Austerity and government neglect of public health have helped fuel UK’s Covid crisis, report finds

Leading expert says ministers failed to take decisions that ‘recognised health and wellbeing of the population as priority’, both before and during the pandemic

England’s high death rate from Covid-19 – one of the worst in Europe – is a result of the government’s poor management of the pandemic and its neglect of public health over the past 10 years, a report has concluded.

The review, led by Sir Michael Marmot, a world-leading expert in health inequalities, said ministers had failed to take the political decisions that “recognised health and wellbeing of the population as priority” both before and during the pandemic.

Due to the climate of austerity ushered in at the start of the past decade, England entered the Covid crisis with its “public services in a depleted state” and its benefit system “re-geared to the disadvantage of lower-income groups”, the report added.

The worsening health and socioeconomic inequalities stemming from extensive cuts to local government meant that the country was ill-prepared to tackle the pandemic, Sir Michael said, adding that England’s weak response had been entirely predictable.

He urged ministers to do “whatever it takes” to put improving health and wellbeing at the heart of all government policy, and said it would be a “tragic mistake” if the country went back to the status quo that existed before the crisis.

Sir Michael stressed ministers now had the opportunity to rebuild England’s public health structures and systems in a “fairer, better way”.

The report, entitled Build Back Fairer: The Covid-19 Marmot Review, highlighted that England had one of the highest excess mortality rates in Europe, alongside Spain, and was among the hardest-hit economies on the continent.

Sir Michael cited contributing factors as “poor governance”, social and economic inequalities, reductions in spending on public services and being an “unhealthy” nation before Covid-19.

A previous report by Sir Michael in February, Health Equity In England: The Marmot Review 10 Years On, found that flatlining life expectancy and worsening health inequalities over the past 10 years had led to a “lost” decade in England.

Sir Michael, who is professor of epidemiology at University College London (UCL) and director of the UCL Institute of Health Equity, said the pandemic had affected every stage of people’s lives.

He said policymakers were previously “not putting health and wellbeing as a priority” and should have seen the growing “crisis” in health inequalities.

He highlighted Test and Trace as an example where poor government decision-making and a previous lack of investment in public health had hindered the country’s attempts to contain the spread of Covid-19.

“The budget for Public Health England was cut after its foundation in 2012 by 40 per cent,” he said. “Spending on public health in local government was cut by about £800m. So then back in February and March, when we should have been setting up a national test, trace and isolate system, where public health should have organised it, we didn’t do it.”

Instead, he explained, the government had been forced to turn to the private sector to run one of the country’s most crucial tools for tackling the virus.

“A colossal error,” Sir Michael said. “We should have used public health. Fund them properly, get them to do it, use NHS labs, use university labs, set up a proper test, trace and isolate system.” 

He said that countries such as Korea and Taiwan had been able to draw on well funded and resourced health systems, enabling them to implement widespread testing and tracing programmes very quickly.

“Here we are in December, and we still haven’t got the system running,” he added. Alluding to other failed policies of the government during the pandemic, Sir Michael said: “There's PPE, there was the speed at which decisions were made, then there was ignoring the advice of the scientists, inconsistent messaging. From beginning to end, we mismanaged this.”

Sir Michael’s report also found that the Covid-19 outbreak had damaged the population’s prospects of improved long-term health, particularly children from deprived backgrounds who risk being condemned to “less flourishing” lives than their parents.

The review found that the pandemic had adversely affected young people’s social and emotional development, widened the education gap between the poor and the rich, reduced family incomes and increased poverty and unemployment.

Underlying health, deprivation, occupation, ethnicity and Covid-19 accelerated regional inequalities, particularly in the northwest and northeast of England, the report showed.

It said these were “undermined by pre-pandemic regressive cuts” and “made worse by differing pandemic containment measures”.

Covid-19 deaths among minority communities were “shockingly high”, with Sir Michael emphasising the need to tackle the “structural racism” that leads to systemic disadvantages such as poorer living conditions.

An increase in alcohol consumption, smoking, obesity inequalities and declines in mental health during the pandemic were leading to a new health crisis, the report added.

Outlining a series of recommendations for the government, Sir Michael warned that unless it took action, England was at risk of becoming “increasingly an unhealthy country with large inequalities” and could “fall behind other European countries in a way that is unnecessary”.

“I think if you don't follow the kind of recommendations we make, we are condemning the next generation to a less flourishing life than their parents had,” he said.

He highlighted countries in Asia, such as Korea and Japan, as examples of nations that had controlled the pandemic well, with less economic and social impact.

The report’s short-term recommendations include catch-up tuition for students in deprived areas, removing the two-child benefit cap, extending furlough support, funding additional training for young people and raising public health funding from 0.15 per cent to 0.5 per cent of GDP.

Longer-term, the report calls for efforts to reduce child poverty, make increased universal credit payments permanent, focus on reducing inequalities in early-years development, cut pollution levels in deprived areas and build affordable, carbon-neutral homes.

“We can’t afford not to do this,” Sir Michael said, arguing that government debt was no excuse. “We've got some incorrect notion about the necessity of austerity,” he said.

Jennifer Dixon, chief executive of the Health Foundation, which commissioned the report, said: “There is no doubt that the Covid-19 pandemic will take its toll on society for some time to come. This report highlights the unequal impact it has had, affecting some people much more than others.

“Mitigating the damage caused by the pandemic to education, employment and income must be at the heart of the government’s plans for recovery and levelling up.”