For the first time in 100 years, Britons are dying earlier. The UK now has the worst health trends in western Europe – and doctors and experts believe that the impact of austerity is a major factor
In a few days, a team of researchers, statisticians and geographers will gather at University College London to tackle an issue of increasing concern for doctors and health experts. They will investigate why many UK citizens are now living shorter, less healthy lives compared with the recent past.
The emergence of faltering life expectancy in Britain has caused particular alarm because it reverses a trend that has continued, almost unbroken, for close to 100 years. Over this period, lives have lengthened continuously, blessing more and more British people with the gift of old age.
But now that increase has come to a halt, statisticians have discovered. Indeed, among many sections of the UK population, declines have set in. Hence the meeting, organised by the British Society for Population Studies, which has been organised so delegates can use data – to be released this week by the Office for National Statistics – to update their life expectancy projections.
“It is a perfect storm,” says Danny Dorling, professor of social geography at Oxford University, who has organised the London meeting. “Our faltering life expectancy rates show we have now got the worst trend in health anywhere in western Europe since the second world war. To achieve that, we must have made a lot of bad decisions,” he said.
Statisticians first noticed in 2013 that rises in life expectancy in the UK had begun to slow down. Gradually, the graph – which been rising for decades – flattened out until, a few years ago, it started to decline for increasing numbers of people. The elderly, the poor and the newborn were worst affected. For example, life expectancies for those over 65 have dropped by more than six months.
The trend now causes considerable concern among doctors who view life expectancy figures as barometers of the health of Britain. From this perspective, the nation is sickening – and a host of different factors have been put forward as explanations.
One frequently made claim is that humans have simply reached the peak of longevity. “Life expectancy cannot be expected to increase forever,” Robert Courts, a Tory MP, told the Commons recently.
Many statisticians point out, however, that life expectancy has continued to rise – well above UK levels – in many other places, including Hong Kong, mainland China, Japan and Scandinavia. Other factors must be involved, they state.
For its part, the Department of Health initially claimed that flu epidemics, triggered by harsh winters, were killing the weak and elderly, raising mortality rates and reducing life expectancies. But this idea is dismissed by Dr Lucinda Hiam, an honorary research fellow at the London School of Hygiene and Tropical Medicine.
“I was working as a GP during this time and didn’t notice a dramatic increase in flu among patients coming into my practice,” she said. In fact, it has been shown that five of the seven winters between 2011 and 2017 had above-average temperatures, making them unlikely triggers of flu epidemics.
Nevertheless, the Department of Health persisted with the idea for some time. “When my colleagues and I first questioned the strength of impact that flu was having in increasing deaths, and suggested the role of the cuts should be explored, we were dismissed by health officials,” Hiam said. “But since then the evidence of flu being solely responsible has largely evaporated.”
Instead, Dorling, Hiam and many other epidemiologists argue that life expectancy started to decline in Britain as a direct result of the austerity measures imposed by the Tory-led government in 2010. These cutbacks – which removed more than £30bn from welfare payments, housing subsidies and social services over the past eight years – were some of the most severe made by any nation after the 2008 financial crisis.
And once imposed, they triggered dramatic reductions in funding for social care, meals on wheels, rural bus services, NHS spending, numbers of health visitors and many other services. These in turn contributed to increased numbers of early deaths of vulnerable people, it is argued.
“Life expectancies started to stall just after the austerity cuts were introduced,” said Hiam. “That alone does not prove the latter was the trigger for the former. However, no other plausible suggestion has since survived scrutiny, so it is hard not to conclude austerity cuts are involved.”
In the case of care for the elderly, the link looks especially persuasive. “Funding for social care for the elderly had already been at breaking point for decades and recent austerity cuts only compounded the crisis,” says Tom Gentry, senior health and care policy manager for Age UK.
Previously the only individuals who had contact with many lonely, isolated old people were social and community care workers. Then came the cuts, which led to a dramatic reduction in this last line in defence of the elderly.
