WeeklyWorker

21.03.2019
Global life expectancy (map created by Tina Gotthardt and Benjamin Henning)

Deadly cost of austerity

James Linney asks what the fall in life expectancy tells us about the state of capitalism in 2019

Life expectancy has long been used as a marker of the health of a society, and for the cheerleaders of capitalism the year-on-year, steady increase has provided them with a comforting proof of the system’s continuing progress. However, in some highly developed countries - most notably the UK and US - something strange is happening: since 2011 the rate at which life expectancy has been increasing has significantly slowed and in the past few years it has actually started to decline. What was initially assumed to be a blip has revealed itself to be a trend that can no longer be dismissed - and one that suggests some very significant underlying societal changes.

Life expectancy is precisely defined as the average number of years a person (genders are usually calculated separately) can expect to live, at a given age, if the current rate of mortalities for that age were to remain constant. So, for example, currently a 65-year-old man in the UK will on average live a further 18.6 years and a woman of the same age 20.9 years, according to the Office of National Statistics.1 Life expectancy in the UK has increased at a relatively steady rate since the beginning of the 20th century up until 2011, females consistently having a higher expectancy than males (on average about 4.5 years more). In 1901 life expectancy at birth was 48.5 years for males and 52.4 for females.2 The improvements seen in the first half of the 20th century were largely due to the reduction in infant mortality through improvements in obstetric care, advances in sanitation and the development of childhood immunisations. After this, increases in life expectancy can be explained by improvements in older-age medicine, such as new treatments for cardiovascular disease and cancers. Thus, people being born in 2011 could expect to live nearly twice as long as in 1901 - with life expectancies of 79 years (male) and 82.2 (female). And there was no need to believe that this rate of increase would slow down any time soon: we were told that the figure would reach 100 within the next 50 years.

The first hint of a change occurred in 2011, when the annual rate of increase started to stall - from about 2% to 0.5%. For the first few years it was assumed this was just a temporary setback due to a few colder winters or simply a data-gathering anomaly. However, the trend continued. Fast-forward to March this year, when the Institute and Faculty of Actuaries, which calculates life expectancy on behalf of the UK pensions and insurance industries, published the most recent predictions: life expectancy at 65 years has now decreased for both men and women by around five months. Men aged 65 are now on average going to die at 86.9 years - down from the previous estimate of 87.4 years - while women who reach 65 are likely to die at 89.2 years - down from 89.7 years. The reversal of this120-year-long trend is not exclusive to the UK - in the US life expectancy has been declining for the past three years - a pattern not seen there since 1915-18,3 when a combination of World War I and Spanish flu took their toll. In America annual mortality rates are now increasing - a consequence of rising suicides and drug overdoses, driven largely by the drug industry-sponsored opioid crisis. Suicide rates have increased by 33% since 1999 and in 2017 a staggering 72,000 people died from drug overdoses.4 Although the UK has seen small rises in such deaths, there has been nothing like the epidemic in the US, while suicide rates here have remained stable. What then can explain it here?

You do not have to be a professor in epidemiology to notice that the slowing down in the rate coincides with the formation of the coalition government in 2010  - so can the change be explained by its implementation of a programme of austerity over the past nine years? This question was examined in two papers by Danny Dorling (professor of geography at Oxford University) and his colleagues.5 In their discussion they recognise that life expectancy rates are a complex matter; indeed, correlation is not the same as causation (it is obviously not possible to reproduce the randomised control study here). However, applying the ‘Hill criteria’ - a long recognised test for causation - they find that most of the nine criteria are easily met and that importantly there are no other convincing causative factors to explain the stalling of life expectancy.

