The Sick Man of Europe
by Michael Patrick O'Leary
A shorter version of this article appeared in the Sunday Island on March 26, 2023.
https://island.lk/the-sick-man-of-europe/
According to The Economist, “Britain has endured a grim decade during which perhaps a quarter of a million people died younger than expected.“
Declining Life Expectancy
Between 1980 and 2011 life expectancy in the UK rose at a steady pace of nearly three months every year. After 2011, the rise slowed. If Britain’s life-expectancy gains continued at the long-term trend, then life expectancy in 2022 would have been 2.2 years longer than it actually was. Those 26 months represent around 700,000 additional people that have died sooner than might have been expected in the early 2010s.
Academics from the University of Oxford and the London School of Hygiene and Tropical Medicine examined global life expectancy ratings between 1952 and 2021. In a league table of life expectancy, seventy years ago, the UK ranked seventh in the world, following closely behind Norway, Sweden, and Denmark. Now, the UK performs worse than all G7 countries except the US. The UK dropped from 7th place to 29th in global life-expectancy rankings. Life expectancy for males in the UK between 2018 and 2020 was 79, for females 82.9. Norway’s life expectancy is 80.9 years for men and 84.4 years for women. The number in Sweden was 83.18 years, marking a 0.18 per cent increase from 2021. Seventy years ago, Britons had longer life expectancy than anywhere in the G7. Now people in France, Germany, Italy, Canada and Japan live longer than Britons. Ireland also has higher life expectancy than the UK. Japan has the highest life expectancy at birth – 85 years. (Although , Monaco is at the top of the UN’s league table with 87 median).
The Economist says, “something has gone badly wrong in the past decade, and large numbers of Britons have lived shorter lives as a result. That raises two big questions. How much of this is specific to Britain? And why?” This is not just because places such as South Korea, Taiwan, Hong Kong and Macau have got richer. The pandemic cannot be blamed for a quarter of a million early deaths since 2011. Britain had already slipped in the ranking before Covid-19 hit and has since returned to its pre-pandemic trajectory. More middle-aged and younger people are dying than otherwise would have. Girls born in 2020 are now expected to die 4.8 years earlier than was expected in 2012, and boys, 4.5 years earlier.
Variations
Analysis by the Health Foundation shows that, compared to life expectancy overall in OECD countries in 2018, only Mexico is lower than the UK. Women in the poorest 10% of areas in England can expect to live on average 78.7 years – significantly below the average of 83.2 years for the whole of England and less than the overall life expectancy for women in countries including Colombia (79.8 years), Latvia (79.7 years) and Hungary (79.6 years).
The shocking thing is that the decline in life expectancy is not evenly spread over the UK. As The Economist put it: “the uncomfortable truth is that the 250,000 do not die in places like the London borough of Westminster (where life expectancy surpasses that in the Swiss canton of Geneva). They die in poorer towns and cities.” Glasgow has the lowest life expectancy in the UK. According to the National Records of Scotland, life expectancy in Glasgow was 78.3 years for females and 73.1 years for males. At the national level, Scotland’s life expectancy was the lowest among UK countries at 76.8 years for males and 81.0 for females. Life expectancy is 18 years higher for men in the richest part of Kensington (92) than it is in New Cross Gate (74), a poor part of London only six miles to the east. Even within the Borough of Kensington and Chelsea itself there are wide variations in socio-economic circumstances. An area best known for royal and Russian oligarch and Saudi residents (or non-resident owners also has pockets, particularly in the north end of the borough, of severe deprivation. The lowest life expectancy in Greater London for both men (77.0 years) and women (81.7 years) is found in Barking and Dagenham. Healthy life expectancy means the average number of years that a person can expect to live in “full health” by taking into account years lived in less than full health due to disease and/or injury. The Healthy Life Years indicator, also known as disability-free life expectancy or Sullivan’s Index, is a European structural indicator computed by Eurostat. Healthy life expectancy for men in Tower Hamlets is 65.3 years whereas for women it is only 57.8 years.
