Inequality and Health

Inequality in the UK and across the developed world is a growing social problem. Oxfam recently published a report predicting that by 2016 one percent of the world would own fifty percent of all wealth. In the UK wealth and income inequality has consistently increased since the 1950s, and due to recent political reforms we have seen growing divides between the poorest and richest halves of society. Alongside this, other social indicators of poverty all point to an increasing state of deprivation for much of the population with more people than ever accessing food banks and levels of childhood poverty at a record high; 3.5 million children now live in poverty in the UK and Save the Children have predicted that number may rise to close to 5 million by 2020.

Parallel to economic inequality we see large divides in health equality; numerous analyses demonstrate the drastically different health outcomes observed between those at the top compared to those at the bottom. Excess mortality, defined as death before the age of 65, more than doubles when you compare managerial workers to unskilled workers, this is matched by a landscape of increasing premature death as you move from the relatively affluent South of England to the relatively deprived North of England and Scotland where the incidence of premature death is approximately 1.5 times greater. With life expectancies over 9 years longer and the amount of time spent in “good” health, a staggeringly high 18 years longer for those in the top 10% compared to those in the bottom 10%. In effect those at the bottom live shorter lives that are disproportionately spent in “poor” health.  Coupled to this idea of “good” health, 40% of adults aged 45-64 on below average incomes have a limiting longstanding illness or disability, compared to fewer than 20% of adults earning over the average income. It is an undeniable fact that economic inequalities within our society seem intimately linked to dramatic divides in health outcomes.

            “40% of adults aged 45-64 on below average incomes have a limiting longstanding illness or disability, compared to fewer than 20% of adults earning over the average income.”

A number of factors explain gaps in health between the rich and the poor including differences in diet, nutrition and smoking. Obesity prevalence decreases as level of education increases, and childhood obesity is twice as high when comparing the bottom decile to the top. Interestingly, data taken from Scottish schools have suggested that a contributing factor in the obesity relationship may be that those in the most disadvantaged areas have similar absolute body weights but reduced height due to growth limitation, indicating that the relationship may also be linked to poor childhood nutrition rather than just overeating. Smoking also shows a clear gradient with rates up to four times higher when comparing the most disadvantaged to the most affluent. This relationship between socioeconomic status and negative health behaviours is seen again and again as diabetes, low levels of physical activity and alcohol and drug intake have all been shown to be linked with increased deprivation.

Alongside physical factors impacting on health it has also been suggested that the ability of the well educated and affluent to advocate for access to healthcare may influence health outcomes. For example, socioeconomic status is linked to access to cancer care trials with the most deprived having the lowest levels of access. In addition the ability to engage with private healthcare services may be out of reach for many lower down the socioeconomic scale. That is not to say that we should not advocate for our own health as best we can but simply that we should not ignore the vulnerable because they do not have the time, education or economic means to ensure an equality of access to healthcare.

         “Those in the most disadvantaged areas have similar absolute body weights but reduced height due to growth limitation…linked to poor childhood nutrition.”

One of the most recent and insightful findings in this area is that inequality alone is shown to be bad for the health of societies as a whole. Countries with higher rates of inequality have increased rates of child mortality and lower life expectancies when compared to their more equal counterparts. This does not just affect those at the bottom as these negative outcomes associated with increased inequality exist across the whole of the social spectrum. Work carried out by Richard Wilkinson and others has shown that this extends to many measures of both health and societal wellbeing, including but not limited to, the UNICEF index of child wellbeing, mental illness, trust of others within your society, violent crime and social mobility. They conclude that in the modern developed world it is not just individual levels of wealth that decide healthcare outcomes, but also the equality of the society that you live in.

A variety of factors seem to influence divisive health outcomes seen between the most disadvantaged and the most affluent; these include but are not limited to poorer health behaviours including increased rates of obesity, smoking and alcohol and drug intake alongside reduced intake of fruit and vegetables and lower levels of physical activity. In addition, lower educational status, access to healthcare and support services and reduced advocacy likely contribute to both health behaviours and healthcare outcomes as a whole. Alongside differences in healthcare behaviours, inequality is increasingly shown to be bad for societies and to have negative impacts on health across the whole social spectrum. As we move forward into the 21st century and away from the austerity of the financial crisis we must attempt to support the most vulnerable and provide them not just with the education and support systems they require to have better health but also with the financial means to manage this. In reducing the economic and educational divides in our society we will not just make life better for the most disadvantaged but for all of us, regardless of our income or wealth. It is therefore in everyone’s best interests to reduce inequality and to provide the support and services required to improve health from the bottom to the top.