A Quick Guide to Health Inequalities
August 2011
Health Inequalities According to the recent strategic review of health inequalities in England “Fair Society Healthy Lives” (the Marmot Review 2010), the more favoured people are, both socially and economically, the better their health. The aim of this quick guide is to provide a brief discussion as to why health inequalities arise, and to outline Marmot’s proposed solution for tackling them. It also provides an example of how the impetus to tackle health inequalities is working in practice by focusing on the city of Preston’s aspiration to make the city a healthier place to live over the next five years.
Health Inequalities at a Glance The Marmot Review argues that social and economic differences in health status reflect, and are caused by, social and economic inequalities in society. Unfortunately, health inequalities prevent people all over the North West from achieving their full potential. For example, people who live in some of the region’s poorest areas are seven times more likely to die early from chronic liver disease than those in the most affluent areas. They are twice as likely to smoke, six times more likely to be affected by anti-social behaviour in their neighbourhood and they are five times more likely to suffer from symptoms of extreme anxiety and depression. Tackling health inequalities, whilst also working to improve and protect the health of the whole population, presents a considerable challenge for government, NHS services, local authorities, GPs, care services, voluntary organisations and communities themselves. Partnership working is key to how well the North West, and the UK in general, address this issue.
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Understanding the Health Inequality Problem At the core of the recent Marmot Review is the notion that social inequalities in health arise because of inequalities in the condition of everyday life: namely, inequalities in power, money and resources. More specifically, inequalities in early child development and education, employment and working conditions, gender, ethnicity and race, standards of living, and, more generally, the freedom to participate equally in the benefits of society, continue to precipitate health inequalities across society.
Figure 1: Health Map (Hugh Barton and Marcus Grant 2006) Page 2
Health Inequalities In short, our health and wellbeing are influenced by a wide range of social factors and these have an effect throughout our lives.
The Health Map presented on the previous page in figure 1 highlights that although our lifestyle choices determine our health, these choices are in turn influenced by factors such as work, income, housing, friends, neighbourhoods, the environment and green spaces. The choices we make, and the context in which we make them, therefore have considerable impact on our quality of life and wellbeing. “People and places matter for health in Britain. More deprivation in an area means worse health. Lower social position means worse health. Both are important. In fact, the two interact.” Michael Marmot; The Guardian, February 16th 2005
The cost of health inequalities can be measured in human terms (as noted above with respect to the North West picture) and also economically. The Marmot Review estimates that inequality in illness accounts for productivity losses of £31-33 billion per year, lost taxes and higher welfare payments in the range of £20-32 billion, and associated NHS healthcare costs well in excess of £5.5 billion per year. In short then creating a fairer society is, according to the Marmot review, fundamental to improving the health of the whole population and ensuring a fairer distribution of good health.
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Figure 2: Conceptual Framework Reduce Health Inequalities and Improve Health and Wellbeing for All
Create an enabling society that maximises individual and community potential
Ensure social justice, health and sustainability are at the heart of policies
Policy Objectives
1. Give every child the best start in life
3. Create and develop healthy and sustainable places and communities
2. Create fair employment and good work for all
4. Enable all children, young people and adults to maximise their capabilities and have control over their lives
5. Ensure healthy standards of living for all
6. Strengthen the role and impact of ill health prevention
Policy Mechanisms Equality and health equity in all policies Effective evidence-based delivery systems
The Solution In order to tackle the health inequality problem, the Marmot Review proposes a conceptual framework (see figure 2 above), which begins with the policy aims and goals and is proceeded by six policy objectives and two policy mechanisms.
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Health Inequalities Reducing health inequalities will require action on six policy objectives: 1. Giving every child the best start in life 2. Enabling all children, young people and adults to maximise their capabilities and have control over their lives 3. Creating fair employment and good work for all 4. Ensuring healthy standard of living for all 5. Creating and developing healthy and sustainable places and communities 6. Strengthening the role and impact of ill health prevention Central to this framework is the notion that action to reduce health inequalities must begin before birth and be followed through the life of the child. Consequently, the review notes that policy objective 1 (giving every child the best start in life) should be the highest priority.
Tackling Health Inequalities on the Ground In addition to the strategic vision which the Marmot review proposes, there are a number of local initiatives currently taking place which are aimed specifically at tackling health inequalities. The city of Preston is, for example, currently doing a lot of work in this area. Preston experiences much worse health than compared to the average for England and has large variations in health across the city. In 2010, however, it applied for and was granted World Health Organisation (WHO) International Healthy City status (2009-2013) and it set out its aspiration to make the city a healthier place for its citizens to live over the next five years. As such, it made a commitment to focus on reducing inequalities arising from gender, age, disability, ethnicity, faith, sexuality and location within Preston and to increase accessibility to services.
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A Healthy City Governance Group has been established to oversee the work programme within Preston and its Framework for Action document details the wide range of ongoing work programmes which support the delivery of three core themes: caring and supportive environments; healthy living; and healthy urban environments and design. Moreover, agencies working together throughout Preston in a healthy city alliance aim to ensure: •
Better outcomes for children and families;
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Age-friendly services throughout the city;
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Supported people who are active in civic work;
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More effective use of health services and other wellbeing services;
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Neighbourhoods with good housing, better transport links, and green open spaces that promote healthy behaviour;
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A programme of health promoting activities.
Useful Linksul links North West Employers – Health Reform Transition Page www.nwemployers.org.uk/?page_id=1161 Local Government Association – Healthy Communities Resource www.idea.gov.uk/idk/core/page.do?pageId=77225 The Marmot Review – Fair Society Healthy Lives www.marmotreview.org/ The King’s Fund – Health Inequalities www.kingsfund.org.uk/topics/health_inequalities/ UK Healthy Cities Network www.healthycities.org.uk
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Talk to us For general enquiries about this Quick Guide or for more information on North West Employers :
Tom Goodwin E: tomg@nwemployers.org.uk T: 0161 241 7110 For more information on the work going on in Central Lancashire :
Jenny Ashburner Public Health Associate Healthy Communities NHS Central Lancashire E: jennifer.ashburner@centrallancashire.nhs.uk T: 01772 643 174
Talk to each other Register and start using the regions new virtual communication platform North West Connex www.nwemployers.org.uk/northwestconnex
Guides in this series: A Councillors’ Role in Public Health
Local Goverment Terminology
Health Terminology
Health Inequalities
Workplace Health
Health Literacy
Health Reform