PODCAST: Austerity: The silent killer

Life expectancy is about more than just health – it’s about the kind of society we live in.

In this episode, Richard Kemp speaks with David Walsh and Gerry McCartney, co-authors of Social Murder?: Austerity and Life Expectancy in the UK, about the monumental impact austerity has had, and continues to have, on life expectancy.

They discuss the real-life stories of people affected by austerity policies, the reasons austerity is often sidelined in official health reports and the steps that need to be taken to reverse the horrific effects of these last 14 years.

Listen to the podcast here, or on your favourite podcast platform:

Scroll down for shownotes and transcript.

David Walsh is Senior Lecturer in Health Inequalities at the University of Glasgow and previously Programme Manager at the Glasgow Centre for Population Health. Gerry McCartney is Professor of Wellbeing Economy at the University of Glasgow and Honorary Consultant in Public Health at Public Health Scotland.

Social Murder? by David Walsh and Gerry McCartney is available on the Policy Press website. Order here for £19.99.

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SHOWNOTES

Timestamps:

Transcript:

(Please note this transcript is autogenerated and may have minor inaccuracies.)

Richard Kemp: You’re listening to the Transforming Society podcast. I’m Richard Kemp, and on this episode I’m joined by David Walsh, senior lecturer in health inequalities at the University of Glasgow, and Gerry McCartney, professor of wellbeing economy, also at the University of Glasgow. David and Gerry’s latest book, ‘Social Murder?: Austerity and Life Expectancy in the UK’, published by Policy Press, goes deep into the last 14 years of austerity policies and the devastating effects they’ve had on people across the United Kingdom.

When you think of austerity policies, perhaps the two child limit comes to mind, or the cap on benefits or even the bedroom tax. In reality, as David and Gerry explain, austerity is in everything. It’s so pervasive that in 2012 annual life expectancy stopped increasing for the first time since the 1920s, David and Gerry’s book provides the data behind the claims, but it also tells the heartbreaking human stories of people let down or ignored by a system that’s been cut to within inch of its life.

It’s a scathing critique of the systematic slashing of services, but it also provides hope through what can be done to reduce health inequalities and turn things around before it’s too late. David Walsh and Gerry McCartney. Welcome to the Transforming Society podcast.

Gerry McCartney: Thank you.

David Walsh: Thanks, Rich.

RK: Thanks so much for coming on today. Let’s, let’s get let’s get right into into your book from from the start actually. At the start of your book, you quote Frederick Engels, who first coined the term social murder in 1845. David, can I ask you first? What is social murder and how does this relate to the condition that the UK is in today?

DW: Yeah. Thanks, Rich. It’s a it’s a good and important question. It’s worth taking a quick step back. I mean you’ve outlined what the book’s about there. But without a kind of visual guide, it’s quite hard for people to understand the actual scale of the changes to life expectancy and death rates that we’ve seen in the UK. I mean, absolutely staggering changes in terms of, you know, mortality rates that have come down decade after decade, after decades have basically gone into reverse in poorer parts of of, you know, across the whole of the UK.

So that means people dying younger, dying in increasing numbers, and that just shouldn’t be happening in the really wealthy society. So we chose the the title carefully. And social murder was a term used famously by Friedrich Engels as you mentioned. And he was a philosopher, social scientist, author, and many, many more things. And one of his more famous works was a book called ‘The Condition of the Working Class in England’, and he wrote this when working himself in Manchester at the height of the Industrial Revolution, and he used that term to describe the appalling living conditions and also working conditions that existed in that city at that time, and also in lots of other industrial cities back in the 19th century. And those conditions led to equally appalling dying conditions because the city was characterized by horrifically high levels of premature mortality, including child mortality. And so that’s what he was using that expression to describe, and his anger was directed at both the factory owners and the private landlords who were profiting from the conditions that people were living in and dying in.

But also more broadly at a society that was allowing those conditions to exist and to persist. And it’s with regard to that kind of latter aspect, that the term social murder has now been used in different for different arenas. So in relation to wherever decisions made by people in power, have led to harm, have led to the deaths of, of individuals, of, of people, of the population.

So it’s been used in relation to, for example, the Grenfell fire in London, particular government’s responses or lack of responses to the Covid pandemic, for example. And then different aspects of health inequalities, because health inequalities themselves are political and it’s also been used in relation to austerity policies, because the austerity policies that you talked about at the start of this podcast have been pervasive and pernicious in terms of astonishing cuts to the income of individuals, in terms of cuts to Social Security that you mentioned, and also cuts to services, really key important services that people depend on.

