Jon Dale, secretary, Unite union EM/NG32 Nottinghamshire Health branch (personal capacity)

The growing gulf between rich and poor has not only been in wealth in recent years. Life expectancy figures show the gap has widened in health too.

A baby born today can expect to live on average until 81 – just eight weeks longer than in 2011. If the rate of improvement between 1980 and 2011 had continued, life expectancy today would be over 83. That means between 2012 and 2022 about 700,000 people died sooner than they might have.

Covid worsened these figures, but the slowdown in improvement of life expectancy was clear after 2013. Glasgow University research has shown around 335,000 more deaths occurred between 2012 and 2019 than was expected based on previous trends, with the excess greater among men. The Tory-LibDem coalition’s vicious austerity cuts to public services and living standards have taken a grim toll.

These figures are not just poorer older people dying younger than better-off older people. Death rates stopped reducing for infants – and rose among 30 to 49-year-olds – from around 2012.

A poor girl in England could expect on average to die 6.8 years younger than a rich girl in 2011, but 7.7 years in 2017. For boys, the gap increased from 9.1 to 9.5 years over the same period. Just six miles separates the most expensive part of Kensington from New Cross Gate in London. Life expectancy for men falls by a shocking three years a mile, from 92 to 74.

‘Deaths of despair’

Life expectancy in the US has fallen even more sharply in recent years. ‘Deaths of despair’, from drugs, alcohol and suicide, have done the most harm. In Scotland, drug deaths have more than doubled in a decade. They are 18 times higher in the poorest 20% of neighbourhoods than the richest. Dundee has the worst drug-deathrate in Europe. Drug overdoses have been second only to Covid as the biggest contributor to rising death rates in Scotland over the last four years.

These figures are also worsening in England and Wales, but the rate of drug deaths is nearly four times higher in Scotland. In England, ‘deaths of despair’ explain one sixth of the life-expectancy gap between the richest 20% and poorest 20% of neighbourhoods.

Income and employment accounted for 83% of the variation between local authorities in life expectancy between 2001 and 2016. And during the 2010s, councils’ spending per person was cut by 16% in the richest authorities, but 31% in the poorest.

Unemployment results in poverty, poor diet, and worse mental and physical health. Low-paid work is often physically hard, with poor working conditions such as dust and fumes, injuries and long-term ‘wear and tear’ like arthritis and lung disease.

Cold, damp housing, with mould-triggering asthma and other health problems, causes child deaths like two-year-old Awaab Ishak in Rochdale. Air pollution (traffic or industrial) causes deaths, like nine-year-old Ella Kissi-Debrah in south London.

The cheapest foods (heavily marketed by big food companies), lack of safe play and exercise facilities contribute to more obesity, diabetes, heart disease and road accidents. These and other factors shorten the quality of life as well as length – ‘disability-free life expectancy’ was 64.3 years in south east England but 56.9 years in north east England between 2018-20.

These statistics precede recent huge increases in heating and food prices. Although the minimum wage, pensions and benefits have always been far too low, many more people have suffered this past winter without adequate heating, hot water and food. The resulting ill health and premature deaths will undoubtedly show in future statistics.

Prevention of ill health would be massively helped by decent pay, benefits and pensions, good, well-insulated housing, easily available good-quality food, free safe local exercise facilities and restoration of school playing fields, cutting traffic with good public transport, trade union control of workplace safety and other measures. These and more would be possible in a socialist society, abolishing the rule of profit-driven big business.


40% of the burden on the NHS could be preventable through tackling causes of avoidable chronic conditions like obesity and diabetes. Years of underinvestment and outright cuts in the NHS have left it in a critical condition. As the costs of treating ill health from poverty and inequality increase, the NHS has fewer staff and resources to meet these needs.

When it’s hard to book a GP appointment or take time off work without losing pay, poorer people are more likely to delay going to the doctor. They are 20% more likely to be diagnosed with cancer at a later stage, when it is more complex and expensive to treat.

Lengthening waiting lists for diagnostic tests mean treatment delays, prolonging immobility so other health problems get worse and shorten life expectancy. GP and hospital services have fewer doctors and other skilled health professionals in poorer areas, despite the need being greater there.

Prevention is always better than cure. Although NHS cuts in general have been severe, public health and its prevention programmes suffered some of the worst cuts. Former Tory Health Secretary Andrew Lansley shifted public health responsibility from the NHS to councils in England in 2012. The Public Health Grant, paid to councils by central government, was cut by 24% in real terms per person between 2015-16 and 2021-22. Public health programmes were pared to the bone – or totally amputated.

This fitted with Tory opposition to the ‘nanny state’. Less spent on prevention of smoking or alcohol addiction meant more tax cuts and profits for big business.

Their short-sighted outlook was exposed during the pandemic. Having starved local public health departments of resources to mount effective contact tracing programmes, the Tories splashed out £37 billion on the privatised track-and-trace system – which failed.

Tory cuts to prevention mirror decades of British capitalism’s low investment in industry, preferring short-term profits. More far-sighted capitalist commentators are now pointing out the results. Many companies can’t recruit enough workers to meet their needs, while workers are off sick long-term waiting for treatment, or retiring early in ill health.

Providing everyone the means to maximise their healthy life needs a mass council housing programme, nationalisation of the food industry and big supermarkets, pumping money back into schools and adult education, nationalised public transport run as a public service, renationalisation of utilities, and rebuilding the NHS. To achieve this will need a mass workers’ party and a socialist programme.