Covid-19 and the human cost of years of austerity

Michael Marmot’s speculation about the key roles of social deprivation and Tory austerity policies in excess Covid-19 mortality is likely to be well founded (Why did England have Europe’s worst Covid figures? The answer starts with austerity, 10 August). But no account of excess mortality can be complete without reference to the high incidence of deaths in care homes – at least half of all virus-related deaths.

The immediate causes have been well aired: failure to protect vulnerable residents, discharge of untested hospital patients, on top of long-term neglect exacerbated by austerity. But we must also factor in institutional ageism. Care home residents are overwhelmingly frail older people; they were sacrificed under austerity and then, to make room for younger adults, under the pandemic. It is telling that 75% of deaths of residents involving Covid-19 took place in care homes rather than hospitals, ie places not designed to treat severe illness. They were left to die. When the reckoning comes, this human cost of ageism must be recognised.
Alan Walker
Professor of social policy and social gerontology, University of Sheffield

• Michael Marmot highlights evidence of the redistribution of health and wealth by the last 10 years of Conservative government. However, this has happened over the last 40 years, starting with Margaret Thatcher.

She discovered that withdrawing the rate support grant paid to local governments would help her reduce taxes while local authorities took the blame for the consequent reduction of services. This substantial grant was redistributive to reflect areas of poverty. The “prudent” Labour interlude didn’t significantly reverse this process, and the good local initiatives centrally funded were easily removed by David Cameron and George Osborne.

Older Conservative governments used to have a substantial number of MPs recruited particularly from the shire counties. They understood and supported local government. This no longer seems to be the case. One could also be suspicious of the role of the civil service. It never liked the open nature of local government – often managed by technically qualified personnel, from different educational backgrounds. There was a clear cultural divide.
Roger Foreman
Gobowen, Shropshire

• Michael Marmot is right to highlight how increasing inequality in England made the country less resilient in the face of the Covid-19 pandemic. Those in government have failed to appreciate the effects of their policies on public health. The focus has been on narrow economics with a bias against public expenditure, but the economy itself fails when public health is ignored.

Obsession with a centralised and contracting-out approach is only a reflection of central government’s attack on local government since 2010. Since then budgets have been cut by 60% and environmental health departments have been an easy target – the very people who, it is now recognised, would be more effective at tracking and tracing contacts. The IPPR has estimated that £1 in every £7 cut from public health services has come from England’s 10 most deprived communities.

As Marmot says, public health should be a local government function, but it needs proper resourcing. Instead the opportunity was taken to make deep cuts – further reducing the country’s resilience. Yet money can be found to waste on contracts that prove to be useless. I cannot understand why the people of England tolerate this.
Dr Stephen Battersby
Chartered environmental health practitioner (retired); vice-president, Chartered Institute of Environmental Health

• Thank you for the wonderfully incisive article by Michael Marmot. Every paragraph was an indictment of the inequality, prejudice and corruption that have become a feature of the British way of life.

It read like the perfect manifesto on which Labour could base its policies as preparation for winning the next general election. If only the Labour party could put aside its internecine strife over Corbynism, and turn its collective attention to the needs of this country. We desperately need a government that can start to redress the harm of the last 20 to 30 years before we sink further into Camus’s plague. Come on Labour, give Keir Starmer a chance.
Mary Rogers
Martock, Somerset