Has austerity reversed decline in infant mortality?
Author: Louise Prime
New Labour policies to reduce inequalities between the most deprived areas of England and the rest of the country were associated with a reduction in infant mortality rates (IMR), a new study* has shown. But, said the authors in the Journal of Epidemiology & Community Health, the austerity policies of the current Conservative government might be undermining these because the trend towards decreasing inequalities has stalled.
The Newcastle University-led researchers explained that following the election of the New Labour government in 1997, the English health inequalities strategy (1999–2010) – “one of the most ambitious strategies of its kind” – aimed to reduce health inequalities between the most deprived local authorities and the rest of England via measures including increased investment in healthcare, the early years, education and neighbourhood renewal. They designed a study to investigate whether the strategy was associated with a reduction in geographical inequalities in IMR.
They used segmented regression analysis to measure inequalities in the IMR between the most deprived local authorities and the rest of England before, during and after the health inequalities strategy period.
They found that for both the most deprived local authorities and the rest of England, there has been a decline in the IMR over time. For the most deprived local authorities, the average IMR has decreased from 10.53 deaths per 1,000 live births in 1983 to 4.36 deaths per 1,000 live births in 2017, while for the rest of England the rate fell from 9.59 deaths per 1,000 live births in 1983 to 3.43 deaths per 1,000 live births in 2017.
They also reported that before the strategy was implemented, absolute inequality in the IMR between the most deprived areas and the rest of England had gradually increased from 0.95 in 1983 to 1.28 in 1999; once the strategy had been implemented, there was evidence of a decrease in absolute inequalities in the IMR, from 1.57 in 2000 to 1.06 in 2010; but after the strategy period had ended, absolute inequalities increased from 0.87 in 2011 to 0.93 in 2017.
The study authors contended that, as argued in the Marmot Review, focusing solely on the most disadvantaged in society ‘will not reduce health inequalities sufficiently’ and population-wide strategies should be used in combination with evidence-based interventions specifically targeted at those areas of higher deprivation that have a higher health need.
They said their results have important implications for current health policy, especially given the recent increase in infant mortality in England in recent years. They said: “Since 2010, successive Conservative-led English governments have introduced a programme of austerity. This has included substantial cuts to funding for local authorities, real-terms reductions to the NHS budget, cuts to the education sector and various reductions across the welfare system. Our analysis suggests that it is increases in public spending on healthcare and welfare that are associated with decreases in inequalities in the IMR, and this is something that should be learnt from by current and future governments. Current government policies are arguably going in the wrong direction and may squander some of the gains made in the health inequalities strategy period.”
They concluded: “The multifaceted English health inequalities strategy, implemented between 1999 and 2010, was associated with a decrease in geographical inequalities in the IMR between the most and less deprived English local authorities. These results imply that government policies specifically introduced to decrease inequalities in health may be beneficial, and that their discontinuation as a result of austerity may see inequalities increasing again.”
*Robinson T, Brown H, Norman PD, et al. The impact of New Labour's English health inequalities strategy on geographical inequalities in infant mortality: a time-trend analysis. J Epidemiol Community Health. Epub ahead of print: 19 March 2019. doi:10.1136/jech-2018-211679.