Local authorities fall at the unfashionable end of the public sector. When I was at university, I don’t think I ever met a single person (except possibly myself) that said ‘I want to work at a local council’. If you did want to work for the public sector, the civil service was likely to be the first thing you thought of, followed by the NHS. Politicians also tend to focus on the more glamorous aspects of government when they campaign in elections. Woe betide the politician that tries to cut NHS funding, or does not look serious about policing and law and order: better local authority funding tends to not get such a mention.
Admittedly I am probably biased because I work with them, but I view local authorities as the unsung heroes of the world. Local authorities are essential to a civilised society and are I’m sure as old as civilisation itself (‘Hundreds’ were the basic unit for administrative, military and judicial purposes in England from around the 7th century, formed of approximately 100 households and their land they form the basis of the district council system still in place in many areas). Partly this is because local authorities do some of the essentials: society does not function without roads, rubbish collection, and street lighting. However, aside from these administrative functions local authorities are also crucial for some other really important things: like how likely you are to die younger than you should. Here’s why.
The NHS characteristically gets the credit for why we are all living much longer, healthier lives than we used to. UK life expectancy was 64 years in 1945 and 81 years in 2020. Undoubtably medical advances such as vaccines and antibiotics take a great deal of the credit for this. However a second slightly more depressing statistic, and one that is discussed at length in an excellent article in the Economist magazine published in March 2023, is that the growth in life expectancy in the UK has stalled since the early 2010s. Life expectancy in the UK is still rising, but at a rate slower than before, and slower than in many comparable countries. This is not all because of Covid. It is also not because of diminishing life expectancy only at the oldest age of the spectrum as medical science reaches the limits of what it can do. The sad truth is that people of all ages are dying younger than they would have if previous trends (and trends that are happening in other countries) had continued. Mortality rates among those aged between 30 and 49 have actually increased in England and Wales since 2012.
The reason for this declining life expectancy growth is not because medicine has got worse. If you live in the UK 80% of your chance of living a long as opposed to short life is due to wider and in theory largely preventable social factors (rather than how good your doctor is, your genetics or getting hit by a bus). Your life expectancy is very highly correlated ultimately with your income and also with factors such as your level of education, quality of housing, diet, lifestyle, employment and use of drugs and alcohol. For those who are elderly or disabled getting the social care that they need will be essential to remaining in good health. These all tend to be things that local authorities do, or at least play a significant part in, rather than their more glamourous partners such as the NHS.
Take education as the first one. If you are better educated, you are more likely to have a good job and earn more. You are more likely to not smoke, take regular exercise and be a healthy weight, as are your children. If you are better educated, you are more likely to go to a GP with early cancer symptoms resulting in a much better outlook for your treatment. Education starts early, the benefits of good quality pre-school support and education (for example through Early Years Children’s Centres) are now well understood. Although the picture is changing at least in England with a greater number of independent academies, it is largely local authorities that are running the schools, children’s centres and further education colleges.
Take housing as the second one. It is difficult to be healthy if you live in overcrowded or unsuitable housing. Those living in overcrowded conditions are more likely to catch communicable diseases, as we saw in the Covid-19 pandemic. Mould, damp and cold (or extreme heat) can exacerbate and cause chronic health problems. Poor living conditions leads to poorer mental health and greater misuse of alcohol and drugs. Local authorities alongside housing associations play an important role in providing housing especially to the poorest in society.
‘Public health’ is an area which has got a lot more recognition since the pandemic. It means preventing the spread of communicable diseases such as covid, TB, flu and measles. It also means improving public health by preventing smoking and promoting healthy diets and exercise. Public health is dealt with by local authorities, who have had their budgets cut much more than the NHS over the past decade. Your wider environment such as access to parks, playgrounds, open spaces, cycle lanes and pavements will also impact on your ability to exercise, be a healthy weight and have better mental health. Local authorities do these things to.
Finally local authorities provide a large proportion of the population’s social care needs. If you need good quality social care and don’t get it this is likely to lead to you having poorer health, more admissions to hospital and lower life expectancy. The funding for social care to local authorities has been cut more than the funding to the NHS for healthcare: even though the two are intrinsically linked. I believe there is now more of an understanding of this by central government politicians who have now allowed local authorities to raise council tax to cover social care costs.
The type of things that local authorities provide: schools, libraries, parks, nurseries, housing and social care often benefit everyone but especially the poorest and most marginalised. It is the poorest and most marginalised in society that rely on these services most that have the lowest life expectancies. It stands to reason that stalling life expectancies in the UK has at least something to do with the cuts to local authority funding seen in the UK during the 2010s and would go some way to explaining why we are doing worse than many comparable countries*. Local authorities: it really is life and death.
* on the plus side we are doing better than the USA, where high rates of ‘deaths of despair’ due to suicide and opiate abuse have been widely publicised.