Devolution isn’t enough: why the north needs redistribution, not tinkering

Andy Burnham likes to say Britain must change course after “40 years of neoliberalism”. Few places make his case more starkly than the north of England. A new study, published in The Lancet Public Health this week, puts hard numbers on the damage.

In 1981, death rates among adults aged 25 to 49 were 13% higher in the north than in the south. By 2024, that gap had more than tripled, to 42%. The figures take account of age and sex differences between the two populations.

For women, the shift is starker still. In the 80s, northern women in their late 20s and 30s faced no excess mortality compared with women in the south. Today, every five-year age band of women from 25 to 49 shows an excess of between 35% and 60%. Overall, the gap for women has grown from around 12% to 41%.

Nor is this simply a hangover from Covid. The researchers, from the universities of Liverpool and Manchester and Health Equity North, found the gap was already widening before the pandemic. It grew for both women and men during 2010–19 – the austerity decade. They found no sign of it narrowing between 2020 and 2024 in any age or sex group. Across everyone under 75, northern death rates were 26% higher in 2024.

As the Guardian asked this week, what happened over those four decades to leave younger adults in the north with so much worse chances of survival?

Jobs, homes and services

The answers are not mysterious. They lie in the jobs people do, or cannot find, the homes they can afford and the state of the public services, like the NHS, that they rely on. Deindustrialisation tore the economic heart out of communities across the north and nothing comparable replaced it. Austerity then stripped away much of what was left.

The new paper looks at deaths from all causes combined and the team plans further work on which causes drive the gap. But earlier research by many of the same academics found deprivation explained up to two-thirds of excess deaths among younger northern adults. Deaths linked to alcohol, drugs, accidents and heart disease were all rising faster in the north.

The study also points to a demographic squeeze. Younger adults leave the north and fewer move in, so its population is ageing faster than the south’s. That shrinks the local tax base and productivity while pushing up demand for health and social care. The authors say this mix of “historical underinvestment, austerity-driven funding cuts, and demographic shifts” has compounded regional disparities, requiring “politically challenging policy interventions”.

A drag on every mission

This is not only a moral question. The authors describe the divide as a major constraint on the government’s own missions: economic growth, more opportunity and an NHS fit for the future. Closing it, they estimate, would release £18.4bn to the economy.

That should concentrate minds at the Treasury. A government chasing growth cannot afford to write off a large slice of the north’s working-age population to early death and long-term ill health.

The budget test

John Healey will deliver his first budget as chancellor on Wednesday. He has promised it will move “money and power out of Westminster, and into every postcode around Britain”. He has also told cabinet colleagues to prepare for cuts to fund Burnham’s pledges and insisted the plans will stick to the fiscal rules inherited from Rachel Reeves.

That tension is the story. Burnham talks a good game on devolution and giving mayors and regions more control has real merit. But devolution without redistribution risks handing the north responsibility for decline without the means to reverse it. A mayor with new powers and the same shrunken tax base is still managing scarcity.

The researchers are clear on this. They call for regional strategic authorities to get sufficient powers to tackle the social and economic causes of ill health. They also want funding targeted at areas of high deprivation. Both, not one or the other.

In practice, that means money following need. It means council and public health funding that reflects deprivation rather than past spending. It means investment in decent jobs and good homes and a social security system that lifts families out of poverty. These are the “sustained large-scale action across central government and regional authorities” the Lancet paper calls for.

Why tinkering won’t cut it

The authors admit the challenge is daunting, given the state of the economy and rising unemployment. But they argue it is essential if the UK is to meet its commitments to growth, opportunity and a healthier population.

Burnham has built his politics on the north’s experience of 40 years of neoliberalism. Next week is the first real test of whether his government means to undo it. A few targeted funding pots, a new devolution deal and a speech about fiscal discipline will not reverse a trend four decades in the making.

The cost of getting this wrong is not measured only in lost output. It is measured in lives cut short – and in the very communities that Burnham says he speaks for.