Health: Mind the gap – it’s killing people

by
01 May 2015

Rising social inequality is bad for our health and our NHS, but the Government is slow to recognise this, says Michael Bond

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Obesity, alcohol, and smoking all affect health outcomes, but social inequality is often overlooked

Obesity, alcohol, and smoking all affect health outcomes, but social inequality is often overlooked

ONE way to judge the complexion of a society is to compare the health of its most deprived citizens with that of its most fortunate. By this measure, Britain is looking decidedly peaky.

Across almost every measure of health, the worse-off suffer more than the rich. Figures from the Office for National Statistics suggest that boys born in the well-off district of South Cambridgeshire can expect to live to 83 - nearly nine years longer than their compatriots in disadvantaged Blackpool. Girls in the prosperous Chiltern district can expect to live to 86 - six years longer than those in Manchester.

By a similar measure, if cancer rates among the affluent were replicated across the whole population, 19,200 fewer people would die each year, the National Cancer Intelligence Network says.

It is tempting to frame this as a problem of poverty: if everyone could afford to eat wholesome food, join a gym, and live without worrying how to feed their family, disparities in health would diminish.

But this is only partly true. A significant cause of health inequalities is the stress of living in a society where the haves have so much more than the have-nots.

Research shows that economic inequality itself appears to be a trigger of disease, and of many other social ills. "The evidence that large income-differences have damaging health and social consequences is strong," Professor Kate Pickett, who studies health inequalities at the University of York, says. 


THAT could be bad news for the NHS, given recent forecasts that predict that inequality in the UK is set to grow. During the recent recession, income inequality decreased, as the richest lost a greater proportion of their earnings. But the Institute for Fiscal Studies (IFS), in London, predicts that, as the recovery continues, and earnings at the top rise more than at the bottom, and cuts in benefit entitlements bite deeper, those falls in inequality "may well be swiftly reversed".

One projection by Professor Mike Brewer, a Research Fellow at the IFS, suggests that income inequality in the UK will return to 2007 levels by 2016.

The Joseph Rowntree Foundation, which researches social issues in the UK, has also predicted a rise in income inequality over the next five years.

The UK is the only G7 country to record rising wealth inequality - the disparity in people's total assets - throughout the period 2000-2014, a report by Credit Suisse Research Institute shows: a trend, it says, that is likely to continue beyond 2019.

Worryingly, wealth inequality in the UK grew four times faster in the seven years after the 2007 recession than in the seven years preceding it. In the World Bank's global inequality list, with the most equal country at the top, the UK sits 73rd out of 154. Only the United States, Israel, Portugal, and Japan are doing worse among developed countries.

THE impact of rising inequality on the NHS could be significant, given the huge body of evidence from across the world that links income-inequality with poorer health and well-being.

A study published in March in the American journal Pediatrics finds that countries with the largest increases in income inequality between 2000 and 2010 showed the greatest declines in child well-being. Another, in February's The Lancet, concludes that rising inequality in Europe and North America over a similar period coincided with greater disparities in the mental and physical health of 11-to-15-year-olds.

And a meta-analysis in the March issue of the journal Social Science & Medicine, by Professor Pickett and Richard Wilkinson, Assistant Professor of Statistics at the University of Nottingham, says that there is now "no doubt" that worse health is associated with greater inequality. Unsurprisingly, those lower down the income distribution bear the brunt of this, further compounding the toll of poverty.

The realisation that others are faring much better than you are can cause a chronic stress reaction that weakens the cardiovascular and immune systems, Professor Wilkinson says.

"We have a psychological sensitivity to status differences that goes right back to our pre-human ancestors." He maintains that inequality affects the whole of society, because it fractures social cohesion and decreases trust between different socio-economic groups. 


THE Government recognises the need to reduce health inequalities. The "health and well-being gap" was identified as one of the three key challenges for health and care in the NHS's recently published Five Year Forward View. And the NHS budget is being redesigned so that deprived areas and poverty-related issues such as smoking, problem drinking, and obesity receive even more than they do now.

"We are very clear that everyone should have the opportunity to live a healthy life, no matter what their social background is," a Department of Health spokesperson said.

It is less clear, however, whether the Government fully appreciates the impact that income- and wealth-inequalities have on these health disparities.

Professor Pickett says that the current political focus on individual lifestyle behaviour-change rather than societal change "is frustrating to most public-health practitioners and academics", because of the wealth of evidence that social imbalances, such as the gulf between rich and poor, are a significant contributor to ill-health. 


REDUCING national income and wealth inequalities is the responsibility of central government, and can be achieved by more progressive taxation, for example. The importance of such measures, and of raising more people out of poverty, was highlighted by the Marmot review in 2010 - an independent study commissioned by the Government into health polarities in the UK.

But Professor Pickett believes that the political parties "lack the courage to tackle [such issues] head on, despite all the research on the costs of inequality".

Dr Subu Subramanian, Professor of Population Health and Geography in the Department of Social and Behavioral Sciences, at the Harvard School of Public Health, says that this attitude is typical of governments worldwide, few of which take the health effects of income inequality seriously.

"Most public policy is still based on absolutes," he says. "I don't think it's because they don't believe it, but it's very difficult for policy-makers to intervene on relative deprivation." Until they do, the NHS will continue to pick up the cost. 

A shorter version of this article appeared in the New Scientist ( www.newscientist.com/article/mg22530134.800-nhs-gamechangers-growing-gap-between-rich-and-poor.html)

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