Poverty
Severe socio-economic deprivation tends to lead to poor health. Poverty is damaging to health in many ways — through mental illness, a lack of education about nutrition and healthy ways of living and inadequate housing. Awaab Ishak was a two-year-old who died because of the fungal mould in the flat in which his family lived. Data obtained by the all-party parliamentary group for households in temporary accommodation from the national child mortality database found that between 2019 and 2021, temporary accommodation contributed to the deaths of 34 children, most under a year old. Lack of safe sleeping provision was the most likely cause but other reasons were damp, mould and overcrowding.
I spent a year in the UK, after becoming an exile 25 years ago. One can see every day on the streets how unhealthy so many people are. So many people look shabby, downtrodden and depressed. The most striking thing is how many grossly obese people are walking (with difficulty) the streets. Some of them are in wheelchairs. One sees a lot of wheelchairs. Obesity is one league table on which Britain ranks highly, beating all other Europeans except the Maltesers. Currently 60% of adults in the UK are obese, with the number estimated to rise to 80% by 2060. Obesity used to be a sign of affluence, now it is a disease of poverty. Around one in every four adults and around one in every five children aged ten in the UK are overweight. The prevalence of reception-aged children living with obesity in 2021-22 was highest in the North East (11.4%) and the West Midlands (11.3%). It was lowest in the South East (8.7%), South West (8.9%) and East of England (9.2%). Diet-related disease is now the biggest cause of preventable illness and death in the developed world – far greater than smoking.
In his new book, Ravenous,Henry Dimbleby writes: “We are hungrier, ultra-processed foods stop us getting full, so we eat more, and what we eat is itself bad for us.” People are at the mercy of a food industry they do not understand. Dimbleby resigned from a government role: “I think the ideology of the Conservative Party and the way that they are dealing with the problem of diet-related disease makes no sense. In ten years’ time, whatever government is in power they are going to be dealing with huge problems to the NHS, which is going to suck money from the rest of government spending and cause misery from diet-related disease.”
Politics of Poor Health
From the 1940s to 2010 the state pension age was 60 for women and 65 for men. Since then, the pension age for women has been equalised with men’s, and both raised to 66. Two further increases are due to follow: to 67 by 2027, and to 68 in 2046. The government was hoping it could bring that second date forward in order to improve its fiscal position. Raising the pension age has caused riots on the streets of France. Tory MPs have urged a delay, arguing that ordinary voters would resent having to work longer at a time when the government has just relaxed tax rules on pensions for the wealthy. One senior Tory MP warned of the “critical juxtaposition” of scrapping the £1m lifetime allowance for pension savings while asking ordinary voters to work until 68 for a not very generous state pension. Prime minister Rishi Sunak has released his tax returns. They show that he has made large sums outside politics and only paid tax at a rate of 22%.
The government has been tempted by the possibility of £ 226 m in extra revenue if they charged prescription fees to the 2.4m people in the 60 to 66 age group. A 2021 consultation paper suggested that this could be “invested” in the NHS and achieve £ 8.4 bn in improved health. MPs of all parties have found this calculation to be bizarre. Health problems could get worse if people on low incomes are charged for essential medicines. The Royal Pharmaceutical Society urged the government to ensure that all patients with long-term conditions get their drugs free. A survey showed that many patients go without their medication in order to pay other bills.
Many people, including myself, have written about the downsides of economic growth. Whatever about all that, those who are supposed to be running the UK are pinning all their hopes on economic growth without having any clear plan about how to achieve it. Liz Truss was toppled by her madcap schemes to boost growth. All she did was give more money to the already rich. Hunt and Sunak seem more sensible but in reality are just mouthing optimistic platitudes.
