Cuts to local government funding and stalling life expectancy
Authors: Dan Lewer, Jo Bibby
Journal: The Lancet Public Health (2021)

Local authorities in England provide a huge range of services that contribute to health and wellbeing, including care for vulnerable children and adults, road maintenance, refuse collection, parks, libraries, and sexual health services. Between 2010 and 2017, government funding for local authorities halved.1National Audit OfficeFinancial sustainability of local authorities 2018.https://www.nao.org.uk/wp-content/uploads/2018/03/Financial-sustainabilty-of-local-authorites-2018.pdfDate: 2018Date accessed: May 14, 2021Google Scholar As a result of these cuts, spending has become more narrowly focused on statutory responsibilities, such as social care, with other services falling behind. Two of the hardest-hit services which have a crucial role in people's health and wellbeing are housing, including support for people who are homeless, and treatment for drug and alcohol problems. Councils commission charities and NHS organisations to provide these services and many are now struggling financially.2St Mungos, Homeless Link, WPI EconomicsLocal authority spending on homelessness.https://www.homeless.org.uk/sites/default/files/site-attachments/Local%20authority%20homelessness%20spending%202020.pdfDate: 2020Date accessed: May 14, 2021Google Scholar, 3Advisory Council on the Misuse of DrugsACMD warns ministers of falling local funding for drug treatment services.https://www.gov.uk/government/news/acmd-warns-ministers-of-falling-local-funding-for-drug-treatment-servicesDate: 2017Date accessed: March 18, 2019Google Scholar Meanwhile, the estimated number of homeless deaths increased by 64% between 2014 and 2019,4Office for National StatisticsDeaths of homeless people in England and Wales: 2019 registrations.https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsofhomelesspeopleinenglandandwales/2019registrationsDate: 2020Date accessed: May 14, 2021Google Scholar and the number of drug misuse-related deaths increased by 35% between 2013 and 2018.5Office for National StatisticsDeaths related to drug poisoning in England and Wales: 2019 registrations.https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2019registrationsDate: 2020Date accessed: February 2, 2021Google Scholar The reduction in local government funding has been unequal across the country, with greater cuts in more deprived areas and in the north of England. Governments, including the UK, recognised in the Ottawa Charter for Health Promotion6WHOOttawa charter for health promotion.https://www.euro.who.int/en/publications/policy-documents/ottawa-charter-for-health-promotion,-1986Date: 1986Date accessed: May 14, 2021Google Scholar that people's health depends on stable public services and a clean physical environment. The Health Index, which includes green space, housing, noise, crime, air pollution, and other community resources provides insight into how well these conditions are being met.7Office for National StatisticsDeveloping the Health Index for England: 2015 to 2018.https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/articles/developingthehealthindexforengland/2015to2018Date: 2020Date accessed: May 14, 2021Google Scholar The Health Index shows that in many places in England, the potential to lead a healthy life has diminished between 2015 and 2017. This points to the ambitions of the Ottawa Charter being unfulfilled in England, and suggests that disinvestment in local government could adversely affect people's health, both in the short term and longer term. A new analysis by Alexandros Alexiou and colleagues8Alexiou A Fahy K Mason K et al.Local government funding and life expectancy in England: a longitudinal ecological study.Lancet Public Health. 2021; (published online July 12.)https://doi.org/10.1016/S2468-2667(21)00110-9Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar published in The Lancet Public Health looks at the relationship between cuts in local government and mortality rates. Concerning trends in mortality rates in England have already been observed.9Public Health EnglandA review of recent trends in mortality in England.https://www.gov.uk/government/publications/recent-trends-in-mortality-in-england-review-and-data-packsDate: 2018Date accessed: May 14, 2021Google Scholar Over the past century, life expectancy increased by around 3 years every decade. In the past 10 years, this steady improvement has ground to a halt. In some specific groups, such as the rate of death due to chronic lung disease among women living in the most deprived areas, mortality rates are actually increasing.10Lewer D Jayatunga W Aldridge RW et al.Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study.Lancet Public Health. 2020; 5: e33-e41Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar There are various competing theories about the underlying reasons for these trends, which are the subject of much debate. The study by Alexiou and colleagues8Alexiou A Fahy K Mason K et al.Local government funding and life expectancy in England: a longitudinal ecological study.Lancet Public Health. 2021; (published online July 12.)https://doi.org/10.1016/S2468-2667(21)00110-9Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar makes a useful contribution to this debate. Their study uses thoughtful methods to compare central government funding cuts to local authority-level mortality rates. It controls for the national trend in mortality and changes to local population sizes and economies. The results show that areas with the biggest cuts tended to have smaller improvements in mortality rates. The article estimates that cuts to local government between 2013 and 2017 were associated with a reduction in national average life expectancy by about 2 months, equivalent to 9600 premature deaths (about 1% of all premature deaths, by our calculation). Isolating specific drivers of life expectancy is difficult for two reasons. The first is that these drivers play out over long periods of time. Since 1980, life expectancy at birth has increased by 9 years for men and 6 years for women,11Office for National StatisticsPeriod expectation of life (ex), by single year of age.https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/datasets/periodexpectationoflifeexbysingleyearofageDate: 2020Date accessed: May 14, 2021Google Scholar largely because of reductions in deaths due to heart disease and stroke. These diseases have long latent periods and life expectancy today is therefore affected by events that happened many years ago. Life expectancy (which is a misnomer, and is really a summary of today's mortality rates rather than the age people alive today can expect to die) reflects the life experiences of the population, and particularly the lives of older people, among whom most deaths happen. Life expectancy is the result of the social and economic history of the past century—the prevalence of smoking, treatment for cardiovascular diseases, road safety, housing quality, safety of childbirth, and many other social changes. Life expectancy is a useful indicator because it is simple, but it also brings together a wide range of long-term changes in society. Therefore, differences in life expectancy across the country might relate to trends that predate funding cuts. A second reason why the relationship between local government funding and mortality could be difficult to study is that the effect of cuts might be concentrated on certain groups within local authorities. The method used by Alexiou and colleagues8Alexiou A Fahy K Mason K et al.Local government funding and life expectancy in England: a longitudinal ecological study.Lancet Public Health. 2021; (published online July 12.)https://doi.org/10.1016/S2468-2667(21)00110-9Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar uses mortality rates for the whole population of local authorities. Cuts to local services might disproportionately affect certain subgroups, such as people who are homeless or those seeking help for drugs and alcohol. Within these subgroups, the effects of cuts might be much greater. Whatever the exact contribution of local government cuts to trends in life expectancy, this study shows that funding has been cut in areas of the country that need it most. This finding underlines the importance that the current government, and its MPs who represent many of these disadvantaged constituencies, put health improvement squarely within its agenda to Level Up deprived areas of the country. We declare no competing interests. Local government funding and life expectancy in England: a longitudinal ecological studyOur findings indicate that cuts in funding for local government might in part explain adverse trends in life expectancy. Given that more deprived areas showed greater reductions in funding, our analysis suggests that inequalities have widened. Since the pandemic, strategies to address these adverse trends in life expectancy and reduce health inequalities could prioritise reinvestment in funding for local government services, particularly within the most deprived areas of England. Full-Text PDF Open Access