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.

 
 
 
 

Transport for London’s fare zones secretly go up to 15

Some of these stations are in zones 10 to 12. Ooooh. Image: TfL.

The British capital, as every true-blooded Londoner knows, is divided into six concentric zones, from zone 1 in the centre to zone 6 in the green belt-hugging outer suburbs.

These are officially fare zones, which Transport for London (TfL) uses to determine the cost of your tube or rail journey. Unofficially, though, they’ve sort of become more than that, and like postcodes double as a sort of status symbol, a marker of how London-y a district actually is.

If you’re the sort of Londoner who’s also interested in transport nerdery, or who has spent any time studying the tube map, you’ll probably know that there are three more zones on the fringes of the capital. These, numbered 7 to 9, are used to set and collect fares at non-London stations where the Oyster card still works. But they differ from the first six, in that they aren’t concentric rings, but random patches, reflecting not distance from London but pre-existing and faintly arbitrary fares. Thus it is that at some points (on the Overground to Cheshunt, say) trains leaving zone 6 will visit zone 7. But at others they jump to 8 (on the train to Dartford) or 9 (on TfL rail to Brentwood), or skip them altogether.

Anyway: it turns out that, although they’re keeping it fairly quiet, the zones don’t stop at 9 either. They go all the way up to 15.

So I learned this week from the hero who runs the South East Rail Group Twitter feed, when they (well, let’s be honest: he) tweeted me this:

The choice of numbers is quite odd in its way. Purfleet, a small Thames-side village in Essex, is not only barely a mile from the London border, it’s actually inside the M25. Yet it’s all the way out in the notional zone 10. What gives?

TfL’s Ticketing + Revenue Update is a surprisingly jazzy internal newsletter about, well, you can probably guess. The September/October 2018 edition, published on WhatDoTheyKnow.com following a freedom of information request, contains a helpful explanation of what’s going on. The expansion of the Oyster card system

“has seen [Pay As You Go fare] acceptance extended to Grays, Hertford East, Shenfield, Dartford and Swanley. These expansions have been identified by additional zones mainly for PAYG caping and charging purposes.

“Although these additional zones appear on our staff PAYG map, they are no generally advertised to customers, as there is the risk of potentially confusing users or leading them to think that these ones function in exactly the same way as Zones 1-6.”


Fair enough: maps should make life less, not more, confusing, so labelling Shenfield et al. as “special fares apply” rather than zone whatever makes some sense. But why don’t these outer zone fares work the same way as the proper London ones?

“One of the reasons that the fare structure becomes much more complicated when you travel to stations beyond the Zone 6 boundary is that the various Train Operating Companies (TOCs) are responsible for setting the fares to and from their stations outside London. This means that they do not have to follow the standard TfL zonal fares and can mean that stations that are notionally indicated as being in the same fare zone for capping purposes may actually have very different charges for journeys to/from London."

In other words, these fares have been designed to fit in with pre-existing TOC charges. Greater Anglia would get a bit miffed if TfL unilaterally decided that Shenfield was zone 8, thus costing the TOC a whole pile of revenue. So it gets a higher, largely notional fare zone to reflect fares. It’s a mess. No wonder TfL doesn't tell us about them.

These “ghost zones”, as the South East Rail Group terms them, will actually be extending yet further. Zone 15 is reserved for some of the western-most Elizabeth line stations out to Reading, when that finally joins the system. Although whether the residents of zone 12 will one day follow in the venerable London tradition of looking down on the residents of zones 13-15 remains to be seen.

Jonn Elledge was the founding editor of CityMetric. He is on Twitter as @jonnelledge and on Facebook as JonnElledgeWrites.