Health inequalities have been increasing in the UK over the last decade, with life expectancy falling in some of our most deprived places. Clare Bambra, Professor of Public Health at Newcastle University and NIHR Senior Investigator discusses the terrible consequences of the cost of living crisis on health inequalities and puts forward a plan for change.
The rise of health inequality
Health inequalities have been increasing in the UK over the last decade, with life expectancy even falling in some of our most deprived places [1]. This has occurred in a context of low economic growth, local authority budget cuts and significant changes to the welfare system [2].
Then, along came COVID-19.
The health, education and economic impacts of the pandemic have also been deeply unequal with, for example, death rates at least twice as high in our most deprived and minoritized communities [3]. Now, off the back of this lost decade for public health, we are experiencing a cost-of-living crisis with discomfort for many – and potential destitution for some.
Increased pressure on household budgets
The cost of living crisis can be characterised by a volatile economy, high inflation resulting in rising food and energy prices, and interest rate increases threatening a housing crisis. These new realities are putting considerable pressure on household budgets across the country.
“Health inequalities have arisen over decades, if not centuries, but underlying them is often the same root cause: an unequal distribution of the wider determinants of health, such as access to resources, opportunities, wealth, education, and power.”
Professor Clare Bambra, Newcastle University’s Faculty of Medical Sciences
As a result, child poverty rates – which have already been increasing in more deprived parts of the country such as Middlesbrough and Liverpool – are predicted to increase further in the UK over time [4].
The high cost of energy – even with the government’s Energy Price Guarantee – is also expected to pull more households into fuel poverty. There are further concerns that increased housing costs could lead to a wave of home repossessions, evictions, and homelessness. Household debt is expected to increase as families struggle to make ends meet. Falling consumer spending and rising business costs may also lead to downsizing and higher unemployment rates.
Decades of research tells us that an economic crisis this severe will likely become a health and health inequalities crisis [5].
The health cost
Poverty restricts peoples’ ability to cover their basic needs and support their children. Children in poverty, on average, live for almost ten years less than those who grow up in affluence and spend twenty years less in good health. They are also much less likely to do well at school and are, in turn, less likely to be employed [6].
Child poverty already costs the UK at least £25 billion a year in lost productivity [6]. Food poverty is associated with lower-quality diets leading to higher rates of obesity and other forms of malnutrition, worse mental health, and in the longer-term hypertension, diabetes, and cardiovascular disease [7].
Cold weather may also increase fuel poverty, which is associated with various health problems, including respiratory and circulatory conditions, cardiovascular disease, mental ill health and excess winter deaths [8]. People with chronic conditions – who are already more likely to live in poverty - may well see their health problems exacerbated. This could increase pressure on overstretched NHS services which are also still dealing with COVID-19 and seasonal influenza.
Rising rates of debt may well increase the incidence of poor mental health as people experiencing debt are twice as likely to experience anxiety or depression [9]. Even the threat of eviction or home repossession can increase the risk of depression, anxiety, psychological distress, and suicide and people experiencing homelessness have an average age of death of just 52 years [10][11]. Unemployment is associated with worse mental health, higher rates of mortality and long-term illness, and suicide [12].
Five principles for change
But it doesn’t have to be this way … the government should commit resources to its ‘levelling-up’ policies as reducing the health gap is too important an agenda to abandon.
“There is no silver bullet that will solve this problem. If we are serious about tacking this problem, then we’ll need a holistic approach, with long-term, collaborative and cross-government strategies that look beyond just one election cycle.”
Professor Clare Bambra, Newcastle University’s Faculty of Medical Sciences
Five key actions that can be taken immediately are:
1. Introduce a national health inequalities strategy which focuses on long-term solutions working across many sectors
Between 2000 and 2010, the national health inequalities strategy led to a reduction in health inequalities [16]. A national health inequalities strategy is needed again. It should focus on tackling the key social determinants of health inequalities across the life course and across the country - as well as increasing NHS provision – particularly in the North.
2. Supporting families better through the cost of living crisis
Key early interventions could include uplifting Universal Credit for families with children; extending the provision of free childcare; extending the provision of free school meals; and investing in children’s services by increasing government grants to the most deprived local authorities, particularly those in the North. Support should also be increased and extended for household fuel costs; increasing the national minimum wage; and ensuring that the state pension prevents old age poverty.
3. Develop and tailor initiatives at a local level
Communities should be involved in designing local interventions. Tailoring them to local needs can increase their effectiveness. For example, flu vaccination programmes are likely to be more successful if they can be offered outside of traditional working hours, while including community-based infrastructure developments in physical activity interventions can make them more sustainable, maintain increased adult physical activity levels and reduce inequalities.
4. Target disadvantaged communities with health promotion and wellbeing programmes
Universally-applied programmes that do not also target disadvantaged communities or account for their particular needs, assets, and barriers to health are less effective in reducing health inequalities and may even widen them. Provision of benefits to disadvantaged groups may better reduce health inequalities, such as food subsidy programmes for low-income women can reduce inequalities in mean birthweight and food/nutrient uptake [7].
5. Allocate NHS resources according to local need
Studies have shown that allocating resources where they are most needed is effective at reducing inequalities. One example is the allocation of NHS resources. Allocating proportionately to geographic need - with more deprived areas receiving more resources - is most effective at reducing inequalities.
