“Life expectancy is decreasing and is lower in poorer areas. A direct result of this Government’s austerity policies.”
That was the claim from Labour’s Debbie Abrahams yesterday. She was talking about new figures out this week that show life expectancy among the poorest women in England has fallen since 2012.
So is austerity to blame?
The figures
The Office for National Statistics (ONS) reports it has found “a large fall in life expectancy at birth among women living in the most deprived areas in England when comparing the periods 2012 to 2014 and 2015 to 2017.”
Just to underscore the significance of this: these figures don’t show that life expectancy for the most deprived women is growing at a slower rate than previously. These figures show an actual decrease in life expectancy at birth for the poorest women in England — a drop of 100 days between 2012-14 and 2015-17.
At the same time, women in the richest areas of the country have continued to see their life expectancy rise, which “has led to a significant widening in the inequality in life expectancy at birth in England”.
The situation is slightly different for men. The ONS found that “in general, males living in more deprived areas had either non-significant slight falls or gains in life expectancy” between 2012-14 and 2015-17.
Looking at the overall picture, the ONS report says “our wider analysis of mortality shows that life expectancy in the UK has stopped improving at the rate that was expected before 2011.”
Is austerity to blame?
A baby born in England and Wales in 1950 could expect to live to 66. By 2010, that figure was 79 years.
Statisticians and health experts predicted that this trend would continue into the 2010s, but since 2011, mortality rates (the rate at which people die) have not been declining as fast as anticipated.
This has caused growth in life expectancy to stall. Researchers have been trying to get to the bottom of what’s caused this shift in the long-term trend.
Veena Raleigh, a senior fellow at the independent healthcare think tank the King’s Fund, wrote in 2017: “two factors are uncontested […] more older people – particularly older women – than expected given historical trends are dying. The second is that flu contributed to excess deaths in some years, notably 2015 and also in 2017.”
But after that, it gets more difficult.
Richard Faragher, Professor of Biogerontology at the University of Brighton, wrote in 2017: “clearly, budget cuts could reduce life expectancy, but the relationship is not straightforward. It is possible to have high or rising life expectancy during austerity, as is the case in Japan. Similarly, you can have rising life expectancy despite high levels of inequality – this was the case in Britain from 1900-1950.”
So austerity doesn’t always lead to lower life expectancy and lower life expectancy isn’t always caused by austerity.
Nevertheless, Professor Faragher suggests that a dramatic increase in the number of older people, exacerbated by relative budget cuts to health and social care provision, is behind the overall stalling in life expectancy across England.
He writes: “it can be argued that the oldest people are highly vulnerable and that excess deaths among them, from underfunded services, are a major cause of the stalled life expectancy increases […] Austerity has unmasked the unhealthy ageing of our population.”
This is broadly consistent with research published in the Journal of Epidemiology and Community Health looking specifically at what caused the spike in deaths in 2015.
The paper’s authors pinpointed a very particular mechanism that they said was at least partly to blame: “delayed discharges”. That’s where patients are ready to leave hospital but can’t because there’s no suitable accommodation or care available for them.
The researchers said “the increased prevalence of patients being delayed in discharge from hospital in 2015 was associated with increases in mortality, accounting for up to a fifth of mortality increases.”
Overall, they concluded that their study “provides evidence that a lower quality of performance of the NHS and adult social care as a result of austerity may be having an adverse impact on population health.”
Is it correlation or causation?
In 2017, the British Medical Journal published research that linked austerity measures, specifically constraints on health and social care spending, with an estimated 120,000 “excess” deaths between 2010 and 2017.
The paper was described variously as a “landmark study”, a “bombshell report”, and evidence that “austerity kills”.
But despite the eye-watering headline figures, we should treat the findings with caution.
Responding to the paper, Martin Roland, Emeritus Professor of health services research at the University of Cambridge, said: “the link to health and social care spending is speculative as observational studies of this type can never prove cause and effect.”
He added “the authors overstate the certainty of this link [between excess deaths and cuts to] funding and are highly speculative about the money needed to ‘save lives’ in future.”
Dr Richard Fordham, senior lecturer in health economics at the University of East Anglia called the paper’s suggestion that extra deaths were linked to falling nurse numbers “a plausible hypothesis”, but pointed out that “other explanations are available”.
He lists some alternatives: “Patient cohorts may have changed (for example more end-stage, longer-term illnesses); patients may have succumbed to different or new diseases (e.g. MRSA, cirrhosis, etc.); or had greater multiple morbidities (asthma plus diabetes plus cancer, etc.) than similar cohorts of the same age before them”.
Taken together, the criticisms of the “120,000 deaths” paper can be summarised as “correlation does not prove causation”.
Similar critiques have been levelled at the other research we’ve considered here.
For example, Adam Steventon, Director of Data Analytics at the Health Foundation think tank says that “the evidence is far from clear” that delayed discharges from hospitals caused the spike in deaths in 2015.
Responding to that paper, he points out that “the causes of the higher mortality rates are not well understood, but are likely to be complex”, and notes that “one possible contributor is an increased prevalence of influenza”, which has affected Portugal, Hungary, Spain, the Netherlands and France — not just the UK.
He concludes that “it is very hard to consider [the study’s] findings to be reliable evidence that there is a link between deaths and delayed discharges”.
What does the ONS say?
FactCheck asked the ONS whether there was any evidence that the trends reported in this week’s figures are caused by austerity.
A spokesperson told us “We are currently working with government departments and agencies such as Public Health England to understand the reasons behind this. We are looking at what other information might help to shine a light on this issue and plan to make more announcements on this topic later in the year.”
FactCheck verdict
Life expectancy in England is not growing at the rate that experts predicted before 2011. And official figures published this week show that for some groups — women living in the poorest parts of the country — life expectancy at birth isn’t simply stalling, it’s actually falling.
Various academic studies have attempted to link austerity policies with the slowdown in life expectancy gains. Some have even tried to put a figure on how many “excess deaths” have been linked to austerity (one paper estimated 120,000 between 2010 and 2017).
But, as even some of the authors of those studies have pointed out, we must treat these findings with caution. They have suggested correlation (increased mortality coinciding with austerity policies). But they have not proved causation (austerity actually bringing those deaths about, and all other explanations being eliminated).
Five of the largest EU countries — France, Germany, Italy, Poland and Spain — saw a fall in life expectancy for men and women between 2014 and 2015, suggesting the phenomenon is not unique to the UK and the austerity we’ve seen since 2010.
The independent King’s Fund think tank says that “in our view, single explanations are unlikely to provide the answer; it is more likely that many factors are at play.”
