Being poor kills – to improve public health the government must tackle inequality

Health policy must include a focus on social determinants


In one of the Government’s most short-sighted moves on the nation’s health, cuts to public health funding of more than £530m during this Parliament have been identified by the House of Lords select committee on the long-term sustainability of the NHS.

These cuts are being made at a time when the NHS is under mounting pressure to meet rising demand with dwindling resources and staff shortages exacerbated by Brexit. Public health funding should be a priority since it tackles the root causes of poor health that feed into demand.

Such cuts are further signs that this Government, as with many in the past, view the NHS as an ‘illness service’ instead of a means of supporting better health in a wider social context. Good health is seen as the personal responsibility of individuals rather than the result of a range of social determinants, which impact on communities and drive health inequalities.

Social determinants are as important as lifestyle or genetics in shaping life expectancy, morbidity rates and life chances. Life expectancy is shorter and disease is more common further down the social ladder.

Economic disadvantage, social exclusion, unemployment, the absence of social support networks, food insecurity, and poor housing are major determinants of our health status. Pollution from cars in city centres is a growing concern. And being a woman, from an ethnic minority and/or disabled are also key markers.

It is no fluke that the colloquial term for being ill is ‘poorly’. Being poor kills. It shortens and blights lives. The difference in life expectancy between inner city neighbourhoods and leafy, affluent suburbs can be as much as ten years.

The costs of poor health flowing from the impact of social determinants are startling. Take housing — it is estimated that a lack of housing at all (homelessness and rough sleeping), or inadequate, overcrowded or fuel poor housing, costs the NHS around £2.5bn annually. And housing is just one social determinant.

So, not is it only short-sighted of the Government to reduce public health budgets, the whole thrust of austerity policy over the last seven years has had major detrimental effects on our health.

The escalation in insecure work, the growth of poverty (especially among children), the proliferation of food banks, cuts in welfare support to low income groups and disabled people, and local government service retrenchment are all factors in the UK’s widening health inequality gap.

These social determinants of our national health may be feeding through into the first drop in life expectancy for decades.  Excess winter deaths of elderly people topped 40,000 last year, the highest number for 15 years. Growing inequality over the last for decades has also taken its toll the nation’s physical health and wellbeing.

The conclusion to be drawn here is that, even with extra funding for the NHS, the UK’s health crisis cannot be resolved without reversing cuts in expenditure on welfare and vital local services, seeking to create more secure jobs, delivering more affordable housing, and confronting levels of inequality that exacerbate poor health.

Kevin Gulliver is Director of Birmingham-based research charity the Human City Institute, writing in a personal capacity. Follow him on Twitter @kevingulliver 

See: Councils’ social care spending has fallen by 11 per cent in six years

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6 Responses to “Being poor kills – to improve public health the government must tackle inequality”

  1. Michael WALKER

    So who is going to pay for all this?

    Hard pressed taxpayers? Or the Magic Money Tree.?

    No reply.

    So not worthy of reading .

  2. James Anderson

    A lovely snide comment, Michael Walker.

    Two things will pay for it:
    1. In the long-term, investments in preventative and essential health care save money. Provision of basic health care avoids the higher costs associated with more serious or emergency treatment, when basic problems are left untreated. So these investments will pay for themselves.
    2. Tackling tax evasion and tax avoidance would pay for the health care deficit dozens of times over.

    But the Tories won’t do it… because they and their donors benefit from tax evasion and tax avoidance.

  3. Larry

    Hey, here’s a crazy idea, why don’t we ask Starbucks to pay all the tax they owe us so we can fund public health better? They woud be paying for the educated worker (education funded by us) who get to the Starbucks on roads (funded by us) or rail network (funded by us), and who are healthy (funded by us), while Strabucks (allegedly) funnel almost all their profits into overseas bank accounts (funding none of us).

  4. Mervyn Hyde

    Michael Walker, as you appear to be an expert on the Money Tree perhaps you could tell us how money actually enters the economy?

  5. ted francis

    Oh dear Mickey, you’re at it again. Let’s get the not-hard-pressed taxpayers to pay for it. You know, those individuals and companies that weasel their money abroad or, perish the thought, how about putting the top level of tax back to where it was marginally fairer? But of course none of it is really necessary because in a couple of years we’ll be getting all that revenue that’s no longer going to Europe: now what was it your friends promised and plastered all over a big red bus…..ah yes, £350,000,000 EVERY WEEK!! There it is, problem solved in one!

Comments are closed.