The situation today

The situation today

Key health inequalities

Leading health think tank The King's Fund summarises some of the most extreme examples of health inequalities in Britain today:

  • Men living in the most disadvantaged communities can now expect to live for 9.5 years less than those living in the wealthiest areas, while for women, the difference is 7.5 years.
  • People living in the most deprived areas spend nearly a third of their lives in poor health, compared with only about a sixth for those in the least deprived areas.
  • In early 2020 black men were 3.3 times more likely to die from COVID than white men.
  • A child in year six in the most deprived part of the country is twice as likely to be obese as their counterparts from the most well off areas.

The impact of COVID

Health outcomes across society have, of course, worsened dramatically as a result of the COVID pandemic, partly due to its direct impacts and partly because of its indirect impacts on people's physical and mental health and wellbeing and on the prevention and treatment of other health conditions. However, the impact of COVID on the most disadvantaged in society has been particularly acute, and has highlighted the importance of pre-existing health and social inequalities. In Build Back Fairer, Michael Marmot made the case that "conditions and inequalities in key areas of life prior to the pandemic – including education, occupation and working conditions, income, housing communities and health itself – relate to England’s high and unequal mortality rate from COVID-19".

The report showed that rates of mortality from COVID-19 in England between March and July 2020 were double in the most deprived areas compared with the least deprived, and that there was a clear gradient in mortality rates related to deprivation. It also demonstrated strong links between living conditions and COVID mortality.

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Impacts on particular groups

Looking beyond the pandemic, there are many signs that different groups in the population experience unfair health outcomes compared to the rest of society. The EHRC's 2018 report Is Britain Fairer? outlines some of these for groups sharing various protected characteristics:

  • Some groups experience worse physical and mental health outcomes than the rest of the population, particularly homeless people, transgender people, Gypsies, Roma and Travellers, refugees and asylum seekers and people with learning disabilities. These are linked with poorer socio-economic outcomes for these groups, which exacerbate poor health.
  • On average, the life expectancy of women and men with a learning disability is 18 years and 14 years shorter than for non-disabled women and men, respectively.
  • Lesbian, gay and bisexual people, and those reporting other sexual orientations were almost twice as likely (27.2%) as heterosexual people (14.3%) to report poor mental health in England.
  • 45% of all looked after children in England have a diagnosable mental health condition (compared with 10% of all children).
  • In 2016/17, known rates of Mental Health Act 1983 detention in the Black or Black British group were over four times that of the White group, and rates of Community Treatment Order use were almost nine times those of the White group. The use of restrictive interventions on mental health service users is also over three times higher for Black or Black British groups compared with White British.
  • In England and Wales, Pakistani and Black African groups had the highest infant mortality rates and the Other White ethnic group had the lowest rate. This pattern has continued since 2009. Infant mortality rates were higher in the most deprived areas compared with the least deprived areas in both England and Wales and increased risk of infant mortality is associated with higher levels of maternal deprivation. Infant mortality, the risk of which increases with deprivation, rose in 2016 for the first time in decades.

The same report also highlighted inequalities in accessing health care for some groups:

  • People with learning disabilities and disabled people more broadly, homeless people, refugees and asylum seekers and Gypsies, Roma and Travellers continue to experience the most significant barriers to accessing healthcare services.
  • Rules governing eligibility to NHS healthcare in England are inconsistently and often incorrectly applied by healthcare providers, resulting in refugees and asylum seekers being wrongly refused access to healthcare.
  • Transgender people experience considerable barriers to accessing specialist services in England and Wales, and regularly face poor treatment and discrimination when accessing general health services.

Health inequalities for black and minority ethnic communities in the UK are particularly stark compared to the rest of the population. A recent report found that black women are four times more likely than white women to die in pregnancy or childbirth in the UK, and women from Asian ethnic backgrounds face twice the risk. The Runnymede Trust's 2021 report on race and racism in England found that BME people with learning disabilities die younger than their white counterparts, with a 26-year difference between white and BME people with profound and multiple learning disabilities. It also found that, had the white population experienced the same risk of death from Covid-19 as black groups, there would have been an estimated 58,000 additional deaths between March and May 2020.

Data

The UK government is starting to produce more detailed data on health equity and social determinants of health, which should produce useful comparative data over the coming years, including Public Health England's wider determinants data and the ONS Health Index.

Life expectancy

The Marmot Review in 2010 showed that people living in the poorest areas of England died on average seven years earlier than those in the richer areas, and that the average difference in disability-free life expectancy was 17 years. The 2020 follow-on review found that, for the first time in more than 100 years, life expectancy had failed to increase across the country, and that for the poorest 10% of women it had actually declined, with an overall widening of health inequalities since 2010 and an increase in the amount of time people spend in poor health. The 2020 report found large regional differences in health outcomes, including in life expectancy, with an increase in the north/south health gap, and an increase in child poverty since 2010, which is also higher than in other European countries (22% compared to Europe’s lowest rates of 10% in Norway, Iceland and the Netherlands). The report blamed many of these worsening indicators on reductions in public spending and the availability and quality of public services, such as the closure of many children’s and youth centres, reduced funding for education, a worsening housing crisis, and more people with insufficient money to lead a healthy life, with unequal cuts that affected more deprived areas the most.