- Oops!Something went wrong.Please try again later.
Last September, life-expectancy researchers made a discovery that ought to have been shocking – except that it wasn’t shocking to the people who study these numbers for a living. They found that British male life expectancy had gone into reverse. The average British man born in 2018 to 2020 could expect to live for 79.0 years – seven weeks less than the average man born in 2015 to 2017. It was the first time such a reversal had happened in the 40 years that the government has been collecting data in this way.
I know what you’re thinking: Covid-19. ‘Once the coronavirus pandemic has ended and its consequences for future mortality are known, it’s possible that life expectancy will return to an improving trend in the future,’ said a government statistician when the data was released.
Note the ‘possible’ in that sentence. While the global pandemic certainly didn’t help, the reversal has, in fact, been a long time coming. ‘All coronavirus did was expose and amplify the underlying inequalities in our society,’ says Professor Sir Michael Marmot, founder of the Institute of Health Equity and a leading expert on public health. He alights on 2010 –not 2020 – as the year that the society-wide gains made over the previous decades began to stall.
Life expectancy (and particularly healthy life expectancy) is important in two ways, he points out. One is obvious: most of us would prefer to live a longer, healthier life than a shorter, unhealthier life. But two, it’s a useful indicator of the overall health of a society. Ever since late Victorian times, life expectancy in Britain has been steadily ticking up due to reduced infant mortality, fewer deaths in childbirth, the antibiotics revolution, plus incremental improvements in nutrition, sanitation, healthcare, housing conditions, working conditions, education, air quality and so on. Life expectancy works on a social gradient – the richer you are, the longer you can generally expect to live. But over the past 100 years, it has been the poorest who have seen the greatest relative gains. ‘For a century, we saw an improvement of one extra year of life every four years – that’s dramatic,’ Professor Marmot says. ‘Over a century, that’s 25 years. And then, in 2010, it slowed down and just about ground to a halt. So, important question: what happened in 2010?’
What happened to the numbers was that the richest in society continued to become healthier. Much healthier. If you’re a man living in the vicinity of Sloane Square in the London Borough of Kensington and Chelsea, you can now expect to live to be 95. However, if you’re a man living in central Blackpool, one of the poorest parts of the country, you can expect to live to be 68. And the gap is widening.
‘It’s astonishing that there hasn’t been more outrage about this,’ says Jonathan Portes, a former government adviser who’s now an economist at King’s College London. ‘We had been making slow and patchy progress at reducing inequality and the ills that result from it. This has now stopped and gone into reverse.’
Deaths Of Despair
It was Professor Majid Ezzati, chair in global environmental health at Imperial College London, who first brought the 27-year disparity to light. He conducted what’s known in the trade as a ‘high-resolution spatiotemporal analysis’ on all 8.6 million deaths in England between 2002 and 2019, assigning each individual to one of 6,791 local communities so he could work out who was dying where, when. What he found was that between 2002 and 2010, the vast majority of communities, rich and poor, saw an increase in life expectancy – not all of them at the same rate, but mostly in line with the overall upwards trend. However, after 2010, longevity began to stall in the poorest communities. And between 2014 and 2019 – long before Covid – male life expectancy fell in 11% of communities, with female life expectancy falling in 18% of communities. Central Blackpool saw the steepest declines among men in this period, who lost 0.4 years of life between 2002 and 2019. Women in the most deprived area of Leeds, meanwhile, lost an astonishing three years of life expectancy in the same period.
‘For health to be getting worse in a wealthy country outside of a pandemic – that is not something that any government wants to hear,’ says Professor Ezzati. ‘This is something that we need to take a lot more seriously.’ And yet, when I ask him if he was surprised at the results, his answer is: ‘Frankly? Not really.’ He has spent much of his career in the US, the world’s richest country, but also among the world’s most unequal societies. American male life expectancy declined for three consecutive years prior to the pandemic (which lopped off an extra 2.2 years). The decline is largely attributed to middle-aged men dying early, particularly in the deindustrialised areas known as the Rust Belt, where millions of skilled jobs have been lost with little to replace them. It’s estimated that in 2017, 150,000 Americans died of what the Nobel Prize-winning economist Sir Angus Deaton has termed ‘deaths of despair’ – suicide, drug overdoses, alcohol-related liver poisoning.
Deindustrialisation is a long-term trend. However, there are things that governments could have been doing to cushion the decline, such as benefit payments, education programmes and targeted support. In his 2010 report, Fair Society, Healthy Lives, Professor Marmot identified six areas that would need to improve if we were to close the health gap between rich and poor in the UK. These were: early years development, education, working opportunities and conditions, income, housing and environment, and what a left-wing person would call ‘social determinants’ – factors such as smoking, gambling and eating healthily – and a right-wing person would call ‘personal responsibility’. Whatever: almost all of the services that worked to address these issues had their funding cut under the austerity programme implemented by the Conservative-led coalition that came to power in 2010. And while the present government has declared an ‘end to austerity’, none have had their funding restored.