Decline and its Causes
The British malaise goes back a long way and Johnson, Truss, Kwarteng, Sunak and Hunt have done nothing but kick problems into the long grass hoping that they will solve themselves. In The Atlantic, Derek Thompson pithily summarises the UK today: “Britain is pretty poor for a rich place. UK living standards and wages have fallen significantly behind those of Western Europe. By some measures, in fact, real wages in the UK are lower than they were 15 years ago and will likely be even lower next year.” Thompson continues: “In the past 30 years, the British economy chose finance over industry, Britain’s government chose austerity over investment, and British voters chose a closed and poorer economy over an open and richer one. The predictable results are falling wages and stunningly low productivity growth.” Another pithy summary from Thompson: “The UK is now an object lesson for other countries dealing with a dark triad of deindustrialization, degrowth, and denigration of foreigners.”
Austerity was the Cameron (remember him coming to Sri Lanka telling us how to run our country?) government’s response to the 2008 global financial crisis. That meant cutting public services even further giving less support for poor people to care for elderly and sick relatives. Brexit was supposed to bring an extra £350 million to the NHS every week. That was a lie. Brexit brought staff shortages to the NHS as foreign workers were made unwelcome. There are food shortages today because there are no foreign seasonal workers to pick the crops and no foreign HGV drivers to deliver to the supermarkets. Imports and exports of food are stymied by hellish bureaucracy.
Where Are the Workers?
Something I noticed while in England, was that it was very difficult to buy anything because there were not enough staff in the shops. We made three visits to a bank to change some accounts but gave up on finding anyone to talk to. Labour market participation has fallen dramatically since the pandemic. Some of this is because exhausted older workers decided tey might as well retire and some from the long-term sick. It is difficult to see where Hunt gets his optimism when the OBR (Office of Budget Responsibility) writes: “Gas prices remain more than twice their pre-pandemic level which, when added to the stagnation in business investment since 2016, the recent rise in labour market inactivity, and the slowdown in productivity growth since the financial crisis, means that there remains weak underlying momentum.”
NHS
The days have probably gone when the NHS was revered. Public satisfaction with the NHS has slumped to its lowest level ever recorded by the British Social Attitudes survey. Just 29% said they were satisfied with the NHS in 2022, with waiting times and staff shortages the biggest concerns.That is seven percentage points down on last year and a drop from the 2010-high of 70% satisfaction.
A study of 37.5 million patients in 2018 suffering four different sorts of cancer showed that British cancer survival rates were worse, not just than EU neighbours, but worse even than China’s. China’s breast cancer survival rate is about the same as Britain’s, its prostate cancer survival rate is worse and its lung and stomach cancer survival rates are better. China is a country in which only half of doctors have university degrees.
A leaked report predicts that NHS staff shortages in England could exceed 570,000 by 2036.The 107-page workforce plan produced by NHS England says the health service is already operating with 154,000 fewer full-time staff than it needs. It says that without radical action, the NHS in England will have 28,000 fewer GPs, 44,000 fewer community nurses and an even greater lack of paramedics within 15 years. Services in rural areas, which already struggle to attract enough staff, will be left unable to give patients – especially older people – the help and treatment they need, it warns. The NHS will not be able to cope with the increasing demand for care that will arise in coming years as a result of the growing and ageing population. The report strongly urges the government to stop relying on hiring more and more overseas health professionals and spending billions of pounds a year on temporary staff. Overseas staff now account for one in six of the workforce – double the number in 2014. Jeremy Hunt is playing a key role in behind-the-scenes moves by the Treasury to water down NHS England’s proposals to double the number of doctors that the UK trains and increase the number of new nurses trained every year by 77% – because it would cost several billion pounds to do that. Hunt’s stance is in contrast to his enthusiastic backing, while chair of the Commons health select committee (and not a minister) , for a massive expansion of the NHS workforce and publication of regular projections for how many staff of different types it needed to keep pace with the growing burden of illness.