“Today, there is often no one who is talking to those elderly folk or spotting when they have stopped eating or noticed that are not moving around or are having balance problems. Then they fall over, lie there for days before being found and are then readmitted to hospital where they have to be given more serious interventions than would otherwise have been the case. Inevitably that will mean shortened lives.”
Earlier this year, the Institute and Faculty of Actuaries said it now expects men aged 65 to die at 86.9 years, down from its previous estimate of 87.4 years, while women who reach 65 are likely to die at 89.2 years, down from 89.7 years. In other words, the life expectancy of people entering pension age has been cut by six months.
This has implications not just for our health services but for our pensions industry. “The recent lowering of improvements in life expectancies has already had consequences,” said Cobus Daneel, of the actuarial body, the Continuous Mortality Investigation. “Insurance companies have been releasing money because it is realised they may not have to pay out as much to pay future pensions as previously expected. Of course, life expectancies still have room to get better in future”
Insurance companies have been releasing money because it is realised they may not have to pay out as much to pay future pensions.
Cobus Daneel, actuary
At the same time, the government has plans to put up the state pension age to 68 and has floated the idea of increasing it to 70. Now it may be forced to backtrack as increases in life expectances stall. “The increase to age 68 is only scheduled to come in between 2037 and 2039 and I would expect there will now have to be a further review before they are implemented,” added Daneel.
Last week the former health secretary, Jeremy Hunt, admitted that some cuts in social care funding imposed by the Conservative government “did go too far”. However, the Department of Health continues to reject any link between those cuts and drops in life expectancies. “We are taking action to help people live longer and healthier lives,” said a spokesman. “Cancer survival is at a record high, while smoking rates and teenage pregnancies are at an all-time low.”
Nevertheless, the connection between austerity and dwindling life expectancy is hard to shake off, says David Walsh, of the Glasgow Centre for Population Health. The city once had some of the worst life expectancy rates in the western world – for example in the central area of Calton, a place blighted by poor housing, illness, high smoking rates, and violence.
Inhabitants suffered high death rates linked to drug and alcohol abuse and suicides. As a result, at the beginning of the 21st century, the male life expectancy in Calton at birth was 54, one of the worst figures in the UK. Glasgow subsequently made major efforts to improve death rates in Calton but is now watching life expectancies slide back towards their old levels.
“I think it is pretty clear that austerity is to blame,” says Walsh. “We have taken away these people’s safety nets.”
The grim future facing these young adults was summed up by Sir Michael Marmot, professor of epidemiology at University College London. “If you were to go to a young man growing up in Calton who is doing drugs and alcohol and smoking and is unemployed and is unemployable and say to him: ‘Look, you really shouldn’t smoke.’ Well, you wouldn’t get far with him and, in any case, he might be quite rational for not making long-term plans because he does not have a long-term future.”
On top of the health impacts on the elderly and the deprived, there has also been a worrying change in infant mortality rates – as was acknowledged last week by the Office for National Statistics. It reported that in 2017, there were 3.9 deaths per 1,000 live births in the UK. In 2016, there were 3.8.
“Infant mortality had been reducing since the 1980s and reached an all-time low in 2014. But since then the rate has increased every year,” said Vasita Patel, a senior research officer at the ONS. “The one in 2017 is significantly higher than the one in 2014.”
To explain this alarming increase in infant mortality, Dorling blames a host of factors: “Fewer midwives, an overstrained ambulance service, general deterioration of hospitals, greater poverty among pregnant women and cuts that mean there are fewer health visitors for patients in need – all these factors are involved.”
The crucial point is that health statistics tells us something fundamental about how well a society is doing, says Marmot. “When you see significant differences in life expectancy rates, that is telling us something particularly important about how well society is distributing its benefits.” According to Marmot, a former president of the World Medical Association, a person with a university degree in Britain has a longer life expectancy than a school leaver with A-levels who in turn will do better than someone who did not sit A-levels. “The higher your income the longer you live,” he states. “Similarly, the higher the status of your occupation, the longer your life expectancy.”
