What Are Health Inequalities and Why Do They Exist?
Did you know that people in the most deprived areas of England were 4x more likely to die prematurely from cardiovascular diseases, and 2.2x more likely to die from cancer than people living in the least deprived areas between 2017 to 20191?
Shocking, huh? Yet the health inequality isn’t exclusive to physical health, either.
Take for instance the inequality gap in suicide rates between the most and least deprived areas of England. Whilst acknowledging that they might have narrowed between 2017 and 2019, the rates are still nearly twice as high in the most deprived areas compared with the least.
Health inequalities – the unfair and systematic differences in health between different groups of people – have been brought to the forefront during the pandemic.
But what exactly are health inequalities, and why do they exist?
Defining health inequality
Health inequality comes down to the differences in the status of people’s health, the care that they receive, and the opportunities they have to live healthy lives.
According to The Kings Fund, health inequality can encompass:
– Health status: life expectancy, prevalence of health conditions
– Access to care: availability of treatments
– Quality and experience of care: levels of patient satisfaction
– Behavioural risks to health: smoking rates
– Wider determinations: quality of housing
These are the inequalities of health, but how are they determined?
In England, health inequalities are generally analysed and addressed by policy across four factors:
– Socio-economic: income
– Geography: region, urban or rural
– Characteristics including those protected in law: sex, ethnicity, disability
– Socially excluded groups: those experiencing homelessness
For many, there is likely to be overlap between factors, which can further impact the severity of the health inequalities experienced.
The social gradient in health
The systematic relationship between deprivation and life expectancy is known as the social gradient in health.
An example of the social gradient is that the life expectancy between the most and least deprived areas of England was 9.3 years for males and 7.3 years for females2.
To put some of these differences into perspective, life expectancy is 78 years in Manchester and 86 years in Westminster3.
Primarily, the most important thing to note about the social gradient is that the relationship holds true across the whole population and isn’t just exclusive to those at the bottom and top.
Similarly, life expectancy and disability life expectancy increase as neighbourhood deprivation falls, referred to as ‘the Marmot curve’ due to Sir Michael Marmot’s report on the social gradient.
The Marmot Review report, ‘Fair Society, Healthy Lives’, was published in February 2010, finding that health inequalities are largely preventable, but required action across all social determinants of health, including education, occupation, income, home and community.
It’s estimated that the annual cost of health inequalities is between £36 billion to £40 billion through lost taxes, welfare payments, and costs to the NHS4.
Health inequalities do not occur by chance
The reason why health inequality goes against our sense of social justice is because it is entirely avoidable on a societal level.
An individual has little control over their socially determined circumstances, but society on a national and local level does; a wider effort should be made to stop or modify measures that are known to widen inequalities.
Groups can be disadvantaged across multiple factors, factors which can be mutually reinforcing.
For example, deprived areas have, on average, nine times less access to green space, higher concentrations of fast food outlets, and more limited availability of affordable, healthy food5.
The inequalities are interrelated, which means that the disadvantages in certain parts of the population can be mutually reinforcing, making it harder for people to move away from behaviours they know to be unhealthy if they are already worse off in other determinants of health.
What can be done?
Firstly, health inequalities need to be acknowledged as complex and treated as such.
An initiative tackling poor diets is likely to be counterproductive if it doesn’t also acknowledge the factors influencing this behaviour, such as access to affordable healthy food, and the impact this can have on access to clinical services as a result.
Health inequalities aren’t just about the healthcare system, it’s about a wider network of socio-economic factors that culminate in someone’s ability to live a longer, healthier life.
In a report on local actions that could be taken to reduce inequalities, a number of experts suggested the following actions6:
– Implementing a living wage policy: life expectancy can increase by up to 9 years if you live in the wealthiest, rather than the poorest, areas. Raising the living wage provides an incentive to work; a way out of in-work poverty; improvements in work quality and productivity; falls in absenteeism; positive impacts on recruitment and retention; and a way of directly addressing inequalities in health and wellbeing.
– Early childhood education and care: learning capabilities are generally formed during the first years of childhood, which is the most effective time to improve education and care, which applies not only to the provision, but the quality of care, including affordability and accessibility.
– A ‘health first’ approach to tackling worklessness: focus on improving and managing the ill health of those out of work, rather than focusing primarily on addressing employability issues. This includes improving the skills and employability of incapacity-related benefit recipients. This also dovetails with a healthy workforce approach that ensures people are fit and able to remain in the workforce to begin with.
The examples above are merely a fraction of the actions that can be taken to reduce health inequality on a local level – yet it can begin with the way that we view health inequality.
We are not all on equal footing when it comes to how we can approach our health, which needs to be recognised before action can be taken against the systemic barriers that are holding so many individuals back.