And in combination, they’ve had an absolutely horrific impact on the health of the poorest and most vulnerable population in our society. So in the book, what we do is we lay out the evidence for what has happened, and we ask the question, is this another form of what Engels referred to as social murder? And we leave it up to the reader to to decide.

RK: Thanks, David. I want to look into the cuts a little bit more that you just mentioned there. The conservative leaders, they told us for years that austerity was and austerity is necessary for improving the UK economy and also the lives of citizens. The sheer volume of cuts that you lay out in in your book are staggering. You show how the amount they defunded equates to the GDP of Latvia, which seems absolutely insane.

And but we’re not even all better off for it. In fact, as you point out throughout the book, we’re much worse off. So why were these cuts made?

GM: So it’s worth just reminding ourselves what the background context for this was. So in 2007/8, there was the global financial crash caused by the banks, you know, in the predatory lending processes that they had engaged in for for decades. And when that came crashing down, you know, there was a sort of world economic crisis. And initially in the government responses across the world were to try and, you know, cancel those debts, find ways of funding and keeping banks alive.

And that involved quite a lot of government borrowing and government money creation. So back at that time, people were quite familiar with the terminology of quantitative easing, in which is the creation of money by governments in order to sort of recapitalize the banks. And that broad political approach, that broad economic approach lasted between 2007 and 2010 across most countries.

There were some exceptions. So Iceland did things a little bit differently. Some countries were treated a little bit differently, but that changed quite dramatically in 2010. So the global financial institutions such as the International Monetary Fund and the World Bank, they were pushing a particular policy approach where they were quite worried about the levels of government debt at that point.

And this was supported by some economic academics and famously Rogoff and Reinhart who published a book around that time, which stated that government debts, if they got too high, which would provide a drag on economic growth rates. And so the the logic was that if you kept government debts low, this would avoid so-called crowding out where available investment wouldn’t be able to go to the most productive activities and that would slow economic growth rates.

Now this was a sort of a political approach as well. So there was a lot of contestation amongst academic economists at this time. So lots of other people were proposing that this was the wrong economic approach. If you were interested in maximizing economic growth. So famously, Mark Blythe wrote a book about austerity being a dangerous idea, there was a team of economists based at the University of Cambridge who were very critical and many, many others.

And they in total were sort of proposing a more Keynesian approach whereby at a time of economic downturn, it was important for governments to borrow, to invest in the economy and invest in the population, invest in public services in order to keep economic growth rates high. Now, although economic growth as a measure, this is very, very far from ideal and it measures good and bad and lumps them all together.

What did happen with the imposition of austerity in the UK and across many other countries from 2010 onwards was that that depressed the economic growth rates and it depressed them to the extent that the IMF actually changed its policy approach about 5 or 6 years later and said, well, no, actually this has been shown not to work. And actually governments need to borrow to invest.

So you’re right, there was a kind of an economic sort of argument at the time. But it was also quite profoundly ideological. So there was this debate, different political parties proposing different approaches. But the austerity approach was certainly supported by these international financial institutions. So in 2010 in the UK, it was a conservative Liberal Democrat coalition that was elected into power.

And famously, George Osborne had an emergency budget. And he quite explicitly started to blame people on low incomes for the financial problems of the country, and particularly targeting those who were in receipt of Social Security benefits, particularly the working age population. And that led to a whole raft of cuts and also in the real term values. So after taking into account inflation, the value of those Social Security benefits.

But it also introduced a series of higher conditions for the receipt of those benefits. So that made it more difficult for people to get the money they needed to to live healthy and productive lives, but also in the UK in particular, those cuts were implemented as reductions in funding to local government. And the worst affected areas were the areas that were already poorest in the north of the country and then more urban areas.

And of course, local government is what provides many of the public services that we rely upon, whether it’s housing or transport services or social security or leisure or education. And these were all cut quite dramatically over the subsequent years. And as we lay out in the book, these were all important pathways leading to health and health inequality consequences.

RK: Yes. Thank you, Gerry. Can you, can you go into a bit more about the actual cuts by name? Because I remember when when austerity was was first being introduced and we were hearing things about, for example, the bedroom tax. And as someone who doesn’t own his own home, when I first heard about the bedroom tax, I thought, oh, okay, someone who can afford a second bedroom, they’re going to pay a bit more towards their home. That doesn’t seem so bad to me. It seems kind of fair, but in your book you talk about the bedroom tax and you also talk about the benefit cap and the two child limit. And, and there’s one about solo parenting that I remember as well.