Equally, the lower the step on the socio-economic ladder that a person stands on, the more dependent they are likely to be on help or support from local authorities. As a result, these individuals are disproportionately affected when cuts are made to services.
“Two years ago, I went out of my way not to blame austerity measures for faltering life expectancy rates,” said Marmot. “Now I am much closer to blaming them for the ills we are witnessing.”
While Marmot remains cautious, Dorling and Hiam are more certain of a causal link between austerity cuts and lowering life expectancy rates. However, all agree on one issue: that there is now an urgent need for a full-scale inquiry into the issue, a move that is also supported by Professor Martin McKee, of the London School of Hygiene and Tropical Medicine.
McKee said: “Health authorities cannot continue to dismiss the possibility of a link between cuts and lowered life expectancies. We need to find precise answers and we need them urgently. The only way to do that is to set up a proper public inquiry – as a matter of urgency.”
Of course, in coming years, mortality rates may halt their decline and begin to show renewed growth. But to rejoice at these would be a mistake, says Dorling.
“Life expectancy in the UK is a long way from what it should be for a country as rich as ours. The argument should not be about weeks of life lost or regained but how many years are being lost to life expectancies because we chose not to do what a normal European country would do and that is to invest properly in social care.”
The real fear is that Britain is falling into a pattern that has emerged in the US where taxes – and social care budgets – are low and where much of the healthcare system is privately run. In the US, life expectancy started falling significantly years ago. Causes of soaring mortality rates there include spiralling rates of drug overdose deaths and suicides. However, care of the elderly and the very young is also under stress in many states.
“I am worried that we are heading along the same route as the US,” says Marmot. “We shouldn’t be. We should be investing significantly in health and social care like the rest of Europe. Its social policies are better for health and long life than American social policies.”
(Source: The Guardian)
In a few days, a team of researchers, statisticians and geographers will gather at University College London to tackle an issue of increasing concern for doctors and health experts. They will investigate why many UK citizens are now living shorter, less healthy lives compared with the recent past.
The emergence of faltering life expectancy in Britain has caused particular alarm because it reverses a trend that has continued, almost unbroken, for close to 100 years. Over this period, lives have lengthened continuously, blessing more and more British people with the gift of old age.
But now that increase has come to a halt, statisticians have discovered. Indeed, among many sections of the UK population, declines have set in. Hence the meeting, organised by the British Society for Population Studies, which has been organised so delegates can use data – to be released this week by the Office for National Statistics – to update their life expectancy projections.
“It is a perfect storm,” says Danny Dorling, professor of social geography at Oxford University, who has organised the London meeting. “Our faltering life expectancy rates show we have now got the worst trend in health anywhere in western Europe since the second world war. To achieve that, we must have made a lot of bad decisions,” he said.
Statisticians first noticed in 2013 that rises in life expectancy in the UK had begun to slow down. Gradually, the graph – which been rising for decades – flattened out until, a few years ago, it started to decline for increasing numbers of people. The elderly, the poor and the newborn were worst affected. For example, life expectancies for those over 65 have dropped by more than six months.
The trend now causes considerable concern among doctors who view life expectancy figures as barometers of the health of Britain. From this perspective, the nation is sickening – and a host of different factors have been put forward as explanations.
 | |
| Crowds on London’s Oxford Street. Photograph: Fiona Hanson/PA |
One frequently made claim is that humans have simply reached the peak of longevity. “Life expectancy cannot be expected to increase forever,” Robert Courts, a Tory MP, told the Commons recently.
Many statisticians point out, however, that life expectancy has continued to rise – well above UK levels – in many other places, including Hong Kong, mainland China, Japan and Scandinavia. Other factors must be involved, they state.
