Being born in the north of England can take a decade off your life expectancy

Blackpool, sickest town in England. Image: Getty.

In spite of being one of the richest nations in Europe, England has some of the worst health inequalities. And within England, some of the very lowest life expectancies can be found in the north.

Analysis published yesterday by IPPR North shows us that, if you’re from the north, you can expect to spend a larger proportion at the end of your life in poor health. In all three of the northern regions, healthy life expectancy – the age at which, on average, people see the end of good health – is lower than the state pension age. This means that northerners, on average, don't even begin to collect their state pension until their health has begun to deteriorate.

At its lowest, healthy life expectancy can be over in the 40s. And neighborhoods where healthy life expectancy is lowest are disproportionately concentrated in the north. Shockingly, in one Salford neighbourhood it's 46, compared to the English average of 63.

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Life expectancy too, in addition to healthy life expectancy, is unacceptably low in parts of the north. In one neighbourhood in Blackpool, the average male life expectancy at birth is 68, compared to the English average of 79.

This pattern, of a north disproportionately affected by health inequalities, can be seen too in specific diseases. Lung cancer is more prevalent in the north’s cities, and liver cancer is strikingly prevalent in Merseyside, Cheshire, Greater Manchester, Northumberland and Tyne & Wear.

Of course, a number of complex factors affect poor health. One of these is air pollution – a big concern for many of the North’s major cities.

Take Greater Manchester, for example. The city region has the highest rate of emergency admissions for asthma in the whole country, and recent research by IPPR North shows that the poor air quality in Greater Manchester alone will cost 1.6 million life years in the coming century and £1bn each year to the economy.

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These stark findings should lead policymakers to ask this key question: is the economy of the North actually detrimental to the health and well-being of its people?

As part of the answer to this question, it’s important to consider the quality of northerners’ jobs. Not only is there an association between whether someone is in work and their health, but the nature of employment is also a determining factor. And it’s important to note that employment-related health problems disproportionately affect people with disabilities, ethnic minorities, and those from disadvantaged socioeconomic groups.

Poor working conditions, lack of job security, long hours, shift work, low pay: situations often seen in the ‘everyday economy sectors’ including health and social care, retail and hospitality, and routine manual occupations – all contribute to poor job quality. Change is needed.

In order to allow more people to enjoy their retirement in good health, we need to work to increase healthy life expectancy. The disparity between the north and south in healthy life expectancy may be significant, but it’s not insurmountable.


One answer? Policymakers should make improving the health and well-being of people a strategic goal of economic policy across the UK, especially in the north.

To achieve this, improving the quality of work in the north is essential. Yes, we need growth to happen – but not for its own sake. Instead we need growth that enables all people to see its benefits.

Inclusive growth is already an aim of many northern areas, and some mayors are in the process of creating employment charters to improve job quality in collaboration with business. However, in order to deliver positive outcomes for the north in general, this needs a radical up-scaling. Northern leaders aren’t currently equipped with the tools and budgets that they need. However, even without greater resources, small steps can and should be made.

Businesses must invest in their workforces and local areas, and aim to deliver high quality work – creating better places to live, and delivering better livelihoods for people.

Most importantly, for people to benefit from economic growth, the Northern Powerhouse agenda should focus on delivering economic justice. Economic policy is a powerful tool that can be used to improve health, well-being, and the quality of work. To do so, central government must support inclusive growth at the regional level, considering the health inputs and outcomes of local economies and embedding a ‘health in all policies’ approach into decisions made within the next phase of the Northern Powerhouse.

Leah Millward is a co-author of State of the North 2018. She tweets @LeahMillward.

 
 
 
 

In South Africa's cities, evictions are happening despite a national ban

An aerial view shows a destroyed house in Lawley, south of Johannesburg, on April 20, 2020. The city has been demolishing informal structures on vacant land despite a moratorium on evictions. (Marco Longari/AFP via Getty Images)

On the morning of 15 July, a South African High Court judge ruled that the city of Cape Town’s Anti-Land Invasion Unit had illegally evicted a man when it destroyed the shack where he was living.

That afternoon, the Anti-Land Invasion Unit was out again, removing shacks in another informal settlement.

Evictions were banned in South Africa for nine weeks, after the national government placed the country under a strict Covid-19 lockdown in late March. At present, eviction orders are automatically suspended until the country moves to a lower “alert level” and can only be carried out with a special order from a judge.

Yet major cities including Cape Town, Johannesburg and eThekwini (created through the merger of Durban with several surrounding communities), have continued to use municipal law enforcement agencies and private security companies to remove people from informal housing. In many cases those operations have been conducted without a court order – something required under regular South African law.

Around 900 people were evicted from three informal settlements in eThekwini during the eviction ban, according to the Church Land Programme, a local NGO. Its director, Graham Philpott, says it’s also aware of evictions in other informal settlements.

While evictions aren’t a “new experience” in these communities, the NGO released a report on lockdown evictions because they were “so explicitly illegal”. “There was a moratorium in place,” Philpott says, “and the local municipality acted quite flagrantly against it. There’s no confusion, there’s no doubt whatsoever, it is illegal. But it is part of a trend where the eThekwini municipality has acted illegally in evicting the poor from informal settlements.”

Evictions also took place in Cape Town and Johannesburg during so-called “hard lockdown” according to local activists. In eThekwini and other municipalities, the evictions have continued despite restrictions. In Cape Town, authorities pulled a naked man, Bulelani Qholani, from his shack. That incident, which was captured on video, drew condemnation from the national government and four members of the Anti-Land Invasion unit were suspended. 


The cities say they’re fighting “land invasions” – illegal occupations without permission from the land owner.

