“Could do better” – the verdict on health inequalities in England

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The Labour government came to power aiming to tackle health inequalities and committed itself in 2003 to reducing inequalities by 10% by 2010, (measured by infant mortality and life expectancy at birth). While overall life expectancy has increased, the health gap between the rich and the poor has actually increased according to “Fair Society, Healthy Lives”, a strategic review of health inequalities in England, published earlier this month.

The review, which was led by Professor Sir Michael Marmot, says that reducing health inequalities is not only a matter of fairness and social justice, but is also vital for the economy. The cost of health inequalities leads not only to additional strain on NHS resources, but also results in lost productivity, lower tax revenues and higher benefit payments.
Highlighted is what the review calls “the social gradient in health” – a strong correlation between health status and social circumstances such as level of education, occupation, employment status, and housing conditions. This social gradient does not just affect life expectancy, which results in an average difference of 7 years between the poorest and richest in society, but also affects disability free life expectancy, which is the number of years a person can expect to be in good health. The review reveals that people living in the poorest neighbourhoods in England can expect 17 fewer years of good health than their wealthy counterparts.
The health inequalities arising from this social gradient cannot be satisfactorily explained by lifestyle or problems in accessing healthcare services. The review therefore recommends that health inequalities are tackled by action on a number of non health-related fronts such as early years education, employment and skills, tax and benefits, public transport, green spaces and energy efficient housing. 

The report also backs the idea of establishing a “Minimum Income for Healthy Living” (MIHL), which would provide people with the income needed for proper housing, good nutrition, transport, healthcare and physical activity. 

Despite government initiatives such as Sure Start, tax credits and pension credits having made some progress in reducing health inequalities, there is still room for significant further improvement. Any action taken needs to be across society, not just aimed at the most needy, and will requires a life course response beginning with early years initiatives and continuing through to retirement.
The Marmot report also highlights potential fairness issues for future governments which are likely to be minded to increase the state pension age to 68 or beyond. If, as the review suggests, 75% of the population will not be in good enough health to work until that age, further action will be required to ensure that reducing social inequalities in later life. To enable people to work longer, for example, more comprehensive preventative healthcare services for the over 50s will be necessary. 

Rebecca Taylor
David Sinclair


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