For its part, the Department of Health initially claimed that flu epidemics, triggered by harsh winters, were killing the weak and elderly, raising mortality rates and reducing life expectancies. But this idea is dismissed by Dr Lucinda Hiam, an honorary research fellow at the London School of Hygiene and Tropical Medicine.
“I was working as a GP during this time and didn’t notice a dramatic increase in flu among patients coming into my practice,” she said. In fact, it has been shown that five of the seven winters between 2011 and 2017 had above-average temperatures, making them unlikely triggers of flu epidemics.
Nevertheless, the Department of Health persisted with the idea for some time. “When my colleagues and I first questioned the strength of impact that flu was having in increasing deaths, and suggested the role of the cuts should be explored, we were dismissed by health officials,” Hiam said. “But since then the evidence of flu being solely responsible has largely evaporated.”
Instead, Dorling, Hiam and many other epidemiologists argue that life expectancy started to decline in Britain as a direct result of the austerity measures imposed by the Tory-led government in 2010. These cutbacks – which removed more than £30bn from welfare payments, housing subsidies and social services over the past eight years – were some of the most severe made by any nation after the 2008 financial crisis.
 | |
| Professor Danny Dorling: ‘We have now got the worst trend in health anywhere in western Europe since World War Twothe second world war.’ Photograph: Murdo Macleod/The Guardian |
“Life expectancies started to stall just after the austerity cuts were introduced,” said Hiam. “That alone does not prove the latter was the trigger for the former. However, no other plausible suggestion has since survived scrutiny, so it is hard not to conclude austerity cuts are involved.”
In the case of care for the elderly, the link looks especially persuasive. “Funding for social care for the elderly had already been at breaking point for decades and recent austerity cuts only compounded the crisis,” says Tom Gentry, senior health and care policy manager for Age UK.
Previously the only individuals who had contact with many lonely, isolated old people were social and community care workers. Then came the cuts, which led to a dramatic reduction in this last line in defence of the elderly.
“Today, there is often no one who is talking to those elderly folk or spotting when they have stopped eating or noticed that are not moving around or are having balance problems. Then they fall over, lie there for days before being found and are then readmitted to hospital where they have to be given more serious interventions than would otherwise have been the case. Inevitably that will mean shortened lives.”
Earlier this year, the Institute and Faculty of Actuaries said it now expects men aged 65 to die at 86.9 years, down from its previous estimate of 87.4 years, while women who reach 65 are likely to die at 89.2 years, down from 89.7 years. In other words, the life expectancy of people entering pension age has been cut by six months.
This has implications not just for our health services but for our pensions industry. “The recent lowering of improvements in life expectancies has already had consequences,” said Cobus Daneel, of the actuarial body, the Continuous Mortality Investigation. “Insurance companies have been releasing money because it is realised they may not have to pay out as much to pay future pensions as previously expected. Of course, life expectancies still have room to get better in future”
Insurance companies have been releasing money because it is realised they may not have to pay out as much to pay future pensions.
Cobus Daneel, actuary
At the same time, the government has plans to put up the state pension age to 68 and has floated the idea of increasing it to 70. Now it may be forced to backtrack as increases in life expectances stall. “The increase to age 68 is only scheduled to come in between 2037 and 2039 and I would expect there will now have to be a further review before they are implemented,” added Daneel.
Last week the former health secretary, Jeremy Hunt, admitted that some cuts in social care funding imposed by the Conservative government “did go too far”. However, the Department of Health continues to reject any link between those cuts and drops in life expectancies. “We are taking action to help people live longer and healthier lives,” said a spokesman. “Cancer survival is at a record high, while smoking rates and teenage pregnancies are at an all-time low.”
Nevertheless, the connection between austerity and dwindling life expectancy is hard to shake off, says David Walsh, of the Glasgow Centre for Population Health. The city once had some of the worst life expectancy rates in the western world – for example in the central area of Calton, a place blighted by poor housing, illness, high smoking rates, and violence.
