Life expectancy has stalled for the first time in more than 100 years and even reversed for the most deprived women in society, according to a landmark review which shows the gap in health inequalities is yawning even wider than it did a decade ago, in large part due to the impact of cuts linked to the government’s austerity policies.

Sir Michael Marmot’s review, 10 years after he warned that growing inequalities in society would lead to worse health, reveals a shocking picture across England, which he says is no different to the rest of the UK and could have been prevented.

Guardian graphic.

The government has not taken the opportunity to improve people’s lives and life chances over the last 10 years, the report says. Real cuts to people’s incomes are damaging the nation’s health for the long term. Not only are lifespans stalling, but people are living for more years in poor health.

“This damage to the nation’s health need not have happened. It is shocking,” said Marmot, who is the director of the UCL Institute of Health Equity.

“The UK has been seen as a world leader in identifying and addressing health inequalities but something dramatic is happening. This report is concerned with England, but in Scotland, Wales and Northern Ireland the damage to health and wellbeing is similarly unprecedented.

“Austerity has taken a significant toll on equity and health, and it is likely to continue to do so. If you ask me if that is the reason for the worsening health picture, I’d say it is highly likely that is responsible for the life expectancy flat-lining, people’s health deteriorating and the widening of health inequalities.

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“Poverty has a grip on our nation’s health – it limits the options families have available to live a healthy life. Government health policies that focus on individual behaviours are not effective. Something has gone badly wrong.”

Guardian graphic.

The report shows that health has worsened in many of the “red wall” constituencies that backed Brexit and returned Boris Johnson’s government to power by voting Conservative for the first time. Voters in the new Tory-held seats can expect to live for 60.9 years in good health life, fewer than in both the long-held Tory seats (65 years) and the Labour seats (61.4 years).

Boris Johnson’s government has promised to “level up” those areas. To do that, says review, they will need to take immediate action to stop the deterioration in health.

Jennifer Dixon, the chief executive of the Health Foundation, which commissioned the review, said this 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. The evidence is clear and the solutions are there – what is needed is the will to act.”

Guardian graphic.

Marmot says the worsening of our health cannot be written off as the fault of individuals for living unhealthy lives. Their straitened circumstances and poor life chances are to blame. His institute’s work has established that healthy lives depend on early child development, education, employment and working conditions, an adequate income, and a healthy and sustainable community in which to live and work.

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Austerity has taken its toll over the last 10 years in all of these areas, says Marmot in a foreword to the report. “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 food banks in large numbers, to ignored communities with poor conditions and little reason for hope … Austerity will cast a long shadow over the lives of the children born and growing up under its effects.”

Guardian graphic.

He dismisses the argument made by government in the past that stalling life expectancy was about more severe winters or flu. It impacts the poorest more than the most affluent. It is also more marked in the UK than it is in most high-income countries, except for the US.

Life expectancy is also actually falling among the poorest 10% of women in Yorkshire and the Humber region, and in the north-east of England. There are no easy answers, says Marmot, but benefit cuts that push single mothers into poorly-paid, part-time jobs – in which they have to juggle families and work– may take their toll.

“If you go back 100 years, from the end of the 19th century, life expectancy just kept increasing by about one year every four years,” Marmot told the Guardian. The dramatic change in the curve began around 2010, he said. “It’s not due to a winter effect, because the slowdown was seven-eighths as big in the non-winter quarters.”

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Public funding cuts have had most impact on the most deprived communities outside of London and the south-east, and accentuated the north-south divide. Public sector spending on services went from 42% of GDP in 2009-10 to 35% in 2018-19. Some of the most deprived 20% of authorities, such as Liverpool, suffered the biggest funding cuts.

Sir Michael Marmot



Sir Michael Marmot says: ‘Austerity has taken a significant toll on equity and health and it is likely to continue to do so.’ Photograph: ABC Q&A

“You talk to local authority after local authority around the country, and they say, ‘We can’t do any more.’ We are closing youth centres, we’re closing Sure Start children’s centres and we are closing libraries, and parks and recreation centres. We can scarcely do what we have to do to fulfil our statutory duty,” said Marmot.

The report calls on the government to reduce child poverty to 10%, reduce “poor quality, low-paid and insecure” work, make sure the national living wage and benefits give people the minimum needed for a healthy life, and invest more in the most deprived areas.

The president of the Royal College of Physicians, Prof Andrew Goddard, said the review painted “a stark picture”, adding: “We agree with Sir Michael that there is a need for a national strategy to tackle health inequalities, as the solutions needed cut across many government departments including education, business and housing. This is a wake-up call for the government to act quickly and strategically to improve the health of people in deprived areas.”

Councillor Ian Hudspeth, the chairman of the Local Government Association’s community wellbeing board, also called the report a wake-up call: “Councils want to work with government on closing this gap by focusing on the social causes of ill-health, such as early years development, education and employment opportunities and improving services for older people. Sustainable, long-term investment in councils’ public health services is also needed.”

Guardian graphic.

Imran Hussain of Action for Children said the report “delivers a devastating judgment on a decade of crippling cuts to lifeline services like Sure Start and benefits for families fighting to keep their heads above water.

The government claimed it was working to reduce health inequalities. The health secretary, Matt Hancock, said: “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.

“There is still much more to do, and our bold prevention agenda, record £33.9bn a year investment in the NHS, and world-leading plans to improve children’s health will help ensure every person can lead a long and healthy life.”



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