The epidemic of poverty - killing before coronavirus
By Simon Korner
The Covid-19 epidemic has exposed the abject failure of capitalism to protect our lives. But in February, before the current virus took hold, a major report revealed that life expectancy in Britain – which had been rising steadily for 120 years – had begun to plateau. The report by Professor Sir Michael Marmot, who heads the Institute of Health Equity, is a sober, and sobering, analysis from a leading establishment academic. Not only life-span but quality of life was examined by Marmot, who documents a huge rise in ill health and disability: “While life expectancy is one important measure of health, how long a person can expect to live in good health is perhaps an even more significant measure of quality of life… For women, healthy life expectancy has declined since 2009–11 and for both men and women years spent in poor health have increased.”
The report points to class inequalities, as seen in stark regional disparities, with the poorest 10% of regions far harder hit than the wealthiest. In the most deprived areas, such as the north-east – and also among certain demographics, such as women of Bangladeshi and Pakistani origin – life expectancy actually fell between 2010-2012 and again between 2016-2018.
Typically, a boy born in the Royal Borough of Kensington and Chelsea might live 8.8 years longer than one born in Blackpool. Similarly, a man in Westminster can expect to live 7 more years than a man in Rochdale. A baby born in a poor area is almost twice as likely to die within the first year of life than one in a rich area. The highest life expectancy in the UK is in London and the south-east – though deprived London boroughs such as Tower Hamlets have some of the lowest levels of life expectancy in the country.
In terms of ill health, people born in Rochdale are likely to develop a disabling condition in their late 50s, according to the Centre for Ageing Better. A boy born in Blackpool today can only expect to reach age 52 without a long-term physical or mental health condition, and a girl can only expect reach age 53 without a chronic disabling condition. That’s nearly 20 fewer years of good health than those born in Richmond, London. “The poorer the area, the worse the health,” says Marmot. “There is a social gradient in the proportion of life spent in ill health, with those in poorer areas spending more of their shorter lives in ill health.”
Overall, the picture is dramatically unequal: if you’re poor your life will be shorter and less healthy than if you’re well off – by a large margin.
The Marmot report is an update of an earlier report, ‘Fair Society, Healthy Lives’, which was commissioned by the Tory-led Coalition government 10 years ago. The previous report recommended among other things “giving children the best start in life” and “fair employment and good work for all.” All of its vital recommendations were ignored. Since then, austerity has led to further massive rises in poverty, precarious employment, cuts in education, unaffordable rents and increased homelessness. Over the past decade, public spending was reduced from 42% to 35% of national income. This meant severe government cuts to local councils. In particular spending on public services was hit hard – down to 1948-49 levels, according to analysis by the Institute for Fiscal Studies (2014). Central government funding for housing was cut by 77%, leading to a massive rise in homelessness.
In 2010, Sure Start centres, which provided help for pre-school children and advice on child and family health, were shut down. The Coalition government also shifted responsibility for public health from the NHS to local councils, whose budgets had been decimated. Ring-fenced government funding for public health was held down in 2014-5, according to the King’s Fund, and local authority cuts in non-ringfenced areas, such as housing and parks and leisure services, damaged public health. Marmot comments: “The cuts over the period shown have been regressive and inequitable—they have been greatest in areas where need is highest… the cuts have harmed health and contributed to widening health inequalities… and are likely to continue to do so over the longer term.”
The “red wall” constituencies that voted Brexit are typically the poorest and least healthy, and receive the least government funding.
Marmot’s current recommendations echo those he made a decade ago, all of which still need enacting. These include raising the living wage; reducing casual employment; removing barriers to welfare payment; increasing spending on early years services; and restoring per-pupil secondary school funding.
Out of the major imperialist countries, only the US has worse life expectancy figures than Britain. Average American life expectancy has fallen since 2014, especially among poor white Americans, while the lowest life expectancy is still to be found among Native Americans and African Americans. Deaths of despair – suicide, drugs, drink – account for much of their rising mortality rate. In England, deaths of despair have likewise risen, particularly related to alcohol. “People who live in more deprived areas are up to six times more likely to die from alcohol related liver disease than those in wealthier places”, writes John Harris (Guardian, 9 March 2020). He adds that the UK has the “highest per-capita rate of drug fatalities in Europe.” Ian Lavery and Jon Trickett’s paper Northern Discomfort links the high unemployment rate in the north-east, Yorkshire and Humber to the high rate of male suicides.
Other rich countries have also seen falling improvements in life expectancy, though France and Germany’s rate of decline is slower – at roughly half the rate of the US and UK. For British women in particular, the 90% slowdown in rising life expectancy is the worst in the rich world.
The EU has contributed to the decline in rising life expectancy by insisting on steep cuts to healthcare and welfare in its member states, making a nonsense of the supposed benefits of the ‘social contract’. The European Commission has made 63 individual demands of member states to cut spending and privatise healthcare services between 2011 and 2018, according to Emma Clancy, Sinn Fein policy adviser in the European parliament.
Compare this situation to a socialist country like Cuba, which has suffered decades of US sanctions. In Cuba, life expectancy is 5 years longer than that of African Americans, though 70% of the Cuban population is of African origin. Its infant mortality is half that in most big US cities. Socialism has prioritised primary healthcare, focusing on prevention – with some of the highest vaccination rates in the world – and excellent medical education.
China’s life expectancy rose rapidly after its socialist revolution, “among the most rapid sustained increases in documented global history”, according to Cambridge academic journal Population Studies (2015). Average Russian life expectancy rose from age 33 in 1917 to age 43 in 1927, according to the World Atlas of the Child (World Bank, 1979). By 1975 it had risen to 70.
Coronavirus has exposed inequality in the starkest ways. The working class are most likely to catch the disease, being forced to work in unsafe conditions without protective clothing and without proper physical distancing. Research on an earlier flu outbreak in Connecticut, USA, found that the rate of infection nearly doubled in poor areas. And, if they escape the disease, workers are more likely to be hit by loss of income or healthcare as a result of quarantine.
Moreover, working class people are not only likelier to catch Covid-19 but to die from it. This is because healthcare is unaffordable to so many. In the US, 26% of people went without necessary healthcare because it was too expensive, according to a recent Gallup poll. 18% of the poll’s respondents said someone in their family had foregone prescribed medication for the same reason. Given that underlying ill health increases the chances of dying from Covid-19, and given that the poorest in society tend to develop chronic health conditions much earlier in life (5-15 years earlier, according to the Annual Review of Sociology, 2009), class is therefore a major risk factor along with age. While on average it is people over 70 who are at much greater risk of dying from the coronavirus, for the poor the figure may be as low as 55.
As Marmot says: “The question we should ask is not, can we afford better health for the population of England, but what kind of society do we want?... Put simply, if health has stopped improving, then society has stopped improving. The health of the population is not just a matter of how well the health service is funded and functions, important as that is, but also the conditions in which people are born, grow, live, work, and age, and inequities in power, money, and resources. Taken together, these are the social determinants of health.”
Dr Lucy Haim and Martin McKee (Guardian, 24 June 2019) underline Marmot’s point: "Life expectancy, mortality rates and infant mortality are the most important statistics a nation can produce about its health – and the UK’s are not only stalling but worsening, falling behind international trends.” And as the award-winning progressive journalist Jonathan Cook points out on his blog: “There is nothing unique about the coronavirus crisis. It is simply a heightened version of the less visible crisis we are now permanently mired in.”