But with the bedroom tax that it it’s it doesn’t it affects you just said yeah at the end at the end about affecting poorer people. And this is a perfect example of affecting poorer people. Can you explain that one please.

GM: Yeah. So with the exception of pensions, almost all social security in the UK is targeted towards people on low income. So even if somebody has a slightly bigger home than they perhaps might need a particular point in time, they’re still on a low income and where restrictions were made on, for example, the benefits that people could get if they had a room that was not being used at that particular point in time, that didn’t mean that their costs where any less.

So what it just meant was that their income was going to be cut for the below what they were actually needing at that time. But the list of cuts and changes to Social Security is really, really long. So we’re quite limited in the number of studies that we can do on the impacts of Social Security cuts, because the DWP, the department for Work and Pensions has always resisted us being able to use their data and and linkage studies to examine the health and health inequality impacts.

But from panel studies like understanding Society there is some ability to look at some aspects of changes to to benefits, one of the most pernicious I would identify is actually the sanctioning of benefits. So this is where people would have their entire or a proportion of their benefits withdrawn for a period of time if they were found not to meet a particular criterion put down by the Department for Work and Pensions.

So, for example, if you were in receipt of employment support. So if you were out of work and looking for work in what we would previously have known as Jobseeker’s Allowance, but these things were bundled up into Universal Credit. But if you were late for an appointment with an adviser at the DWP office, you could be sanctioned of some or indeed all of your benefit if it was a repeat offence.

And we know people who were sanctioned from their benefits because the bus was late and this would happen recurrently, and this would mean that people would be living without any state income for six months or even a year. And the consequences of that on people’s health is simply devastating. And explains why so many people were put into destitution, and indeed were relying then on charitable donations in order to feed themselves and their families.

RK: Wow, thank you, Gerry. David, did you want to add on that?

DW: I was just going to add to Gerry’s first point there about the sheer scale of it all. Again, there’s not there’s not time here to go into it all. And there wasn’t actually space in the book to go into all the detail, but it’s worth just thinking that, you know, austerity was introduced in 2010 by the conservative Liberal Democrat coalition government.

And in that first parliament alone, there were about 150, I think maybe more than 150 so called welfare reforms. So changes to Social Security eligibility, particular benefits, so it’s that sheer scale of it that has impacted on the poorest populations so much. We include some of the figures in the book, but there’s been different estimates about the scale of the reduction in government spending generally and specifically within the social Security budget.

But whatever figures you use, it’s virtually unimaginable in terms of of that scale. So some estimates say that by 2019, the the annual, so yearly, amount of government spending had been reduced in comparison with 2010 by about 91 billion. So that’s every single year. Within that social security, the estimates about, around the cuts to Social Security range from about 26 billion per year.

But that’s judged to be probably too low, up to about 56 billion. Other estimates are around 47 billion, 37 billion. In a way it doesn’t really matter. The point is these are huge, huge, huge numbers. And they’ve impacted horrifically on really, really large sections of the population who were already struggling. Because the context of this is also the the UK compared to other high income countries.

And many European countries already had very low levels of social security. So, so the system was already not great compared to elsewhere even before all these cuts.

GM: And it’s worth also just saying that these cuts have not been reversed so much as the new labor government have come in over the summer and they’ve announced some changes to things like local government funding, which are, you know, better than what has gone before. There’s been very little that has improved the situation in relation to Social Security benefits.

And indeed, there seems to be an ongoing narrative which blames those who are out of work for their own poverty. It blames, you know, individuals for being unable to find work, and it seeks to use the the Social Security system, to punish those, to try and coerce or force or encourage those people back to work. But in the UK, although unemployment remains, you know, too high in a sense it is much lower than it is in other countries.

And yet we already have a very stingy welfare benefit system. So, yeah, if we’re to really protect the populations who need it most, we need to get rid of benefit sanctions, and we need to increase the real term value of social Security benefits back up to a level that’s commensurate with any sort of healthy life.

DW: And just one final point, Rich, just because you specifically mentioned the bedroom tax. So the issue with that was that somebody who as Gerry said would already be in a low income, might have had a spare bedroom, and they were then punished for that. But it’s not like in lots of areas, there was all this available social housing for people to move into, there’s the whole issue around availability of decent, quality housing is you know, hugely problematic across all of the UK.

