The crisis of public health

The UK faces a health crisis. In 2018–20 growth in life expectancy stalled for women and declined for men, taking men back to the level in 2012–14 (ONS, 2021). Although the immediate cause was the outbreak of COVID-19 in 2020, a slowing-down in improvements in life expectancy had been happening for a decade, particularly affecting the most deprived 10 per cent of the population, and falling or stagnating for some groups (Marmot, 2022). In other comparable economies, life expectancy has increased at a faster rate (OECD, 2023), so the latest figures are the culmination of a longer term trend. But COVID-19 also led to a surge in the number of those of the working-age population being unfit for work through extended sickness. Before 2020, less than 5 per cent of the relevant population were unfit for work in this way; by 2022, it was more than 6 per cent (Neville and Borrett, 2023). COVID-19 hit the UK population hard because there had been a failure of public health planning over many years. The result was the growth in a number of health risks that bring illness in their wake and impose severe strains on the National Health Service (NHS). The omens in respect of these health risks look poor.

Consider obesity. As Figure 1.1 shows, obesity rates are high in the UK when set against comparable western European countries. While obesity has increased in all the high-income countries, rates in the UK more than tripled between 1975 and 2016, whereas France and Germany showed much lower rates of growth, as did other European countries like Italy. To be sure, the UK does not equal the US or Australia in its obesity, but it is closer to them than to its European neighbours. Obesity is an important public health measure because being obese leads to a predictor of poor health, causing strain on the skeleton and increasing the risk of fatal heart attacks or stroke. It also leads to an increased risk of type 2 diabetes, a disease that is responsible for some 10 per cent of NHS expenditure.