The British are in the midst of a critical health epidemic. In the 12 months to June 2016, the number of deaths jumped by the biggest absolute and relative amount since 1940 – a rise of 52,400. And this appears not solely to be an effect of a growing and ageing population, since the increase is spread across age groups. (Deaths rose by 12% among those aged 90 and over; 10% for 85-89; 7% for 80-84; 5% for 75-70; and 3% for those aged 55-74.) This is unprecedented in peacetime .
The jump, unreported in national media, is not entirely a surprise. Death rates have been rising slightly since 2010, reversing what was a steady fall since the 1970s. This is part of a general decline in health and wellbeing over the same period. The Office for National Statistics’ survey of wellbeing reports that the numbers who are self-reporting satisfaction with their health has consistently declined since 2010. The “happiness index” recorded its lowest ever level in March 2016.
It was the over-65s whose votes are taking Britain out of the EU: the working population between 18 and 64 voted Remain by a narrow margin, with the majorities increasing among successively younger voters. The common explanation is that the elderly, pampered by their pensions rising in real terms, could indulge a misty-eyed vision of a 1950s-style sovereign Britain and voted for an irrecoverable imperial past rather than a European future. But these figures offer a darker explanation. The elderly knew the current order was so dysfunctional it was not only making them ill, it was making an increasing number of their friends die earlier than anyone had expected.
There is affirmation from the US. It was the old and ill who gave Donald Trump his victory. The Institute for Health Metrics and Evaluation at the University of Washington, the Economist reports, has compiled county-level data across the US on life expectancy and the prevalence of obesity, diabetes, heavy drinking and lack of regular physical exercise. Mr Trump beat Mitt Romney’s base of support in 2012 by a stunning margin, but the analysts think that these indicators of ill-health explain 43% of those gains – an even greater indicator, then, than being college or non-college educated. As the Economist wryly remarks, if diabetes had been 7% lower in Michigan, heavy drinking 5% lower in Wisconsin or 8% more Pennsylvanians had taken regular exercise, then Hillary Clinton would now be heading for the White House.
White working-class America has been enveloped in a gathering public health crisis for decades. As life expectancy for Hispanics and African Americans has risen, so it has fallen for poor whites, with alcoholism, suicide and drug abuse rising strongly. Deindustrisalisation and the collapse of blue-collar employment not only mean lost jobs and declining real wages, they create futility and purposelessness that can lead to self-harm and early death, especially if the wider structures that offer health and social care are weakening.
All this is overlaid on a country where the inequalities have been growing faster and to higher absolute levels than anywhere in the industrialised world. In large parts of the country there is no more than a “foundation economy” providing subsistence – supermarkets, petrol stations, schools, hospitals and local administration – with virtually no economic activity adding value. Productivity runs at a fraction of the levels of London and the south-east. Local authorities presiding over all this have suffered incredible cuts and have less power to compensate by raising money locally than in any other western country, another bitter first in a catalogue of baleful league tables. Older voters living in these areas – the rise in death rates in the north-east, for example, was the highest in the UK – can be forgiven for thinking that anything would be better than the status quo, even a change as self-destructive as Brexit.
Theresa May’s government, and business secretary, Greg Clark, in particular, are at least beginning to understand the spatial inequality problem and the redirection of policy needed to address it. The autumn statement promised a quintupling, to more than £2bn over the next five years, of the resources that Innovate UK will have to stimulate fast-growing firms, especially in the “left-behind” parts of Britain – a 360-degree reversal of their predecessors’ policy, which was a running down of the entire apparatus.
But while this is a good starting point, there is as yet no sense of urgency or creation of a national purpose within which an imaginative and convincing response might be cast. Too much energy is spent keeping the fissiparous Tory party together rather than governing for the country. Hard Brexit, with a bill running into many wasted billions, is a destructive distraction. Meanwhile, the squeeze on health and social care continues. There is no willingness to relegitimise taxation as the means to create public good. The debate about immigration is wildly disproportionate to its importance in the revitalisation of British life: after all, fewer than 80,000 non-UK citizens took full-time residence in the UK last year. Dispelling the widespread sense of futility, ill health and unhappiness that besets so many lives is going to require more than controlling immigration.
The Labour leadership offers little or nothing; it is intellectually bereft and politically marginalised. Of course, the Lib Dems are right to insist we must stay as close to the EU as possible, but that alone will not address the depth of the inequalities and lack of hope at the root of declining life expectancy and the collapse in wellbeing. Yes, the madness of hard Brexit should be stopped, but that can only be done by offering hope and resources to the millions who have been denied both for too long. So, 2017 needs to be the year when our national debate gets real. A death epidemic is a grim reminder of how high the stakes have risen.