health inequalities
A report released by Oxfam today revealsthat the wealth of the UK's richest 5 families is greater than the poorest 20% of people. According to the report, the poorest 20% in the UK had wealth totalling £28.1bn – an average of £2,230 each. The latest rich list from Forbes magazine showed that the five top UK entries – the family of the Duke of Westminster, David and Simon Reuben, the Hinduja brothers, the Cadogan family, and Sports Direct retail boss Mike Ashley – between them had property, savings and other assets worth £28.2bn.
Last week, the Office for National Statistics published data showing that the gap in healthy life expectancy (the number of years people are expected to live in ‘good’ health and are disability-free) between people living in the most deprived (52 years for men) and most affluent (71 years for men) areas of England now stands at almost 20 years. That means that those living in the 10% richest parts of our country do not develop a significant illness until 20 years after those in the 10% most deprived areas. Whilst this is part of a long term trend in which area health inequalities have risen almost every year since the 1980s – indeed the UK has the highest regional inequalities in health in Europe - it seems likely that the Coalition’s programme of austerity is not helping matters.
Since 2010, the poorest communities have suffered the consequences of the financial crisis with reductions in the value of welfare benefits, restrictions on entitlements to support, the introduction of the Bedroom Tax, as well as rising costs of food and fuel. Local authorities have had to make savage service cuts to meet centrally imposed budget cuts that are often in excess of 40%. These have been particularly high in the more deprived and Northern local authorities. The NHS is also struggling to cope with the budget restrictions that have been placed upon it and the costly reorganisation imposed by the 2012 Health and Social Care Act with rising waiting times in A&E. Food banks have become common place in deprived areas up and down the country as hundreds of thousands of families struggle to survive in austerity Britain.
Previous studies of past welfare state expansion and contraction on health inequalities suggest that inequalities increase when welfare services are cut (Bambra, 2013). For example, a USA study found that inequalities in mortality and infant mortality rates declined between 1966 and 1980, but then increased between 1980 and 2002 (Kriegar et al, 2008). The reductions occurred during a period of welfare state expansion (the ‘War on Poverty’) whilst the increases occurred during the Reagan-Bush period of ‘austerity’ when public welfare services (including health care insurance coverage) were cut. These findings are mirrored in studies of welfare state cuts in New Zealand (Blakely et al, 2008; Shaw et al, 2005) which found that inequalities in mortality amongst men, women and children increased in the 1980s and the 1990s during a period in which New Zealand underwent major welfare reform. Research into the health effects of Thatcherism (1979-1990) has also concluded that neo-liberalism, the large scale dismantling of the UK’s social democratic institutions and the early pursuit of ‘austerity-style’ policies increased health inequalities between the richest and poorest and between North and South (Scott-Samuel et al, 2014).
These rises in inequalities were not inevitable as social inequalities in mortality declined from the 1920s to the 1970s as the welfare state was expanded (Thomas et al, 2010). Today’s data reinforces that politics matters and that choosing to pursue policies of austerity increases inequities in our society - with those in the poorest communities paying the very highest price of all in terms of early ill health.
Bambra C. (2013) ‘All in it together’? Health Inequalities, Austerity and the ‘Great Recession’, in Health in Austerity London, Demos. http://www.demos.co.uk/publications/healthinausterity
Blakely, T.et al. (2008). Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies. BMJ, 336, 371–375
Krieger, N.et al. (2008). The fall and rise of US inequities in premature mortality: 1960–2002. PLoS Medicine, 5, 227–241
ONS Healthy Life expectancy by area deprivation http://www.ons.gov.uk/ons/rel/disability-and-health-measurement/inequality-in-healthy-life-expectancy-at-birth-by-national-deciles-of-area-deprivation--england/2009-11/info-inequality-in-hle.html?WT.mc_id=09eb80477ad2e2d3516a6c32040e05f2&WT.sn_type=TWITTER&WT.z_content=infographic&WT.z_format=nugget&WT.z_taxonomy=population&WT.z_trigger=proactive&hoot.message=Inequality+in+Healthy+Life+Expectancy+by+area+deprivation+%5BInfographic%5D+%5BLINK%5D&hoot.send_date=2014-03-14+09%3A44%3A12&hoot.send_dayofweek=Friday&hoot.send_hour=09&hoot.username=ONS
Scott-Samuel, A. et al. (2014) The impact of Thatcherism on health and wellbeing in Britain, International Journal of Health Services, 44:53-72.
Shaw, C.et al. (2005). Do social and economic reforms change socioeconomic inequalities in child mortality? A case study: New Zealand 1981–1999. Journal of Epidemiology and Community Health, 59, 638–44
Thomas, B. et al. (2010) Inequalities in premature mortality in Britain: observational study from 1921 to 2007. British Medical Journal, 341: c3639.