Between 1945, when the second world war ended, and the start of the 2010s, average life expectancy and mortality rates in high-income countries improved continuously. But from around 2012, in the UK and in several other countries like the US, Germany and the Netherlands, the rate of improvement slowed, stopped, or even went into reverse.
The trends for people living in more disadvantaged areas were even worse, with mortality rates (the number of deaths per 100,000 people in a population) actually increasing for those living in the poorest 20% of areas in the UK. Our new book, Social Murder? Austerity and Life Expectancy in the UK, shows how austerity policies have been the most important cause of this change in trends, leading to hundreds of thousands of avoidable deaths in the UK alone.
Austerity can mean different things. Economists tend to define it as the introduction of policies to reduce the size of government deficits. That is, the gap between what governments spend and the amount of tax revenue they raise.
More broadly, austerity is a policy approach associated with public sector restructuring (including privatisation) and increased labour market flexibility (the degree to which workers’ employment rights and security of work have been eroded), as well as reduced spending or increased taxes.
In the UK, the 2010 Conservative-Liberal Democrat coalition government introduced a large austerity programme. This reduced real-term spending on a range of public services. Some of the largest cuts fell on local government and social security benefits for working-age people. These cuts disproportionately affected poorer areas and people already on low incomes.
Over the following 14 years, the cuts intensified. They left public services and the social fabric of the UK in tatters. Unsurprisingly, the consequences for health have also been catastrophic.
Many studies have been undertaken to evaluate the impact of austerity policies on health and mortality in the UK. They show that cuts to local government funding overall, as well as to particular services including housing, culture, environmental and planning services, all had detrimental impacts. Cuts to the real value of social security benefits and greater conditions on people receiving benefits, were shown to have damaged mental health.
Internationally, countries that introduced austerity policies were found to have worse mortality trends. A systematic review that brought together the evidence from all those studies confirmed this link.
Yet despite this plethora of evidence, many UK public health agencies and thinktanks have ignored or downplayed the role of austerity in these catastrophically changed trends. This has been hugely damaging.
Austerity policies were identified as detrimental to health from the aftermath of the 2007/8 financial crisis onwards. But government body Public Health England, independent charity the Health Foundation and independent thinktank the King’s Fund all suggested that there was not enough evidence to identify austerity as a cause of the changed trends in the UK.
This sowed confusion about the role of austerity for a prolonged period of time, and allowed government ministers to repeatedly hide behind these organisations’ reports.
Although austerity is the most important cause, other factors have also impacted on the mortality trends. In the UK, the rise in obesity up to 2010 is likely to have had a harmful effect. Subsequently, the COVID pandemic (including the disruption to the economy, social networks, education and healthcare), and then declining real incomes due to high inflation, are both likely to have caused substantial additional deaths. However, austerity has been the principal driver.
The public health impact of austerity-style economic policies have long been understood. Given this knowledge, what justification can there be for adopting these policies in 21st-century Britain, and in other wealthy countries around the world?
Political theorist Friedrich Engels stated that “when society places hundreds … in such a position that they inevitably meet too early and an unnatural death” it amounts to “social murder”. As public health researchers, we argue that social murder may be an apt description of the policies introduced after 2010 in the UK, and elsewhere.
If mortality rates are to be improved, it is essential that the Labour government in the UK, and other governments around the world, understand the evidence, quickly reverse the erosion of public services and social security systems and protect those at greatest risk.
Gerry McCartney receives funding from Economic and Social Research Council (ESRC) and the University of Glasgow, and has previously received funding from the National Institute for Health Research (NIHR), the World Health Organisation (WHO) and British Academy/Leverhulme Trust.
David Walsh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
