Nothing is surprising about the latest figures showing that people in deprived areas are dying of coronavirus at double the rate of affluent areas. Shocking, perhaps, but the ONS findings follow a pattern that is familiar to those who research the impact of wealth on health.
So far they have been raising the alarm to deaf ears. The governments of the last decade have widened the health and wealth divide. The recent Tory era is defined by its most measurable outcome – the abrupt end to increasing life expectancy. For the first time in a century, women in poorer places are dying younger than those born before them. For the first time in anyone’s lifetime, infant mortality has risen. The country entered this crisis in social reverse.
All the indefatigable research on poverty has been ignored by Tories who have been in power most of my lifetime. And since 2010 they have taken a chainsaw to benefits and services for those with the least. Yet still they emerged the largest party in each of the last four elections. The hope must be that this pandemic changes people’s social sensitivities beyond recognition.
However, the fear remains that this will be another Grenfell Tower episode. That horror lifted gravestones on some stark figures: life expectancy is 22 years shorter in Kensington and Chelsea’s Grenfell ward than in the borough’s Harrods ward. Epic disadvantage in life chances was laid bare by the fire, with promises of lessons to be learned. But the news moves on.
This time the coronavirus epidemic touches everyone, as all can see who is harmed most. This time, double the death rate for the low-paid, their coffins soon piling up twice as fast in Blackpool or Middlesbrough as in the richest parts of the country, may deliver a shock on the political Richter scale rarely registered before.
Years of research show the social gradient of death is not a poverty cliff-edge but that it runs in a straight line from bottom to top: on the graph people get gradually healthier as they get richer. The grim reaper may wave a coronavirus scythe at the Prince of Wales, the prime minister or Tom Hanks, but death prefers the more fertile territory of Newham, Birmingham and Liverpool.
Professor Michael Marmot, director of University College London’s Institute of Health Equity, drew the seminal social graph of sickness and early death in 1978. He chose Whitehall, where employees are neatly socially graded 1-7, from messengers to top ranks, none destitute, all in secure work. He found a fourfold health difference from bottom to top – and it applied to all major causes of death. Social differences, such as smoking and weight gain, accounted for only a third of the death-rate difference.
Wider surveys since have found the same, such as The Spirit Level by Richard Wilkinson and Kate Pickett, and Anne Case and Angus Deaton’s Deaths of Despair and the Future of Capitalism. What kills is inequality itself. Beyond the struggle to get by, it’s the stigma of disrespect, the lack of choice or agency. Disempowerment makes people ill and die young.
Marmot’s report in February measured the steep deterioration in health inequality in England since 2010: the rise in child poverty, insecure work, food banks, worsened living conditions “with insufficient money to lead a healthy life”, and the loss of children’s centres. “Austerity,” he warned, “will cast a long shadow over the lives of the children born and growing up under its effects.”
Is he surprised that Covid-19 is not a leveller, but has double the death rate in deprived districts? “It’s exactly what I expected,” he told me this week. “Most diseases follow the social gradient. The poor are most likely to suffer hypertension, COPD [a lung condition], obesity – all carrying a greater risk of fatal infection. The poor are older biologically, ageing faster.”
Prime Minister Boris Johnson, embarrassed by the dramatic reversal of longevity, pledged in the 2019 Tory manifesto to give us an added five years of healthy life by 2035. But the cold Covid-19 facts reveal just how far over the rainbow that is. It would require a U-turn in policies – not just to restore pre-2010 rates of progress but to accelerate them greatly. Marmot’s report expects the opposite: “Healthy life expectancy will improve more slowly, not faster.”
Matt Hancock, the health secretary, acknowledged the problem, but not the true cause or necessary remedies, in a revealing speech in February to the all-party group on longevity. “A man born in Blackpool can expect only 53 years of healthy life, while a man born in Buckingham gets 68. That’s wrong,” he said. He used the “levelling up” mantra – aspiring to good jobs, warm homes, better air quality and more cycling. “But the rest is down to genetics, the environment, and the lifestyle choices we make.” That’s the old story: it’s not money, not inequality, not lack of agency, but that the poor make bad choices. Will the Covid-19 rollcall of death change that perception?
Hancock promises to “improve access to healthcare”, as if NHS failings were the cause of early death. But of all aspects of society, the NHS is the most equal feature in our lives. Intensive care units are packed with the low-paid: they are the sickest. Intensive-care baby cots for premature neonates are most used by disadvantaged families. Unlike the rest of society, only the NHS treats everyone according to need. That’s why it’s so loved.
But that’s dealing with the symptoms, not the cause. Inequality is responsible for the longevity decline, and this government has no chance of reversing it without radically transforming life chances. Five more years of healthy life? We must hold the government’s feet to the fire on that promise. The virus has shone a light on the facts of British life and death.
• Polly Toynbee is a Guardian columnist