Mind the gap: Seventy years after the NHS was founded, a new survey shows a shocking health divide between rich and poor


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The Independent Online

The gap between the health of the rich and the health of the poor is not a problem unique to the UK. It exists between nations, and it exists within every nation. But in this country, it somehow feels more galling, more unjust. Seventy years ago we had a public debate about health and equality; the outcome was the NHS, a comprehensive medical service open to all regardless of means. Shouldn’t health be the one arena in which, despite all the other inequalities that plague us, we are on a level playing field?

The findings from Public Health England (PHE) constitute the latest evidence to the contrary. While our access to good healthcare may be universal, our chance of having good health is still determined by where we live. It should be a blot on the conscience of a nation that once prided itself on social solidarity that to be among the poorest in North-west England means an average life expectancy eight years below that of the richest in East England. And if the South-east of England were a country it  would be at the top of the list of wealthy nations for health.

The evidence of factors beyond the reach of traditional health services – parenting, education, employment, income – influencing our likelihood of becoming sick has been piling up for many years now. Professor Sir Michael Marmot, the University College London academic who pioneered this field, calls them the “causes of the causes”: how social, educational and economic factors make us more likely to smoke, to drink excessively, to be stressed, to eat badly; and how in turn these things make us more likely to be sick, and to die before our time.

The field, known as the “social determinants of health”, is not new, and is far advanced in its evidence base. We know what works because in some countries, including our Scandinavian neighbours, the health gap between rich and poor is not as wide as it is here. Good support for parents in children’s early years, a generous welfare system to ensure all families can afford to eat healthily, good education and healthy workplaces all help.

There is a very clear correlation between the generosity of a state’s spending on health and education, and the health of its citizens. It sounds an obvious finding, but when governments throughout Europe are demanding the withdrawal of state support in so many areas, it bears repeating.

Such simple solutions might be dismissed as economically illiterate. We do not have a money tree. But take one of PHE’s most striking findings. Forty per cent of sickness in England is caused by risk factors that could have been prevented. Another way of putting that is: 40 per cent of the NHS’s workload, or 40 per cent of the annual cost of the health service – in the region of £46bn – could have been spared.

Every pound invested in addressing the “causes of the causes” of ill health will lead to savings down the line. It costs more to treat than it does to prevent, as PHE knows. The quango will take its findings to the Government and use them to make the case for greater investment in the social determinants of health. It should be forceful in the argument, for it is charged with the protection of our common health. If the evidence says that more public spending in areas such as education is good for us, it should be willing to make that case.

Of course, this takes us into the realms of political debate about the size of the state – an area health authorities have been wary of entering. But the good health of the nation is a moral imperative; a trump card in any debate. If they want action from Government, the leaders of the NHS and PHE should not be afraid to play it.