Staff shortages, delays to cancer treatment, year-long operation waiting times and overwhelmed ambulance services – these are the things we tend to think about when we consider the current state of health in the UK. Addressing the burden on the NHS front line is a crucial part of improving the country’s health. But health is about so much more than healthcare services; it encompasses all facets of our lives, from the food we eat to the air we breathe and the homes we occupy. To narrow the inequality gap, the government needs to focus its efforts on the whole picture.
Rarely do we think about unemployment, access to education, and availability of green spaces or adequate housing as “health issues”. But all this and more impact our life outcomes. Our health and well-being are influenced by a complex range of factors, including our income, ethnicity and race, where we live, and even our digital and financial proficiency.
The link between health and wealth in particular is inseparable; areas of high deprivation are more likely to have higher rates of childhood obesity, pollution-related respiratory conditions and lower life expectancy, which is the biggest indicator of health inequality by far. The life expectancy gap can be as stark within cities as it is between them. In south London, a man in Peckham typically lives 12 years fewer than a man living in neighbouring areas Herne Hill and Dulwich Park. The statistics are also shocking on the world stage. According to the Health Foundation think tank, women living in the poorest areas of England are dying earlier than the average woman in all other OECD countries except for Mexico.
This inequality urgently needs to be addressed. One of the most ambitious goals of the government’s levelling-up white paper is to narrow the gap in healthy life expectancy (HLE) by 2030, and increase HLE by five years by 2035. To make this happen, the government needs to focus on prevention rather than just cure – improving access to decent housing, healthy food, unpolluted playgrounds and parks, employment opportunities and the benefits system.
As the cost-of-living crisis worsens, a holistic approach has never been more important. Separating health from economics does not help us find solutions; research consistently shows us that when people are well, they are more productive. The recent Marmot Review into health inequities found that ill health is responsible for 30 per cent of the productivity shortfall between the “Northern Powerhouse” and the rest of England.
At Impact on Urban Health, our programmes address the complex causes of poor health across Southwark and Lambeth in London. One area we work in is financial inclusion – the link between health and debt is well-documented, with research from the Centre for Social Justice revealing that two-thirds of people using loan sharks have a long-term health condition. Our Covid-19 Financial Shield scheme provided financial and health advice to people who couldn’t work during the pandemic due to having a long-term condition. This included access to GP services but also guidance around money and debt management and benefit entitlements, helping them significantly boost their yearly savings. This in turn improved their mental health, reducing the emotional toll that comes from money worries while not being able to work.
We also run several initiatives to improve air quality; we’ve partnered with engineering consultancy Arup and the construction industry to improve building practices across south London, and have worked with think tank Centre for London to research how to reduce delivery-related emissions from freight (an industry that boomed during lockdowns as more people opted for online deliveries).
If the government is serious about closing the life expectancy gap, it needs to invest in these kinds of coordinated, localised measures focused on finding practical solutions that make a real difference. Tackling the “social backlog” is as crucial as tackling the NHS backlog. Financial support to help people through the cost-of-living crisis, policies to improve access to decent housing in the private rental sector, and the recent increases to the minimum wage are all part of making people and places healthier. The upcoming health disparities white paper is a chance to do this and create a more cohesive response to health inequality.
Individual cities also have a key role to play in developing innovative solutions. London’s Ultra Low Emission Zone (ULEZ) has reduced air pollution, Manchester’s integration of health and social care services has unified services, and Leeds’ investment in healthy school meals has reduced childhood obesity. These are all models that can inspire other regions; innovation should not happen in silos, and both the public and private sectors can help to instil such initiatives nationwide. This could include a government programme for universal, free, healthy school meals, big supermarket chains discounting fruit and vegetables nationwide, or construction companies and housing associations investing in infrastructure with a lower carbon footprint.
Crucially, there also needs to be a shift in thinking. We often associate health conditions such as diabetes and obesity with willpower or personal responsibility when environment is a massive factor. Deprived areas have five times as many fast-food shops as richer areas, and are ten times more likely to have betting shops – if someone is surrounded by these things, they are more likely to use them. We need to think about health as a community issue rather than an individualistic one.
The pandemic was evidence that our health is paramount – but it also demonstrated that healthiness is not equal, with people from minority and disadvantaged groups being far more likely to be hospitalised or die from Covid-19. If the government really wants to reduce the life expectancy gap, it must recognise that health and social inequality are intrinsically linked.
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