This has been a lost decade for tackling health inequalities
Dr Kailash Chand
Who could disagree with Professor Sir Michael Marmot: ‘If health has stopped improving, it is a sign that society has stopped improving. When a society is flourishing, health tends to flourish.’
If you are living in poverty, you get ill quicker, more often and you die sooner. Life expectancy is flattening and declining for the poorest 10% of women. Health inequalities are widening and the North/South health gap has increased. All this increases strain on the NHS in general and general practice in particular. The latest report out today, by Professor Marmot – who I greatly admire - comes 10 years after he first published data on the growing gap between rich and poor, and between north and south, in England.
Our health is determined by a complex mix of factors including income, housing and employment, lifestyles and access to health care and other services. Professor Marmot today says: ‘If everyone in England over the age of 30 had the same low mortality as people with university education, there would be 202,000 fewer deaths before the age of 75 each year.’
Three million extra years of life saved each year. This could be multiplied all over the planet.
Lifestyle principles across the board are much more powerful than anything a doctor can do for his patients. Much more than 90% of modern diseases are preventable through education. A heart attack can cost £20,000 to treat. If it can be prevented, that has huge cost implications. I would estimate that something like 50% to 70% of my patients’ medical costs would not just be reduced but eliminated if their diets were healthier and they exercised more.
Politicians and policymakers openly recognise the relationship between state of economy, lifestyle and poor health. In his first speech as health secretary, Matt Hancock said everyone has a part to play in preventing ill health, ‘from the education we receive, to the home we live in to, to the job we do… all of this shapes our physical and mental health.’
But what has he done to walk the talk? Surely there can be no greater social injustice than people dying sooner due to poverty. Professor Marmot’s devastating report today shows that after ten years of grinding austerity, health inequalities are actually widening.
If the minister does believe this, he must agree to reversing the swathe of public health cuts
If the minister does believe this, he must agree to reversing the swathe of public health cuts to council budgets, increasing substantially primary care funding, would be a sensible place to start.
Public Health England (PHE) recently mapped mortality rates across the country so that local people and councils can see where they rank for premature deaths from the four main killers: cancer, lung disease, liver disease, and heart disease and stroke. The figures show that people living in the worst performing area, are more than twice as likely as people in prosperous areas, to die before the age of 75.
In the face of a worsening demographic picture nationally, local authorities have now been asked to find additional in-year savings of millions. This was described by the Kings Fund as ‘the falsest of false economies’ – a judgement it seems difficult to disagree with.
In addition, there will be considerable pressure on the public health function in England in coming months and years to deliver short-term savings. Perhaps the greatest impediment faced would be the reduction of funding from social care budget, causing the passage of older patients through the system to grind to a halt.
Public health interventions deployed over the short term that potentially offer quick savings are an appropriate part of tackling the public health challenge. But NHS England should not lose focus on longer term and potentially genuinely transformative interventions directed, for example, toward changing unhealthy behaviours and addressing the social determinants of health.
Ultimately, like any other part of the planet, patients in this county hope for a health and social care system with both the energy and passion to bring about the kind of radical strategic change the UK needs to become a healthier and fairer society – which is how the World Health Organisation defines a healthy country.
Boris Johnson and Matt Hancock must tackle health inequalities if they are serious about saving the NHS.
Dr Kailash Chand OBE is a retired GP in Tameside