So it’s not that people could just decide, okay, I’ll move to a smaller house, that that possibility just wasn’t there in the majority of cases. So it was just another way that they were targeted and had money cut for, you know, something that wasn’t their fault.

RK: How much of all these cuts that are punishing the poor that you explained today and also in your book, how much of that is is it thoughtlessness? Is that what’s leading? Is that what led and is leading to this? Can you explain a bit on that?

GM: I mean, it’s difficult to be sure what is going through the head of politicians when they make these kinds of decisions. But I suppose in the past we would have had people from working class backgrounds who were directly represented within Parliament, and they were organized through trade unions and community organizations, and that those forms of organization have been damaged and are much more threadbare than they have been in the past.

And so it’s difficult to see how the interests of those who are most disadvantaged are best represented in Parliament. And so it does seem that there’s a there’s a greater distance between politicians and the, you know, large parts of the population now. But also I think there is an ideological element to this that can’t really be avoided. So there is a sort of dominant ideology now that dictates that low taxes are a good thing, that a smaller government, a smaller range of public services should be funded and that people should be less dependent on the state for different aspects of their life.

And that’s a that’s a change from what we had for example, back in the 1960s and 1970s in the UK. And it’s and it’s different from what you see in much of continental Europe, where there is a, you know, a larger government, there’s a larger role for public services, there’s much more progressive taxation, and the state provides for its populations and ensures that everybody has what they need to to remain healthy.

And so there’s there’s very little political opposition to that in Parliament nowadays. So although there are minor differences between political parties around different aspects of policy, there’s also a vast amount of agreement about, for example, keeping Social Security benefits at low levels. And, keeping public services at a sort of more minimalist level.

RK: You preface every chapter of your book with the real life story of someone affected by austerity policies. I found Moira’s story particularly harrowing. Victim of severe domestic abuse while her three daughters slept. She arrived in hospital with blunt trauma to the back of the head. How was Moira…Or actually can you explain, can you explain a bit more about Moira’s story, and then also how she was treated through the austerity process?

DW: Yeah, sure. So as you say, every chapter in the book is prefaced with, the story of real people who have been affected by these policies. That’s important to do anyway. But we also tried to include stories that reflected the different aspects of austerity. People were affected in different ways by different components of austerity, if you like.

Moira, was a Scottish woman who moved down to the Midlands of England as a young girl and she trained, qualified and then worked as a nurse as you mentioned, she was married to an abusive man and subjected to an unimaginably horrific attack. I won’t go into the details here, but the consequences were that her husband was jailed and then she was left with long lasting injuries.

And there’s a couple of aspects of this whole story that I think are important, and I’ll reflect back on them just in a second. One of them relates to the fact that she, when she came out of hospital with injuries she could have actually signed on for Social Security benefits, could’ve been signed off as sick, but she refused to do so because she loved her occupation as a nurse, and she wanted to work to, you know, make a living for for looking after her three young children.

But later in life, when she was in her 50s, these injuries basically caught up with her. And at that point she was forced to give up work and had to turn to the state for help. She then needed needed help. We’ve talked about the different aspects of austerity in relation to Social Security. What it meant was that there were cuts in terms of the levels of Social Security, but also they were increased punishments.

These sanctions that Gerry mentioned. And what happened to Moira was that she was unable to attend an interview in relation to the Social Security claim because she was very ill. And at that point her money was therefore cut off and she was sucked into a really just a horrific experience with a kind of uncaring system. And the net effect of that was that she suffered huge amounts of health damaging stress.

I won’t…the details are in the book, but it was, it was an absolute nightmare for her and her family. Moira died when she was 61. She died from cancer. But as her daughter Nicole pointed out, very movingly, the time, that that could have been spent with Moira and her children was cut short, very short. As a result of all that additional stress that was created by the Social Security system.

And that and basically hastened their death. And I think that there are I mean, there are many important points from that story. Two particular key ones are when when the austerity policies were introduced back in 2010, they were accompanied by a fairly vitriolic campaign, partly by people in the government, but echoed by people in the media, which basically demonized a lot of people on benefits.

You’ll remember, and it still happens today, words like scroungers and skivers getting thrown about and absolutely baseless because a lot of research has gone into that shows absolutely no evidence to support that. And actually, in Moira’s case, you couldn’t really find someone for whom those terms were more inappropriate, given this was somebody who, you know, was was committed to working to looking after a family, did not really want to claim Social Security benefits until it was a necessity.

