Health inequalities worst since the Great Depression – with the cuts still to come
Inequalities in premature death are as high as they have ever been in this country, and this is before the cuts. The Lib-Con coalition thinks that deep, swingeing spending cuts are the only way to get this country out of its economic hole, but is there any justification for that view? Or is there another agenda at work?
Research published this week in the British Medical Journal looking at health inequalities between the richest and poorest areas of the country found that “inequalities in premature mortality between areas of Britain continued to rise steadily during the first decade of the 21st century. The last time in the long economic record that inequalities were almost as high was in the lead up to the economic crash of 1929 and the economic depression of the 1930s… geographical inequalities in mortality are higher in the most recent decade than in any similar time period for which records are available since at least 1921. By 2007, for every 100 people under 65 dying in the best-off areas, 199 were dying in the poorest” (link).
The research also found that “Recent government interventions have aimed to reduce these inequalities, but, the evidence suggests, to little effect”. This is amply borne out by a report from the National Audit Office earlier this month, looking at the success (or otherwise) at the Department of Health’s efforts to reduce health inequalities in England (link).
By way of contextualisation, the report begins by stating that “In the early 2000s, in England, people living in the poorest neighbourhoods, could on average expect to die seven years earlier than people living in the richest neighbourhoods and spend far more of their lives with ill health.” Addressing health inequalities was something that New Labour made a priority, at least rhetorically. Their target was to reduce inequalities in life expectancy between the poorest areas and the national average by 10% by 2010.
The outcome of their efforts has been that “life expectancy in spearhead areas has not improved as fast as the whole population and the gap in life expectancy between the two has widened since the baseline by 7 per cent for males and 14 per cent for females. Life expectancy for the whole population now stands at 77.9 years for males and 82.0 years for females”, with the result that inequalities in life expectancy “can still be 10 years or more depending on socio-economic background… In Blackpool, for example, men live for an average of 73.6 years, which is 10.7 fewer than men in Kensington and Chelsea in central London, who reach 84.3 years. Similarly, women in the Lancashire town typically die at 78.8 years – 10.1 years earlier than those in the London borough, who reach an average 89.9 (link).”
One does not need to look too far to find the cause of Labour’s failure. By now there is a good deal of research literature on the ‘social gradient’ of health: that “health inequalities result from social inequalities… the lower a person’s social position, the worse his or her health” (link; see also http://www.iwca.info/?p=10011). As the socioeconomic gradient steepens, so the social gradient of health steepens, something that Labour allowed to happen on their watch (link).
This brings us to the present day pass where Dr Sam Everington –a former deputy chair of the British Medical Association, and now a GP in Tower Hamlets- can state of his patch that “We estimate probably a half of our children are malnourished; vitamin D-deficient, iron-deficient. We have a massive problem right next to the City of London. It’s very similar to what you would find in developing countries in big parts of our communities” (link). That ‘Third World’ conditions should be emerging in London, cheek by jowl with tremendous wealth, simply shouldn’t be possible, but it is happening, demonstrating that “Inner London is by far the most unequal of all regions in England” (link).
Recent research has shown, that the Cockney accent –the accent of working class London- is being forced out of the capital, to surrounding areas like Hertfordshire and Essex (link). This gets called ‘white-flight’, but it’s not solely white-flight anymore, and has far more to do with affordability and economic opportunity than race. With the decline of industry, the rise of finance and its offshoots, and the decline of social housing, the working class is being priced out of the nation’s capital, with the city becoming increasingly the domain of the wealthy and welfare dependent. And this latter group will come under increasing pressure once the cuts in housing benefit kick in.
“Slashing spending in the midst of a depression, which deepens that depression and paves the way for deflation, is actually self-defeating”
Will the cuts do anything to reverse the appearance of child malnutrition in London? The Lib-Con coalition and its supporters argue that the cuts are for the patients’ benefit, that the long-term effect will be to purge the economy of waste and inefficiency, restore market discipline, drive down the cost of government borrowing on the international bond markets, lowering long-term interest rates and allowing the private sector to power us back to prosperity.
That’s the justification that is being given, but is there any truth to it? The medicine certainly doesn’t appear to be working in Ireland. Ireland has been undergoing deep spending cuts for almost two years now, yet this week saw the Irish government’s credit rating downgraded by the ratings agency Moodys. The reason given was “the Irish government’s gradual but significant loss of financial strength, as reflected by its deteriorating debt affordability”. As the Financial Times explains, “The country has suffered a dramatic contraction in GDP since 2008, causing a sharp decline in tax revenue. The general government debt-to-GDP ratio rose from 25 per cent before the crisis to 64 per cent by the end of 2009, and is continuing to grow” (link).
The austerity which has helped devastate the Irish economy has not appeared to improve their fiscalposition one bit: the proportion of government debt in the economy has risen, and the Irish government is still paying 5.5% to borrow on the international bond market, compared to around 2.5% for Germany. We see no evidence of Ireland reaping any rewards, from the bond market or anywhere else, for its masochism. As the Nobel Prize-winning economist Paul Krugman has said: “It’s almost as if the financial markets understand what policy makers seemingly don’t: that while long-term fiscal responsibility is important, slashing spending in the midst of a depression, which deepens that depression and paves the way for deflation, is actually self-defeating”(link).
Why, then, are the Lib-Cons so gung-ho about making cuts so soon and so deep? As Will Hutton has said of what’s in store for us, “No country has ever volunteered such austerity” (link). Certainly, no such measures are being planned in the US. What we are seeing in Britain is a rerun of 1929, when the Treasury argued that domestic fiscal deflation is an appropriate method of pulling a country out of recession. In the words of Robert Skidelsky, “The implicit premise of the coming retrenchment is that market economies are always at, or rapidly return to, full employment. It follows that a stimulus, whether fiscal or monetary, cannot improve on the existing situation. All that increased government spending does is to withdraw money from the private sector; all that printing money does is to cause inflation” (link).
Such market fundamentalist thinking is, almost unbelieveably, back in the ascendant after the financial crash. So weak is the left that, in the wake of the worst crisis of capitalism since the 1930s, neo-liberal ideology is coming back even stronger. There is currently a robust debate taking place among economists and academics on how fiscal deficits should be tackled (link), but the Lib-Cons are apparently as unaware of this debate as they are of what’s happening in Ireland.
What is happening is the triumph of ideology over pragmatism, in the name of shrinking and remodeling the state along neo-liberal lines. New Labour were hampered in this quest by their dependence on the public sector unions for finance, votes and their activist base. The Lib-Cons have no such obstacle. In 1929 there may have been the excuse of inexperience. Now, only the most blinkered ideologue can unquestioningly laud the benefits of cutting spending in a recession, and blinkered ideologues it is who are in the Treasury. In 1929 it led to tragedy. In 2010 it will do so again.