Higher taxation for the rich may need to be considered if the UK is to tackle the decline in life expectancy in parts of the UK and the widening gap in health inequalities, according to Sir Michael Marmot, the country’s leading authority on the issues.
Ten years on from his seminal review for the Labour government of health inequality in England in 2010, Marmot will publish a review of what has been achieved and the current state of the nation with the Health Foundation. The evidence is expected to show that initial progress faltered and then stopped under the pressure of austerity, Marmot told the Guardian in an interview.
In 2015, Marmot’s research showed the expected life of a one-year-old child living in one of the poorest areas could be on average more than eight years shorter than a child in the most affluent 10% of the country.
When the Marmot review was published in 2010, Gordon Brown’s Labour government welcomed it and the Conservative-Liberal Democrat coalition government that took over in May published a white paper, promising to put health inequalities at the heart of its public health strategy.
“But then the actions that were taken nationally were all to do with austerity,” Marmot told the Guardian. “And that meant cutting funding to local government. In turn local government had less money and was closing children’s Sure Start centres. It meant capping welfare payments and reduction of tax credits and the harshness of universal credit.”
Handing public health to local authorities was an opportunity, he said. His review recommended action in early child development, education, employment and minimum income, and in creating a healthy and sustainable environment – many of which were local authority responsibilities.
“The context for action on the social determinants of health in England has been difficult,” he says in a blog for the Health Foundation. “The government’s stated priority has been fiscal rectitude – austerity.
“It may be predicted that cuts in funding to local government, schools and social care, as well as an unfavourable climate for benefits, will take their toll on health and health inequalities. The failure of NHS funding to rise in accord with historical trends won’t help.”
Some local authorities have championed change – notably Coventry, which has declared itself a “Marmot city” and is now in the process of assessing what it has achieved over the years. Manchester and Liverpool are also actively working on health inequalities.
But, said Marmot, a change in approach by central government is also needed. And he thinks there is now public support for some reform of taxation. He cited Dutch historian Rutger Bregman, who caused a sensation at Davos by challenging billionaires who he said could solve inequalities by paying more tax. It was “taxes, taxes, taxes, and all the rest is bullshit in my opinion”, Bregman said.
“In the US, the majority of the population think that rich people should pay more tax,” Marmot told the Guardian. “The argument that having a higher marginal rate of tax at some higher level of income I think is very strong.
“The evidence suggests very rich people when their marginal rate at the top gets high enough they stop paying themselves so much – they reinvest in their companies. It’s why [American politician] Alexandria Ocasio-Cortez recommended a 70% marginal rate above incomes of $10m.
“I think the economists who’ve looked at this suggest you don’t get a drop in productivity or innovation at those top levels so thinking about more progressive taxation schemes that would be good for everybody. Even in the United States, this is no longer on the left fringe.”
The review is a collaboration between Marmot’s Institute for Health Equity and the Health Foundation. It plans a “deep dive” analysis of key areas including early years and education, work and income and housing, places, and communities. It will be published in February 2020, exactly 10 years after the original.
“The original Marmot review was a landmark study, revealing the shocking scale of the health gap between the best and worst off in England,” said Tim Elwell-Sutton, assistant director of strategic partnerships at the Health Foundation.
“Although there has been progress in some areas since 2010, health inequalities are still widening and improvements in life expectancy are stalling. A flourishing society, ready to face the future, will only be possible if we understand what’s driving these trends and what can be done to reverse them.”