Britain told social inequality has created 'public health timebomb'

UK is failing its children, women and young people on a grand scale, says Marmot report on links between inequality and health

In Britain one child in four lives in poverty, the report says.

Women and children in the UK would have longer and healthier lives if they lived in Cyprus, Italy or Spain, and Britain is facing "a public health timebomb", according to a study by an expert on inequality and health.

Sir Michael Marmot, who is known worldwide for his work on the social determinants of health, says much of the rest of Europe takes better care of its families. Life expectancy for women and death rates among the under-fives are worse in the UK, where there is also more child poverty.

The public health time bomb Marmot describes is caused by the large number of so-called Neets – young adults who are not in education, employment or training.

Women in the UK can expect to live to 83, but those born in a number of other European countries will live to a riper old age: in Germany and Cyprus, their life expectancy is 84, while in Italy, France and Spain it is 85.

And while child mortality rates in global terms are low in the UK, at 5.4 deaths per 1,000 among the under-fives, many countries do better. Some of those are in eastern Europe, such as the Czech Republic, with 3.4 deaths per 1,000 births, and Slovenia with three. Most countries in western Europe do better than the UK. Greece has four deaths per 1,000 births and Luxembourg has three. Iceland has the lowest child mortality, at 2.2 deaths per 1,000 live births, and Finland is next best, with 2.9.

The report points out that there is a recognised relationship between poverty and under-five child mortality.   In the UK, the report says, one in four children live in poverty – more than in many other European countries. Iceland has the fewest in poverty – one in 10 – closely followed by Norway, Denmark, Slovenia, Cyprus, Finland, Sweden and the Czech Republic.

Only half the children living in poverty reach what the report defines as "a good level of development" by the time they are five, compared with two-thirds of the others.

"Good quality early-years provision can help improve outcomes, especially for the most disadvantaged," the report says. "However, childcare is expensive in the UK, and many people cannot afford to utilise it or go back to work after having children.

"All children aged three and above are eligible for 15 free hours of early-years education per week. In addition, from September 2013, the most disadvantaged two-year-olds will be also be eligible. Local authorities will be responsible for funding these places, and there are concerns regarding the effect that this will have on other services available to families."

The report, by a team of international experts led by Marmot, is published by the UCL Institute of Health Equity, which he leads, and the World Health Organisation. It looks at the disparities in health and social, educational and economic circumstances of the 53 countries of the European Union and recommends policy changes to their governments.

Marmot is particularly concerned by the plight of the Neets. "Unemployment may be falling in the UK, but persistent high levels of the number of young people over 18 not in employment, education or training is storing up a public health timebomb waiting to explode," he says. "We are failing too many of our children, women and young people on a grand scale.

"I would say to any government that cares about the health of its population: look at the impact of their policies on the lives people are able to lead and, more importantly, at the impact on inequality. Health inequality, arising from social and economic inequalities, is socially unjust, unnecessary and avoidable, and it offends against the human right to health."

The UK is an unequal society in many respects, but it is an exemplar in its provision of healthcare. In the NHS, it has universal healthcare, offered through one of the most equitable systems in the world, says the report.

But Marmot says action needs to be taken to reduce inequalities in UK society so that people are less likely to become ill.

"In the UK, as in other European countries, health follows a social gradient: the lower the position on the social ladder, the worse the health," he says.

"Action to improve everyone's health and reduce the social gradient in health needs to start at the earliest age, before people become unwell. Good quality early- years provision must be a priority for all children.

"There needs to be a broad range of social policies, including improvements in every child's start to life, [and] adequate social protection that can act as a buffer against low income over the life-course and provide a minimum standard for healthy living."

Guardian