And the second point is, is that, you know, in a civilized society, when people do need help from the state, they should receive it. And in Moira’s case, when it came to the point to ask for help. Not only was she not given help, in a way she was attacked by the system. You know, it created even more stress for her and added to older problems.

So I think there are those really important key points about this whole story. And I think Gerry used the word pernicious earlier, I think there’s elements of perniciousness in the whole system. As a kind of postscript, to the whole unfairness of all of all this the family made an appeal terms of what has happened with the DWP withholding her money, and they won the appeal and, the money was reinstated.

But by that point, Moira was had already passed away several months earlier. And when it was pursued with politicians, they were told from people in power that they were perfectly happy with how the system had operated. So I think it gives you again a little bit of insight around some of the policies we’ve been talking about.

RK: Does that also speak to kind of the ideology as well in terms of like their conclusion at the end, the government is we are happy with the way that the process we are satisfied with the way that the processes proceeded. They did the things in the, in the, in the right order that we have deemed correct. And and does that does that also kind of speak as like an ideological thing too.

DW: Yeah, I mean, it’s difficult to comment on how somebody responded when asked the question about the system, but obviously they’re not going to stand up at that point and say, yes, we agree with we’ve we’ve made an absolute mess of things. So politicians will always defend what has been done. I think I think the key points are just about how the system doesn’t do what it should do.

As I said in a civilized society, that’s the system should accept that somebody is in need, somebody is vulnerable and should be helped, and it’s not a system that should basically be turned on them, you know, ramp up the stress, the experience. And I’m not going into all the details here, but it’s a truly, truly miserable story. And it’s not an isolated story.

That’s the other point. You know, we’ve we’ve we’ve taken seven individuals to illustrate, as I said, different aspects of austerity. But when you start researching this and looking into it, you know, the number of people affected in this way is absolutely enormous and it’s appalling, it’s appalling.

RK: Yeah, I was quite I was quite shocked by just the numbers of stories, stories and also the statistics of people who are living, quote unquote, normal lives. And then they get sucked into the system of austerity and they and they end up becoming they end up becoming one of those stories that then, as you said, the, the, the press end up labeling as scroungers.

It’s, kind of it was I mean, yeah, every every one of those stories was heartbreaking. and it, it just kind of it was quite scary reading all these stories as well, just to think that these aren’t just these aren’t just like people who are destined to to become down on their luck. Any any one of you could become one of those people. Yeah. Truly terrifying.

DW: Yeah. And as I said, we tried to choose stories that were reflective of different aspects of austerity and some of the ones around people who had disabilities. And part of the Social Security reforms were about, they ramped up the kind of assessments to see if people were fit for work. And an awful lot of people who are clearly not fit for work were told they were fit for work, and if they didn’t work, had the money taken away.

And when researching some of those stories and speaking to a 1 or 2 families and looking at what’s out there, the number of people in that category, it was astonishing the number of stories out there, people who were clearly not well enough to work and again, clearly needed help and support. But the opposite happened. The number of these stories was was astonishing.

RK: In in one chapter, you you look at austerity measures in other countries outside the UK, in the Netherlands, they coined the term for the fact that volunteer organizations needed to step up and and fill in the gaps. They called it participation Society. Can you explain this term of participation society in terms of, the increase of food banks in the UK?

GM: Yeah. And I suppose that the term that people will be more familiar with in the UK is the big society. So this was a term used by David Cameron when, when he was prime minister. So this was, this was part of this broad sort of vision that politicians had during the 2010s, where they wanted the size of the state, they wanted the number and quality of public services to be reduced.

And they sort of argued that what would fill this gap of, of unmet need in the population would be the civic society or volunteers or, you know, good people lending a hand would somehow provide the range of public services that people would no longer have access to through local government and central government. And so this was the idea of the big society, and it was framed as this kind of, you know, we’re all in it together, we can all help one another.

We can all have, you know, a strong social fabric in our communities. And that will be, to everybody’s benefit, a sort of almost, you know, war mentality that, you know, help, help your neighbors. And there’s something in that that I think we can all sort of reflect on and say, well, you know what that that’s a good thing. It we we all should look after our neighbors.

That’s is not a bad thing to be volunteering and contributing in your, your local communities. It’s not a bad thing to have a, you know, a strong civic society where, you know, we all contribute in different ways to to helping one another and creating a sort of better sort of neighborhood. But that’s absolutely no substitute and can be no substitute for good public services or indeed the incomes that people need.

