This pandemic should be a watershed moment for health inequalities

Jon Ashworth
© UK Parliament/Jessica Taylor

Inequality in health is the worst kind. If we address the factors that mean some people live shorter lives, in more pain, and with physical limitations, because of socioeconomic circumstances over which they have little control, we take steps to making this a better world. Tackling deeply ingrained health inequalities whilst improving population health is a driving mission of mine and will be a priority for a Keir Starmer Labour government.

In the pandemic, those who faced existing disadvantage experienced the most tragic consequences. Working-age adults in the poorest areas were almost four times more likely to die from Covid-19. From January to November 2020, 60% of all deaths involving Covid-19 were amongst disabled people. In the first wave, men from Black African communities were at a 3.7 times greater risk of dying than white men.

A decade of austerity has given us the worst population health in Europe, falling life expectancy for some, and rampant health inequalities. People in our deprived areas are likely to develop a long-term health condition 19 years earlier than those in our wealthiest areas. On average, people living in the poorest English areas will die seven years earlier than those in the richest. Some mental health conditions are more common in deprived areas, alongside higher rates of suicide, addiction, and overdose deaths. Austerity left us exposed, and during the pandemic our poorest communities paid with their lives and livelihoods.

Certain groups face unique inequalities that have not reversed as other health indicators improved. Women with learning disabilities live on average 27 fewer years than the rest of the population. Black women are four times more likely to die in pregnancy or childbirth. People from South Asian backgrounds are more likely to develop type 2 diabetes.

These inequalities have disfigured Britain for years, but the pandemic has lent urgency to a problem the government had been ignoring for over a decade. Since Labour’s health inequalities strategy was scrapped by the Conservative-Liberal Democrat coalition in 2010, ministers have allowed inequality to progress relatively unchecked.

Tackling health inequalities is about social justice, the core of what Labour stands for. It makes economic sense as well – the cost of inequality is around £40bn annually in lost taxes, lost productivity, welfare payments and NHS costs.

Improving population health is not just about treatment, but also preventing illness and creating health. Prevention demands action across all drivers of health, from housing quality to education – so we need engagement in every department and level of government. Creating the conditions to help people enjoy healthier, happier, longer lives is vital and measures of health and wellbeing should become as central to our national debate as GDP.

But here I want to focus on the narrower contribution of health policy to tackling inequalities. First, we know that we could prevent 75% of heart disease, stroke, and type 2 diabetes cases, 40% of cancer cases, and reduce dementia levels by tackling smoking, alcohol consumption, unhealthy diets, and physical inactivity. Local public health services could help with this, but for years the Tories have devastated them with deep cuts. For example, we know smoking leads to serious health conditions and that people on low incomes are more than twice as likely to smoke. Yet smoking cessation services have been cut by 17% since 2016. Similarly, drug and alcohol services have been cut by 15% since 2016, despite increasing deaths due to addiction. The pandemic should have reminded Ministers of the value of local public health teams. They deserve the tools and resources to target inequalities.

Second, we need to confront commercial influences on ill health. Government must do more to help people make healthier choices. Tackling advertising of unhealthy products and sugar and salt content is vital. Of equal challenge is food poverty. If the poorest were to follow healthy eating advice, they would spend 74% of their income on food. 320,000 children were referred to a Trussell Trust food bank in 2019/20. These numbers should shame ministers.

Third, we must ensure every child matters again. Health inequalities observable at birth continue and compound throughout a child’s life. By the time they leave primary school, 27.5% of children living in the most deprived areas are obese, almost 3 times as many as in the least deprived areas. This has worsened by around 50% over the last 15 years. Evidence shows children who are overweight, have lower birth weights, or suffer mental ill health are at increased risk of ill health in adulthood.

At September’s Labour Party conference, I announced Labour will put in place the largest children’s health and wellbeing programme ever seen. From a focus on early years, to valuing health visitors and improving mental health provision, we will provide children with the support they deserve.

Fourth, we must tackle inequality in access to health services. Ministers should be appalled that GP practices in poorer areas receive 7% less funding per patient than richer areas and have four fewer GPs for every 100,000 patients. Access to healthcare was blighted by inequality throughout the pandemic – completed treatment pathways fell further in the most deprived areas than in the wealthiest.

When Labour introduced health checks for over-40s in 2009, we wanted to improve everyone’s heart health. But checks were crucial for tackling inequalities, given the burden of cardiovascular disease in poorer communities. However, under the Tories in 2019, only half the people invited were receiving those checks, and they were paused during Covid-19. It is vital they are relaunched, and ministers should put in place a plan to ensure people attend them.

Finally, we face the challenge of scaling up technological innovation to benefit us all whilst reducing inequalities. Throughout the history of the NHS, technology has transformed healthcare, and the pandemic has shown the remarkable achievements of our scientists. Advances in genetic sequencing and artificial intelligence will provide patients with greater precision in managing long-term conditions, which cluster in poorer communities. Continuing to champion our research and science base must be a priority.

This pandemic should be a watershed moment for health inequalities. We must all dedicate ourselves to finding solutions and making them real – Labour is ready to do so.

This essay is an edited version of one that first appeared in the Fabian pamphlet ‘Prescription for Fairness’.

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