“Land invasions derail housing and service projects, lead to the pollution of waterways, severely prejudice deserving housing beneficiaries and cause property owners to lose their investments over night,” Cape Town’s executive mayor, Dan Plato said in a statement. (Plato has also claimed that Qholani did not live in the shack he was pulled from and that he disrobed when municipal authorities arrived.)

South African municipalities often claim that the shacks they destroy are unoccupied. 

If they were occupied, says Msawakhe Mayisela, a spokesman for the eThekwini municipality, the city would get a court order before conducting an eviction. “Everything we’re doing is within the ambit of the law,” Mayisela says. But “rogue elements” are taking advantage of Covid-19, he added.

“We fully understand that people are desperately in need of land, but the number of people that are flocking to the cities is too much, the city won’t be able to provide housing or accommodation for everyone overnight,” he says. 

While eThekwini claims to be a caring city, local activists say the evictions show otherwise.

In one case, 29 women were evicted from shacks during the hard lockdown. With nowhere to go, they slept in an open field and were arrested by the South African Police Service for violating the lockdown, Philpott says.

“These evictions are dehumanizing people whose dignity is already compromised in many ways,” says S’bu Zikode, the president of Abahlali baseMjondolo, a community organization whose Zulu name translates to “the people of the shacks”. 

“It has reminded us that we are the people that do not count in our society.”

Municipal law enforcement and private security contractors hired by cities regularly fire rubber bullets, or even live ammunition, at residents during evictions. Some 18 Abahlali baseMjondolo activists have been killed since the organization was founded in 2005, Zikode says, most by the eThekwini Land Invasion Unit and Metro Police.

(Mayisela says that if city employees have broken the law, Abahlali baseMjondolo can file a complaint with the police. “There is no conclusive evidence to the effect that our members have killed them,”  he says.)

Other Abahlali baseMjondolo activists have been killed by what Zikode calls “izinkabi,” hitmen hired by politicians. Two eThekwini city councillors were sentenced to life in prison 2016 after they organized the killing of Thuli Ndlovu, an Abahlali baseMjondolo organizer. A member of the Land Invasion Unit who is currently facing a charge of attempted murder after severely injuring a person during an eviction remains on the job, Zikode says.

South Africa’s 1996 constitution is intended to protect the public from arbitrary state violence and guarantees a right to housing, as well as due process in evictions. But for Zikode, the South African constitution is a “beautiful document on a shelf”.

“For the working class and the poor, it’s still difficult to have access to court. You’ve got to have money to get to court,” he says. 

The actions by municipal law enforcement are breaking down social trust, says Buhle Booi, a member of the Khayelitsha Community Action Network, a community group in the largest township in Cape Town.

“There’s a lack of police resources and those very few police resources that they have, they use to destroy people’s homes, to destroy people’s peace, rather than fighting crime, real criminal elements that we see in our society,” Booi says.

For him, it’s a continuation of the practices of the colonial and apartheid governments, pushing poor people, most of whom are Black, to the periphery of cities.

Around one-fifth of South Africa’s urban population live in shacks or informal dwellings, according to a 2018 report by SERI. Many more live in substandard housing. City governments maintain that the shacks destroyed during anti-land invasion operations are unfinished and unoccupied. But Edward Molopi, a research and advocacy officer at SERI, says that this claim is an attempt to escape their legal obligations to get a court order and to find alternative accommodation for affected people. 

The roots of the current eviction crisis go back to apartheid, which barred non-white people from living in cities. Between the 1940s and 1970s, tens of thousands of people were forcibly relocated from neighbourhoods like Johannesburg’s Sophiatown and Cape Town’s District Six to remote townships.

In the 26 years following the end of apartheid, deepening economic inequality and rampant unemployment have limited access to formal housing for millions of South Africans. Government housing programs have mostly focused on building small stand-alone homes, often on the peripheries of cities far from jobs and amenities.

While these well-intentioned projects have built millions of homes, they’ve failed to keep up with demand, says Marie Huchzermeyer, a professor at the Centre for Urbanism & Built Environment Studies at the University of the Witwatersrand in Johannesburg. Government-funded housing projects “will never on it’s own be enough,” she says. “It has to be accompanied by land release.”

Government policies call for the “upgrading” of informal settlements and the formalization of residents’ occupation. But “there are still very, very, very few projects” of that nature in South Africa, Huchzermeyer says. “Even if it’s an informal settlement that’s been around for 20 years, there still seems to be a political wish to punish people for having done that.” The government wants people to go through the formal process of being given a house, she says – and for them to be thankful to the government for providing it.

At the municipal level, change will require “real leadership around informal settlement upgrading and around ensuring that land is available for people to occupy,” she says. 

Despite the end of enforced racial segregation, spacial apartheid remains a factor in South Africa. There are few mixed-income neighbourhoods. Those who can afford to often live behind walls in sprawling low-density suburbs, while the poor live in overcrowded slums and apartment buildings.

The creation of the apartheid city “didn't happen by chance,” says Amira Osman, a professor of architecture at the Tshwane University of Technology. “It was a deliberate, structured approach to the design of the city. We need a deliberate, structured approach that will undo that.”

Since last fall, Johannesburg’s Inclusionary Housing Policy has required developments of 20 or more units to set aside 30% of those units for low-income housing.

The policy, which faced significant opposition from private developers, won’t lead to dramatic change, says Sarah Charlton, a professor at the Centre for Urbanism and Built Environment Studies, but it is “an important and significant step.”

Zikode isn’t optimistic that change will come for shack dwellers, however.

“People in the high positions of authority pretend that everything is normal,” he says. “They pretend that everyone is treated justly, they pretend that everyone has homes with running water, that everyone has a piece of land – and hide the truth and the lies of our democracy.”

Jacob Serebrin is a freelance journalist currently based in Johannesburg. Follow him on Twitter.