Few public policies in recent British history have inflicted as much harm and suffering on the population as austerity. That is the message of ‘Social Murder? The Effects of Austerity on Population Health in the UK’,1 in which authors David Walsh and Gerry McCartney draw on their significant expertise to explore the devastating consequences of austerity policies in the UK. Based on peer-reviewed research, including their own substantial contributions,2 the authors synthesise a vast body of evidence alongside the personal stories of seven people profoundly impacted by austerity.

Walsh and McCartney argue that measures of population health, such as life expectancy, are more than just statistics: they reveal the kind of society we live in. Recent figures underline the urgency of the authors’ call for action. There was no improvement in self-reported health in the decade to 2021,3 while inequalities in healthy life expectancy widened.4 The Royal Society for Public Health described this as a ‘lost decade’,5 echoing Sir Michael Marmot’s warnings in 2020.6

Across seven chapters, Social Murder? details the substantial and unrelenting harms of austerity, manifest as the deep cuts to public services imposed by the Conservative-Liberal Democrat Coalition Government from 2010, ostensibly to ‘cut the deficit’ following the financial crash of 2007/2008. Walsh and McCartney document how austerity in the UK disproportionately affected people in vulnerable situations, leading to widespread and preventable harm. By interweaving the real-life stories of Michael, Rachel, Frances, Paul, Moira, Ellen and David, they recall the famous phrase attributed to Sir Bradford Hill: ‘Health statistics represent people with the tears wiped off’. These worsening health outcomes are not just numbers—they are people’s lives.

The first two chapters outline the stalling and, initially for some groups, worsening life expectancy after 2012, with the starkest reductions in the most deprived areas. In Chapter 3, the authors argue that while other causes have played some part, such as obesity, it is austerity policies that are the most important cause. In Chapter 4, the authors confront the argument that life expectancy gains slowed in other countries, so we should look to other causes. They counter this argument effectively by looking at one country after another, in each case showing the link to differing types and degrees of austerity and making a compelling case that they are all experiencing the consequences of shared causes—chiefly austerity—implemented differently across nations with varying impacts.

Chapter 5 is especially novel and thought-provoking, exploring ‘the story of the story’—how the deterioration in health outcomes went on for so long (and continues to) without anyone in power doing anything, and why so many were (and, some to this day, are) unable and unwilling to see what was in front of them. Walsh and McCartney scrutinise the failure of many public health agencies and think tanks to sound the alarm and hold those in power accountable. They write that these responses ‘…ranged from (at best) unhelpfulness to (at worst) denial, obfuscation and dereliction of public health duty’, words that might invite reflection for those in charge of such bodies.

The authors provide a detailed timeline of events from 2010 to 2023, illustrating how Public Health England (PHE) and others repeatedly attributed deteriorating health outcomes to ‘traditional’ (and perhaps more comfortable) explanations like influenza, even as mounting evidence pointed to austerity. By failing to confront the reality of the impact of austerity, they describe how PHE and others gave politicians cover to deny what was happening and escape accountability. Even as recently as the COVID-19 inquiry, the architects of austerity, David Cameron and George Osborne, refuted any links between austerity and health.

The authors ask a very important question. Why was no public health emergency declared, even as life expectancy in deprived areas began ‘falling rapidly’? Walsh and McCartney propose three possible reasons why public health agencies failed to act: fear of embarrassing or undermining the government; dismissal of well-recognised political determinants of health as ideological; and selective application of different evidence thresholds depending on the causes being invoked, demanding impossible standards, such as randomised controlled trials, to establish the harm of austerity. These failures, they suggest, perpetuated a cycle of inaction and denial.

The book’s final chapter, written before the Labour Government came to power in July 2024, outlines the actions needed to address the health inequalities that austerity has exacerbated—and the vast evidence base and resulting policy recommendations for such action.2 7–9 Walsh and McCartney argue that these inequalities are inherently political and require bold political solutions. They call for transformative changes, beginning with a ‘first level’ intervention: make the UK more equal. Their proposals include introducing a real living wage, advancing economic democracy and addressing food poverty and insecurity. They call for reversing the cuts to public services that have disproportionately harmed the most vulnerable, directing resources to areas of greatest need (also those most affected by austerity) and the importance of ‘proportionate universalism’7—universal access to services with greater resources allocated to those who need them most. They stress that addressing structural issues, including the obesogenic environment, requires effective policies informed by the wealth of existing recommendations.2 7–10

Unsurprisingly, Walsh and McCartney argue against current and future austerity policies. The authors confront the economic and political challenges of implementing dramatic changes to governmental policy. While acknowledging the substantial costs involved, they argue that the UK’s vast wealth could easily fund much-needed interventions if distributed more equitably. They point to the staggering concentration of wealth in the hands of the 50 richest families, which equals more than that of half the population combined, as evidence of the resources available to address inequality—should the political will exist to do so.

Walsh and McCartney leave the reader to grapple with the book’s intentionally provocative title, invoking Friedrich Engels definition: ‘when society places hundreds… in such a position that they inevitably meet a too early and unnatural death… its deed is murder just as surely as the deed of the single individual’. Social Murder? documents not only the harm caused by austerity but also the widespread evasion of responsibility by those in power. This book is a call to action for the public health and medical communities to confront uncomfortable truths about the political determinants of health and to advocate for policies that prioritise equity and well-being. It underscores the urgent need to bridge the widening gap between public health and politics, especially in an era of polarisation, misinformation, and populism.11 12

Social Murder? is an unflinching indictment of austerity, offering a definitive account of its devastating impact on population health in the UK. The book adds to existing pressures on the new Labour Government to make a critical choice: address health inequalities (and inequality more broadly) or allow the alarming decline in health outcomes to continue. It should be required reading for those in power along with anyone invested in the health and well-being of their communities. The evidence is overwhelming and the consequences devastating. Continuing the status quo is not just neglectful—it is complicit. As Walsh and McCartney make clear, no one can claim ignorance of austerity’s terrible toll on the lives of people in the UK.

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Thanks to Danny Dorling and Martin McKee for their informal feedback on this review.