In a recent interview, Rishi Sunak highlighted the rising number of people unfit to work in Britain due to ill health. “In the last decade” he said, “the number of people who are signed off has tripled. Now do I think our country is three times sicker than it was a decade ago? The answer is no.” By drawing attention to how the nation’s poor health impacts on productivity—manifesting as an increase in people unable to work due to illness and/or disability—the prime minister has raised an important issue: why are so many people being signed off as too sick to work? And is he correct to dismiss the simplest answer to that question—that more people are being signed off sick because the people of Britain are sicker than a decade ago?
Perhaps the fairest way to explore whether Britain is “sicker” is to examine some of the objective summary measures of the health of a population: life expectancy (based on mortality or death rates) and infant mortality rates. Life expectancy is the predicted lifespan of a baby born today if current death rates stayed the same, while the infant mortality rate describes the number of babies dying before their first birthday per 1,000 babies born in a calendar year. Both measures allow comparison of trends over time and between groups.
In the past decade, life expectancy and infant mortality rates in the UK have alarmed observers. Both had been steadily improving, with some fluctuations, until 2012—when life expectancy improvements stalled before stopping completely. From 2014 to 2015 infant mortality rates increased. When analysed by ethnicity and deprivation, these numbers are even more concerning. Life expectancy has fallen for women living in the 10 per cent most deprived areas. Regional inequalities have also widened. Those living in the northeast of England now have an average life expectancy five years lower than people in London. It is not just that people are dying sooner than previously anticipated: before an early death, the number of years spent in poor health or with disability has increased for both sexes.
The infant mortality rate rose every year between 2014 and 2017, and again from 2020 to 2021. In 2021, still births and neonatal deaths increased for the first time in seven years. In 2023, black or black British babies were almost three times more likely to die in their first year (8.7 per 1,000 live births) than white British babies (3.0 per 1,000 live births), with Asian British babies more than twice as likely (6.2 per 1,000 live births). Babies born in the most deprived quintile were more than twice as likely to die in their first year (5.9 per 1,000 live births) than babies in the least deprived quintile (2.2 per 1,000 live births). The rates have all increased since 2020.
Britain is objectively sicker than it was a decade ago: people are dying earlier than had been anticipated, as previous rates of improvement have not continued, and more babies are dying in their first year of life than three years ago. The deterioration in these measures cannot be consistent with implications of patients malingering or doctors signing too many sick notes. These figures are appalling, but perhaps not unexpected in a country where nine million adults (17 per cent of households) are experiencing food insecurity, and the number of children of living in destitution has more than doubled since 2017. It is therefore unsurprising that 75 per cent of adults think the UK is in a worse state in 2024 than it was in 2010.
The increase in people unable to work due to chronic illness in Britain began before the Covid-19 pandemic and worsened considerably during it. In 2022, while other developed nations were returning, or had already returned, to pre-pandemic levels of employment, the UK continued to see a rising number of working age people neither employed nor seeking work, with chronic illness the most common reason.
What is exceptional about Britain? Since 2010 successive Conservative governments have implemented cuts to public services through austerity—failing to acknowledge that austerity is harmful to health, and that economic productivity depends on health. A growing economy can reduce poverty and increase life expectancy, but an economy cannot grow with a sick population.
Sunak is almost right: more people than a decade ago are being signed off sick. But he is wrong to reject the simplest reason why. More people are being signed off sick because today’s Britain is a sick society. It is sick due to consistent, relentless underfunding—not only of the NHS itself, but to social care, public health, and other areas of society that can support people to be healthy, such as education. It is sick due to child poverty and hunger levels so extreme that international bodies including the United Nations rapporteur for extreme poverty and Unicef have called on the UK government to act. The action needed is not tax cuts and welfare reform. Further reductions in public spending will make an already sick population sicker. The first step to solving the problem is to acknowledge that we have one.
