From conference speeches to multimillion pound funds that have yet to materialise, we can’t stop hearing about ‘levelling up’. The Conservative government’s flagship policy announced as part of its 2019 manifesto promised to redistribute wealth and jobs away from the capital and combat the widening level of regional inequality that has become an inescapable part of the political discourse – despite no-one being entirely sure what it means in practice.
There has, predictably, been little real movement in this direction. Last week came the news that England’s richest are now expected to live a decade longer than the country’s poorest.
The analysis of ONS data by healthcare think tank The King’s Fund was an indictment of what it called ‘institutionalised’ inequalities in healthcare and wider society. Take Westminster and Blackpool, the two areas with the biggest divide. Wealthy Westminster saw male life expectancy rise from 77.3 to 84.7 years between 2001-03 and 2018-20 – a rise of 7.4 years. In Blackpool, which has the lowest prosperity rates and was found to be home to eight of the ten most deprived neighbourhoods in England, longevity only increased by 2.1 years from 72 to 74.1. That means the life expectancy gap between the two has risen from just over five years to 10.7 years in less than two decades. For women, the same gap had risen from 3.9 to 8.1 years.
While the data goes as far back as 2001, it’s worth noting that some of the most significant effects on life expectancy date to 2010, and the election of the current government. A huge array of studies from academics studying stalling life expectancy, rising mortality rates, and austerity have all pointed to the government’s decision to slash health services in real terms as the major cause of these regional inequalities that we’re now trying to ‘level up’.
Often the social impacts of poverty and deprivation can seem abstract, particularly because of scale: it’s hard to wrap your head around five-figure increases in deaths and rising averages. But behind each of those numbers is someone whose brain tumour wasn’t caught until it was terminal, and a family who now face living without their relative. When we talk about regional inequality and falling life expectancy, that is what we’re talking about.
The ‘social determinants of health’ are, in fact, everywhere. Premature death rates are much higher for those living in homes without proper heating or insulation during winter, while living in overcrowded housing increases the risk of cardiovascular diseases, respiratory diseases, depression, and anxiety. In the most deprived parts of the capital, the concentration of nitrogen dioxide, one of the main air pollutants that cut short 28–36,000 lives a year, is 24 percent higher in the most deprived areas than the least deprived. From access to green spaces, education, risk of road traffic accidents, the list goes on and on.
Even after diagnosis, despite the NHS thankfully being free at the point of use, your level of wealth can heavily impact your ability to receive and survive treatment. The most recent data from 2017 shows that 14.3 percent of people from the most deprived areas of England who attended A&E were not seen within the target, compared to 12.8 percent of people from the least deprived areas. After the government cut Universal Credit for millions—including for 60,000 cancer patients—experts have warned that countless more diagnosed patients will die as a result of the rising rates of poverty.
To those with money, that may seem surprising. But for the immunosuppressed cancer patient who faced playing ‘Russian roulette with their life’ because they were forced to take public transport during a pandemic, or to others who couldn’t pay for heating or new clothes for their terminally-ill partners, the effects of poverty on your ability to fight a disease is obvious.
This kind of inequality is heavily regional. In 2019, just under 140,000 deaths—nearly one quarter of all deaths—were considered avoidable either through timely, effective healthcare or wider public health policy. Within that, Blackpool had the highest preventable male mortality rate for the fifth year running, with 349.7 deaths per 100,000 males. Affluent, rural Hart in Hampshire only had additional 246.5 deaths per 100,000, making it the lowest in the country. By almost every metric, if you’re wealthier, or from wealthier parts of the country, you are healthier, too.
Those inequalities appear within regions as well. Take the Queen Elizabeth Hospital in King’s Lynn, which not only received an ‘Inadequate’ rating in its most recent CQC report, but is actually unable to afford to fix its roof. The roof is propped up by almost 200 supports to keep it from collapsing. The number of patients waiting over four hours in A&E at Queen Elizabeth Hospital well over doubled in the years after the Conservatives took power in 2010.
Meanwhile, nearby Norwich has hospitals that consistently rate far higher. Just over the county border in affluent Cambridge, Addenbrooke’s and Royal Papworth Hospitals are some of the highest rated in the country. Unsurprisingly, the child poverty rate in Cambridge is nearly half the 29 percent child poverty rate in King’s Lynn. Even in cities like London, hospitals can see dramatic shifts in quality between wealthier and poorer boroughs, since the government NHS trusts of the latter often have much higher costs and far less funding, limiting the treatments they can provide.
‘That’s a thing that horrified me when I was diagnosed – not all hospitals give the same treatment,’ one cancer patient I previously interviewed put it. ‘And then money becomes an issue when you’re weighing up your health… Is it about going to the better hospital or only having the money to go to a closer hospital?’
These problems aren’t some unsolvable fact of life: the very fact that inequalities have worsened after years of austerity is proof of that. But more needs to be done – at the current rate The Health Foundation found it could take several decades to close the gap. From offering a real long-term solution to the social care crisis and much higher NHS funding to solving the underlying poverty that causes these inequalities, the ideas and policies that could help solve this are out there.