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Health inequalities led to one million early deaths in England in 2010s, as Europe fared better

Health inequalities saw more than one million people living in 90% of areas in England living shorter lives than they should have between 2011 and the start of the Covid-19 pandemic – equivalent to the whole population of Birmingham, or that of Edinburgh and Glasgow combined, new research has found.

According to research led by University College London’s Institute of Health Equity (IHE), the period from 2011 to 2019 saw more than a million people dying earlier than they otherwise would have done had they experienced the death rates seen in the least deprived decile of areas.

Of these excess deaths, 148,000 were additional to what might have been expected based on levels in the two years prior to 2011, the report – titled ’Health Inequalities, Lives Cut Short’ – said.

And in 2020, the level of excess deaths rose by an additional 28,000 compared to those over the previous five years.

To contextualise the UK’s downwards health trend, the IHE analysed European Union data and compared healthy life years (HLY) – the number of years a person is expected to continue to live in a healthy condition, and also called disability-free life expectancy – in the UK to other European Union countries.

In 2014, both males and females in the UK had a higher average number of healthy years lived (HYL) than those in the EU. However, by 2017, HLY in the UK had stagnated for men, and fallen for women.

In the same period, HLY increased by more than two years in the EU. Consequently, 10 EU countries had higher HLY than the UK for males, and 14 had higher HLY than the UK for females.

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UCL IHE Director, Professor Sir Michael Marmot, said: ’If you needed a case study example of what not to do to reduce health inequalities, the UK provides it. The only other developed country doing worse is the USA, where life expectancy is falling.

’Our country has become poor and unhealthy, where a few rich, healthy people live. People care about their health, but it is deteriorating, with their lives shortening, through no fault of their own. Political leaders can choose to prioritise everyone’s health, or not. Currently they are not.’

Referring to this ’dismal state of affairs’, he is calling on political party leaders and MPs to prioritise health equity and wellbeing.

’Important as is the NHS – publicly funded and free at the point of use – action is needed on the social determinants of health: the conditions in which people are born, grow, live, work and age. These social conditions are the main cases of health inequalities,’ he said.

Ahead of the general election, the IHE is also proposing the appointment of an independent health equity commissioner and the establishment of a new cabinet-level health equity and wellbeing cross-departmental committee.

In 2020, Sir Michael’s ’Build Back Fairer: The Covid-19 Marmot Review’ document highlighted how pre-pandemic social and economic conditions contributed to the unequal Covid-19 death toll.

The UK cabinet office cited the report as ‘the most comprehensive early assessment of how Covid-19 exacerbated existing health inequalities’ when he was named in the 2023 King’s New Year Honours.

Last January, Sir Michael criticised the UK Government’s short-term policies being announced and rolled out, stating that they damage the service overall, and warning health leaders to be ‘aware of short-term fixes that might undermine a longer term agenda’ for the service.

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