Boris Johnson’s post-Covid “levelling up” agenda will fail unless it addresses declining life expectancy and deteriorating social conditions in England’s poorest areas, a leading authority on public health has warned, as he published figures showing the impact of the pandemic on Greater Manchester.
Sir Michael Marmot revealed the coronavirus death rate in Greater Manchester was 25% higher than the England average during the year to March, leading to “jaw-dropping” falls in life expectancy and widening social and health inequalities across the region over the past year.
The deteriorating health equalities picture in the region and across similarly deprived areas of the country was a result of longstanding, avoidable socioeconomic inequities and ethnic disadvantage, exacerbated by a decade of spending cuts and amplified by Covid and the effect of prolonged lockdowns, he said.
Marmot proposed a “moral and practical” plan for government investment in jobs, housing, local services and education to tackle longstanding health and social inequalities in Manchester and similar areas. “If government is serious about levelling up, here’s how to to it,” he said, introducing the report Build Back Fairer in Greater Manchester: Health Equality and Dignified Lives.
Ministers’ ambition to level up regional differences has been criticised for overly focusing on large economic infrastructure projects. Marmot’s proposals suggest the focus should be widened to address the social conditions that cause inequalities at community level. “Levelling up really ought to be about equity of health and wellbeing,” he said.
The findings of the Greater Manchester report were “generalisable” across other deprived areas of England, added Marmot, saying: “It’s pretty bad for life chances to live in poorer parts of London, too. Levelling up shouldn’t only be about the Midlands and the north-east and the north-west [of England]. Deprived parts of London need attention as well.”
Marmot is the director of the UCL Institute for Health Equity and an eminent public health expert known for his landmark work on the social determinants of population health. Just prior to the pandemic he published research linking UK austerity cuts to the first falls in life expectancy for more than 100 years.
His latest report shows life expectancy in north-west England fell in 2020 by 1.6 years for men and 1.2 years for women, compared with 1.3 years and 0.9 years across England as a whole. Within the region, life expectancy dipped most sharply in the poorer areas. Such a rapid decline was in life expectancy terms “enormous”, Marmot said.
Life expectancy had gone down all round the country but the degree to which people were affected depended on two things: level of deprivation and the region of the country in which they lived.
Covid-19 mortality rates varied within the region from around 400 males per 100,000 in the poorer boroughs such as Salford and Tameside to fewer than 250 per 100,000 in more affluent Trafford. For women they ranged from just under 250 per 100,000 in Manchester, to 150 per 100,000 in Stockport. Almost all local authority areas in the region had mortality rates above the England and Wales average.
Marmot called for a doubling of healthcare spending in the region over the next five years, as well as a refunding of local government, to tackle and prevent these inequalities and growing problems such as homelessness, low educational attainment, unemployment and poverty.
Future spending should prioritise children and young people, who had been disproportionately harmed by the impacts of Covid restrictions and lockdowns, and had experienced the most rapid increases in unemployment and deteriorating levels of mental health.
A decade of government spending cuts had left the poorest parts of England in a weakened state when Covid hit in 2020, and there was an urgent need to do things differently, Marmot said, adding that as the UK emerges from the pandemic it would be a “tragic mistake to attempt to re-establish the status quo that existed before”.
As well as damaging communities and harming health prior to the pandemic, funding cuts had “harmed local governments’ capacity to prepare for and respond to the pandemic and have left local authorities in a perilous condition to manage rising demand and in the aftermath of the pandemic”, the report said.
Even before the pandemic the UK had witnessed a stagnation in health improvement that was the second worst in Europe, and widening health inequalities between rich and poor. “That stagnation, those social and regional health inequalities, the deterioration in health for the most deprived people, are markers of a society that is not functioning to meet the needs of its members.”
The report was commissioned by the Greater Manchester Health and Social Care Partnership.
The mayor of Greater Manchester, Andy Burnham, said: “The pandemic has brutally exposed just how unequal England actually is. People have lived parallel lives over the last 18 months. People in low-paid, insecure work have often had little choice in their level of exposure to Covid, and the risk of getting it and bringing it back home to those they live with.
“Levelling up needs to start in the communities that have been hit hardest by the pandemic. To improve the nation’s physical and mental health, we need to start by giving all of our fellow citizens a good job and good home.”
The Department of Health and Social Care was approached for comment.