Health in England 'faltering' after 10 years of austerity, warns damning Marmot review

Life expectancy has stalled, patients are living longer in ill health and health inequality has risen after a decade of austerity that will 'cast a long shadow' over the lives of UK children, according to a devastating follow-up to the 2010 Marmot review.

Professor Sir Michael Marmot (Photo: Pete Hill)
Professor Sir Michael Marmot (Photo: Pete Hill)

In a scathing 172-page report published a decade on from his landmark 2010 review, Professor Sir Michael Marmot warns that England's health is 'faltering'.

Continuous improvement in life expectancy throughout the 20th century has 'slowed dramatically, almost grinding to a halt' since 2011, the report warns, while 'life expectancy actually fell in the most deprived communities outside London for women and in some regions for men'.

Time spent in ill health for men and women across the England is increasing - and the 'damage to health and wellbeing is similarly nearly unprecedented' across the four UK nations. Reducing health inequality has not been a priority since 2010 and there has been 'no national strategy' to achieve this, the report warns.

Health inequality

Despite the 'shocking' findings highlighted in the report, its author is clear that 'the damage to the nation's health need not have happened'. If governments had chosen to act on 2010 recommendations for reducing health inequality, there is strong evidence that 'health would have continued to improve and health inequalities would not have grown larger', the report argues.

Professor Sir Michael warns in an introduction to the Marmot review 10 years on report, commissioned by the Health Foundation think tank, that 'austerity has taken its toll' across all six of the domains set out in the original review.

He highlights the devastating impact of factors ranging from 'rising child poverty and the closure of children’s centres, to declines in education funding, an increase in precarious work and zero hours contracts, to a housing affordability crisis and a rise in homelessness, to people with insufficient money to lead a healthy life and resorting to foodbanks in large numbers, to ignored communities with poor conditions and little reason for hope'.

Outcomes are 'even worse for minority ethnic population groups and people with disabilities', Professor Sir Michael warns, and changes 'such as the increase in child poverty, will mostly show their effects in the long term'.


He adds: 'Austerity has adversely affected the social determinants that impact on health in the short, medium and long term. Austerity will cast a long shadow over the lives of the children born and growing up under its effects.'

The report calls for rapid investment as a priority in areas hit hardest by reductions in funding through years of austerity - identified as 'mostly regions in the north of England, more deprived areas and ignored communities throughout England'.

It adds that 'regressive' changes to funding distribution have increased unfairness since the 2010 review: 'The data presented in this report show that government spending has not only declined in key social determinants of health, but that it is now also allocated in a less equitable way - meaning that spending allocations are less weighted towards deprived areas and communities than previously.'

The report calls for more spending on early years support for children and a drive to reduce child poverty to match the lowest rates in Europe. It calls for equity to be central to all government decisions about education policy and funding, and for action to boost fair employment.

Universal credit

It calls for an overhaul of universal credit and an increased national living wage to ensure everyone has an income sufficient for healthy living, for investment in healthy, sustainable communities and a national strategy to reduce health inequality.

Health Foundation chief executive Dr Jennifer Dixon said: 'A healthy population is one of the nation’s most important assets. The landmark Marmot review in 2010 showed striking differences in health between people living in the wealthiest and most deprived communities.

‘Today’s report shows that things are now worse, especially for women. There has been a decrease in the proportion of our lives that we can expect to live in good health.

‘Levelling up will require the government to go further than investment in infrastructure – building bridges, train lines and new hospitals. It must also invest in the circumstances in which people live that have powerful impacts on their health and wellbeing – such as poverty, employment, housing and education.'

Life expectancy

BMA board of science chair Professor Dame Parveen Kumar said: 'With the health of the population deteriorating, the gap between the health of those in the most deprived and those in more advantaged areas widening, and life expectancy stalling, alarm bells should be ringing for the government.

'It is unacceptable that those living in the most deprived areas outside of London are seeing their life expectancy stalling or even declining in some cases – this must be addressed.

'As this report highlights, fulfilling the ambition outlined in the government’s green paper - to ensure that people can enjoy at least five extra healthy, independent years of life by 2035 and to narrow the gap between the experience of the richest and poorest – has never been more important.

Labour shadow health secretary Jonathan Ashworth said: 'This is a devastating verdict on 10 years of austerity under the Conservatives, and demands urgent action from Boris Johnson.

'There is no greater social injustice than people dying sooner because of poverty and austerity. Yet not only is life expectancy stalling for the first time in more than 100 years, shockingly it is actually declining for the poorest 10% of women.'

Patients Association chief executive Rachel Power called the report's findings 'truly shocking reading'. She said: 'There are clear divides along economic, geographic and ethnic lines: people on the wrong sides of these divides are living shorter lives, and experiencing poor health for longer.

'These declines have not occurred in other developed countries: the report shows that they are the direct result of policy choices by successive governments since 2010. There is no justification for our political leaders degrading the health of the population in this way – it is a monstrous failure.'

Health and social care secretary Matt Hancock said: 'The ultimate goal of the NHS is to increase healthy life expectancy, and this government is determined to narrow the gap by levelling up access to healthcare across England.

'I thank Professor Sir Michael Marmot for his dedicated work to shine a light on this vital issue. His findings show just how important this agenda is, and renew my determination to level up health life expectancy across our country. After all, levelling up health is the most important levelling up of all.'

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