Inhabitants suffered high death rates linked to drug and alcohol abuse and suicides. As a result, at the beginning of the 21st century, the male life expectancy in Calton at birth was 54, one of the worst figures in the UK. Glasgow subsequently made major efforts to improve death rates in Calton but is now watching life expectancies slide back towards their old levels.
“I think it is pretty clear that austerity is to blame,” says Walsh. “We have taken away these people’s safety nets.”
The grim future facing these young adults was summed up by Sir Michael Marmot, professor of epidemiology at University College London. “If you were to go to a young man growing up in Calton who is doing drugs and alcohol and smoking and is unemployed and is unemployable and say to him: ‘Look, you really shouldn’t smoke.’ Well, you wouldn’t get far with him and, in any case, he might be quite rational for not making long-term plans because he does not have a long-term future.”
On top of the health impacts on the elderly and the deprived, there has also been a worrying change in infant mortality rates – as was acknowledged last week by the Office for National Statistics. It reported that in 2017, there were 3.9 deaths per 1,000 live births in the UK. In 2016, there were 3.8.
“Infant mortality had been reducing since the 1980s and reached an all-time low in 2014. But since then the rate has increased every year,” said Vasita Patel, a senior research officer at the ONS. “The one in 2017 is significantly higher than the one in 2014.”
To explain this alarming increase in infant mortality, Dorling blames a host of factors: “Fewer midwives, an overstrained ambulance service, general deterioration of hospitals, greater poverty among pregnant women and cuts that mean there are fewer health visitors for patients in need – all these factors are involved.”
The crucial point is that health statistics tells us something fundamental about how well a society is doing, says Marmot. “When you see significant differences in life expectancy rates, that is telling us something particularly important about how well society is distributing its benefits.” According to Marmot, a former president of the World Medical Association, a person with a university degree in Britain has a longer life expectancy than a school leaver with A-levels who in turn will do better than someone who did not sit A-levels. “The higher your income the longer you live,” he states. “Similarly, the higher the status of your occupation, the longer your life expectancy.”
Equally, the lower the step on the socio-economic ladder that a person stands on, the more dependent they are likely to be on help or support from local authorities. As a result, these individuals are disproportionately affected when cuts are made to services.
“Two years ago, I went out of my way not to blame austerity measures for faltering life expectancy rates,” said Marmot. “Now I am much closer to blaming them for the ills we are witnessing.”
 | |
| Professor Sir Michael Marmot: ‘Two years ago, I went out of my way not to blame austerity measures for faltering life expectancy rates. Now I am much closer to blaming them for the ills we are witnessing.’ Photograph: ABC Q&A |
McKee said: “Health authorities cannot continue to dismiss the possibility of a link between cuts and lowered life expectancies. We need to find precise answers and we need them urgently. The only way to do that is to set up a proper public inquiry – as a matter of urgency.”
Of course, in coming years, mortality rates may halt their decline and begin to show renewed growth. But to rejoice at these would be a mistake, says Dorling.
“Life expectancy in the UK is a long way from what it should be for a country as rich as ours. The argument should not be about weeks of life lost or regained but how many years are being lost to life expectancies because we chose not to do what a normal European country would do and that is to invest properly in social care.”
The real fear is that Britain is falling into a pattern that has emerged in the US where taxes – and social care budgets – are low and where much of the healthcare system is privately run. In the US, life expectancy started falling significantly years ago. Causes of soaring mortality rates there include spiralling rates of drug overdose deaths and suicides. However, care of the elderly and the very young is also under stress in many states.
“I am worried that we are heading along the same route as the US,” says Marmot. “We shouldn’t be. We should be investing significantly in health and social care like the rest of Europe. Its social policies are better for health and long life than American social policies.”
(Source: The Guardian)
No comments:
Post a Comment