It did what people said it would do. “Austerity blamed for life expectancy stalling for first time in century” the Guardianheadline rang out in response to Sir Michael Marmot's review of his 2010 report into health inequalities.
No anti-austerity campaigner was surprised to find the ten-year slashing of public spending had taken its human toll, but it was useful to have it set out so clearly.
Marmot's report sets out the evidence that socioeconomic status is closely linked to life expectancy, health and disability. It found that health inequalities have widened since 2010, with life expectancy for the poorest women actually going into reverse, particularly in Northern England. Early mortality is rising among certain age groups.
In housing, in employment, in neighbourhoods, public policy is making people stressed, depressed, malnourished and ill. It represents a total failure of politicians—to listen, to learn, or to have any concern at all.
“This damage to the nation’s health need not have happened,” said Marmot. “Austerity has taken a significant toll on equity and health, and it is likely to continue to do so.”
The report also puts into perspective the row over whether 120,000 people have or have not died because of austerity. This debate now looks woefully irrelevant—a distraction from the fundamental point that people have died as a result of austerity, and that those deaths were both predictable and predicted.
“If the Tories had actually killed 120,000 people do these guys really think lots of us would still support them?” asked the right-wing columnist Ed West earlier this month. Well, no. Instead, right-wing politicos and propagandists will engage in denial, deflection and distraction. 'Can you prove that number's right?' 'Have you established causation beyond all possible doubt?' 'Didn't that researcher once tweet a left-wing opinion some time in 2013?'
No, you cannot establish causation beyond all possible doubt. This isn't war: to precisely calculate austerity's death toll would require investigation of the cause of death of every mortality in Britain, and then following the chain of causation back each time. It is an impossible task.
But we know that austerity has certain consequences and that poor health is among them. It is not simply the funding squeeze in the NHS itself—which Marmot does not focus on. It is the hardship created by benefit cuts, the stress of homelessness, and the long-term effect of child poverty on life chances.
That long-term impact is key. Coverage of the new Marmot report focused on the effect of austerity so far, and the yawning regional divides in its impact. But a constant thread running through the report is how this impact will last long into the future.
Rising levels of child poverty, for instance, “will continue to have long-term negative impacts on the lives of affected children and their families and communities.” The 47 percent of children in lone parent families who are in poverty “are particularly at risk of low outcomes and poor health, both in childhood and throughout life.” Poverty “has a cumulative negative effect on people’s health throughout their life.”
Benefit cuts have “pushed many families into deep and persistent poverty, which is transmitted to the next generation.” As the report puts it: “Insufficient income is associated with poor long-term physical and mental health and low life expectancy.” Cuts to housing benefit have been linked to rising mental health problems among those affected.
Meanwhile, food insecurity—which has exploded among low-income households—likely contributes to “inequalities in cancer, diabetes and coronary heart disease.” Children growing up in such households are likely to have worse health and educational outcomes.
And in the most blatant example of the impact of austerity, rough sleepers, who are thought to have trebled in number since 2010, die 30 years younger than the general population.
We do not yet know to what extent all this will affect life expectancy in the long run—but we can be certain that it will.
Austerity did not spring from nowhere. It was introduced by public demand and endorsed with a fresh electoral mandate in 2015.
Many voters took a dim view of benefit claimants; already reacted to single mothers—one of the main targets of austerity—with a reflex that they should keep their legs shut; were happy to assume that council spending was wasted on translation services for immigrants.
Much of this persists. While voters have swung behind higher spending on schools and the NHS, Lord Ashcroft's recent focus groups with 'Red Wall' voters who abandoned Labour for the Conservatives found they associated Jeremy Corbyn's party with benefit claimants—represented by “a lazy bloke on the sofa.”
Perhaps one area where views are shifting is regional inequality. Back in 2010, right-wingers saw poorer regions such as the North East as over-dependent on public sector jobs and government funding. Now, England's right-wing, Brexit-voting middle classes are delighted that their political preferences are anointed with the moral force of 'left behind' areas—while the Conservatives have an incentive to spend on the seats they have won for the first time in decades.
As a result, voters who dislike redistribution to poorer people appear, for the moment at least, to be more supportive of redistribution to poorer areas. Whether this takes the form of social spending, rather than just the infrastructure fixation of wonkish technocrats, remains to be seen.
But even if it does, the long-term legacy of the last ten years will be hard to reverse. The likelihood is that even decades from now, people will still be dying earlier than they otherwise would have, as lingering victims of austerity. It is slightly excessive to describe these deaths as political choices made by public demand. But only slightly.