In her opening speech as the new British Prime Minister, Theresa May highlighted the great inequalities in health in the UK including the large life expectancy gap of nine years between boys born in the richest neighbourhoods and those born in the poorest. Media commentators have also drawn parallels between her speech and her desire to heal these health divides, to that of Mrs Thatcher when she became Prime Minister in 1979 and used the prayer of St Francis. Theresa May has also drawn parallels between herself and Mrs Thatcher - not least in her first stint in Prime Minister's questions. So, will Theresa May succeed in reducing health inequalities? Unfortunately, the lessons from the past and from the Thatcher era in particularly are not promising - they suggest strongly that not only will Theresa May fail to reduce health inequalities, but that, if she pursues similar policies to the Conservatives in the 1980s, new Labour in the 1990s or the coalition government's austerity agenda, then she is very likely to actually increase them during her term of office.
Babies born today in the most affluent areas of the United Kingdom, such as Kensington and Chelsea, can expect to live many years longer than that those born in the poorest areas, such as Glasgow or Blackpool. Men and women in the North of England will, on average die 2 years earlier than those in the South. Scottish people also suffer a health penalty with the highest mortality rates in Western Europe. Whilst health inequalities such as these have been observed since the early 19th-century, they decreased in the post-war period before increasing significantly in the 1980s. The Scottish health effect (whereby Scotland, particularly the West of Scotland has significantly worse health than other parts of the UK) increased in the early 1980s as a result of rapid increases in the diseases of despair - suicide, alcohol-related mortality and drug-related deaths. The North-South health divide in England was also exacerbated in this period and the gap in life expectancy between the richest and poorest areas also increased.
In my new book, Health Divides: where you live can kill you, I show how the welfare cuts enacted by successive neoliberal governments have contributed to these increased health inequalities. The Thatcher "reforms" of the 1980s, many of which were continued under subsequent governments, reduced the social safety net which protected the health of the poorest in the post-war period, reduced the influence of trade unions in terms of negotiating better wages and working conditions and the commitment to full employment was abandoned resulting in millions of people and whole communities feeling left behind. These negative social and health trends are similar in other neoliberal countries, such as the US or New Zealand. There is also emerging evidence that austerity (itself the consequence of neoliberal policy choices, in particular the deregulation of financial markets and institutions by the Reagan and Thatcher governments in the 1980s) is beginning to have unequal impacts on the health of the nation with welfare and local authority budget cuts particularly hitting the Northern and deindustrial areas.
But, there are alternatives: health inequalities were reduced during the period of welfare state expansion and full employment in the UK from the 1950s to the 1970s and in the US during the 'war on poverty' instigated by President Lyndon Johnson (LBJ) in the 1960s. In my book, I outline the evidence for how an alternative politics leading to a more inclusive welfare state, publicly provided services and stronger work and employment rights can lead to public health improvements for everyone - whether they are rich or poor, Northern or Southern, Scottish or English.
So will Prime minister May take a healthy approach to economic and social policy? It seems unlikely given her pro-welfare cuts voting record as an MP and Conservative minister. Likely, there will be a policy focus on interventions aimed at changing individual health behaviours as these blame people for their own health problems, thereby letting governments and businesses off the hook for the wider economic, social and environmental determinants of health inequalities.
There is little evidence that such lifestyle interventions are effective in reducing health inequalities - as my book shows, most of the health gains over the nineteenth and twentieth centuries were brought about by far-reaching economic, political, and social reforms.
So for Mrs May to be successful in her desire to unite and heal the nation, she will need to become more like President Johnson and less like Mrs Thatcher.
Clare Bambra's book Health Divides: where you live can kill you is available now from Policy Press priced £12.99Suggest a correction