United Kingdom: An unsettling fall in life expectancy

A troubling trend has fallen under the radar in the Brexit-dominated UK. British life expectancy has been in a steady decline for several years. Successive austerity policies seem to be a crucial factor in this.

The decline has been sustained through the 2010s

The present-day UK seems to be dominated by the Brexit process. So much so that a troubling trend has fallen under the radar. British life expectancy has been in a steady decline for several years. Successive austerity policies seem to be a crucial factor in this.

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In September 2019, while Boris Johnson maneuvered his way through a general election, 1,248 people died above the historical average for the time of the year in England and Wales. The focus on life expectancy decline was overlooked in public debates for the sake of tradition: the "purdah" was in place. The purdah, is a period from the announcement of an election until the voting day, in which government officials are discouraged from making announcements that may influence the voting population. But perhaps, avoiding a public debate on the UK’s falling life expectancy was a convenient and deliberate approach during the purdah, according to Danny Dorling, professor of geography at the University of Oxford. In an article published in December 20191, the geographer expressed his surprise that this trend did not make more noise and challenged the approaches and explanations of successive British governments to explain this decline. For him, this transcends any particular party, and it boils down to austerity policies.

Already in 20142 Prof. Dorling brought attention to an internal report by Public Health England (an executive agency of the UK's Department of Health and Social Care) that leaked into the Health Service Journal. The report said: "When we focus on mortality over 75, we see a rapid increase in mortality for both men and women, which will occur throughout 2012 and continue into 2013." The Health Service Journal explained at the time that due to the increase in deaths among the elderly, 2012 was the first year in which overall mortality for all ages had increased since 2003. Life expectancy for both women and men throughout the UK has now fallen to below its 2014 level.

The flu, the winter...and other tales

Public Health England argued that the report was flawed by methodological weaknesses, without specifying them, and naming influenza A(H3N2) as the "major explanatory factor" for the decline in life expectancy. However, the Office for National Statistics (ONS) stated that "Influenza activity in 2012-13 was relatively low", a fact that was confirmed by the European Centre for Disease Prevention and Control. The Center estimated that the United Kingdom one of the lowest influenza intensities reported in Europe that winter. David Stuckler, a researcher at the University of Oxford, and Martin McKee of the London School of Hygiene and Tropical Medicine estimated that influenza and pneumonia contributed only to a range of withing 3.5% and 5.8% of the rapid increase in mortality.

Extreme weather is the other explanation put forward several times between 2015 and 2019 by Public Health England. However, the UK has not experienced an unusually cold winter since 2010. A closer look at this argument raises more questions on policy choices. The British government, via the National Health Service's (NHS), provided advice to older people on how to protect themselves from the cold via the internet. But how many people over 85 have access to the internet? Prof. Dorling pointed out as a comparison, that countries with harsher winters, such as Germany and Finland, have very low rates of weather-related winter mortality. A simple truth: these countries have higher standards and access to the proper heating and insulation of individual homes.

The price of austerity

Neither the flu nor the cold seem to be solid alibis to Prof. Dorling, who puts forward other explanations. It is the elderly who are visited less often when the price of fuel rises. They are the first to suffer the supply of healthcare is reduced. They are the ones who have a hard time going to a food bank. And if they suffer more from the cold, it is mainly because they cannot keep warm due to lack of resources. People with cognitive impairment are the first to suffer from a reduction in personnel for health services.

In the 1970s, the United Kingdom looked closer to the egalitarian models like Sweden. Successive austerity policies, particularly accentuated in the 2010s, have reduced public spending from 41% of GDP in 2006 to 36% in 2019. A figure only slightly above that of the United States. The parallelism is troubling: In 2008, with the end of George W. Bush's second presidency, an America marked by a stark reduction in social assistance saw a fall in life expectancy for the first time in 15 years.

For Prof. Dorling, this process of austerity is now having devastating effects. Between 2008 and 2013, 483,000 elderly and disabled people lost all or part of their access to healthcare. Over the past nine years, the NHS has been struggling to meet the needs of the population. Drastic cuts in social services budgets have also meant that many hospital beds are occupied by elderly people who cannot go home because they cannot get access to healthcare at their home addresses.

His observation is shared by Simon Wessely, Head of the Department of Psychological Medicine at the Institute of Psychiatry, Psychology & Neuroscience at King's College London. Prof. Wessely said in 2014: "It is hard to think of a single policy that will do more to widen the health gap between rich and poor than Hunt's latest plans”. Jeremy Hunt was UK Secretary of State for Health from 2012 to 2018.

The new generations are also affected

Infant mortality in England and Wales is also increasing. In 2014, 3.6 babies died per 1,000 births. This figure rose to 3.7 in 2015, 3.8 in 2016 and 3.9 in 2017. A smaller but statistically significant change according to the ONS. Most of the additional deaths occur in the first weeks of a child's life, which raises the question of the impact of austerity in the operating rooms at maternity hospitals, the training of midwives, and the NHS's capacity to support pregnant women. On the other hand, Scotland has chosen to draw on several funds to finance policies in these areas. Scotland's infant mortality rate, which was the same as England and Wales in 2014, has since fallen (3.6 babies died per 1,000 births in 2014, 3.2 in 2018).

On December 9th, 2019, a TV journalist showed Boris Johnson a photo published in a tabloid newspaper. The photo showed a four-year-old child lying on the floor of a hospital in Leeds, in the north of England, as a bed was not available for him. The photograph caused an outcry among the public and politicians. "Have you seen the picture?" asked the journalist. The Prime Minister first looked away and explained the importance of breaking the national political deadlock as soon as possible. For many, this behavior reflected his lack of empathy on the current trends affecting inequality and healthcare access in the UK.

A darker time to come?

While the drop in life expectancy since 2014 is officially being approached as some sort of temporary "downturn", Prof. Dorling does not hide his pessimism. For him, the United Kingdom is now in uncharted territory, since nowhere else in Europe is life expectancy falling and infant mortality rising. "Of the people who died recently, homeless, on the streets of Oxford, two of them had gone to the same school as me as a child," he reflected.

Sources :
1. “The biggest story in the UK is not Brexit. It’s life expectancy”, by Danny Dorling, The Correspondent, December 2019
2. “Why are old people in Britain dying before their time?”, by Danny Dorling, NewStatesmanAmerica, 13 February 2014