Social conditions and health 'linked'

Inequalities in social and economic conditions cause inequalities in standards of health, according to a major new report commissioned by former Secretary of State for Health, Alan Johnson.

The review, entitled Fair Society, Healthy Lives, was headed by Sir Michael Marmot, professor of epidemiology and public health at University College London. Findings include an average seven-year difference between expected lifespans of those living in England's poorest areas and those in the country's richest.

It was also found that the average difference in living life without a significant disability was 17 years, meaning the country's poorest are more likely to die sooner and live more of their shorter lives with a disability.

This was a particularly worrying concern for the authors of the review, which noted that with the levels of disability shown, more than three-quarters of the population will have some form of disability by the age of 68 – the projected pensionable age for England in 2046.

'If society wishes to have a healthy population, working until 68 years,' said the report 'it is essential to take action to both raise the general level of health and flatten the social gradient.'

The review, which set out to 'assemble the evidence and advise on the development of a health inequalities strategy in England', did find that life expectancy had increased overall though, with men in the bottom quarter of socio-economic standings having their average life expectancy increase by three years since 2000, despite the inequalities between rich and poor.

In terms of reducing these health inequalities, the review argued that the benefits would be both economic and social.

The costs incurred due to inequality in health, including loss of productivity, NHS spending, welfare payments and lost taxes, amount to over £50bn a year, according to the report.

When comparing the cost of inequality in human terms, it said an extra 1.3m to 2.5m years of life would be added to those currently dying 'prematurely' if everyone in England had the same death rates as the most advantaged. There would also be an extra 2.8m years free of limiting illness or disease for those currently affected.

As a result of these findings, the following six policy objectives were drawn up by those involved in the review to decrease the lack of equality in health:
• Give every child the best start in life
• Enable all children, young people and adults to maximise their capabilities and have control over their lives
• Create fair employment and good work for all
• Ensure healthy standard of living for all
• Create and develop healthy and sustainable places and communities
• Strengthen the role and impact of ill health prevention.

The review stated that these objectives 'will require action by central and local government, the NHS, the third and private sectors and community groups. National policies will not work without effective local delivery systems focused on health equity in all policies.'

There was also a call for 'empowering' individuals and local communities to create effective participatory decision-making at local level to fully deliver these objectives.

Speaking on the review, current Secretary of State for Health, Andy Burnham said: "It is not right that where we live can dictate the state of our health. Everyone should have an equal chance at good health. I am passionate about getting to the heart of this issue and ensuring that young people can look forward to the same life expectancy regardless of where they are born. This report will help us make that historic achievement."

Professor Mike Kelly, director of the Public Health Excellence Centre, National Institute for Clinical Excellence (NICE), focused on the objectives proposed by the review: "Public health interventions are extremely good value when compared with the costs of clinical interventions. We need to shift the emphasis away from medical interventions that treat existing illnesses to interventions to prevent those illnesses developing in the first place, but it needs political support and system change to make this happen.

"A modest switch in resources to public health, to invest in those interventions which have been shown to be effective and cost effective by NICE, would from a societal point of view and a social justice point of view, be an important investment for the future."

The full report can be found on the University College of London website