1. Health inequalities Joan Garrod Philip Allan Publishers © 2016

2. Health inequalities The following slides give some information about health inequalities in the UK, and also some reasons that have been put forward to explain them. (You will note from your textbooks and class notes that there are other explanations.) Look at the slides carefully, and decide how you could use the information to help to answer a question about the causes of health inequalities in modern Britain. Philip Allan Publishers © 2016

3. Health inequalities The World Health Organization (WHO) defines health inequalities as follows: ‘The differences in health status or in the distribution of health determinants between different population groups.’ In the UK, the population groups showing differences in health and health chances are based on: Social class Gender Ethnicity Region These are not, of course, mutually exclusive — e.g. working-class people tend to live in more deprived areas. Philip Allan Publishers © 2016

4. Health inequalities Professor Danny Dorling, an expert in health inequalities, is in no doubt regarding the main cause of health inequalities in the UK. He wrote that the strongest correlation to poor health is poverty, and the longer people live in poverty, the shorter their life expectancy. (Dorling, D. ‘In Place of Fear’, Centre for Labour and Social Studies, May 2013) Task: Write down four ways in which living in poverty might damage your health and lower your life expectancy. Compare your answers with those of the rest of the class. Philip Allan Publishers © 2016

5. Health inequalities Here are some reasons — you may have thought of others. Living in poor housing that is damp and poorly insulated. Living in temporary accommodation, e.g. bed and breakfast, without access to proper cooking facilities, and in extreme cases being homeless. Malnutrition caused by lack of food. Obesity — often a result of comfort eating and/or lower resistance to advertisements for ‘junk’ food and sugary drinks. High levels of stress and anxiety, which can lead to mental health problems and have other health effects such as high blood pressure. Living in an area with poorer than average health facilities — it is harder to attract well-paid doctors and surgeons to live and work in poorer areas. Engaging in ‘poor lifestyle behaviours’ such as smoking, excessive drinking and physical inactivity. Being the victim of a violent attack — members of the lower social classes are at greater risk of this. Philip Allan Publishers © 2016

6. Health inequalities The think-tank The King’s Fund published a study in 2012 which looked at data gathered between 2003–08, a period when the Labour government embarked on a massive campaign to encourage people to adopt healthier lifestyles. The data looked at findings from the NHS health survey for England, and focused on four types of behaviour that are closely linked to disease and early death. These are: Smoking Excess use of alcohol Poor diet A sedentary (non-active) lifestyle Between them, these four factors are estimated to account for almost half the burden of ill-health in developed countries. Philip Allan Publishers © 2016

7. Health inequalities The researchers found that the number of people engaging in three or four of these risky behaviours fell from 33% in 2003 to 25% in 2008 — what they termed a ‘significant improvement’. However, when they looked at the data in more detail, they found that ‘these reductions have been seen mainly among those in higher socioeconomic and educational groups’. Question: What reasons can you think of to explain why ‘those in higher socioeconomic and educational groups’ should adopt healthier lifestyles more readily than those in lower groups? Philip Allan Publishers © 2016

8. Health inequalities In September 2015, Sir Michael Marmot, now president of the World Medical Association, said that about 550 people a day in the UK are dying prematurely because of social inequalities that are becoming entrenched. He said that not only do the poor die on average 7 years earlier than the rich, but they can expect to become disabled 17 years earlier. It was in the field of education that research showed how unfair life was becoming. He said: ‘If everybody had the same mortality as those with a university education, then we could prevent 202,000 deaths [each year].’ In his book The Health Gap Marmot concludes that the key to reducing health inequalities is creating the conditions for people to lead flourishing lives and thus empowering both individuals and communities. Philip Allan Publishers © 2016

9. Health inequalities In April 2014, the Office for National Statistics released data from its Opinions and Lifestyle Survey of Great Britain 2012. These are some of the findings from the ‘Adult Health’ section. Unemployed people (those out of work but looking for work) were almost twice as likely as those in employment to have a limiting longstanding illness or disability (17% compared with 9%). Question: How might you explain this statistic? People with higher incomes were less likely than those on lower incomes to have a limiting longstanding illness or disability. Only 6% of those with an income of £50,000 or more were in this position, compared with 30% of those with an income of up to £10,000. People from white ethnic groups were almost twice as likely as those from non- white ethnic groups to have a limiting longstanding illness or disability (20% compared with 11%). Question: What reason might there be for this? Philip Allan Publishers © 2016

10. Health inequalities Inequalities of income and wealth in the UK are rising, which is bad news for health inequality. Professor Danny Dorling says that British society is now as unequal as it was in the 1930s, reversing a long trend towards greater equality. Almost certainly reflecting this, there has been a slight rise in mortality rates. Again, the last time this happened was during the interwar depression of the 1930s. There is also concern over the possibility of a fall in life expectancy, which has already been noticed in Glasgow. The Joseph Rowntree Foundation recently found that at least 8.1 million parents and children were living on incomes below what is needed to cover a minimum household budget. This is up by more than a third, from 5.9 million in 2009. Philip Allan Publishers © 2016

11. Health inequalities Freedom of information data obtained in November 2015 by a Birmingham City University student and published in the Guardian revealed another aspect of health inequality — malnutrition. More than 2,000 cases of patients with malnutrition were recorded by 43 hospital trusts in England in a single year. The figures were revealed as Tameside Hospital in Greater Manchester became the first NHS hospital in the UK to set up a permanent food bank on its site. Hospital staff reported that a growing number of malnourished patients were turning up for treatment and care. The hospital’s chief executive said people were making choices about whether to pay a bill or feed their family. The Trussell food-bank charity said that families were struggling to feed themselves. A member of the charity said: ‘We often see parents who are going without food so that they can feed their children.’ The charity director of Age UK said that malnutrition in older people, both in the community and in hospital, was often undetected. Philip Allan Publishers © 2016