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
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