‘This is not a science experiment – we can’t be 100% sure of cause and effect,’ says Professor Marmot. ‘But we can say that the things we recommended in the 2010 report to reduce health inequalities pretty much all went in the opposite direction. And given that they went in the wrong direction, it’s likely that the consequences were as we predicted.’
Professor Ezzati agrees. ‘The austerity period in the UK made it look more and more like America,’ he says. ‘People are less stable, they don’t have secure jobs. They’re suddenly poorer because the government has taken away state support. On top of that, local services, primary care, GPs, addiction services and mental health services all have had their budgets cut. The post-2010 era is when these things happen all at once.’
The Forgotten Town
By now the people of Blackpool have become resigned to being held up as a symbol of everything that has gone wrong in English society. Linzi Cason, a charity worker who lives and works in the town, says she sighs when she hears people talking about all the problems: the drug addicts, the homelessness, the suicides in the multistorey car parks. ‘Blackpool has always had a bad press,’ she says. ‘I remember going to health conferences when I worked for Blackpool Council and I can recall people saying: “If you’re a man in your twenties, your life expectancy is really low.” To be honest, your eyes glaze over after a while.’
A colleague who grew up in Blackpool says he has watched its decline through visits over the years – though many of his friends have long since left. ‘There are two Blackpools: one receiving massive investment to pimp and primp the facade for tourists; the other, two streets behind, a broken-down rookery of squats and abandoned B&Bs serving as hostels – official or otherwise. “Dickensian” is a cliché, but to step behind the curtain in Blackpool, among the chain-smoking walking wounded, really is like a falling back a century.’
At least Blackpool is forgotten no longer. It contains two of those Red Wall constituencies that the Conservatives won from Labour in the general election of 2019, which centred so heavily on Brexit. The health secretary, Sajid Javid, referenced Blackpool’s low life expectancy in a speech at the Conservative party conference last October and spoke of the need to ‘level up’ on health.
He could have cited any number of other figures. The town has eight out of 10 of the most deprived wards in England and the highest number of Universal Credit claimants in the country, numbered at 22% of the workforce. According to Public Health England data, 26% of Blackpool’s children are born into low-income families and 24% of year-six pupils are classed as obese. As for those social determinants, in everything from hospital admissions for self-harm to people killed on roads, the prevalence of smoking among adults to hip fractures in older people, and violent crime to loneliness, Blackpool rates ‘significantly worse’ than the national average. In most cases, the situation is worsening.
It has also suffered disproportionately from cuts imposed since 2010. Professor Marmot notes that local government funding in the least deprived areas went down by 16% per person under austerity; in the most deprived areas, it went down by 32% per person. Mike Crowther, the CEO of local charity Empowerment, reckons that Blackpool Council has had over £1 billion removed from its budget under the ongoing austerity programme; in 2017, it was forced to sell 30,000 deckchairs to help fund the shortfall to its services. And yet for all the talk of ‘levelling up’, it’s not clear what the current administration is willing to do to reverse that disparity. Javid, in his speech, went on to lower expectations: ‘Government shouldn’t own all risks and responsibilities in life. We as citizens have to take some responsibility for our health, too.’
The problem with such statements is that the people of Blackpool will tell you they are taking responsibility. David Flanagan, who runs the Blackpool Centre for the Unemployed on Waterloo Road, is thinking of changing the name of the charity because around 85% of the people who walk through his door are, technically, employed. It’s just that they don’t get paid enough to live on.
‘One of my bugbears is the insecure employment here in Blackpool,’ he says. ‘We find really poor employment terms here, zero-hours contracts, low pay, bad conditions.’ Blackpool, he points out, is highly dependent on tourism. But the number of day-trippers fell through the floor during the pandemic. The seasonal nature of the work makes for lean times during the winter, too. ‘It frustrates me when I see local figures boasting about high employment – you scratch beneath the surface and there are no guarantees these people are actually getting work.’
Flanagan feels that the ‘skivers versus strivers’ narrative pushed by certain politicians has only worsened the mental burden for those who suddenly find themselves unable to support their families. ‘We’re finding a higher proportion of men coming forward finding themselves with significant reductions in household income through no fault of their own,’ he says. ‘That then has knock-on effects on family life and everything else. They often can’t believe that they’ve found themselves in this position – there’s pride involved.’ And once they’re not earning enough money, things can spiral. ‘There’s a five-week delay between applying for Universal Credit and getting your first payment, so people are finding themselves very quickly in debt.’
Those Left Behind
There is another Blackpool-specific problem: it’s a net exporter of people with ambitions and a net importer of people with issues. ‘A lot of the people I’ve worked with have been single men who had come to Blackpool in later life for whatever reason,’ says Cason. ‘There might have been a tragedy or a breakdown or addiction and they have fond memories of Blackpool as a child.’ Blackpool is a happy place for a lot of people, she says; it’s by the sea, it’s lively, it’s friendly – and it’s also quite cheap for someone who wants to make a fresh start (as little as £25 a night for a hotel room). Cason remembers one particular man she worked with in her time at the Red Cross. ‘His words were: “I’ve come here to die.” He was having chemotherapy treatment but he wanted specifically to live on the promenade. He got himself a bedsit so he could look out at the sea and the lights. That was his dying wish.’
