This Need Is Urgent

Kevin Gulliver writes:

Imagine if, at birth, newborns were divided into five groups. The five groups are allotted varying time-spans on the planet, with the bottom fifth having the shortest lives, the next fifth longer life, and so on, with the top fifth living longest. 

The upshot is that that the top fifth of newborns have lives ten years longer than the bottom fifth. Real disparities in life expectancy in the 21st century UK are as glaring as this. Residents of the most affluent communities live almost a decade more than those of the most deprived.

For decades, the links between health, poverty and inequality have been securely established, with perhaps the most renowned work on it – by Professor Michael Marmot – revealing how mortality and morbidity are linked to ‘social determinants’ of health. Chief among them these social determinants are class, ethnicity, gender, disability, relative wealth and poverty, the characteristics of neighbourhoods, quality of environment, and housing. 

Yet poor lifestyle choices in deprived communities continue to be blamed for health inequities. New analysis reveals how that view is wrong. Professor Marmot writes in the foreword to a forthcoming report by the Human City Institute (HCI): 

“There is a rumour going around that poor people are unhealthy because they make unhealthy choices. This rumour is a myth. It has the causal connection backwards…It is not poor choices that lead to poverty, but poverty that leads to poor choices. Change circumstances and people on low incomes are more likely to adopt the choices that are good for health.”

This need is urgent. HCI’s research shows that significant health inequalities exist at all geographical levels, and are on the rise. Major disparities in life expectancy exist between the countries and regions of the UK, between local councils within regions, and most starkly, between neighbourhoods within local authorities.

The most deprived neighbourhoods include larger concentrations of poor and overcrowded housing, which poses major risks to health – including poor mental health, respiratory disease, long-term health and disability and the delayed physical and cognitive development of children. Cold housing is especially damaging for health, and causes an estimated fifth of excess winter deaths. Insecure and short-term tenure housing is especially damaging for physical and mental health. 

Levels of poor, hazardous and overcrowded housing are also on the rise. It is estimated that such housing costs the NHS £1.4bn annually. Austerity and welfare reform introduced in 2010, are factors in widening health inequalities. As the BMA says in a recent report:

“Austerity is the central public health issue of our time. From A&E departments to mental health to child health, austerity hampers the ability of the NHS to respond to the needs of the British population…and austerity falls hardest on the poorest in society, the most vulnerable, the voiceless.” 

The Tories’ record on health is weak and worsening – spending on the NHS has fallen as a proportion of GDP and now lags behind the EU average; public satisfaction with the NHS plummets as crisis after crisis hits the NHS; and public health has been reorganised, reduced and rendered less effective. Alongside this, we see cuts to services from Sure Start to welfare benefits, coupled with stagnating earnings at the bottom of the income scale.

All this exacerbates inequality – which in turn is feeding into low life expectancy for the poor. That this is not a national scandal in the 70th anniversary year of the NHS says an awful lot about the priorities of politicians, the media and the British people.

Read the Human City Institute report here.