Municipal Heroes
Most improvements in infant mortality and life expectancy in Britain came not as a result of experiments on animals or investment by drug mega conglomerates but because of public health measures implemented by local government. Successive Conservative governments have cut public spending, starving local authorities of funds to give social support to local communities. Improvements in nutrition, hygiene, housing, sanitation, control of infectious diseases and other public health measures historically reduced mortality rates. Very old people were rare 100 years ago. Less than one in 150 people was aged 80 and over in the 1920s. By 1920, life expectancy was 56 years for males and 59 years for females. Males born in 1841 could expect to live to only 40.2 years and females to 42.3 years, mainly because of high mortality rates in infancy and childhood.
The Great Stink of London by Stephen Halliday is a fascinating read. It recounts how civil engineer Joseph Bazalgette built London’s first sewer network (still in use today), which helped to wipe out cholera in the capital. The summer of 1858 was particularly hot and humid. For centuries, the Thames had been the city’s main thoroughfare as well as a dumping ground for human, animal and industrial waste. I travelled at dawn on the Ganges at Varanasi and was shocked to see people brushing their teeth in water that had dead cows and humans floating past.
London’s population more than doubled between 1800 and 1850, making it by far the largest in the world. By 1858, the stench overwhelmed Parliament and the politicians decided to do something about it. Bazalgette produced a network of 82 miles of new sewers, great subterranean boulevards that in places were larger than the underground train tunnels then under construction.
Raw sewage was dumped into rivers and coastal areas across England more than 300,000 times last year. In 2023, Britain’s rivers are again full of shit plus a lot of chemicals and microplastics that were unknown in Bazalgette’s time. Untreated sewage released by privatised water companies is responsible for 35% of the pollution of British rivers. Pollution by water companies is particularly high in the south and southwest of England. Excessive use of fertiliser and pesticides in agriculture is responsible for 40% of river pollution. Run-off from roads and towns which contains pollutants such as oil is responsible for 18%. Professor Steve Ormerod, an ecologist at Cardiff University, warns of other threats. He says: “We need to understand the risks which come with emerging pollutants – pharmaceuticals, microplastics. We don’t know, at this stage how big a problem they’re going to be.” The Environment Agency says, “people in deprived and heavily populated urban areas were more likely to live within 600m of a river with poor chemical or biological quality”.
The Environmental Audit Committee’s inquiry uncovered “multiple failures in the monitoring, governance and enforcement on water quality,” carried out by England’s Environment Agency. Since 1993, the number of water quality samples taken annually by the Environment Agency and Natural Resources Wales has dropped by 57%, which the committee says is a result of budget cuts.
Amy Slack, campaigns manager at the charity River Action said: “The government has let water companies monitor themselves … for decades while defunding regulators that fail to enforce the law. The result: more than 600 sewage overflows free to pollute our rivers and seas unchecked.” Fearghal Sharkey, the former Undertones singer and now water activist who has backed The Times’ Clean it Up campaign, said: “It’s time to pull the handle, a full flush, a total restructuring of the industry all the way from No 10 to your local sewage overflow.”
Seven of the UK’s nine water companies gave bonuses to their executives linked to environmental targets last year, despite significant amounts of sewage being dumped into UK waterways. An analysis of water companies’ accounts by PoliticsHome found that overall bonuses were worth a total of over £1.35m shared between 15 different executives across the sector in 2021-2022, even as untreated sewage was released into UK rivers for more than 2.7m hours that year.
Hunt’s Budget
On Wednesday March 17, 2023, the Chancellor of the Exchequer, Jeremy Hunt, presented his budget to the House of Commons, a budget that needed to restore economic health to the UK after the disastrous budget of his predecessor Kwasi Kwarteng. Economic health is an important factor in the physical health of the people of Britain. The physical health of the population in turn affects the health of the economy. Disturbing statistics are emerging which indicate that the health of people living in the UK is declining. A relative worsening of population health has historically been an early sign of severe political and economic problems. The crisis is here for the UK, the sick man of Europe.
Padraig Colman 