The Cost of Living Crisis Is a Public Health Emergency
People are being forced to go without heat or food just as spiralling costs push a ravaged NHS even closer to the brink. The health consequences will be catastrophic – we need immediate action.
Spiralling prices raise the cost of running energy-intensive buildings like hospitals. (FG Trade / Getty Images)
As winter closes in, the catastrophe embodied by the cost of living crisis will only become clearer. Skyrocketing energy bills, rising food prices, and high inflation have already combined with existing problems like high rent, stagnant wage growth, and problem debt to push people in this country to the brink. Very few now have any kind of security against the months that lie ahead—if that security hadn’t already been dismantled.
That this is a crisis of living standards, poverty, inequality, and destitution has been well documented. But what has been less regularly noted is that the cost of living crisis is also a public health emergency.
Last week, the NHS Confederation made the unique move of calling for action on energy prices to avert what they termed a ‘humanitarian crisis’. They are right. The cost of living threatens not only to cost people their lives by exposing them to severe illness—it also risks tipping our already-ravaged NHS into total collapse this winter.
The Humanitarian Crisis
The evidence is clear that an unabated cost of living crisis will have a terrifying impact on our health. Cold homes are the tip of the iceberg. As people ration their food and energy use—or as the credit runs out on the prepayment meters of 4.5 million UK homes—a growing number of lives will be at risk.
Cold homes cause a whole host of health conditions—heart attacks, strokes, breathing problems, and depression among them. In 2016, Age UK estimated that one older person died from the cold every seven minutes. In England, the NHS estimates that it spends £1.3 billion each year treating conditions caused by cold, damp homes that are entirely preventable. These statistics are all from long before energy prices reached their current dizzying heights.
For others, the rising cost of food will cost them their lives. As Jack Monroe has highlighted, even record inflation figures understate the spiralling cost of food essentials. Many will struggle to put any food on the table: charity Sustain estimates that 8.4 million people in the UK are already living in food poverty.
For many more, it is the nutritional impact of rising food prices that will do long-term harm. Our unregulated food market is dominated by what Henry Dimbleby has termed the ‘junk food cycle’—a system in which cheap, ultra-processed foods are oversupplied because it is more profitable, and in which healthy, sustainable, fresh food is out of reach for many. One study in the Lancet put poor diet behind fourteen percent of deaths in the UK in 2019. Without action, that is a figure that is very likely to rise.
Heaping Pressure on the NHS
As a result, inflation and the attendant cost of living crisis present a perfect storm for the NHS. The rising cost of living increases acute need and demand on services; inflation wipes away a big chunk of the NHS’s budget in real terms; and spiralling prices raise the cost of running energy-intensive buildings like hospitals.
It all comes just as the health service has just faced down an incredibly tough summer. The data has been alarming. The number on NHS waiting lists have ticked up to 6.7 million, and 30,000 people waited for more than twelve hours in A&E in July, after a decision was made to admit them. 1.2 million are waiting for community mental health care. As John Burn-Murdoch has calculated, 500 people may be dying every week because of the collapse in emergency care—the equivalent of 26,000 a year.
Invariably, winter is even tougher. Flu ramps up and Covid rates spike. As things get worse, we will inevitably see blame levied at our ‘wasteful’ NHS—with attendant calls for some for an immediate move to an insurance-based, two-tier system. But make no mistake: this is about political choice. Far from the ‘blank cheque’ supposedly offered by then-Chancellor Rishi Sunak, the NHS has been starved of resources, with overworked and underpaid staff pushed to the brink.
An Existential Threat
There is a longer-term threat, too, than this winter. It’s at the moment the NHS is no longer able to provide excellent, universal care that we are most at risk of losing it. The existential threat to the NHS isn’t, immediately, denationalisation or an American free-trade deal: rather—as I argue in the Five Health Frontiers—it is people being pushed into opting out.
Research shows this is happening in practice. IPPR polling has indicated that millions of people have turned to private healthcare, often after having tried to get NHS care first but finding it too difficult. ‘Out of pocket’ healthcare expenditure—people paying for their care directly—is set to be higher in the UK than the US as a percentage of GDP by around 2030.
The people now opting out of the NHS almost universally support its NHS’ founding principles: free at the point of delivery, based on need, comprehensive, and funded by taxation. But with NHS resources stretched to breaking point, those principles are growing ever harder to apply in practice—forcing people to reluctantly bypass the public healthcare system. If this continues, it is the public confidence that sits behind and sustains the NHS that is at stake.
The choices made by the next prime minister and their cabinet will determine whether people live or die: in the immediate term, in deciding whether people are subjected to cold homes, bad diets, and deep poverty; in the short term, by deciding whether inflation and energy costs cut our NHS’s budget back further; and in the long term, by whether their actions erode the coalition that sits behind the NHS.
For campaigners and activists, the message is clear. This is a health emergency. People face no less than death and despair. But even now, an emergency winter plan, based on sensible funding, more hospital capacity, better staff retention, decent pay and conditions, and better prevention could pull it back from collapse. We need that plan, and we need it now.