Growing health inequality in UK prompts call for ‘joined up strategy’

In the last UK election in 2019, the NHS emerged as a major talking point, as the scale of the country’s support of the service was brought to the fore. Now, with health inequality a growing issue and linked to other major discussions, such as the cost of living crisis, Ben Hargreaves finds that this topic could emerge as a new political battleground over the future of the nation’s health.

By any measure, the UK is going through a period of significant economic turbulence. The country is battling to lower the rate of inflation, which has remained consistently higher in comparison to the Eurozone. With higher inflation, the general population is facing a cost of living crisis, greatly impacting the price of food and energy bills. Beyond these factors, the UK is facing the challenge of creating a post-Brexit strategy that allows it to remain competitive on the world stage.

With these issues dominating political conversations, the reality of a worsening landscape of health inequality across the country could be missed. However, the cost of living crisis is directly exacerbating the existing inequalities facing the country. The former chief economist at the Bank of England, Andy Haldane, told The Guardian: “For the first time since the industrial revolution […] health is now serving as a brake in the rise of growth and wellbeing of our citizens.” A survey published in the British Medical Journal in 2022 saw 55% of respondents report a negative impact on their health from the increase in the cost of living.

Why health inequality matters

Health inequalities are systematic differences in the health status of different population groups. The differences can come about through differing levels of income, gender, ethnicity, education, and employment status, among other factors. One particular recent example of this occurred during the pandemic, where health inequity was demonstrated on a global scale, as low-income countries suffered from far lower access to the available vaccines. Within a country, health inequality can lead to differences in life expectancy, access to care, quality and experience of care, behavioural risks to health, and other determinants of health, such as quality of housing.

At an economic level, there are also major impacts due to the high healthcare costs associated with parts of the population suffering from a greater number of health problems. This then has a knock-on impact on welfare, productivity, growth, and development, even in a strong economic climate. The Institute of Health Equity, a UK institute for research and policy action, estimated that, if everyone in the UK had the same health outcomes as the most advantaged, then 2.8 million years free of limiting illness or disability could be gained. Economically, the institute worked out that this would save productivity losses of £31-33 billion per year, and £20-32 billion per year of lost taxes and higher welfare payments. The NHS would also save approximately £5.5 billion per year. By contrast, if no action is taken on the current situation, the cost of treating various illnesses resulting from inequalities in obesity alone will rise from £2 billion per year to £5 billion per year in 2025.

Taking stock of the UK’s position

A recent study by Blue Horizon created a ‘healthiest area’ index of the UK. The research took into consideration air quality, admissions to hospitals, the number of cancer patients, levels of physical activity, and other factors to determine the most and least healthy areas in the UK. By doing so, Blue Horizon was able to identify where some of the largest discrepancies existed in health inequality.

Unsurprisingly, areas in the capital city, London, fared some of the worst for levels of air quality, such as Tower Hamlets and Hackney, while Allerdale, a district of Cumbria, had the best quality of air. Of the top five locations for quality of air, three of these were ranked in the top five overall for general health, suggesting air quality has an outsized impact on overall health. Of the top 10 areas for health, the list is dominated by regions that have a large proportion of higher earners, such as South Hams, Richmond upon Thames, and Harrogate. At the opposite end of the scale, the report identifies areas such as Peterborough, Liverpool, and Portsmouth. The latter three struggle with problems with obesity rates, alcohol-related hospital admissions, and problems with drug-use.

A major marker of the overall health of a country is its life expectancy, and particularly whether it is rising or falling. Research by Michael Marmot, leader of the Institute of Health Equity, has shown that life expectancy had been growing in the country until 2010, increasing by approximately one year every four years. However, this has now reversed and women’s life expectancy has fallen by 0.9 years and in men by 1.2 years. There are other indicators of a worsening situation, such as the height of UK children falling from being position 69th out of 200 similar nations in 1985 to 101st position in 2023.

Marmot explained, “The genes didn’t change in that time. Genes determine the heights of individuals. It’s nutrition, infection, poverty, stress [that determine the heights of groups]. What we can say is [between 2010 and 2020] we [the UK] had the slowest improvement in health equity of any rich country, except Iceland and the US.”

In outlining why this fall in health equality has occurred, Marmot stated three major causes had been responsible: a decade of economic austerity, the COVID-19 pandemic, and the cost of living crisis. As suggested by Blue Horizon’s research, where an individual is based can be a major determiner of health. Marmot added a qualifier, by stating that, if people are poor, then their location makes a major difference to their health outcomes. As such, he outlined that the deprivations for ill-health are bigger in areas in the north, such as Liverpool, Manchester, Newcastle, and Sunderland, when compared with wealthier areas in the south, such as London and the broader south-east region.

Government reaction

Part of the UK’s government’s current political strategy is based around the idea of ‘levelling-up’. The idea behind the campaign was to provide funding to projects across the UK to end ‘geographical inequality’ across the country. However, a recent planned whitepaper on health inequalities and the development of a strategy to counter the issue was scrapped by the UK government, at the beginning of 2023. The government moved to replace this whitepaper with a ‘Major Conditions Strategy’ proposal, which is in the process of calling for evidence to tackle major health conditions. Rather than being a driver of strategy in this proposal, the new proposal includes inequality as being one of a group of conditions that will be researched, including obesity, smoking, and alcohol use.

The British Medical Association released a statement on the shift, saying: “We and many other health organisations have been raising the alarm over the ticking time bomb of ill health for years. We have heard harrowing testimony from doctors across the country as they struggle to cope with afflictions beyond their control: in-work poverty, cold homes, poor child nutrition. These require a joined up strategy across all government departments to treat, but with the scrapping of this whitepaper the government has shown it never had the appetite to commit to one.”

The challenge for the UK government in committing to such action is two-fold: finding the funds to address the issue while the NHS struggles with its own financial crisis, leaving a conundrum of where to set priorities; and, specifically targeting health inequality raises questions about the politics that allowed this situation to become entrenched during successive Conservative party governments.

On the economic side of the equation, even the IMF considers addressing long-term sickness in the UK to be a major economic priority to boost the short-term labour supply, and therefore also improve inflationary pressures from a tight labour market. Politically, with the next general election taking place no later than 28 January 2025, this area could become a battleground.

The Labour Party released a paper earlier this year on its ambitions for the NHS and stated that it would focus on “tackling the social inequalities that influence health,” noting that it would draw influence from Marmot’s work to achieve this. The difference in approach could set the two parties at odds in the forthcoming election and, as the cost of living crisis continues, could call more attention to the issue of health inequality – raising the stakes for both parties.