So relying on charity to have people fed or to have the public services that people need or the incomes that people need is, is, you know, it’s always going to be a disaster. People will always fall through those cracks. It’s very stigmatizing. It relies on people who are already stretched and strained to provide that form of welfare. And it’s just hugely problematic in so many different ways.

And the fact that it was kind of dressed up as a sort of positive sort of community development approach is is almost as damaging as the actual reality, because, of course, you know, building a sort of strong community and civic society and, and charitable organizations in parallel with a strong state and well-funded public services could be really important.

But to do that as a substitute, at the same time as these public services were being cut and as people’s money was being cut, and they were basically being asked to go and then use food banks to feed themselves, it’s just horrific. And we make a point in the book that food banks in the UK are a really new thing, there was only a handful of food banks before 2010 across the whole of the UK.

Now you go to every town, village, housing scheme across the country and you find the food bank. Every supermarket has a sort of container at the exit, where people are invited to put, you know, durable goods and to to feed their fellow citizens. And there are queues at food banks across the country every week now. And that’s not that’s not the the Britain or the Scotland or the country that I recognize or that I’d want to live in.

That’s that’s a marker of utter failure. And it’s the sort of the, the visual compounding of this. When we had ministers, government ministers at this time, proudly going to the opening of local food banks, as if this was some sort of successful volunteering initiative, instead of a marker of how awful they had made the lives of the citizens that they were put in Parliament to represent. I think it’s just unbelievable and staggering.

RK: Absolutely. When, when, when looking, reading through your book, I, I’d forgotten that food banks were new until until reading your book and being reminded that that this is such a new thing. And it’s a horrific thing as well, that the people yeah, people have to that, that, that this, that, that this should be a need at all. Just seems plain wrong.

DW: Yeah. I think as Gerry has alluded to, it’s the normalization of it now that’s so terrifying that as if it’s a normal part of society, when it’s only 14 years ago, that they were on basically the periphery of society and this has been looked at in various bits of research done that has quantified this. But even if you just look at some of the data from the Trussell Trust, which is only, it’s one of the biggest food bank providers, but only one of them, I mean, it’s absolutely astonishing.

Back in 2010, the number of kind of food parcels was in the, I think, maybe tens of thousands across all of Britain by 2019/20 it was around 2 million. And then one of the figures from the Trussell Trust was that by 2021/2, around 11 million people were experiencing what gets referred to as food insecurity in quotation marks. When translated into English, that means people are hungry, you know, and in a country as wealthy as Britain.

And it’s really important to remember that Britain is a very wealthy society. I think that fact gets lost a little bit in discussion, especially from politicians, around, you know, deficits and black holes and all the rest of it. Britain’s an enormously wealthy society. It’s just that that wealth is massively unequally distributed. But for 11 million people to be hungry in Britain today is astonishing and depressing and miserable.

And it’s just not right, is it? I mean, we shouldn’t be. People should be screaming about this. And indeed, this is one of the reasons for doing the whole book is to try and kind of shout about this and say you know, what’s going on. And, you know, what do we need to do to to rectify this? Because this just isn’t right at all.

RK: You give a timeline of research published on austerity. As early as 2012, a study linked austerity to worsening health across Europe. In 2011, a study linked austerity to HIV outbreaks in Greece. So many governments pointed instead to flu as a key reason for declining life expectancies. Even the World Health Organization and Public Health England, did that.

And so and, and this was long before Covid even arrived. Why why have so many institutions that are supposed to protect their citizens ignored the research on austerity?

GM: So, first of all, I should declare an interest in the sense that I was, you know, a key part of that system for a long, long time. So I headed up the Scottish Public Health Observatory team within the National Public Health Agency in Scotland. And so I was involved in a lot of the discussions that happened about these trends up until around 2020 or 2021.

And so I kind of experienced firsthand some of the reasons why this might be the case, but I think further research needs to be done to understand this better. What I would suggest is that there are a number of different things going on. So I think that a lot of people working in these public health agencies are under implicit or sometimes explicit pressure to avoid doing research or publishing work or publishing hypotheses even that might embarrass or undermine different politicians or different governments.

So you get this idea that these these agencies work entirely independently. That’s not the case. So your work plan is discussed with civil servants working on behalf of politicians. And if there’s anything that’s particularly controversial that can be subject to quite a lot of discussion and as I say these kinds of different pressures. And so I suspect that a lot of people working in this area came under those kinds of pressures and therefore were discouraged, either from their own understanding or explicitly from examining some more unpalatable hypotheses and explanations for these changes and trends.

