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25 March 2020

England: rise in poor-quality work a key factor in the deterioration of public health

“England is faltering,” declares the opening lines of the Marmot Review of Health Equity in England, published in February 2020 and coordinated by esteemed epidemiologist Sir Michael Marmot, Director of the Institute of Health Equity. The life expectancy rate, which, alongside continuous improvements in health, had been rising steadily since the beginning of the twentieth century, has been slowing down since 2011 to an extent not witnessed for 120 years: a phenomenon not seen anywhere else in Europe. In the most deprived communities outside London it actually fell for part of the decade 2010-2020.

This is just one of the damning conclusions of the independent review, which reveals widening health inequalities in the country and a general deterioration in both physical and mental health. Since Marmot’s original 2010 report on health inequalities, commissioned by the then Secretary of State for Health, a decade of austerity policies has passed, implemented by successive Conservative-led governments. While the link between austerity and health inequalities cannot be proved, such policies undeniably impact on what Marmot calls the “social determinants of health”. The review points out that past decreases in life expectancy in other countries were a “result of catastrophic or severe political, social or economic disruptions”, such as the breakup of the Soviet Union.

Another disturbing finding is that the UK currently has one of the highest rates of child poverty of all the OECD countries. The rate is higher, for example, than in such EU countries as Italy, Portugal, Slovakia, Latvia, Poland, Czechia and Hungary. This is, amongst other things, a serious public health concern according to the review, as child poverty is more likely to lead to “adverse childhood experiences” such as abuse and neglect, and consequently poorer health.

Regarding public health, there are clear inequalities between genders, regions and communities. Healthy life expectancy has declined for women since 2010, and particularly in the more deprived areas of the country. These poorer communities, which have also suffered the most from years of austerity which led to severe cuts in local authority funding, are generally to be found in the North of England. The largest decreases in the life expectancy rate, for example, were seen in the most deprived 10 per cent of neighbourhoods in the North East, while the rate has actually increased in the least deprived 10 per cent of neighbourhoods in every region.

One of the most significant factors contributing to deteriorating health outlined by the review is the rise in poor-quality work. While employment rates have increased since 2010, an increasing proportion of the population are working part-time, in insecure jobs and/or on zero-hour contracts. There has been a correspondent increase in work-related stress, depression and anxiety. Furthermore, rates of in-work poverty have increased. The UK experienced negative growth in average annual real wage changes between 2007 and 2018 – alone amongst other European OECD members, with the exception of Italy, Portugal and Greece. Marmot warns that “It is not enough for the government simply to declare that austerity is over.” Spending must be increased on education and youth services, the national living wage increased, and investments made into creating healthy and sustainable communities.


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