Action is urgently needed on the social determinants of health in the UK

With less than two weeks to go before the UK’s general election on 4 July, voters have a decision to make. When asked “what are the most important issues facing the country,” the latest YouGov poll reported half of those responding place health (50%) and the economy (51%) at the top.1 Three-quarters said the UK government should spend more on the NHS.1 It is easy to see the importance of the economy to voters reflected in the media election coverage. Latest growth figures have been widely reported and mentioned in the speeches made by politicians. Receiving fewer headlines, however, is the coverage of worsening health in the UK, particularly the dire state of many of the social determinants of health including housing, education, and poverty.

The evidence for this is overwhelming, and continues to be forthcoming, including in the past week when a number of stark reports were published that should raise alarm bells for anyone who reads them. First, a report from the Joseph Rowntree Foundation (JRF) detailed how millions of people in Britain are going without “basic essentials” such as food, appropriate clothing, and heating; what they describe as “hardship.”2 The authors explored the impact of this hardship on those providing services by speaking to and surveying staff in primary schools and community healthcare settings. They found services are “staggering under the weight of hardship,” with the consequences of hardship consuming a huge amount of resources—financial, emotional, time-related—and diverting resources from other essential activities.

Second was a report from the Food Foundation, entitled “A Neglected Generation: Reversing the decline in children’s health,”3 which detailed the decline in the average height of 5 year olds in the UK, rising obesity, and poor nutrition—reported in The Guardian under the headline “UK children shorter, fatter, and sicker amid poor diet and poverty.”

Third, the Office for National Statistics (ONS) reported the latest data on avoidable mortality (deaths from causes considered preventable or treatable in those aged under 75 years).45 These data showed that avoidable mortality is increasing, including in children, with marked regional inequalities—so much so that while some local authorities have seen an improvement (i.e. a decline) in avoidable mortality since the Conservatives Coalition government came to power in 2010, others have seen a rise, with more people dying from preventable or treatable causes.

Sadly, these three publications are far from unusual. At the start of 2024, the ONS figures for life expectancy showed a decline for both males and females to 2010-2012 levels (and just before for men).6 In 2023, child mortality figures showed rising child and infant deaths, with significant inequalities,7—a concern that had been highlighted repeatedly over the past decade.8 Beyond these deteriorating summary measures of health, the evidence that action on the social determinants of health is needed has been ample, and practical recommendations for implementation have been available for some time. In 2010, the Marmot review detailed how these issues could be tackled to improve health, but no action was taken.9 Fourteen years on, the situation is considerably worse.1011

At the time of writing, none of the major parties are acknowledging the need to tackle this hardship, nor acknowledge the role of austerity in the dire state of health that the UK is in now.12 As the JRF report highlights: “No plan to improve schools or healthcare should be taken seriously if it is not supported by an urgent action plan to address hardship.”2 Whatever government is in power after 4 July, they must first acknowledge the significant problems of poverty, poor housing, and nutrition, particularly for children, and we must continue to implore them to listen to the evidence—and, crucially, to act.