Sunday, June 23, 2019

Falling Life Expectancy

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.

Statisticians first noticed in 2013 that rises in life expectancy in the UK had begun to slow down until, a few years ago, it started to decline for increasing numbers of people. The elderly, the poor and the newborn were worst affected. 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. 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.

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.”

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.” 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.” Dorling says, 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.”

Dr Lucinda Hiam, an honorary research fellow at the London School of Hygiene and Tropical Medicine 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.”

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.”

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 Martin McKee, of the London School of Hygiene and Tropical Medicine 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.”

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.”

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