The scandal of UK health inequalities

Large gaps in health between different parts of the country are unfair and unjustifiable. They are driven by social and economic inequalities, and they are avoidable.

In this summer’s sci-fi blockbuster, ‘Elysium’ is the manmade space station where the wealthy have moved to escape diseased planet Earth by the year 2154. Earth has been ravaged by climate change and the majority of the population are living in poverty and sickness. There is no disease in Elysium however: the wealthy elite there enjoy a fresh new ecosystem and have special machines that can restore health within minutes.

“I promise you, one day I'll take you to Elysium” says the hero, Max Da Costa (Matt Damon) to his childhood friend. As an adult he fights for equality between the polarised worlds, attempting to bring the health and wealth of Elysium to Earth. “I promise you, one day I'll take you to Richmond” doesn’t have the same ring to it.  But given the data on health inequalities in England, we may well want to move there.

The Office for National Statistics (ONS) recently released estimates for life expectancy and healthy life expectancy for people in the UK. These tell us (a) how long we can expect to live and (b) how many of those years we can expect to be in good health. They picture is one of stark contrasts:

• Richmond comes out on top for years in good health. Women in Richmond upon Thames have a Healthy Life Expectancy of 72.1 years and men 70.3 years.
• Tower Hamlets is bottom – with women hit worse than men. Women living in Tower Hamlets can expect to live only 54.1 years in good health, and men 55.7 years.
• Manchester also has poor results.  Healthy Life Expectancy is 55.4 years for women and 55 for men.
• Average Healthy Life Expectancy is 64.2 years for women and 63.2 years for men.

Nationally, there are gaps of 7 years for life expectancy and as many as 18 years for living in good health. If you live in Tower Hamlets or Manchester you can expect to see your neighbours getting sick and unwell nearly two decades earlier than you would if you lived in Richmond. Mortality rankings show high risk of developing heart disease, lung disease and cancer before the age of 75 in both Manchester and Tower Hamlets – along with Blackpool, Liverpool and Salford. In these areas, it is likely people will get unwell before they retire. These inequalities in health between the most and the least deprived areas in England are growing, even as overall life expectancies improve.

I fear that, if we allow these trends to continue, we will create ‘Elysiums’ in the UK – a handful of places where people have excellent health, while poor health persists elsewhere. International research concluded that inequalities in health originate in inequalities in the conditions of daily life, rooted in inequalities in power, money and resources. Danny Dorling has produced beautiful but concerning maps, tracking wealth and assets in the UK geographically since the 1980s. He has shown that wealth and assets have concentrated around particular places – leaving other areas with increasingly high concentrations of poverty.

Running parallel to geographical polarisation we’ve known growing social inequalities, described in our recent report: Distant Neighbours. Professor Michael Marmot, in his review of health inequalities in England and Wales (Fair Society Healthy Lives, 2010), highlighted five ‘persistent social inequalities’ that lead to health inequalities between people and places, in:

• early child education and development
• employment and working conditions
• housing and neighbourhood conditions
• standards of living
• freedom to participate in the benefits of society.

There’s such a powerful link between health inequalities and socioeconomic inequalities that change is unlikely unless these factors are addressed.

Since we can’t all move to Richmond, we must advocate for the change that will reduce economic and social inequalities, thereby changing the conditions of daily life that are leading to unfair differences in health and mortality.

A few principles for action:

1. Appreciate the importance of ecosystems and local environments in delivering well-being and good health – because the conditions of daily life in neighbourhoods, in terms of green space and access to nature, matter.
2. Push for economic equality, seeking coordinated action on a national level to break the cycle of income and wealth inequality. This would mean rebalancing the polarised labour market and changing structures of asset ownership.
3. Encourage social equality through childcare, education, improvements in working conditions and job security, social participation and support.
4. End austerity. The impact of austerity has been to deprive the public and private sector of resources, leading to an intensification of poverty and everyday insecurity. Our research reveals the growing prevalence of precarious working conditions, zero-hours and temporary contracts. There are mounting pressures to afford basic necessities such as food, utility bills, and rent; and an unravelling safety net as benefits and tax credits are becoming less generous, more conditional, and increasingly punitive. This is bad for people – for their physical and mental health. Austerity has been championed with powerful rhetoric but is not necessary. We need to convince the country of a different story.

Above all, let’s remember that health inequalities are not inevitable. The genes we were born with are only a small part of the picture. So much of what makes us healthy is found in our daily lives and can be improved: our social lives, our connection to nature and our patterns of work, rest and exercise. But we need to recognise the economic bases of these everyday decisions. They depend on having certain resources at our disposal. A healthier country will be one in which we not only make healthier ‘lifestyle decisions’, but in which there is a fairer distribution of resources (financial, social and natural) between people and places. The year 2154 is still a long way off – and if we put our energies into health equity and social and environmental justice, we shall have no need for Elysium.

new economics foundation