So some things could be sort of explained away as some pseudo natural phenomena. So an influenza outbreak, you know, governments aren’t normally held responsible for influenza outbreaks, albeit there’s actually a lot more than people might think about how these things are handled and and what the impacts of it are. But in a sense, it’s a non-politicized cause, it’s something extrinsic to the control of governments, whereas austerity is obviously a very politicized cause.

It’s something that politicians have decided to do, and therefore it’s a much more challenging area of research for public health agencies to look at and to, to examine and research and write about, because it ultimately could point the finger back towards their their funders and their and their, you know, the governance structures about who’s responsible for this. I think there’s also a sort of, a self-censorship, amongst public health officials at times around this because it’s it’s more difficult to get into those politicized areas, that it becomes more challenging to navigate those relationships with government agencies and officials.

And I think the default has often been to hide behind sort of nonspecific terms. So in public health, we’d often talk about the social determinants of health, which is a sort of catch all term for all the things we talk about in the book. So economic policies, housing policies, welfare policies as well as physical and social environments. And there’s a sort of catch all term.

So you say well you know social determinants might have changed. That might be something to do with the change in trends. Well, yes, but that doesn’t really help you understand exactly what’s happened and what policies need to change to improve the trends. I think there are some other things going on as well. So I think with things like austerity, there’s a sort of fear of being dismissed as a scientist, perhaps as being too ideological or idealistic in looking at this, whereas things like influenza or sort of more statistical kind of analyzes might be seen as more proper and, less risky.

But I also found in all of those discussions that different thresholds for evidence were used. So in public health it can be sometimes quite difficult to generate good, high quality so-called causal evidence, where you can be really sure that some factor is definitely the cause of some outcome that’s quite different from, say, drug trials, where you can do a randomized control trial and examine exposures in exposed and unexposed groups and see what the difference is in outcomes.

But in public health, you’re often relying on observational data. And so you have to do a lot more work to try and triangulate across different sources of information and research in different ways of trying to understand what would have happened had the particular policies not been introduced. And so the threshold of evidence in public health sometimes can be a little bit different from drug trials.

But what I found is that and what we found in the book is that, some hypotheses, like influenza, even though the quality of evidence was really, really poor for suggesting that this was the cause of the change in trends, public health agencies are very happy to put that in reports and suggest that influenza was a cause of the change in trend, but the quality of evidence for austerity was much, much higher.

And when we got into these kind of discussions, people would suggest, no, no, we need a better quality of evidence in order to reach that conclusion for this austerity. And so there was this kind of unfairness. But in truth, people weren’t looking for the evidence. So we list sort of in a sort of chronological way, all of the studies that examined the, the, the role of austerity in explaining the trends and many, many studies were published by the time that these big summary reports were published by the public health agencies.

So there was more than 40 studies linking austerity and mortality trends by the time many of these were were put out into the public domain. But these weren’t cited. So these these studies, weren’t looked for, they weren’t examined. They weren’t read and they weren’t included in the reports. And it was a kind of hear no evil, see no evil approach.

And that just left a lot of room for speculation and politicians exploited that. So again, in the book, we show how various ministers were asked questions by some members of Parliament who were concerned about the change in trends and were concerned about the role of austerity. But ministers were able to stand up and say, well, we have these official reports saying that we’re not clear about what’s caused this.

There could be a number of different factors and more research is required. And that just left ministers off the hook to be honest. And it also did a disservice to the public who frankly, deserve to know what the best quality research is and deserve to know what role austerity played in the change in trends.

RK: If, so we measure economies, you said earlier that the UK is is one of the world’s wealthiest economies, and we’re measuring by GDP, gross domestic product. So the amount of wealth that’s in the country, something something I don’t quite I don’t pretend to be an expert in it, but I but my understanding is that it’s not really measuring the wealth or ability to just kind of live day to day of citizens is that it should like, should we be measuring our economies in a different way? And if we were to do that, would we would we be looking at these kind of austerity studies differently?

GM: So you’re absolutely right. There’s been a huge amount of criticism of the the common measures of economic success and indeed national success, like GDP or gross domestic product. So GDP is a really odd statistic that’s got history, really in trying to ramp up the production of goods and services for war economies. And it counts everything that, you know, a country adds value to.

And it sort of sums that up in some way. But the irony is that it counts the good and the bad in the same number. So if I throw a brick through a window that increases GDP because a glazier is employed to fit the window, and a policeman is probably employed to come and arrest me as well. But all of that is just added up as if it’s all some sort of positive metric.

