By Rosie Duffield, MP for Canterbury and Whitstable

When we think of healthcare, we tend to think of hospitals and nurses and medicines and ambulances. This isn’t wrong, of course, but it is in some ways reductive. These things might nurse us back to health when we get sick; but the things that keep us healthy are far, far broader. Green spaces and libraries; good employment and quality housing; being free from stress, able to spend time with family and friends. In short, the public realm has a lot to do with our health and wellbeing, a relationship reflected on in the 2010 Marmot Review into health inequality in England. However, over the last decade of Conservative rule, austerity has taken its toll on the public realm - and, as a result, the health of the nation itself.

Cuts are a political choice, as is the decision for such changes in funding to fall differently in different places. It is the wave of cuts we saw in the last decade, settling themselves unequally over the county, which have been the primary driver behind the shocking results of the Marmot Review’s re-visit a decade later.

Life expectancy has halted for the first time in a century and amongst some groups, most notably poor women, it has in fact decreased.

“It is shocking,” says Sir Michael Marmot, the director of the UCL Institute of Health Equity, from whom the review takes its name.

This is about cuts to our NHS, yes; but it is also about cuts to council services and everything from fewer Sure Start centres to bigger class sizes. Our social fabric is threadbare, and it is our health that is suffering as a result. Under successive Tory governments, we are living more difficult lives, something borne out by the numbers - and it is a burden being borne unequally.

We hear a lot about the new Conservative “Blue Wall” seats and about “levelling up” across the UK’s regions. This is an admirable aim, but the record of the Prime Minister’s party in government is nothing less than one of steadily, precipitously increasing inequalities between the regions – as is shown out in data on life expectancies across the regions.

Covid-19 will cause us to confront a number of these inequalities head on. The gig economy, zero-hours contracts and earning thresholds mean around two million workers are ineligible for statutory sick pay. It is unacceptable that some of the lowest-paid workers who may need to self-isolate over the coming weeks may - in the absence of any government action - be forced to make a choice between their health and financial hardship.

As Sir Michael points out, health inequality is the sibling of economic inequality; the two are deeply intertwined and a social safety net so shot through with cuts that it is unable to secure even stable life expectancy will not be able to “level up” economically. To be prosperous, people need to be healthy; but for me, health is a greater inherent good than economic prosperity, and public health is the cornerstone around which we should build this country’s recovery from a debilitating decade of austerity.

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