Professor Sir Michael Marmot, who chaired the WHO commission on the social determinants of health and also chaired a major review of health inequalities in England in 2010, told the RCGP annual conference in Liverpool last week that life expectancy in England had improved 'about one year every four years since the end of World War One', but that this improvement stopped in 2011.
Sir Michael argued with the then health secretary Jeremy Hunt about the issue on Twitter in 2017, after which he wrote to Mr Hunt. 'I said you should take this slowdown in the improvement in life expectancy as seriously as you would a winter bed crisis. And he did. He ignored them both,' Sir Michael told the conference.
He explained that while life expectancy increases had slowed in all European countries, the most marked slowdown was in the UK.
'So it was not the case that we'd simply reached peak life expectancy, because European countries that had longer life expectancies than us continued to increase further,' Sir Michael said.
Inequalities are increasing
He added that in the bottom five deciles for deprivation, life expectancy had actually declined for women in the UK and remained flat for men in recent years, 'so the inequalities got much bigger'.
'If health is not improving then something is going wrong. And if inequalities in health are increasing, then inequalities in society are increasing,' Sir Michael said. 'And that’s why I wrote to the health secretary and said you need to take this seriously. What can be more important than this?'
Sir Michael highlighted that the majority of people in poverty are in a household where at least one adult is working. 'These people are in poverty not because they are irresponsible, they're in poverty because they are low paid,' he said.
He presented data to the conference showing that if people followed Public Health England's healthy eating advice, those in the bottom 10% of household income would have to spend 74% of their wages on food.
'So when you tell your patients eat healthily, more fruit and vegetables, well who will pay the rent?' he said. 'How can these people eat healthily if it would take 74% of household income?'
Tax avoidance
Sir Michael said one way to tackle inequalities was to 'get more money into the system', and argued that more needed to be done to prevent tax avoidance by both individuals and multinationals.
'Tax havens increase inequality,' he said. 'Fifty per cent of the wealth in the tax havens belongs to the top 0.01% of people in advanced economies. That wealth is equivalent to 5% of global GDP. It’s tax avoidance on a massive scale. And added to that is avoidance of tax by multinationals – 600bn Euros a year is shifted to the world’s tax havens by mutlinationals.'
'One of the things we could do if we stop Brexit is try and get rid of tax avoidance,' he added.
Sir Michael, who is professor of epidemiology at University College London and director of the UCL Institute of Health Equity, said an important part of his work since publishing the Marmot Review in 2010 had been monitoring progress against the report's six domains of recommendations.
He revealed his team were working on a follow-up of the review, which he expects to publish in February 2020, that will set out 'what has happened in the last 10 years'.
Sir Michael was invited to deliver the RCGP's John Hunt lecture, named after one of the RCGP's founders, by college president Dr Mayur Lakhani. The lecture takes place once every three years and is traditionally given by someone who is not a GP.
