Background

Since 2010, large reductions in funding for local government services have been introduced in England. These reductions in funding have potentially led to reduced provision of health-promoting public services. We aimed to investigate whether areas that showed a greater decline in funding also had more adverse trends in life expectancy and premature mortality.

Methods

In this longitudinal ecological study, we linked annual data from the Ministry of Housing, Communities, and Local Government on local government revenue expenditure and financing to 147 upper-tier local authorities in England between 2013 and 2017 with data from Public Health England, on male and female life expectancy at birth, male and female life expectancy at age 65 years, and premature (younger than 75 years) all-cause mortality rate for male and female individuals. Local authorities were excluded if their populations were too small or if changes in boundaries meant consistent data were not available. Using multivariable fixed-effects panel regression models, and controlling for local socioeconomic conditions, we estimated whether changes in local funding from 2013 were associated with changes in life expectancy and premature mortality. We included a set of alternative model specifications to test the robustness of our findings.

Findings

Between 2013 and 2017, mean per-capita central funding to local governments decreased by 33% or £168 per person (range –£385 to £1). Each £100 reduction in annual per person funding was associated over the study period 2013–17 with an average decrease in life expectancy at birth of 1·3 months (95% CI 0·7–1·9) for male individuals and 1·2 months (0·7–1·7) for female individuals; for life expectancy at age 65 years, the results show a decrease of 0·8 months (0·3–1·3) for male individuals and 1·1 months (0·7–1·5) for female individuals. Funding reductions were greater in more deprived areas and these areas had the worst changes in life expectancy. We estimated that cuts in funding were associated with an increase in the gap in life expectancy between the most and least deprived quintiles by 3% for men and 4% for women. Overall reductions in funding during this period were associated with an additional 9600 deaths in people younger than 75 years in England (3800–15 400), an increase of 1·25%.

Interpretation

Our findings indicate that cuts in funding for local government might in part explain adverse trends in life expectancy. Given that more deprived areas showed greater reductions in funding, our analysis suggests that inequalities have widened. Since the pandemic, strategies to address these adverse trends in life expectancy and reduce health inequalities could prioritise reinvestment in funding for local government services, particularly within the most deprived areas of England.

Funding

National Institute for Health Research (NIHR) School for Public Health Research, NIHR Applied Research Collaboration North East and North Cumbria, NIHR Applied Research Collaboration North West Coast and Medical Research Council.

中文翻译：

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英国地方政府资助和预期寿命：一项纵向生态研究

背景

自 2010 年以来，英格兰开始大幅削减对地方政府服务的资助。这些资金的减少可能导致提供健康促进公共服务的减少。我们的目的是调查资金下降幅度更大的地区是否在预期寿命和过早死亡率方面也有更多不利趋势。

方法

在这项纵向生态研究中，我们将 2013 年至 2017 年期间英国住房、社区和地方政府部关于地方政府收入支出和融资的年度数据与英国公共卫生部门的数据联系起来，关于男性和女性出生时的预期寿命、男性和女性 65 岁时的预期寿命，以及男性和女性个体的过早（小于 75 岁）全因死亡率。如果地方当局的人口太少，或者边界的变化意味着无法获得一致的数据，则地方当局被排除在外。我们使用多变量固定效应面板回归模型并控制当地社会经济条件，估计 2013 年以来当地资金的变化是否与预期寿命和过早死亡率的变化相关。

发现

2013 年至 2017 年间，对地方政府的人均中央资助减少了 33% 或每人 168 英镑（范围从 385 英镑到 1 英镑）。在 2013-17 年的研究期间，每人每年资助减少 100 英镑与男性出生时预期寿命平均减少 1·3 个月（95% CI 0·7–1·9）和 1·女性个体2个月（0·7–1·7）；对于 65 岁时的预期寿命，结果显示男性个体减少 0·8 个月 (0·3–1·3)，女性个体减少 1·1 个月 (0·7–1·5)。更贫困地区的资金减少幅度更大，这些地区的预期寿命变化最严重。我们估计，资金削减与最贫困和最贫困五分之一人口之间的预期寿命差距扩大有关，男性为 3%，女性为 4%。

解释

我们的研究结果表明，削减地方政府的资金可能部分解释了预期寿命的不利趋势。鉴于更多贫困地区的资金减少幅度更大，我们的分析表明不平等现象已经扩大。自大流行以来，解决预期寿命的这些不利趋势和减少健康不平等的战略可以优先考虑对地方政府服务的资金再投资，特别是在英格兰最贫困的地区。

资金

国立卫生研究院 (NIHR) 公共卫生研究学院、NIHR 东北和北坎布里亚应用研究合作组织、NIHR 西北海岸应用研究合作组织和医学研究委员会。