Non-Covid Health Inequalities
Health inequality has been a key point of discussion during the pandemic, with disadvantaged communities being hit hard by Covid-19.
With so much of the present discussion resting on Covid-19 health inequalities, there is little room left to discuss health inequalities outside of Covid, even though these inequalities are still equally important and relevant to the communities experiencing them.
What is health inequality?
The term health inequality is a description of the differences in health status within a population, which can cause individuals to view, interpret, and act on healthcare messaging differently.
Primarily, health inequality rests on the unequal distribution of income, power and wealth, which results in poverty and marginalisation.
The conditions in which we grow up, live, and work all impact our opportunities for health, and how we think, feel, and act about health. These are systemic and unavoidable differences that shape our wellbeing, mental and physical health.
It’s not just that an individual’s potential to be exposed to ill-health is affected, but also their ability to manage it.
Social class can be a large element of health inequality, yet there are other components that are independent of social class that can influence health. Examples include older or younger people, sexual minority groups and individuals with mental health conditions (when compared to the general population).
Accessibility to resources is also an issue going hand-in-hand with health inequality, but it is not the sole reason for it, so much as it is a component alongside other factors.
The widening gap
The gap in life expectancy between the most and least deprived areas of England has widened significantly for both sexes in recent years.
For males, it has increased to 9.4 years in 2017 to 2019, up from 9.0 years in 2011 to 20131.
For females during the same period, the gap has increased from 6.9 to 7.6 years.
This systematic relationship between deprivation and life expectancy is known as the social gradient in health.
Additionally, people in the most deprived areas were 4x more likely to die prematurely from cardiovascular diseases, and 2.2x more likely to die from cancer than people living in the least deprived areas in 2017 and 2019.
Part of the reason why health inequality has been a significant focus during the pandemic isn’t just due to the effect of Covid on these communities, but because health inequality has been a global failure for some time – the risks driving the above statistics have never been addressed.
In the UK, risk factors such as diabetes, smoking, cardiovascular diseases and obesity are unequally distributed, which has contributed to said risks and other factors flying under the radar during the pandemic, even though they continue to have adverse effects on health.
The broader issue
There are few situations in which health inequality becomes more apparent than when an individual states that access to healthcare is universal, or that self-care is available for all.
The access to health services that a wealthy individual with a high income in an affluent area has will be significantly different to the access a single parent with minimal income and dependants (children or elderly relatives, for example) will have.
We know that the availability of quality housing, work and education isn’t equal, so it follows that there are multiple other factors inhibiting individuals from having their needs accommodated.
How can anyone claim that the level of care or the opportunities they have to lead healthy lives are the same when there are so many factors contributing to their health status?
From wider social issues around access to quality housing, to the availability of treatments and the prevalence of health conditions in communities, has the ground ever been equal for everyone in society?
A household in the bottom fifth of income distribution would need to spend an estimated 42% of their after-housing income on food to be able to follow Public Health England’s recommended diet2.
Hardly equal footing, is it?
What needs to change?
Firstly, there needs to be an acknowledgement of the complexity regarding health inequality.
The factors of inequality are inter-related, and as a result, can be mutually reinforcing. Therefore, it is extremely difficult for an individual to reduce unhealthy behaviours if they are already facing a wide range of health determinants that they are worse off in from the beginning.
Focusing on one specific area is unlikely to yield results, as there are poor outcomes throughout society, not just in the bottom percentile – universal action is required.
It begins with childcare and giving children the opportunity to maximise their capabilities, and continues with fair employment opportunities and practices, healthier living standards and sustainable practices for communities.
Ill-health prevention is only one aspect of health inequality. Local government and national government have a role to play.
As the Marmot Review report explains, a goal of environmental sustainability can also assist with health inequality by promoting sustainable local communities, active transport, sustainable food production, and zero carbon houses, which all have health benefits.
When health inequality starts being viewed as something that isn’t fixed, we can begin moving towards comprehensive change that actually tackles the issues at hand, rather than pointing the finger solely at the healthcare system.