Editorial: A vivid lesson in the economics of health

Debates about public health have been regularly punctuated by studies confirming the intractability of the link to poverty. This latest is shocking, but no surprise

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The variation in early death rates between different parts of the country is “shocking”, according to the Health Secretary. Shocking it may be; but surprising it is not. Ever since the seminal Black Report, published in 1980, set out in stark, evidential terms the link between deprivation and poor health, debates about public health have been regularly punctuated by studies confirming the intractability of the problem.

The latest contribution is a Public Health England website that allows local premature mortality rates to be compared with those of other areas with a similar population and wealth for the first time. A useful tool, no doubt. But it is the national map that is so striking.

Not only is there a two-fold difference in cancer death rates between the top- and bottom-ranking areas (Harrow and Manchester), a three-fold disparity for heart attacks and strokes (Wokingham and Manchester, again), and a near five-fold gap for lung and liver disease (with Blackpool bottom in both). More concerning still is that the vast majority of “worst” and “worse than average” are in the North.

Cue the usual flood of glib remarks about avoiding Manchester (overall worst) and moving to Wokingham (overall best). Of course, there are lessons to be learned. Some relatively affluent places – Thurrock, say, or Bedford – have worse than average premature death rates; meanwhile, deprived Enfield and Brent do better than many, much wealthier counterparts. But such cases are exceptions. In the main, health – or the lack of it – correlates more closely with wealth than anything else.

The latest data is less of a condemnation of individual local health services, then, than a map of British lifestyles. And, to a large extent, that means drinking, smoking and obesity.

Thanks to the recent changes, such matters are now the responsibility of local authorities. Councils certainly do have a part to play. In part, by helping with the revolutionary task of tilting NHS priorities towards prevention as well as cure; but also through community action. Getting rid of fizzy drinks vending machines in schools, an idea backed by the Health Secretary yesterday, would be a start. Proposals to limit the number of fast-food outlets, or curb daytime sales to schoolchildren, also deserve a hearing – albeit with an eye on the practicalities. Education is also of central importance.

For all Jeremy Hunt’s fulminations, however, there is also much that central government might do but is choosing not to. Both of the Coalition’s high-profile public health measures – the imposition of a minimum per-unit price for alcohol, and the introduction of plain packaging for cigarettes – have been kicked into the political long grass. They should be swiftly retrieved.

The sharp rise in obesity also warrants action at a national level. Talks with the food industry over fat and sugar content and clearer labelling have not been pursued with sufficient gusto. Supermarkets’ strategies, such as festooning their check-out aisles with chocolate and holding different stock – often with fewer fresh products – in poorer areas, also raise questions.

Ultimately, of course, individuals are free to make their own choices. But consumers deserve to be both better informed and offered real alternatives. It can only be hoped that the premature death map that has so shocked the Health Secretary will concentrate minds.

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