That might sound rather depressing, but there are many who benefit from the fresh Lancastrian sea air. ‘We’ve seen people make so many changes in their lives and developing and going on to help other people,’ explains Cason. ‘I see so much positivity in this community.’ She connects me with Ellis, 29, who came to one of the drop-in centres that she runs for isolated men in Claremont, one of the most deprived areas of the town. He arrived in Blackpool from Toxteth in Liverpool in early 2020, citing family problems. He chose Blackpool because rents were cheap – ‘very, very cheap’ – and the estate agent got back to him quickly.
However, he doesn’t recognise the grim picture that others paint of his new home. Compared with Toxteth, it’s paradise. ‘Where I’m from is generally regarded as one of the worst places you could be, so moving from somewhere like that to Blackpool was just so nice. It’s quiet. People are friendly enough. It’s close to the sea, which is lovely. I’m pretty much in the town centre. I felt safe walking the streets. But there was just a general feeling of moving somewhere positive.’ While he experienced extreme feelings of isolation during the pandemic – the lockdown didn’t help with his general anxiety – he has connected with other men in the area via the extensive network of support services that Cason has helped to set up. ‘I ended up talking with this fellow there, John, for two hours,’ says Ellis. ‘I was so excited to talk to somebody that I wouldn’t shut up. It’s at a point now where it’s the highlight of my week going there. It’s helping with my anxiety, too. I really wasn’t going anywhere but it’s helping reintroduce me to society.’
There’s a fierce pride evident in Blackpool – a pride that comes from people looking out for each other when others aren’t. And yet in blunt statistical terms, Ellis isn’t doing Blackpool any favours. He’s been signed off work with anxiety and depression, and so is one of those Universal Credit claimants. He’s also had to absorb a £20 cut to his payment recently – ‘a big chunk of my money’, he admits – which means he isn’t always able to make the sort of choices he’d like to make. ‘I’m not as reliant on it as other people might be. I live on my own. I don’t spend much on travelling because I don’t go anywhere and food-wise I get the basics.’ He does say that he doesn’t eat too well, though. ‘I’ve tried every now and again. But the price of an unhealthy meal compared to one that is healthy is drastic, I would say. It’s not too surprising that I’ve got a belly on me.’
This is one of those classic ‘social determinants’ of health – a Sajid Javid might be inclined to say that Ellis should take more responsibility for his diet. However, the evidence suggests that merely urging people to make better choices isn’t going to do much. ‘Look at the NHS’s healthy-eating guide,’ says Professor Marmot. ‘If you’re in the top 10% for household income, you’d need to spend 6% of your household income in order to eat healthily. If you’re in the bottom 10% for household income, you’ll have to use 74% of your income. That’s not lack of personal responsibility. That’s poverty. And more than half the people who are in poverty have at least one adult in the household in work. These people aren’t lazy or feckless. They’re poorly paid.’
I contact Scott Benton, the MP for Blackpool South, to see what he has to say – since he has frequently expressed the opinion that men’s health problems are ignored by the mainstream media. He doesn’t get back to me. He seems to be more interested in appearing on GB News and attending various sporting events as a guest of the gambling industry – for whom he is an enthusiastic champion. His plan for Blackpool appears to be: build a casino.
But Mike Crowther, the CEO of Empowerment, the charity that launched the sessions Ellis attended, feels there’s a lot more to his town than is captured in the statistics. ‘Blackpool does have some serious issues around social deprivation,’ he says. ‘The disparity in male life expectancy between Blackpool and Chelsea is stark. It’s real. But you have to take on board people’s lived experience. What do people feel? What’s their experience of living in the town? Lots of people do truly love living here. There’s also incredible creativity and innovation here. I’ve never experienced such compassion and care as I have working in Blackpool and that never comes across in the reporting.’
Beacons Of Hope
Of course, there are areas within the locality where life expectancy is going in the right direction, just as there are areas within the Royal Borough of Kensington and Chelsea where life expectancy is low (around Grenfell Tower, for example). Overall, Professor Marmot cautions against despair. He says he’s now approached weekly by local authorities, large and small, who want to follow his metrics for measuring and improving health: Lancashire, Cumbria, Greater Manchester, Coventry, Clacton-on-Sea… ‘It doesn’t let central government off the hook,’ he’s quick to point out. ‘But there’s plenty that local authorities can do to address social determinants of health and that does give me hope.’
And while all this seems incredibly complicated – everything causes everything else – on another level it’s quite simple, says Professor Portes. ‘Everything we know suggests that if you radically reduce income inequality, that would lead to a radical reduction in health inequalities. If you really want to do something about it, you just have to make Britain a more equal society. Simple as that.’
You Might Also Like