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Austerity, not influenza, caused the UK’s health to deteriorate. Let’s not make the same mistake again
  1. Lucinda Hiam1,2,
  2. Danny Dorling3,
  3. Martin McKee2
  1. 1 University of Oxford, Oxford, UK
  2. 2 London School of Hygiene and Tropical Medicine, London, UK
  3. 3 School of Geography and the Environment, University of Oxford, Oxford, UK
  1. Correspondence to Lucinda Hiam, University of Oxford, Honorary Research Fellow, London School of Hygiene and Tropical Medicine. South Parks Road, Oxford OX1 3QY, UK; Lucinda.hiam{at}; lucinda.hiam1{at}

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Prior to the COVID-19 pandemic, England and Wales had seen stalling life expectancy, rising infant mortality rates, increasing mid-aged mortality (including so-called deaths of despair) and tightening restrictions on access to healthcare.1 Spikes in age-standardised mortality rates have been, by many, attributed almost wholly to influenza, though the evidence does not support this.

As we enter winter 2020 with a health and social care service that has endured a decade of insufficient funding, a population whose health has been worsened by austerity, and now a pandemic, let’s not once again suggest that influenza was the main cause of excess mortality and cancelled elective surgeries in previous winters.2 Figure 1 is taken from the Office for National Statistics excess winter mortality data for England and Wales 2015–2016.3 This shows weekly deaths from all causes alongside influenza-like illness (ILI, from Public Health Wales and Royal College of General Practitioners) consultations per 100 000 population in England and Wales from 1993 to 2016. Since 2011, ILI has not exceeded weekly mortality peaks. Notably in 2015–2016, when the biggest year-on-year increase in deaths for almost 50 years was seen,4 ILI rates were not unusually high.

Figure 1

Weekly deaths from all causes and Royal College of General Practitioners and Public Health Wales influenza-like illness (ILI) consultation rates per 100 000 population, England and Wales, 1999–2016.

It is often said that it cannot be proven that austerity has resulted in higher mortality than expected. We disagree. However, what matters now is going into winter 2020, after an incredibly challenging year for the four nations of the UK not only in terms of the pandemic but unemployment, housing precarity, hunger, poverty and the huge impact on mental health, we accept the role has played in the deteriorating health of the nation, and do not repeat the mistakes of the past in blaming ‘influenza’.



  • Twitter Martin McKee @martinmckee, Lucinda Hiam @lu_hiam and Danny Dorling @dannydorling.

  • Contributors DD conceived the idea and prepared the graph. LH wrote the draft of the letter, which MM and DD reviewed and edited.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.