A time for action
With many more people unable to meet their basic needs of food, shelter, and heat this winter, the prevalence of these public health risks will increase. The crisis is also likely to be deeply unequal as it will especially impact on low-income families, more deprived and minoritized communities, and those parts of the country - disproportionately located in the north of England - already experiencing above average levels of poverty, unemployment, and poor health [13].
However, government action – such as improving Universal Credit and pension rates [14], expanding housing benefit, providing targeted energy cost support for vulnerable households, and taking stronger action on child poverty – could stop the cost-of-living crisis becoming a health inequalities crisis [15].
You may also like:
- Find out more about Clare Bambra, Professor of Public Health
- Explore the NIHR Applied Health Research Consortium Health Equalities theme
- Explore Newcastle University’s Faculty of Medical Sciences
- Read the press release: Experts urge government to keep focus on levelling-up health
- Read the paper in the National Library of Medicine: Levelling up health: A practical, evidence-based framework for reducing health inequalities
- Read the previous blog: Health for Wealth: Levelling up the North-South health divide
References
[1] Office for National Statistics (2022) Life expectancy for local areas of the UK: 2001 to 2020 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/lifeexpectancyforlocalareasoftheuk/between2001to2003and2018to2020#life-expectancy-at-local-level [accessed 8/10/22]
[2] National Audit Office (2018) Financial sustainability of local authorities 2018 https://www.nao.org.uk/wp-content/uploads/2018/03/Financial-sustainabilty-of-local-authorites-2018-Summary.pdf [accessed 8/10/22]
[3] Bambra, C., Lynch, J., Smith, K.E. (2021) Unequal Pandemic: COVID-19 and Health Inequalities, Bristol, Policy Press
[4] Stone, J. (2022) Local indicators of child poverty after housing costs 2020/21, Loughborough University,https://endchildpoverty.org.uk/wp-content/uploads/2022/07/Local-child-poverty-indicators-report-2022_FINAL.pdf [accessed 8/10/22]
[5] Bambra, C. (2011) Work, Worklessness and the Political Economy of Health. Oxford: Oxford University Press
[6] Pickett K., Taylor-Robinson, D. (eds) (2021) Child of the North: Building a Fairer Future after COVID-19, Northern Health Sciences Alliance and N8,
https://www.thenhsa.co.uk/app/uploads/2022/01/Child-of-the-North-Report-FINAL-1.pdf [accessed 8/10/22]
[7] Bell, Z., Scott, S., Visram, S., Rankin, J., Bambra, C., Heslehurst, N. (2022). Experiences and perceptions of nutritional health and wellbeing amongst food insecure women in Europe: a qualitative meta-ethnography, Social Science & Medicine, 311, 15313, https://doi.org/10.1016/j.socscimed.2022.115313
[8] Public Health England (2014) Local action on health inequalities: Fuel poverty and cold home-related health problems,
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/355790/Briefing7_Fuel_poverty_health_inequalities.pdf [accessed 8/10/22]
[9] Skapinakis, P., Weich, S., Lewis, G., Singleton, N., Araya, R. (2006). Socio-economic position and common mental disorders: Longitudinal study in the general population in the UK. British Journal of Psychiatry, 189(2), 109-117. https://doi.org/10.1192/bjp.bp.105.014449
[10] Vásquez-Vera, H., Palència, L., Magna, I., Mena, C., Neira, J., Borrell, C. (2017) The threat of home eviction and its effects on health through the equity lens: A systematic review, Social Science & Medicine, 175: 199-208, https://doi.org/10.1016/j.socscimed.2017.01.010
[11] Aldridge, RW., Menezes, D., Lewer, D. (2019) Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. Wellcome Open Res, 4:49 https://doi.org/10.12688/wellcomeopenres.15151.1
[12] Barr B, Taylor-Robinson D, Scott-Samuel A, McKee M, Stuckler D. (2012) Suicides associated with the 2008-10 economic recession in England: time trend analysis, BMJ; 345:e5142 https://doi.org/10.1136/bmj.e5142
[13] Munford, L., Mott, L., Davies, H., McGowan, V., Bambra, C. (2022). Overcoming health inequalities in ‘left behind’ neighbourhoods. Northern Health Science Alliance and the APPG for ‘left behind’ neighbourhoods, https://www.appg-leftbehindneighbourhoods.org.uk/wp-content/uploads/2022/01/Overcoming-Health-Inequalities.pdf [accessed 8/10/22]
[14] Albani, V., Brown, H., Vera-Toscano, E., Kingston, A, Eikemo, TA., Bambra, C. (2022) Investigating the impact of on mental wellbeing of an increase in pensions: a longitudinal analysis by area-level deprivation in England, 1998-2002; Social Science and Medicine, 311: 115316 https://doi.org/10.1016/j.socscimed.2022.115316
[15] Simpson, J., Albani, V., Bell, Z., Bambra, C., Brown, H. (2021) Effects of social security policy reforms on mental health and inequalities: A systematic review of observational studies in high-income countries, Social Science and Medicine, 272, 113717 https://doi.org/10.1016/j.socscimed.2021.113717 [accessed 8/10/22]
[16] Holdroyd, I., Vodden, A., Srinivasan, A., Kuhn, I., Bambra, C., Ford, J. (2022) A systematic review of the effectiveness of the health inequalities programme in England between 1999 and 2010, BMJ Open, 12:e063137. doi: 10.1136/bmjopen-2022-063137