The EconomistFebruary 29th 2020 Britain 23W
hen michelle fisherwas a teen-
ager, money was tight, and she had
to ration the number of tampons she
used. Despite experiencing extremely
heavy periods, she would use only one or
two a day. Once, she bled through onto a
chair at school. “Even to this day when
I’m buying products it still feels like I
need to ration myself as an after-effect of
being so restricted growing up.”
Ms Fisher shared her experiences in
the course of a consultation on a bill that
would make Scotland the first country in
the world to offer free period products to
all women. The Period Products Bill has
just passed its first legislative hurdle,
and if it becomes law, which looks likely,
the Scottish government will be obliged
to provide free sanitary pads and tam-
pons to “anyone who needs them”. Many
countries have cut taxes on sanitary
products, and Scotland is not the only
place to give them out free in schools. But
this bill offers the widest provision of
pads in the world, costing £24m a year,
according to the government.
The woman behind the bill is Monica
Lennon, a Labour member of the Scottish
Parliament. She initiated the first con-
versation about the cost of periods in the
Scottish chamber’s history; in 2020 she
has grey-haired malemsps talking about
bloody tampons. Earlier this month the
ruling Scottish National Party aban-
doned its concerns about period tourism
flooding over the English border, so the
bill has the support of all parties and
looks set to cycle through Parliament.
The prevalence of women in Scottish
politics seems to be one reason whyScotland looks like achieving a world
first on this issue. The Scottish cabinet is
more than half female (compared with a
quarter at Westminster’s top table), and
Scotland has had a female first minister,
Nicola Sturgeon, for five years. She
championed the introduction of free
period products in schools in 2018.
The measure is also an indication of
the Scottish government’s appetite for
radical social legislation, points out
Mark Diffley, an independent polling
consultant in Edinburgh. Scotland has
provided free university tuition and
personal care, banned smoking in public
places and set a minimum price on alco-
hol. Such measures are increasing the
distance between Scotland and Eng-
land—which, as far as thesnpis con-
cerned, is all to the good.Scotland’s free periods
MenstruationAnother way in which the difference between Scotland and England is growingT
en yearsago the Marmot Review, a
study commissioned by the govern-
ment, asked a big, complicated question:
why do some people in England live longer,
healthier lives than others, and what can be
done to reduce the gap? The answer it
found was simple. Some people lived lon-
ger because they were better-off. To change
this, it concluded, the government would
have to reduce social inequality.
A new report by its author, Sir Michael
Marmot of University College London, re-
views the past decade’s changes. The num-
bers speak for themselves. In the three de-
cades leading up to the first report, life
expectancy at birth for men increased by a
year every four years. Between 2011 and
2018 that rate slowed to a year every 15
years. For women the decline was even
starker, from a year every five-and-a-half
years to one every 28 years. And for the very
poorest women, things have gone back-
wards. Life expectancy for those in the
most deprived areas has declined by 0.3
years from 2010-12 to 2016-18. All women
born later in the past decade are expected
to have fewer healthy years than those born
at the start of it.
Moreover, both men and women under
the age of 50, particularly between 45 and
49, have seen mortality rates tick up (see
chart). Sir Michael suggests that this could
be related to suicide, alcohol use and rising
drug toxicity, making it the British version
of rising mortality rates among poor Amer-
icans, termed “deaths of despair” by Anne
Case and Sir Angus Deaton, two econo-
mists who study the phenomenon.
What happened? The report stops short
of putting the blame squarely on austerity,
though it notes government spending has
declined sharply in the past decade. One
reason women may have suffered more
than men is that spending cuts hit them
harder. Research by the House of Com-
mons library found that the majority of re-
ductions have been borne by women, be-
cause the benefits they were likelier to
receive saw deep cuts. Regional differences
matter too. Poorer areas in the north are
even more likely to have worse health than
those in the south-east. “I invite you to
speculate that it is highly likely that some
of these [cuts] will have had an adverse ef-
fect on health,” says Sir Michael.
Yet the link between austerity and poor
health is hard to pin down. David Sinclair
of the International Longevity Centre, a
think-tank, points out that several Euro-pean countries underwent a period of aus-
terity in the 2010s without drastically wors-
ening health outcomes. And increases in
life expectancy have slowed across the rich
world, notes David Buck of The King’s
Fund, another think-tank, though the
slowdown in Britain has been sharper than
most. Both Davids agree with Sir Michael
that to improve public health governments
must spend not just on health services but
also on education, child support and com-
munity services. The health secretary, Matt
Hancock, also welcomed the report. “He
said ‘we’re committed to levelling up’, and
levelling up, and levelling up. He said level-
ling up four times I think,” says Sir Michael,
referring to the government’s plan to boost
poor parts of the country. “And in case I
hadn’t got it: ‘levelling up’.” 7Health inequality in England was bad.
It has got worse
Life expectancy
Groundhog day
Mid-life deathsSource: ONSEngland and Wales, deaths per 100,000 population
Selected five-year age bands01002003004002000 05 10 15 1835-394 0-4445-4950-54