Public health work at one primary care trust has shown how unemployment could have massive impact on a generation’s life expectancy, and why it’s important they get back to work. John Middleton reports.

The national tragedy of over one million unemployed young people, under 25, continues. It would seem from the rhetoric, that to be “unemployed” is to be “worthless”,  “pathetic”, “useless”.  So “apprentices” stumble from one £2.50 a week job to the next, as cheap sub-minimum wage employees. Without future, hope or dignity.

The Faculty of Public Health has published various resources that make it clear how strong the link between that employment and mental wellbeing is. Fortunately. some young people, like apprentices in West Bromwich where I work, do hold their heads high despite the system.

As a director of public health in a small provincial backwater in the West Midlands, I was criticised under the last government’s performance regime for failing to improve life expectancy in Sandwell fast enough to reduce our health inequality in line with national rates. 

It took me a while to understand why the health of Sandwell people was not improving as fast as the rest of the country, despite the welcome increases in investment in our local health services. Men aged between 45 and 65 years were dying before their time in the “noughties” because they had been made unemployed during the the recessions of the 1980s. Most of them had left school at 16, secure in the expectation of a lifetime’s job in manufacturing. As local Frank Skinner said once: ‘They didn’t go much on education where I come from’.

When the jobs in manufacturing went, the chances of something else in IT, finance or new technology did not exist. Most of that generation did not work again except for casual, dirty, dangerous, wearisome and unrewarding work. They lived out much of their lives smoking and drinking in pubs, eating cheap, processed foods high in fat, being inactive, but being also stripped of opportunity, respect and hope, living for the dole cheque, afflicted by coronary heart disease or lung cancer at an early age.  

And now a new and even bigger generation are looking forward to lives of hopelessness, bereft of dignity, meaning and value. We should project a decrease in life expectancy again in 2030, if we cannot give meaningful existence to our new generation of young people who are keen and hungry for work. 

Sandwell Primary Care Trust responded to the credit crunch offer of the last government by creating apprenticeships for 38 young people in 2009. Nathan, one of our apprentices, recently prepared a brief for our chairman and chief executive on how, finally, by 2009, we were seeing Sandwell’s life expectancy improve faster, narrowing the gap with the national rate.   

This is because we have invested much in prevention, and in identifying and treating people at risk of heart disease. By prescribing more statins and anti-hypertensives and quit smoking services, we have supplied technological fixes to prevent early deaths caused by a lifetime of economic and social deprivation. Nathan may not have realised until now that his evidence is an historic record of disappointment, hopelessness, political neglect and the premature death of a generation not unlike him 30 years before. In 1984, JRA Mitchell said, in a British Medical Journal editorial:

“Britain is currently witnessing two uncontrolled mass experiments in social isolation and life stress in theshape of our three million unemployed and the conflicts between working and non-working miners, which will produce lasting bitterness for them and their families within previously tightly knit communities. Can we ensure that the medical consequences of the resulting life stress and social isolation will be properly documented? … we must now include life stress and social isolation among our prognostic markers, and try to find out how pain, pleasure, hope, or fear is the cause of an agitation whose influence extends to the heart.”

Sadly, Professor Mitchell’s appeal for better prospective study has not been realised. But a 2009 BMJ paper concluded that we were not seeing as much reduction in heart disease in the under 65s in poorer social classes.

Economic deprivation in one generation will have an impact on their health for many years, and ultimately result in their untimely deaths. It should be compelling enough evidence to put our potentially lost one million young people back to work now for their own good, for the good of our community safety and for our nation. If we don’t, we might simply heap a burden of ill health and early death upon them and society in 30 years’ time. Surely this makes it all the more urgent that we get people back to work.