What is it about?
A dramatic increase in deaths in the UK since 2011 has defied actuarial forecasts. This has led some to propose a direct link with government social care austerity. However, several facts argue against this link. Firstly, age standardised mortality in the second quarter of 2019 was statistically lower than the second quarter in all years since 2001, clearly austerity is still present, but age standardised mortality has recovered. Also, deaths have increased equally across the whole of the UK, whereas social care austerity has largely been restricted to England. English citizens resident outside of the UK also show the same trend in deaths as the four countries of the UK. These effects are highly reminiscent of a recurring series of disease outbreaks of an unidentified pathogen. In addition, increases in deaths are always linked to increases in medical admissions. This linkage arises since around half of a person’s lifetime use of acute services is compressed into the last 6 months of life, irrespective of the age at death. This is called the nearness to death effect. International research is needed to understand exactly why deaths are behaving in this unique way. While austerity has created a significant problem relating to delayed discharges in hospitals and has highlighted serious problems with how end-of-life care is to be funded, it seemingly cannot be blamed for the increase in the mortality rate or for directly causing more deaths.
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Why is it important?
Government policy requires correct attribution of cause and effect. Hence, while it is desirable to end government austerity there is no reason that deaths should show any reduction. The exact causes of the increased deaths do however need to be investigated.
Perspectives
My own research over the past 10 years shows that recurring periods of increased deaths in the UK behave in small-areas in a manner entirely consistent with the movement of an infectious agent. See http://www.hcaf.biz/2010/Pub;ications_Full.pdf for more details. Most will be aware of newspaper headlines suggesting that government austerity killed people. However, the majority of such studies were conducted using national level data. The danger is one of an apparent correlation without actual causation. If there is real causation the correlation should hold true at local government level where the extent of budget cuts should reflect in the extent of local increased deaths. This study shows that no such relationship exists. Hence claims that government austerity killed people are spurious and misleading. It is of interest to note that during the austerity years deaths increased the most among the least deprived (rich) areas. If you read the papers you would think that austerity killed many deprived (poor) people. There are multiple perspectives on this complex issue and the calculation of age standardized mortality is not without potential flaws.
Dr Rodney P Jones
Healthcare Analysis & Forecasting
Read the Original
This page is a summary of: Austerity in the UK and poor health: were deaths directly affected?, British Journal of Healthcare Management, November 2019, Mark Allen Group,
DOI: 10.12968/bjhc.2019.0016.
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