A public health strategy with teeth could be a magic bullet for UK government

Unhealthy lifestyles in deprived communities are stoking a series of economic and policy challenges in the UK, a new paper from Bayes Business School (formerly Cass) suggests.

The paper says health inequalities between the richest and poorest have reversed the post-1945 increase in life expectancy, while boosting both NHS waiting lists and welfare spending. It has also driven the politically toxic post-Brexit rise in immigration through distorting local labour markets – exacerbating other national challenges such as the housing shortage.

Without a major drive aimed at deterring unhealthy lifestyles, the paper warns, health inequalities and the economic and social pressures they breed will continue to soar.

Published in the journal Risks, the paper says:

“It is obvious that life expectancy is at a moment of crisis as the UK struggles to regain years lost during and since the pandemic, and for at least six years before it began. Without major changes, current trends suggest that existing inequalities are likely to persist and even increase, given the limited progress to date.

“We found clear patterns linking poor health and life expectancy at various ages to deprivation. However, the two measures are not in lockstep, and the damage done to the economy through poor health is greater than a fall in life expectancy.

“With current policies alongside an increasingly ageing population, the health of the nation will worsen and be ever more costly in public expenditure terms.”

Les Mayhew, Professor of Statistics at Bayes Business School (part of City St George’s, University of London), drew on analyses he and others have published in recent years, as well as fresh research.

The numbers of working age people claiming health or disability-related benefits has climbed by 33 per cent since 2019, rising from 2.1 million to 2.8 million. With numbers expected to rise further, the Office for Budget Responsibility has projected the cost of those benefits for people of working age will reach £63 billion by the end of the decade – compared to £36 billion in 2019.

A massive backbench revolt by Labour MPs derailed the Government’s attempt to curb access to such benefits last spring – but Chancellor Rachel Reeves pledged in her high profile speech this week that ministers will try again.

Politicians and the media have focussed largely on the surge in the numbers of young adults who are not working due to anxiety and/or depression.

However, the paper also points to the knock-on impact that the rise in ‘economically inactive’ people of working age has on other societal challenges.

Professor Mayhew said; “Economic inactivity is also linked to higher net immigration, which is running at around 500,000 a year.  Much of that figure comes from the need to fill lower-paid jobs as the demand for labour is broadly fixed in the short term. An influx of migrants inevitably affects other policy pressure points, such as housing.”

Avoidable poor health is the common thread running through so many of the most difficult challenges and problems facing both politicians and tens of millions of people.

In earlier papers Professor Mayhew has revealed that a five-year improvement in ‘healthy life expectancy’ would increase life expectancy by two years and extend working lives by almost one year. Longer working lives and reduced dependency on working age benefits and less demand for health and social care services would deliver economic and fiscal gains equivalent to 2.4 per cent of the tax burden[i].

His latest paper concludes: “There is a need to understand both the economics of ill health and the case for a much-strengthened role for prevention, but there is no magic wand. A comprehensive approach is needed for assessing the full cost of ill-health over the life course, linking health and finance together. The unresolved policy issue is how to do this in an evidence-based way, and the timescale and policies involved.”

The study found that:

• UK life expectancy stalled after 2010 and the subsequent drop during and after the covid pandemic is the second highest among 17 advanced economies, behind only the US.
• Out of the 17, life expectancy stalled in five countries but increased in eleven, suggesting that these countries were better prepared for the pandemic than the UK. The asymmetrical relationship found between health and life span at the sub-national level resulted in deprived areas spending more years in poor health, as well as a greater proportion of their lives (Bennett et al. 2018).
• The scale of inequality has had a major impact on different areas of public expenditure—whether in healthcare, welfare benefits, economic activity, or, indirectly, pensions.

It concludes that poor health is a key factor why the UK economy has struggled since 2010, following the 2008 financial crisis and now COVID, constraining economic growth and driving up public sector costs. A comprehensive approach is needed for assessing the full cost of ill-health over the life course, linking health and finance together.

He says the unresolved policy issue is how to do this in an evidence-based way, and the timescale and policies involved. Expressing the financial benefits of good health fills a gap and opens the way to create stronger evidence based case for change because it hits people in their pockets.

Professor Mayhew said: “The health and economic benefits of prevention can take decades to show up and politicians need to be brave as they might initially alienate both business and people affected by new ‘sin taxes’. The legislation going through Parliament to ban the sale of tobacco to anyone born after 2008 is a big step forward, but it will make little noticeable difference for a couple of decades.

“However, over time it would boost good things like productivity and life expectancy while reducing many of the seemingly intractable challenges the nation faces – ranging from the benefits bill and NHS waiting lists to immigration to fill jobs Brits are too unwell to undertake.”

[i] Counting the cost of inequality – putting a price on health

October 2023, Journal of Demographic Economics 89(3).