Creeping Health Crisis: Something unusual is happening in the UK

Something unusual is happening to health in the UK. Over the last 15 years, the growth in life expectancy has slowed faster than in most other countries except the US. In some parts of the UK, life-expectancy growth has gone into reverse.

What’s more, there are two more unusual trends: a marked uptick in mortality, particularly in men of prime working age (25-49 years) of deaths from drugs alcohol suicide and violent causes. And there has been a marked increase in the number of people of working age who are not working due to chronic ill health:  2.7 million people. Much of this rise happened since the pandemic. Also, economic inactivity (working-age people who are not looking for work) has not fallen as in most other European countries.

What’s going on?

A closer look at these trends in England show much of the death and ill health is concentrated in socioeconomically deprived areas, particularly in the north, which deindustrialised over the course of the 20^th century.

Across the world there are “left behind” places like it. Once flourishing, they now languish, buffeted by economic forces and social change that leaves the population there baffled, ignored, and angry. Visit these areas and you see towns with their high streets decimated, shops boarded up, and few places for the community to congregate.  The decline in union membership and the industries that supported it have led to a lack of collective sense of identity, security, and support.

The most florid example in England is the Northeast. This is an area that deindustrialised over most of the 20^th century, shedding jobs in mining, shipbuilding, and steelmaking. The jobs, the economic security, and lifestyles they brought haven’t returned. And the memory of the bitter battle between the government and the National Union of Miners in 1984/5 is still keenly felt.  While most of the economic damage to the region had happened by the 1980s – four decades ago – its imprint is still clearly visible on people, places, and trends today.

In addition to poor health, many economic and social indicators in the region, including child poverty, educational attainment, productivity, and rates of economic inactivity, are the worst in England.   Unsurprisingly, this is associated with frustration and rage with “the establishment”: for example, the Northeast had the highest Brexit vote, saw a swell in support for the right-wing Reform UK party and like other deprived and left-behind areas in England was the scene of ugly civil disorder in the summer of 2024.

The advantages of the Northeast

Yet the Northeast also has strong assets and social fabric, a greater sense of pride of place and belonging, as well as neighbourliness and levels of informal volunteering, than almost anywhere else in England. It has a healthy voluntary and community sector, a rich natural environment, and an ecosystem uniquely positioned to deliver on the green energy revolution: plentiful wind energy, and potential for carbon capture and hydrogen storage.

But with key health, economic, and social dials flashing red, and economic performance in the UK unlikely to generate the levels of public investment needed to help shift them anytime soon, what is to be done to lift the region?

The seeds of recovery are mainly economic. In particular, rebalancing a country that is hypercentralised politically and economically, with economic growth and productivity concentrated in London and the Southeast. This is well described by Torsten Bell in Great Britain? How we get our future back. There have been attempts to craft an industrial strategy over the last decade: to level up the country through public and private investment in skills, jobs, and supporting infrastructure. New jobs in the green-energy sector may help:  the Northeast for example has plenty of wind for renewable energy.  But unless the transition is planned well – stable, long-term policy-making, and true partnership to develop skills and opportunity for local communities – then these jobs are unlikely to absorb more than a fraction of the local pool of labour.

There is also a growing cultural alienation in places such as the Northeast which is more challenging to address – alienation that is eroding local identities and fuelling resentment and aggressive backlash.  This is the cohort effect of changing social attitudes, in particular of successive generations to post-materialist progressive issues such as identity, gender, sexuality, diversity, and immigration, which is brilliantly described in Cultural Backlash by Pippa Norris and Ron Igelhart. As they and many others have observed, older traditional voters are more likely to be alienated and look to populists to represent them and recreate something resembling the past.

Ever larger economic divide

Another related long-term trend is the growing divide in economic and other life prospects of the college educated and non-college educated. This isn’t just a growing economic divide, as income and asset levels of these groups have diverged over the last 30 years, but one of where the worth and dignity of those without formal academic skills is neglected, as explored by Michael Sandel in The Tyranny of Merit.

Of these, the first area – growing the local economy – is likely to be more straightforward. Clearly having an intelligent industrial strategy with public investment drawing in private monies will help. Investing in areas that already have significant infrastructure and other local assets would be a wise early step. Investing in skills, infrastructure, and jobs will be central to any strategy, as will the stability of policymaking over a period longer than two to three years.

Linked to that is the policy to devolve more political power away from London to the English regions. The current government is pledging this, and a white paper is planned before Christmas. With more powers, the idea is that the regions will be able to make better decisions for local communities. Afterall, they know the context far better than civil servants in Westminster. Clearly this shift seems like the right one if accompanied by investment. It is however no panacea for improvement given the experience of devolution in Scotland, Wales, and Northern Ireland.

Economic growth and development will take time. In the meantime, how do we address the cultural alienation that is increasingly stressed by populist parties? This is just as big a question for remedy as weak economic growth – and yet there are even fewer answers.

The health of the population is a useful weathervane to show whether a society is flourishing. There is a long way to go in the UK and it will take significant commitment to make progress. I hope we are up to it.

Dr. Jennifer Dixon is the Chief Executive of the Health Foundation.