Introduction

This chapter examines the effects of austerity on geographical inequalities in health using case studies of the North–South health divide in England and inequalities in health between local neighbourhoods. The chapter is divided into three sections. First, it introduces how geography matters for health, outlining the two case studies – the North–South divide and local inequalities. It then outlines the austerity and welfare reforms that have been enacted in England since 2010 and the effects that these policies are having upon these spatial health divides. The latter section draws on previous international research into welfare retrenchment, as well as qualitative data about the lived experiences of people at the sharp end of austerity. The chapter concludes by arguing that austerity measures are having uneven implications for health across localities, as well as across different sociodemographic groups, further increasing existing health inequalities.

Health and place

Health varies spatially – between countries, regions, cities and even neighbourhoods. This section examines two key examples of such spatial variations: the North–South health divide in England and inequalities in health between local neighbourhoods. It then examines explanations for the relationship between health and place with a focus on political and economic approaches.

North–South divide

Northern England (commonly defined as the North-East, North West and Yorkshire and Humber regions) has persistently had higher allcause mortality rates than the South of England, with people in the North consistently found to be less healthy than those in the South, across all social classes and among men and women (Dorling, 2010). This is demonstrated through life expectancy at birth (see Figure 20.1). Since 1965, this has amounted to 1.5 million excess premature deaths (Whitehead et al, 2014). A baby born today in the North-East will live, on average, six years less in good health than one born in the South-East (ONS, 2014). Likewise, the life expectancy gap (how long someone is expected to live, on average, based on contemporary mortality rates) between the two regions is over two years for both men and women.

These spatial inequalities in health between North and South have been documented since the mid-18th century and have fluctuated over time (Hacking et al, 2011; Bambra et al, 2014).