T EN YEARS ago the Marmot Review, a study commissioned by the government, asked a big, complicated question: why do some people in England live longer, healthier lives than others, and what can be done to reduce the gap? The answer it found was simple. Some people lived longer because they were better-off. To change this, it concluded, the government would have to reduce social inequality.

A new report by its author, Sir Michael Marmot of University College London, reviews the past decade’s changes. The numbers speak for themselves. In the three decades leading up to the first report, life expectancy at birth for men increased by a year every four years. Between 2011 and 2018 that rate slowed to a year every 15 years. For women the decline was even starker, from a year every five-and-a-half years to one every 28 years. And for the very poorest women, things have gone backwards. Life expectancy for those in the most deprived areas has declined by 0.3 years from 2010-12 to 2016-18. All women born later in the past decade are expected to have fewer healthy years than those born at the start of it.

Moreover, both men and women under the age of 50, particularly between 45 and 49, have seen mortality rates tick up (see chart). Sir Michael suggests that this could be related to suicide, alcohol use and rising drug toxicity, making it the British version of rising mortality rates among poor Americans, termed “deaths of despair” by Anne Case and Sir Angus Deaton, two economists who study the phenomenon.