Within the small local authority of Stockton-on-Tees, where one of us lives and works, the difference in male life expectancy between the most and least deprived areas is 17 years. This is comparable to the difference in average male life expectancy between the UK and Senegal. It does not mean that moving from a richer and leafier ward into Stockton town centre will shorten your life expectancy but it does reflect the consequences of what sociologist and urbanist Saskia Sassen calls “a savage sorting of winners and losers”.
The sorting has not just happened. It is the end point of a decisive shift away from the postwar welfare state, and what Thomas Humphrey Marshall called social citizenship. The retreat from social citizenship in the UK began in the Thatcher era, if not earlier, but the financial crisis that swept across the world in 2008 provided a pretext for a new round of (selective) austerity. As tax revenues shrank, the need to control borrowing and the resulting fiscal deficits was invoked to justify drastic but selective public expenditure cuts, such as the bedroom tax (a benefit reduction for social housing tenants), increased benefit sanctions and reductions in local authority budgets that will hit the poor and the poorest regions hardest. Even before May’s general election, it was widely agreed that the harshest cuts have yet to occur.
In concrete terms this means that, as one report called it, the relentless rise of food poverty in Britain will continue, as austerity measures lead to increased reliance on food banks. And more cases will occur like that of diabetic former soldier David Clapson, who died with just £3.44 left in his bank account and an empty fridge after he was sanctioned for missing an appointment with a Job Centre adviser.
In our new book, we draw on an extensive body of scientific literature to assess the health effects of three decades of neoliberal policies. Focusing on the social determinants of health – the conditions of life and work that make it relatively easy for some people to lead long and healthy lives, while it is all but impossible for others – we show that there are four interconnected neoliberal epidemics: austerity, obesity, stress, and inequality. They are neoliberal because they are associated with or worsened by neoliberal policies. They are epidemics because they are observable on such an international scale and have been transmitted so quickly across time and space that if they were biological contagions they would be seen as of epidemic proportions.
Both the financial crisis and the austerity response are consequences of neoliberal policy choices, in particular the deregulation of financial markets and institutions by the Reagan and Thatcher governments in the 1980s. Again harking back to before the election, a depressing political consensus appeared to exist among the three largest UK parties that there is no alternative to austerity.
We reject that consensus. A looming public health crisis can still be avoided, but it will require a different set of political choices, which recognise that public finance is a public health issue and the Conservative project of shrinking the state comes with a body count. The indispensable elements of those alternative choices: more progressive taxation, in contrast to post-2010 policies that have actually redistributed income upward; strengthened rather than weakened social protection; and less spending on warheads and £15 billion roads to nowhere.
In 2008 the World Health Organisation’s Commission on Social Determinants of Health issued a landmark report on health inequalities that called for closing the gap in a generation. It began with the observation that “social injustice is killing people on a grand scale”.
Five years on the chair of the commission, Sir Michael Marmot, branded the coalition government’s social policies “a grotesque parody of fairness” in an address to the American Public Health Association. If only our political leaders had the same courage.