Between skyrocketing energy bills, massive inflation, tax hikes, stagnant wages, and real-terms cuts to social security, the cost of living crisis is here, and it’s biting. People across the country are being stripped of their ability to afford the basics like food and a warm home—with the potential for drastic and longlasting consequences, including for health.
The pandemic brought a renewed focus to the social determinants of our health, emphasised by the disproportionate impact of Covid on working-class communities. Last year, research into regional inequality found that England’s richest are now expected to live a full decade longer than its poorest, a disparity that appears after ten years of brutal austerity by a government that cares more about profits than preserving life or its quality.
The rising cost of living means this situation is only set to get worse—which is why, to really understand the crisis and its consequences, we need to look at it through a public health lens.
Government estimates say 2019 saw 13.4% of households in England experience fuel poverty, defined as the inability to afford adequate home heating, or, specifically, the need to spend 10% or more of household income on heating the home to an acceptable standard. In the UK, fuel poverty is associated with living in private rented accommodation and unemployment. There’s a social gradient, with lower income households more likely to face fuel poverty than their wealthier counterparts. Single-parent households are at the highest risk, while those over sixty have the largest average fuel poverty gap—£289.
This already disastrous fuel poverty situation is being compounded by the inadequacy of Rishi Sunak’s response: a paltry £200 energy bills rebate, which is actually a loan to be repaid over five years. (Across the Channel, meanwhile, the French government has decided 80% state-owned energy supplier EDF will take the hit from the energy crisis, so household bills won’t rise by more than 4%.) The result is a growing number of people living in cold, damp homes—which, unsurprisingly, leads to a higher risk of poor health outcomes.
Fuel poverty is an exacerbating factor in the risk of several common conditions, including the flu. This is evidenced by the persistent phenomenon of excess winter deaths (EWDs), which the UK and other countries with relatively mild winters like Spain and Portugal actually suffer more of than countries with colder winters which have more fuel-efficient housing.
In England, there were an estimated 63,000 excess winter deaths in England and Wales in winter 2020 to 2021, 6.1 times more than winter 2019 to 2020. Further estimates suggest that some 10% of excess winter deaths are directly attributable to fuel poverty, with 21.5% attributable to the coldest 25% of homes.
A comprehensive review of fuel poverty conducted by Sir Michael Marmot and his team in collaboration with Friends of the Earth ten years ago divided its health consequences into sections like circulatory disease (responsible for about 40% of EWDs) and respiratory disease (about 33%). There’s a 19% rise in GP consultations for respiratory tract infection for each degree drop below five Celsius, and those with asthma are two to three times more likely to have been exposed to cold, damp conditions compared to non-asthmatics.
Children growing up in cold and damp living conditions are more likely than others to experience stunted physical growth and cognitive development, and have higher risk of respiratory problems, long-term ill-health, and disability. At the other end of the scale, older people are particularly vulnerable to cold conditions as they can cause high blood pressure, increasing the risk of strokes and other circulatory problems. Cold homes have been associated with lower strength and dexterity and exacerbated symptoms of arthritis, too.
In short, living in fuel poverty is at best uncomfortable, and at worst, life-threatening.
And fuel poverty isn’t the only problem compounded by the cost of living crisis. Last summer, we all followed the public mobilisation behind Marcus Rashford’s campaign against food poverty after the government chose to vote in favour of depriving children of free school meals. Despite being the fifth wealthiest country in the world, the UK currently has four million children experiencing food insecurity.
One of Britain’s biggest food bank networks, the Trussell Trust, reports that a record 2.5 million parcels were given to people in crisis last year alone—a 33% annual increase—with the number of people needing help to obtain food rising every year since 2015. 980,000 of those 2.5 million went to children. Food campaigner Jack Monroe has highlighted the steady hike taking place in food prices in recent years, which, as Carys Kettlety has noted, includes the fact that ‘supermarket ‘value’ ranges have disappeared, while the costs of basics have increased exponentially; where prices have stayed the same, product sizes have decreased, a phenomenon known as ‘shrinkflation’.’
Millions of families in the UK cannot afford to eat in line with the government’s own dietary guidance. According to the Food Foundation, 4.7 million UK adults—or 8.8% of households—experienced food insecurity in the last month, an increase from 7.3% in July 2021. One million reported that they or someone in their household had to go a whole day without eating because they could not afford or access food. This problem is being made worse by the global energy crisis, with supermarket bosses warning that ‘the worst is yet to come’ in terms of price hikes.
Like fuel poverty, food insecurity causes negative health outcomes. This is particularly the case for children. A report published this month by the Joseph Rowntree Foundation noted that ‘for children, severe food insecurity has been linked to chronic health conditions like asthma, behavioural problems and depression’. It’s also associated with birth defects, anaemia, growth stunting, and worse oral health.
It might sound like a neglible issue, but poor oral health has a serious impact on children living in food-insecure households. If permanent teeth are damaged in childhood, individuals spend the rest of their lives with dental damage and sometimes serious pain. This is a problem made worse by the fact that, as adults, they have to pay for their dental care, alongside which they will be facing a higher likelihood of developing chronic diseases like arthritis, asthma, diabetes, hypertension, insomnia, and even cancer.
The Government Doesn’t Care
None of this even begins to consider the mental health effects of living in a cold, unsafe home and going hungry, or worrying about your children going hungry. This type of stress, also known as poverty-related stress, is not just limited to economic causes and effects: it affects family relationships, too, contributing to and reproducing feelings of stigma, isolation, and exclusion for every member of a household. This stress, in turn, can help to keep people in poverty.
The reality is that many of the health problems endemic in British society today have been generated and compounded by the policies of a government that simply doesn’t consider the lives—let alone the quality of life—of the working class to be important. And they’re allowed to get away with it by an opposition unprepared to make the basic demands necessary to prevent the crisis in which we now find ourselves.
It is abundantly clear that that no politician is going to fight for us when it comes to this crisis—for our food and fuel, for our lives and livelihoods, for our health and wellbeing. Instead, it’s up to us to push for change.