UK austerity policy is shortening the lives of Scots, public health experts are warning – and unless urgent action is taken to close the gap between the rich and the poor, deaths will continue to rise.
New data on deaths show that for the first time since the Second World War, the life expectancy of people living in Scotland has begun to fall. Westminster cutbacks to public benefits and services are to blame, according to a Scottish Government adviser and a leading academic.
For six decades life expectancy has been improving, with women in Scotland living to 80 and men to 75 in 2010. But since 2012, the increase has plateaued.
Now there is evidence that life expectancy started declining over the past three years, and Scots are dying earlier than before.
“This is obviously a matter of huge concern because life expectancy is a marker of the overall health of a society,” said Dr Gerry McCartney, public health consultant at NHS Health Scotland.
“So when life expectancy is not improving that tells us something is going wrong more generally in society. This is a big problem.”
Scotland is not alone in experiencing a downward trend in life expectancy. England, Wales, Northern Ireland, the Netherlands and USA have seen similar patterns.
“However countries across Europe are doing much better, such as France, and countries like Japan and Korea that were already doing well are continuing to improve quite rapidly,” said McCartney, who leads the Scottish Public Health Observatory team that monitors health trends.
“That means there’s nothing inevitable about these trends because if the countries with the highest life expectancy are continuing to improve, then we should be able to improve as well.”
Instead, the data shows that across all ages, causes of death and socioeconomic groups, lifespans in Scotland are shortening. Scotland has the lowest life expectancy in the UK, with women living two years less than in England, and men 2.5 years less.
The steepest rises in deaths affect people living in the most deprived communities. “Inequalities in health are rapidly rising, so all of the causes that are getting worse are getting worse most quickly in the poorest parts of Scotland,” said McCartney.
There are variations in the rate of decline between the UK countries, with Northern Ireland faring worst overall. However Scotland’s drug-related death rate – part of the overall picture – is nearly three times worse than that of England.
“There are different factors at different age groups, but almost all causes of death and almost all age groups are getting worse,” added McCartney. “This this makes it more like that the reason is something that affects lots of things, rather than a more specific cause.”
Links to academic papers revealing the scale of the problem were contained in an online annex to the Chief Medical Officer for Scotland’s latest annual report in April. But they were not publicised and have so far have gone unnoticed.
Deaths from dementia among older people have risen, even accounting for the ageing of the population. In late middle age, deaths from cardiovascular disease and strokes are now improving much more slowly than they did up to 2012.
For the generation that grew up during the 1980s, drug-related deaths are at record levels.
Theories about the causes of the mortality decline have been hotly debated in public health circles. Contributing factors suggested include the impact of influenza outbreaks, loneliness and isolation, and over-stretched care services.
To try and identify the primary cause, in November 2018 NHS Health Scotland convened a series of workshops to investigate all theories. “There have been a couple of influenza outbreaks, but they don’t explain deaths from non-respiratory causes, and these are growing across-the-board,” said McCartney.
“Mortality rates have consistently changed, not just in outbreak years, and we see it across all age groups. Although ‘flu may be playing some sort of role, I don’t think it’s the underlying cause.”
Lifestyle-related causes of death, including obesity, alcohol, smoking and poor diet, and the effects of budget cuts on local authority and health services, have all been considered. They are regarded as secondary causes of what experts think is the fundamental problem: austerity.
“What we’ve seen since around 2010 is that the social security system has been changed quite radically, which has meant that benefits have not increased in line with inflation, so the real terms value to buy food and housing for the poorest has been put under real pressure,” said McCartney.
“People have to jump through more hoops to get their benefits now, there’s been caps and conditions put in place. We know that only about half the people who are unemployed currently claim jobseekers’ allowance, and people have been put off claiming the benefits they are due.”
Austerity has had a negative impact on health because that’s meant the money in people’s pockets and the public services they rely upon have all been reduced. Dr Gerry McCartney
McCartney made a distinction between recession and austerity. In a recession deaths from road traffic accidents typically fall because people drive less, and there are fewer alcohol-related fatalities because people can’t afford to drink as much, balancing out death rates.
He said: “Unlike previous recessions, this time the unemployment rate hasn’t gone up much. People have largely maintained work, although the quality of that work is different.
“We’ve seen people working shorter hours, and in more precarious forms of employment, so the overall recessionary effect of health has been much more muted.”
McCartney pointed out that the UK government’s response to recession has been to cut spending on public services in the name of austerity. “That has had a negative impact on health because that’s meant the money in people’s pockets and the public services they rely upon have all been reduced,” he said.
Professor Danny Dorling, a specialist on international inequality and mortality rates at the University of Oxford, believes austerity is killing people. “I’ve never seen anything quite as clear as this,” he said.
“We’ve looked at every other possibility and ruled them out and we are left with the smoking gun of year-after-year of repeated cuts, happening just a few years before we see people’s mortality increase.”
Japan, a country with the world’s lowest levels of social inequality also has the longest lifespans. “What we’ve found over the last 10-20 years is that those affluent countries which have much smaller differences between the lives of the rich and poor have moved ahead in how long they live and how healthy they are,” said Dorling.
“In contrast the UK is the most unequal country in Europe, and the USA has a huge gap between rich and poor and some of the worst health in the rich world.”
Dorling credited Scotland with the introduction of policies to limit smoking, increasing the cost of drinking alcohol, improving child health, and mitigating benefits cuts. But the responsibility for austerity rests at Westminster, where welfare policy is reserved.
Some academics and policy makers have doubted a causal link between austerity and ill health. But Dorling insisted that we now knew enough to act.
“The most famous hunch in medicine was the hunch that smoking cigarettes might kill you, and it took a long time to prove that,” he said.
“We do know that Britain has seen some of the biggest cuts in Europe to vital services, and that it is the only country in Europe that has seen life expectancy fall in 2015, 2016, and possibly 2017 too – at the same time as we make cuts to services.”
We remain focused on addressing the underlying causes that drive health inequalities. Spokesperson, Scottish Government
The Scottish Government highlighted positive trends. “Over the long term, life expectancy in Scotland has increased, and premature mortality rates in the most deprived areas are down 13 per cent since 2007,” said a spokesperson.
“Overall, premature mortality rates are down 18 per cent. We remain focused on addressing the underlying causes that drive health inequalities, which has income inequality at its heart.”
The government spokesperson added: “Our bold package of measures to help tackle key issues such as smoking, obesity, inactivity, and alcohol misuse will support people to live longer healthier lives.
“We are also tackling the wider causes of health inequalities through measures such as investing in affordable housing, providing free school meals and continuing commitments like free prescriptions and free personal care.
“In 2018-19 we invested over £125 million to mitigate the worst impacts of welfare reforms and to protect those on low incomes, over £20 million more than the previous year. We are also introducing the Scottish Child Payment to help tackle child poverty by providing eligible families with £10 a week for every child under 16.
When asked what was meant by life expectancy increasing “over the long term”, the government pointed out that mortality rates had improved since the Second World War. “Although the rate of improvement slowed between 2010 to 2016,” said the spokesperson.
The UK government has not responded to requests to comment.