Cost-of-Living crisis threatens to worsen health inequalities

The UK’s cost-of-living crisis threatens to erode people’s health and widen already stark health inequalities – unfair and avoidable variations in health outcomes between different groups within society. In a YouGov poll recently commissioned by the Royal College of Physicians (RCP), 55 per cent of respondents said the crisis had negatively affected their health, with poorer people more likely to disclose that their health had worsened. Meanwhile, the charity Macmillan Cancer Support has reported that nearly a quarter of people with cancer are buying less food or making fewer meals to make ends meet. ‘I have an overwhelming anxiety as all the money worries add up, and on top of this, I am so fearful about how our standard of living will affect my cancer recovery,’ said Laura Burwell, a nurse diagnosed with cancer in 2019.

Before the current crisis, health inequalities were already pervasive within the UK. Implemented from 2010 onwards, the government’s austerity program saw deep cuts to the country’s social safety net, making it much harder for poorer people to access public health and social care services. When COVID-19 struck, the most deprived areas had a mortality rate approximately 2.6 times higher than the least deprived areas. With energy and food bills spiralling this year, the cost-of-living crisis will push millions of low-income families into poverty – an underlying cause of ill health – deepening these health inequities yet further.

Closing the gap in health outcomes between the country’s poorest and richest residents will require bold and concerted action by politicians. Many of the determinants of health – diet, exercise levels, alcohol consumption, and smoking – are rooted in socio-economic factors, not just individual behaviour. Among researchers, there is a general consensus that the primary causes of health inequalities lie in large-scale, macro structures, such as income levels, environmental conditions, and housing quality. As such, policy efforts to reduce health disparities in the long term must seek to address the structural and socioeconomic determinants of health, especially key material inequalities linked to income and wealth. It is thus unlikely that any of the current short-term measures to address the cost-of-living crisis will have a sustained impact on trends towards wider health inequalities.  

That said, policymakers can take two concrete steps in the medium term to tackle health care inequities. First, the central government should reverse the last decade of public health cuts and improve the capacity of local councils to invest in programs that boost health. Driven by the government’s austerity agenda, Westminster has slashed the money it distributes to councils for public health in recent years. Between 2016 and 2021, the Department of Health and Social Care reduced its public health grants to local governments by 24 per cent on a real per capita basis, with even worse reductions in the most socioeconomically deprived areas. Councils use much of this money to fund programs with a proven track record of reducing health disparities, such as alcohol and smoking cessation services. Restoring this crucial funding must be the first step in tackling the UK’s entrenched health inequalities.

Second, the government should refine its levelling up funding schemes to prioritize addressing regional health care disparities. There is a strong geographic component to health inequities in the UK. On average, people in the North of England live for two years less than people in the South of England. When the government released its much delayed and anticipated white paper on levelling up in February 2022, it set ambitious targets for addressing these geographic health disparities, including a commitment to closing the gap in life expectancies between poorer and richer regions by 2030. But the 139 pots of levelling up funding are poorly targeted for achieving this goal. Under the current system, the central government places all local authorities in Great Britain into three priority groups, with preference given to bids from areas in priority group one (which contains approximately one third of all local authorities). Figure 1 shows the levelling up priority groups and female life expectancies at birth for all 311 of England’s local authorities. Several areas with female life expectancies significantly below the national average of 83.6, such as Corby in Northamptonshire and Telford and Wrekin in Shropshire, have been placed in priority groups two and three. Overall, fifteen local authorities with below-average life expectancies have been put in the lowest priority group, suggesting that the fund is not adequately targeting areas with the worst health outcomes. To rectify this, the government should place health disparities front and centre in its criteria for distributing levelling up money.

Such reforms will require strong political buy-in. Encouragingly, health inequality is firmly on the political agenda for the first time in years due to the government’s levelling up ambitions and the extensive media coverage of COVID-19’s uneven impact, opening a window for potential change. In February 2022, former health secretary Sajid Javid announced plans for a government white paper on the issue, informing Parliament that the government planned to ‘break the link between people’s background and their prospect for a healthy life.’ If real change is to occur, this white paper, which is due out later this year, must place improving health inequalities at the heart of the government’s agenda and acknowledge the fundamental causes of these disparities. Otherwise, the rise in the cost of living will continue to have a detrimental effect on the nation’s health.