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
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
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
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