Health inequality
Mike Hedges MS
Health inequality has been known for over 50 years, when Dr Julian Tudor Hart, a GP in the Afan valley, wrote an article in The Lancet on the inverse care law. The inverse care law is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served. He said:
‘In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support, and inherit more clinically ineffective traditions of consultation, than in the healthiest areas; and hospital doctors, shoulder heavier case-loads with less staff and equipment, more obsolete buildings, and suffer recurrent crises in the availability of beds and replacement staff.’
Has it changed? As Frank Dobson put it when he was Secretary of State for Health: ‘Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you’ll die sooner because you’re badly off.’
Then there’s a social gradient in lifespan. People living in the most deprived areas in England and Wales have an average life expectancy of about nine fewer years than those in more affluent ones for men, and seven for women. Men and women living in the most deprived areas can expect nearly 20 fewer years in good health. So, people not only die younger but are ill for a larger period of their life. If I were living now in the area I went to school, the likelihood is, as a man of over 60 years of age, it would be over 50 per cent that I would be suffering from serious ill health. Almost half the gap in life expectancy between the two areas is due to excess deaths from heart disease, stroke, and cancer.
As well as lower life expectancy, there’s a higher prevalence of many behavioural risk factors among the most deprived areas compared with the less deprived areas. These health inequalities are underpinned by inequalities of both social and economic circumstances that influence health. Health cannot be looked at on its own. The unequal distribution of the social determinants of health, such as education, housing and employment, drives inequality in physical and mental health, reducing individuals’ ability to prevent sickness or to take action and access treatment when ill health occurs. People cannot afford to stay home from work when they are ill because the effect it has on their income. That has a serious effect on their life expectancy in the long run, but it also affects them very badly in the short term.
These inequalities are complex; they are embedded in society. But they’re also preventable. The dimensions of inequality are complex and overlapping, as is representing the overlapping dimensions of health inequality. Health inequalities such as deprivation, low income and poor housing have always meant poorer health, reduced quality of life and early death for many people. The COVID-19 pandemic has starkly exposed how these existing inequalities and the interconnection between them, such as race, gender, and geography, are associated with an increased risk of becoming ill with a disease such as COVID-19. But it would be true of any pandemic.
The link between poor housing and poor health is well established. Clement Attlee created a ministry of health and housing under Nye Bevan. Unfortunately, no Labour leader since has managed to join the two together. The Labour Party has a strong and proud record of providing good-quality social housing, and this leads to improved health for the residents of these properties. But we also have people living in cold, damp and unsuitable privately rented accommodation. Is it any surprise that they have poor health, and many children have poor educational outcomes?
Homelessness has a huge impact on a person’s physical health. Sleeping rough makes it difficult to get good-quality sleep, maintain an adequate and healthy diet, stay clean and take medical treatment. It’s not surprising that research by University College London discovered at least one third of homeless people have died from readily treatable conditions, and almost all of them died young.
Many studies have found a direct link between good health and interaction with the natural environment, with stress lowered, obesity rates lessened and concentration improved. Health inequality is just another manifestation of poverty: poor diet, poor-quality housing, inadequately heated housing, lack of interaction with the natural environment, lack of exercise, and continually worrying about money inevitably producing less good health outcomes and early death.
There are large numbers of my constituents who daily worry about the amount of money they’ve got and how they’re going to pay their bills. I remember once saying that if I was in that situation of not knowing how I was going to feed my children, if I didn’t know how I was going to pay my rent, I would be depressed as well, and it seems mental health is driven by the fact that people are poor. So, let’s deal with the real cause of health inequality , which is poverty and poor housing, and if we can deal with those, then we can improve health and health outcomes.
Mike Hedges is the Senedd Member for Swansea East