Socio-economic inequality leads to health inequalities

Health inequalities are driven more by social determinants of health (income, work, housing, education and so on) than by behaviours, genetics or differences in care. Health inequalities have grown since the publication of the first Marmot review in 2010. People can expect to spend more of their lives in poor health; improvements in life expectancy have stalled, and have actually declined for the poorest 10% of women. The health gap between wealthy and deprived areas has grown over that period, but there are additional regional inequalities; for example, people living in a deprived area of the North East suffer worse outcomes than people living in a similarly deprived area in London, so much so that their life expectancy is nearly five years less.

More than 330,000 excess deaths in Britain in recent years can be attributed to spending cuts to public services and benefits during the period of austerity between 2012 and 2019 (before COVID). These additional deaths seem to reflect an increase in the number of people dying prematurely as a result of lower incomes, poor health, nutrition or housing, or social isolation. Mortality had been declining up until 2010 but then started to increase again; for example, death rates among women in the 20% most deprived areas of England increased by 3% during this period, after a 14% decline over the previous decade. There were more excess deaths among men than women.

The pandemic has shown the huge differences in the health of people of working age based on their wealth; under-65s in the poorest 10% of areas in England were almost four times likely to die from COVID than those in the richest. Disabled people, ethnic minority communities, care home residents, prisoners, homeless people and people suffering from sexual exploitation have faced particular challenges. Non-health issues such as poverty, poor housing, poor quality work and struggling public services all worsened the impact of the pandemic, whether by increasing some people’s exposure to the virus or by making them (and our society and economy as a whole) more vulnerable to its effects.

A child born today in the poorest part of the UK can expect to die 10 years before a child born in the wealthiest area. We have failed to make progress on tackling health inequalities because governments are too focused on short-term priorities and on narrow measures of success like GDP, and have not managed to work effectively across departments. But part of the problem also lies within the NHS, specifically its structure, its priorities and its centralised approach.