GOOD news: people in Britain are living longer than ever before. They are the healthiest they have ever been. Moreover, the lot of the poor has been improving at a phenomenal rate. Over the decade to 2005, the most recent years for which data are available, life expectancy for boys born in the least salubrious neighbourhoods has rocketed by 2.7 years to more than 75 years. Yet, despite this progress, they are losing ground to more fortunate folk. Boys born to parents living in more comfortable surroundings have always expected to live longer. But the gap between the two groups has increased.
On February 11th Sir Michael Marmot, a well-known epidemiologist at University College London, published a report looking at the relationship between health and wealth. It was the third officially-sanctioned attempt to do so in 30 years. The findings demonstrate what Sir Michael calls “the social gradient in health” (see chart). People living in rich communities live longer than those in modest suburbs who, in turn, outlive those residing in the rougher parts of town. And the poor also spend more of their shorter lives coping with a disability. In England people on the poorest housing estates die, on average, seven years earlier than those in the grandest accommodation. They can expect to become disabled 17 years earlier.
Why should this be, given that the National Health Service (NHS) provides free care to all? One argument is that the poorer people are, the more likely they are to do unhealthy things that brighten their otherwise dull lives temporarily. Smoking, for example—blamed for a third of all cancers—is twice as common in households where the main breadwinners have routine and manual jobs than in professional and managerial homes. And white-collar workers are kicking the habit faster than manual labourers. So too with obesity, which causes diseases such as diabetes: it is increasing fastest among those at the bottom of the heap. Yet the rich also have their vices, among them under-reported drink: a third more alcohol is put back by professionals than by manual labourers.
The government has long sought to reduce persistent health inequalities, but to little effect. One problem has been that it sets targets which focus efforts in the wrong places. For example, the goal of reducing infant mortality among lower social classes, more prevalent than higher up the scale, initially appears laudable. But the mandarins count only those babies whose father’s occupation is stated clearly enough for the cherub’s social class to be ascertained. Infant mortality among the offspring of single mothers, and of others whose partners remain vague, is ignored in the rush to reach the target. Yet infant deaths in this group are markedly more frequent than among babies whose fathers are poor but committed parents.
Anna Dixon, acting head of the King’s Fund, a health-policy think-tank, describes the reasons for health inequalities as “complex and long-standing”. It is clearly up to the NHS to help everyone improve their chances to live longer and healthier lives. But the health service on its own cannot do away with all the factors that lead to poor health. The government should take a wide view in assessing health inequalities and support not just NHS efforts but programmes that address the wider determinants of health, she says.
The highest priority, Sir Michael suggests, is to ensure that every child has a good start in life by concentrating on poorer children during their earliest years. This begins when a child is in the womb and his mother needs extra health care. Toddlers whose mothers may not have achieved much at school themselves and so might fail to equip them properly for starting school also need help, through more SureStart centres and the like. Equality of nurturing is key.
Sir Michael points out, sensibly, that more should be done to avoid ill health in the first place. The NHS accounts for a fifth of all public spending but uses just 4% of its funds to dodge disease rather than tackle it. As ever, prevention is better than cure.