Given the frenzied speculation about who will be the next leader of the Conservative party and thus prime minister, it was understandable that other news would get far less attention. Last week it was reported that the infant mortality rate (IMR) in England and Wales had worsened, for the third year in a row.
The report from the Office for National Statistics (ONS), covering 2017, said that “the infant mortality rate increased to 3.9 deaths per 1,000 live births compared with 3.8 in 2016”. In 2014, it was 3.6 deaths per 1,000. The situation had been improving steadily until 2014, when it went into reverse. This should not be happening, especially in one of the largest economies in the world. Alarmingly, when declines such as this have occurred elsewhere, for example in the Soviet Union in the 1980s, it has been an early marker of severe problems in society. But while these figures are sufficiently concerning in their own right, they are national averages and the situation is even worse in some places. In the most deprived areas of England, babies were more than twice as likely to die within the first year of life (5.2 deaths per 1,000 live births) than those in the least deprived areas (2.7 deaths per 1,000 live births). Equally concerning, the UK now lags well behind many other European countries, with 24 nations achieving better rates out of the 42 with available data for 2017.
Prof Russell Viner, president of the Royal College of Paediatrics and Child Health, said: “To address the UK’s dismal infant mortality rates, it is paramount that the government take immediate steps to tackle social inequality and improve maternal and early years care.” This is not the first time urgent action has been called for.
Related: Why is life expectancy faltering?
As Viner notes, the reasons these babies are dying in increasing numbers are complex. Healthcare plays a part, but so do the conditions in which they and their families live, work, grow and play – what we call the social determinants of health. And many of these are inextricably linked to the growing rates of child poverty in the UK. Yet, despite clear evidence and recommendations, no action has been taken.
While the latest report focuses on the deaths of babies, there are signs that not all is well at older ages. As with infant mortality, improvements in life expectancy have stalled, peaking in 2014 and so far failing to return to that level. What is especially worrying is that life expectancy at older ages has actually been worsening, again an extremely unusual situation. Meanwhile, a recent report from the Nuffield Trust showed that death rates in those aged 20 to 24 increased between 2013 and 2016. More young people are dying, more babies are dying, and we can expect to live shorter lives.
Life expectancy, mortality rates and infant mortality are the most important statistics a nation can produce about its health – and the UK’s are not only stalling, but worsening, falling behind international trends.
These developments must surely be a concern for an incoming prime minister, but what can be done? The first priority must be to determine why they are happening. We can exclude some obvious explanations. While flu may explain some of the increasing deaths at older ages, it cannot explain them all, and it certainly cannot play a major role in the increasing deaths at younger ages. Nor have any data errors or mass population changes been reported. Global heating is undoubtedly of concern, but this did not suddenly occur in 2011. We are left with the inescapable conclusion that what has happened since 2010 is most likely to reflect the deliberate and sustained diminution of public services. Rising homelessness, food bank use, and deaths from those wrongly denied welfare support are just a few of the signs.
In a few weeks Jeremy Hunt or Boris Johnson will be declared leader of the Conservative party. And unless a significant change of course using substantial public service investment is implemented by whichever one of them becomes the next prime minister, he, too, will add his name to the list of leaders who have overseen the worsening health of the people they represent, obliterating the key part of the social contract a government holds with its electorate: to protect the health of the nation.
• Lucinda Hiam is a GP and honorary research fellow at London School of Hygiene and Tropical Medicine. Martin McKee is professor of European public health at London School of Hygiene and Tropical Medicine