For socialists, tackling inequality is at the heart of our politics. When it comes to health inequalities, the sense of moral disgust appears to go well beyond socialism, there is a general belief that it is wrong that how much someone has in the bank should have so significant impact over how long they are able to live. This is perhaps unsurprising, given that it is the basis upon which the NHS, our national religion, was founded.
Last month, Public Health England released their latest data on life expectancies in the UK and, sadly, it has once again shown that health inequalities are growing. Worse, since life expectancy no longer appears to be growing in the way it once did, this doesn’t simply amount to people being left behind but an actual decline in life expectancy for some communities.
To be fair, there is more to health inequalities than simply financial deprivation, for instance the famed ‘Glasgow Effect’ highlights that residents of all incomes in the city tend to have shorter life expectancies than those living in comparable financial positions in other UK metropolitan areas.
Nonetheless, financial deprivation remains a good predictor of health inequality and one which helps explain why the disparity in lifespans within local authorities is usually greater than the disparity between local authorities. Crawley CCG’s Strategic Service Development Plan highlighted a seven year difference in life expectancy in Crawley between Broadfield (78.4 years) and Maidenbower (85.4 years).
It is simply unacceptable that in a country as wealthy as the UK that we allow these inequalities to persist, but what can be done about them? Central government has tried various initiatives over the years to try to resolve health inequalities, yet they don’t seem to be cutting through. This is not without its reasons.
Top-down initiatives rarely have the full-impact which central government hopes. Civil servants in Whitehall are too physically remote from the means through which they are trying to enact policy on the ground, between the top and the bottom the policy can fall apart at any number of stages and they lack the capacity to react effectively to changing circumstances in each locality.
Initiatives driven from the centre also tend to ignore the considerable regional differences in problems and potential solutions. For instance, Crawley may have a higher incidence of lung cancer than coronary heart disease, so a national programme for reducing the incidence of coronary heart disease might have a beneficial effect nationally but widen local health inequalities.
The last issue is that the NHS wasn’t really designed to create ‘health’ but rather to help address ‘sickness’. In our system we treat illnesses, rather than trying to ensure people generally keep themselves in good health. It is far cheaper to keep people well than it is to have them visit their GP or a hospital, it is better for the patient’s quality of life and it will ultimately improve their expected lifespan.
To tackle health inequalities we need to approach the problem on the ground. We need to tackle low life expectancy by addressing the individual sets of problems facing that locality and customising our interventions. This can’t simply mean traditional healthcare provision and running a few public awareness campaigns, it means following global examples, such as Oklahoma City and building health into the literal fabric of the city. We need to recognise that health is more than the NHS, health is transport, health is housing, health is education, health is employment, health is community, it is an integral part of every moment of our waking lives.
If we can promote healthy living as part of our day-to-day existence we can tackle health inequalities. Yes, it means more devolution, but not necessarily in the ways you might think. It means giving planning and highways authorities more flexibility around how they look at projects, rather than incredibly pro-developer and pro-car system the government has created, whatever the long-term consequences. It means pooling of health and local authority budgets, so we can do the public health work the NHS needs to keep people out of hospital. It means changing the way we teach our children, so that health is no longer limited to two hours of PE a week, but rather about developing an understanding of what can keep them happy and well, from weight training and cardio to proper nutrition and mindfulness meditation.
We can build a happier and healthier society, where life expectancy cuts uniformly across all incomes, but it won’t be easy and it must start with central government learning to let go.