England's health inequalities 'unfair and unjust'
Most people in England don't live as long as the rich and spend longer in ill health, according to the review by Professor Sir Michael Marmot. Action to reduce inequalities and tackle the 'social gradient in health' must become one of society's core priorities.
People living in the most deprived neighbourhoods will not only die sooner than people living in the richest neighbourhoods (seven years earlier on average) but will also spend more of their lives with disability (an average total difference of 17 years, and still 13 years difference when excluding the poorest 5% and the richest 5%). However, the review - Fair Society, Healthy Lives - concluded that, although health inequalities involving premature illness and death are normally associated with the poor, they affect everyone below the wealthiest tier (the strength of the correlation produces a clear 'social gradient effect' in line with overall prosperity). It argues that, traditionally, government policies have focused resources only on some segments of society. To improve health for all of us action is needed across the social gradient. Differences in health status that could be avoided by reasonable means are unfair. Putting them right is a matter of social justice.
Central to the report's approach is to create the conditions for people to take control of their own lives. This requires action on the 'social determinants' of health. These are described as the conditions in which people are born, grow, live, work and age. The review proposes six main recommendations to improve everyone’s health by giving more people the life chances currently enjoyed by the few. These are:
- Giving every child the best start in life
- Enabling all children, young people and adults to maximize their capabilities and have control over their lives
- Creating fair employment and good work for all
- Ensuring a healthy standard of living for all
- Creating and developing sustainable places and communities
- Strengthening the role and impact of ill-health prevention
Local councils and their partners have a vital role in building the wider determinants of good health and working to support individuals, families and communities. Engaging them is crucial in making change happen. The report relates strongly to the core business of local councils as local leaders for the improvement of residents' health and well being, as revealed in the review's estimates of the annual economic cost of health inequalities:
- Productivity losses of £31 - £33 billion
- Lost taxes and higher welfare payments in the range of £20 - £32 billion
- Additional NHS healthcare costs well in excess of £5.5 billion
The review also predicts an increase in the cost of treating the various illnesses that result from inequalities in obesity alone, to rise from £2 billion per year to nearly £5 billion per year by 2025.
Good intentions are not enough - evidence matters. The Review has assembled the evidence of effectiveness that will be used by the government to develop its forthcoming health inequalities strategy for England.
Read the report or executive summary.
Listen to Professor Marmot on BBC Radio4 Today programme.
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