So there have been lots of different suggestions for better ways of measuring societal progress. Everybody from the OECD to the Carnegie Trust to the Wellbeing Economy Alliance have suggested alternative measures. And these alternatives, more often than not, will include some measures of health, because health’s a really good measure of how well a society is doing, some measures of inequality.

So again, what are the rates of poverty? What are the what are the rates of economic inequality between social groups of different forms within society? That’s really important. But also you know, how ecologically sustainable are we as a society? So if we’re simply just pushing problems into the future and undermining the health of the planet as a consequence, then that’s not really a healthy society.

It’s not a healthy economy. So, and then you can add in things like democracy as well. So how how democratic a society is. So if you look at the countries that do best in the world, if you like, or have got the highest GDP. It tends to be middle eastern oil producing states who gain a lot of income from selling oil and gas.

But these countries tend to have pretty threadbare democratic systems and have high rates of inequality both between men and women and across different social classes. And they’re very, very unsustainable. So I’m not sure if they’re a particularly healthy society in any real sense of the word.

RK: Throughout your book and today we’ve talked about it, I’ve asked you plenty about it I mean, the, the, the effects of austerity, from from leading people to depression to malnourishment and even to suicide in many cases. But in your book, you also offer hope in what can be done. What steps do we need to take to reverse the horrific effects of the last 14 years of austerity?

DW: Yeah, I think it was important to end the book on a more positive note. And so in the final chapter, we try to do that. So throughout the book we present the evidence. Obviously, of what’s happened, the evidence of, of of what’s caused it, the things we’ve talked about, this morning, the dismantling of a Social Security system that, you know, doesn’t really protect people who need help.

The cuts to vital services for people who are in difficulty and need help. So the obvious policy responses are to reverse those things, because the evidence shows that they have caused a huge amount of damage. So, you know, for a new UK government to be in place, we can make the case that it’s really, really important that they understand the evidence, understand all the evidence that’s been laid out in this book, but also in countless studies that we cite in the book, understand what epidemiologists refer to as the causal pathways, and so how those austerity measures have actually damaged health.

The processes that are involved and then act on it, you know, create a social security system that actually does what it’s meant to do in terms of helping people who need help, invest in services to help people who who need those kinds of services. There’s a there’s a broader point around, you know, what we’ve seen is not just these changes to mortality rates, but a massive, massive widening of of inequality, health inequalities, mortality inequalities.

And there’s a related point around, you know, the evidence around what’s needed to address health inequalities. And the important point is that a lot of politicians sort of indicate that it’s, you know, it’s a very, very hard thing to do to narrow inequalities. But actually all the evidence is out there. It’s been published, and lots and lots of things for many, many years.

So we know what we have to do. Generally around health inequalities. We know what we need to do specifically about reversing the harms of austerity. It’s about political will now, it’s about politicians understanding that evidence and then implementing the appropriate actions. In that final chapter we go into a lot of detail, I won’t do it here, around specific policies that are required around lots of things like Social Security, you know, redistributing income around taxation of assets, wealth and all that kind of stuff.

So it’s all laid out there. And it’s also important to say that we didn’t just do this on the hoof. You know, the kind of policy recommendations we make there are based on lots of other policy recommendations that lots of other organizations have made based on the evidence of what’s required. So they are evidence based recommendations that lots of people understand would be effective.

But what it needs now is for government to listen to that and to act upon them.

RK: Well, thank you David. Thank you. Gerry, it’s been an absolute pleasure to talk to you about your book today, and I look forward to it being read by every minister in Parliament, by the way. Before, I’ll let everyone know where they can find your book in a moment, I just want to ask first, is there anywhere we can find you online?

GM: So I’m still a refugee on what’s now called X so @GerryMcCartney1. But, how much longer that will remain the case? I’m not sure.

DW: I avoid all social media like the plague, but I work at Glasgow University so anybody can find me and drop me a line. What I would just say, in case we are accused of being hypocrites. Is that all the royalties from this book go not to us, but to NHS charities. So we encourage people to have a look at the evidence by buying the book and yes, and then send it to the local MP.

So maybe they can understand the evidence too.

RK: That’s great. Thank you. ‘Social murder?: Austerity and Life Expectancy in the UK’ by David Walsh and Gerry McCartney is published by Policy Press. You can find out more about their book by going to policy.bristoluniversitypress.co.uk and also transformingsociety.co.uk.