We’ve had a torrid experience of Covid-19 in this country. While the UK accounts for less than one percent of the global population, it has been the site of 1 in every 25 deaths from Covid. Our health outcomes are among the worst in the world.
A number of reasons have been put forward as to why we’ve had such a bad time. Early on, many talked about beds: after a decade of central government closing beds to save money, the NHS found itself left with a comparably small and extremely unsafe number – too few to be confident of providing universal care during a health shock.
The small size of our workforce is sometimes blamed too. For a country of our size, we have far too few doctors, nurses and social care workers. A bed is no good if no-one is available to staff it. It would take tens of thousands of new doctors and potentially hundreds of thousands of new nurses to get us to the level we should be striving for.
These are important factors – and they represent how far awry we have gone in the last decade. Too often, though, we’ve overlooked an equally important factor in our outcomes: unjustifiable levels of health inequality, compounded by seven years of public health cuts. These cuts drove the unequal impact of the pandemic in 2020.
Overall health in the UK is relatively good, compared to similar countries. The average life expectancy for women in high-income countries is 83.4 years – just a little higher than the UK average of 83.1 years. UK men can expect to live a year and a half longer on average than men from other high-income countries, reaching 79.5 years to their counterparts’ 78.1.
But these averages mask considerable inequalities within our country. The picture outside the South and London is not nearly so rosy.
Compared the rest of the country, you’re far more likely to die ‘prematurely’ if you live in the North West or North East. Rates of depression and anxiety are almost 3 percent higher in the North than the English average. Diabetes prevalence, obesity, early cancer mortality, arthritis – all are higher in the North of England or the Midlands than in the South.
We’ve long known that underlying health conditions are a risk factor for this virus. These inequalities lie behind the fact that many more people die from Covid in the top half of our country than in the bottom half, which means in turn that people in the North have also had to put up with more lockdown restrictions – often without sufficient support.
Compounded by Public Health Cuts
Large and ingrained health inequality is bad enough. What’s worse is that inequality has been exacerbated by political choices made by this government – namely, austerity. The Tories have overseen seven years of brutal raids on local public health budgets as part of a wider assault on local government funds.
This week, new IPPR research revealed the extent of the damage. £750 million has been taken from local public health services since 2014. That’s money out of the services specifically designed to help people avoid developing underlying health conditions. It’s through local public health budgets we fund vital services for drug addiction, alcoholism, stop smoking support, sexual health, physical activity, and care for young children.
And that money has not been taken equally. It’s been drawn disproportionately out of the North and the Midlands.
No-one has escaped cuts – the average public health cut in England is £13.20 per person – but some have been hit much harder than others. In the North West, cuts have been £15.10 per person. In the Midlands, they have been £16.65 per person. And in the North East they have been over £23 per person.
Dive even deeper and we see some true horror. Take Gateshead, a relatively deprived local authority in the North East. There, the cuts have been £34 per person – including £3.3 million cut from drug and alcohol services alone.
Thirty miles away, in Middlesbrough, the country’s fifth most deprived local authority, cuts are over £41 per person – with half a million taken out of tobacco control alone. People there have access to the NHS, but public health cuts have stripped back their health security and put them at needless risk.
Inevitably, this affects our ability to face a pandemic: public health is about preventing health risk. So while it is shocking, it’s perhaps not surprising that areas with the most Covid deaths have lost 3.5 times more from their public health budgets.
We were told by the architects of austerity that we could only have good health if we showed prudence during a fiscal crisis; in reality, public health austerity has stolen resilience from the places that needed it most. Now, the pandemic is making the folly of the last decade clear.
A Vicious Cycle
The government is intent on pretending the economic crisis will be homogenous – the same across the country, and amenable through a one-size-fits all response. This is not realistic. Health inequality will mean highly localised economic strife.
Health and prosperity are intricately tied together. When health is bad, it is hard to have strong, inclusive growth. Bluntly, if you want people to be in work, they need to be alive – and if you want those jobs to be full-time or productive, you need to protect their health.
And when the economy isn’t working, it is hard to have good health. Our health is intricately tied to the places we live. When we can’t afford good housing, when poverty pay is rife, pollution high, leisure time limited, or work insecure – that’s when we get sick.
This is bad news for the places that had the worst Covid-19 outcomes. The disproportionate health impact from the virus will widen existing economic inequality, which in turn, will suppress health in the long-term – with its own economic consequences. It’s the epitome of a vicious cycle, and one that could turn ad infinitum.
Such inequality is not inevitable: it just needs to be met with bold and affirmative action. This will be the truest test of the government’s so-called ‘levelling-up’ agenda.
But early signs are less than promising. The government’s sparring match with the Mayor of Manchester showed that affirmative action for the North would have to be hard won. The ‘Levelling-up fund’ from the Comprehensive Spending Review is a farce insofar as it’s competitive funding – a policy design that has been discredited for the simple reason that it enables cronyism.
It’s becoming clearer that the idea of ‘levelling-up’ – while it sounds nice – is not backed by anything that can pass for strategy. There’s no real plan to spread opportunity outside London and the South East corner. It’s vital this government rectify that. At the heart of a real strategy would be better public health.
Public health is about giving everyone the right to fair chance in life. That isn’t possible when premature mortality, chronic diagnoses and mental ill-health strike so unevenly. And it’s about giving people security – so they are not left unfairly vulnerable to a shock diagnosis or a shock pandemic.
It’s time to stop the cuts, reverse the damage done through public health austerity, and prioritise the health and security of everyone in our country.