Plenty of alternative explanations have, however, been suggested - one being that medical advances are hitting the ceiling of possible human biological longevity. This argument is clearly false, given the increasing number of people living to 100 years and beyond and the fact that the UK - ranked 20th - remains well behind other countries’ life expectancy at birth, most of which are not in decline. Nor do rising obesity levels or influenza outbreaks go towards explaining the pattern, especially given that these have been partly offset by the improving cancer survival rates and reduced smoking. Dorling’s conclusion is that austerity is the strongest contender to explain things, but that there can be no certainty when dealing with an outcome with so many uncontrollable variables. He suggests further investigation is urgently needed - a pretty tame statement. However, the department of health was quick to dismiss the need for more studies and remains uninterested in the changes in life expectancy. It called these papers “a triumph in personal bias over research”.

Attacks

Yet for readers I am sure that it will not come as a surprise that the circumstances in which we live affects our health and determines our lifespan. The 2008 economic crisis has had implications globally, but here in Britain it provided a political space for a Tory government and its austerity project. We have subsequently seen an attack on the national health service and an assault on benefits. Homelessness is climbing and there has been a surge in child poverty. A 2017 study in the British Medical Journal cited austerity - in particular the resulting medical staff shortages - as being responsible for an estimated 120,000 deaths since 2010.6

Of course, the working class shoulders the burden when capitalism has a crisis and the life expectancy trends reflect this, so the gap between the more and less well-off in the UK has dramatically widened since 2011. A boy born in 2015 in the most deprived area of the country (parts of Glasgow) could expect to live 8.5 years less than his equivalent in the richest (Buckinghamshire), compared to a 7.4-year gap in 2001.7

Like the authors of the studies above, we must recognise that there are limitations to the conclusions we can draw from the data. The declining life expectancy seen in the UK and US do not represent a universal trend and the period of decline is still a short one that may only be temporary. It is, however, clear that, in the UK, Tory government policy - particularly the starving of the NHS of funds - has led to an increase in mortality and a stall in life expectancy increases. Yet our response must not be, like plenty on the left (including the current Labour Party leadership), simply to call for an end to austerity. We must interpret this data in the context of global trends and consider what we can learn about the real problem: capitalism.

The data is useful in helping to dispel the myth that capitalism and scientific or medical progress are somehow synonymous. It is true that capitalism’s need to continually reinvent its methods of production and create new markets has at times been the catalyst for great scientific advances, but these have only been a side effect and are usually accompanied by enormous harm. To give a few examples of this:

One final demonstration of the fallacy of linear capitalist progress can be demonstrated using recent data - by comparing the average life expectancy at birth of the US and western Europe (80-83.7 years) to those in parts of Africa - the lowest being the Central African Republic (49.53), Lesotho (49.50) and Eswatini (49.18): ie, equivalent to the UK rate 120 years ago. Globally billions of people still have a life expectancy below 70 years - not only having their lives shortened, but being made to live in abject poverty.

The only way that humanity can be freed from the unspeakable costs of capitalism’s ‘progress’ is through its destruction. Only then will we be able to live not only long, but also truly fulfilled, lives.

Notes

  1. www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2015to2017.
  2. www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/articles/howhaslifeexpectancychangedovertime/2015-09-09.
  3. www.washingtonpost.com/national/health-science/us-life-expectancy-declines-again-a-dismal-trend-not-seen-since-world-war-i/2018/11/28/ae58bc8c-f28c-11e8-bc79-68604ed88993_story.html?noredirect=on&utm_term=.1f7f1ba36e00.
  4. www.cdc.gov/nchs/products/databriefs/db293.htm.
  5. L Haim, D Harrison, M McKee and D Dorling, ‘Why is life expectancy in England and Wales “stalling”?’: https://jech.bmj.com/content/72/5/404; and ‘The cuts and poor health: when and how can we say that one thing causes another?’ Journal of the Royal Society of Medicine 2018, Vol 111, pp199-202.
  6. www.bmj.com/company/newsroom/health-and-social-care-spending-cuts-linked-to-120000-excess-deaths-in-england.
  7. www.independent.co.uk/news/uk/home-news/life-expectancy-gap-rich-poor-england-increase-health-wealth-living-standards-diet-education-crime-a8211866.html.