Fault lines

Philip Hunt on the government’s failure to get to grips with the UK’s widening health inequalities

Nearly 40 years ago, the Conservative government was rocked by a report warning of the huge scale of health inequalities in the UK. Sir Douglas Black, President of the Royal College of Physicians, pinpointed the unequal distribution of ill-health due to social inequalities in income, education, housing, diet, and conditions of work.

Sir Douglas’s seminal work was so embarrassing for the then Prime Minister, Margaret Thatcher and her ministers that very few copies were ever printed. Indeed, the very word ‘inequalities’ was banned from use by civil servants.

Now another Conservative government is presiding over a similar challenge. The Chief Medical Officer (CMO), Dame Sally Davis recently produced one of the most hard-hitting public reports ever seen, laying out not just the scale of health inequalities that exist in our country but the need for action.

Shockingly, these inequalities have worsened in recent years. In 2016, life expectancy for women at birth ranged from 78.8 years in the most deprived areas compared to 86.7 years in the most affluent. For men the range was 74.0 years to 83.8 years.

Significantly, the CMO pointed to the emergence of working poverty as a prominent issue – a result of the combination of higher employment and poor pay growth. This has contributed to 1.5 million people experiencing destitution and a substantial rise in child poverty, because families with kids (and especially those with lone parents) have been particularly affected by cuts to benefits.

Combined with the impact of austerity, it is little wonder that poorer people’s health has been so badly affected. Children centres and other sources of social support for families have been drastically reduced. And this has been matched by the slashing of public health budgets by £700 million over the same period. Some 85% of local authorities plan to reduce their budgets over the next year. Programmes that support smoking cessation, the tackling of obesity and sexual health will all also suffer.

Looking ahead to 2040, the CMO concluded with a seismic warning that if current trends continue or get worse, we could end up with a society where the most deprived are cast adrift from the rest of society. The gap in life expectancy and healthy life expectancy could worsen substantially.

Alternatively, we could prioritise health as one of our nations’ primary assets. The CMO makes a compelling case for a combination of high and continuing rising taxation on tobacco and alcohol. Dame Sally also wants to see the use of fiscal disincentives for foods high in sugar and salt, alongsides incentives to increase fruit and vegetable consumption.

The government’s ten year long-term plan for the NHS, published earlier this month, was an ideal platform for ministers to show they had got the message. Sadly, the plan is almost entirely focussed on the NHS and ducks many of the questions raised by the CMO. There’s far too much focus on individual interventions and an ignorance of the wider societal measures (including fiscal policies) that are so essential.

I’m convinced there is a majority in Parliament for decisive action. My oral question in the House of Lords this afternoon will test this out and make clear to ministers that the CMO’s report on health inequalities must not be swept under the carpet.

Lord Philip Hunt of Kings Heath is a Labour Peer and a former Health Minister. He tweets @LordPhilofBrum

Published 21st January 2019

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