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9 March 2015

It’s not just “boozy“ northern cities: health inequality is a national disease

Health inequality is a big issue in the UK: tackling it will help income inequality, the NHS and the economy, but the causes of it are not as straightforward as they seem.

By Dan Holden

Inequality is a headline grabber. We’ve all heard about executive pay meaning CEO’s earn more than an average year’s salary in just two working days, but perhaps what we don’t hear so much is the inequality rife in the UK’s health.

Today, the ONS released statistics on the inequalities of life expectancies as determined by area deprivation. Men in deprived areas have life expectancies nine years shorter than those in the least deprived areas and of those years lived, the years of “good health” for deprived men is 52 years, compared to 70 for the least deprived. For women, the life expectancy gap is less, at a six year difference (as opposed to nine) but the disparity of their lives spent in ‘good health’ is greater. These statistics tell a story that is familiar to most people; health and life expectancies are damaged by deprivation, which then in turn fuels said deprivation in a brutal cycle.

It is however, not as simple as this. There certainly is a link between growing economic inequality and health inequality, but it cannot all be explained by this. Glasgow has some of the worst problems with health and life expectancy in the country, but not all of this can be explained by deprivation; less than half of the life expectancy gap between Glasgow and the wealthiest areas of the UK can be explained by deprivation.

It is the big cities that see the biggest inequalities between socio-economic classes in health around the country; the local authorities with the biggest gaps are largely in central London but also in Newcastle and Cardiff. The big cities don’t define the regions that they exist in though; although London has very high health inequality in places, the southeast in general has some of the lowest health inequalities of any English region, second only behind the east of England. The heightened disparity in health of cities speaks to the other factors at play with health; the alcohol consumption in the north of England far outstrips that of the southeast and the South in general.

This boozy culture (although it sounds like tabloid fodder) instead shows the impact of the politics of culture and place. On an individual deprivation level, those in the poorest Northern regions fare worse in health terms than they should, due in part to the post-industrial regeneration focus on Northern cities being bar-heavy (according to Dr Townshend of Newcastle University). Economic inequality is not the be-all and end-all of health inequality; where you live matters too, as we can see so clearly in Glasgow.

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Both the moral and the economic arguments around health inequality have already been won, but despite that, little has happened. All parties and politicians believe in tackling health inequalities, as we have seen from the wholesale support of the Marmot review (a government review which looked into health inequality). The review set out a rigorous agenda, including early intervention recommendations and attention to communities and place. It also points out, through some pretty conservative estimations, the “large” economic benefits of tackling health inequality; if we can intervene in the long-term illness problems of places like Glasgow, the NHS will save money and people will be healthier – a winning strategy all round.

As with all things in life though, you have to spend money to save money; early intervention always costs but pretty much always pays off. Money isn’t the only solution though; structural reform may be necessary too. The Smith Institute recently published a report on the role of healthcare in local economies which described how “the scale of health inequality across the country is significant and has been persistent or increasing in recent decades”. With local factors contributing to health inequalities alongside socio-economic forces, we may well be seeing more of the localised health agenda that we have seen materialise in Manchester’s devolved health budget. The UK’s health inequality average is better than England’s, largely due to England’s highly centralised health service; if the next government is going to tackle the geographical-lottery of health, then we might need to fight it locally.