A Prescription for Change: Systemic Health Inequalities


Omar Amin discusses how the NHS and burgeoning health inequalities will play a key role in the next General Election

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Image by LSE.ac.uk

By Omar Amin

At the heart of British society,  the National Health Service (NHS) and its notion of care “from the cradle to the grave” at no cost to the user, engenders pride across the nation. Despite the NHS’s commitment to providing universal healthcare, rampant health inequalities persist, silently shaping the health outcomes of millions. With the hangover of Covid-19 bringing focus to the large cracks in our healthcare system, it is important to understand the impact and real human cost the effects of health inequalities can propagate in British society.

In January 2021, the University of Manchester released a scathing report which identified that the average health of 60-year-old men belonging to Traveller, Bangladeshi, Pakistani, and Arab groups was similar to that of a typical 80-year-old White British man. Similarly, the wealthiest women in England have better health at age 76 than the poorest at age 60. More recently, the Institute of Health Equity found that a premature death toll of 1,062,334 people could have been avoided had these people resided in regions inhabited by the wealthiest 10 percent of the populace.

It is no secret that for those born in deprived areas, health inequalities place a timepiece on life itself.  Children born in these areas are 2.4 times more likely to die before their first birthday than those born in more affluent areas. Similarly, childhood obesity is 2.4 times higher in deprived areas. Male life expectancy at birth from 2012 to 2016 was greater among higher managerial and professional occupations at 83.6 years, 5.5 years longer than those of routine occupations. Indeed, health has become a marker of social stratification in the UK, and things are only getting worse.

The glaring inequalities in health aren’t solely the consequence of an ill-funded NHS but are the cumulative effects of the wider determinants of health. The common idea of health being merely a bodily illness is simply false, rather it is an illness of society. Those living in poorer areas have diminished access to green spaces, and often those on low incomes do not have the disposable time or resources to cook nutritious meals. It would appear that every aspect of life for many working-class individuals actively decreases their health and well-being. This is especially true for BAME groups, with the proportion of Black children living in poverty increasing from 42 percent in 2010-2011 to 53 percent in 2019-2020. Furthermore, for all family types, people from ethnic minorities are more likely to experience income poverty than their White British counterparts. With income being one of the most impactful determinants to health, we can begin to understand why minority groups are so much worse off, especially in the NHS.

With this, an important question to ask is: where did we go wrong? These are issues that governments have known for years, but meaningful progress has often been difficult to come by. There has been some successful progress in the reduction of geographical disparities in previous years, under Labour between 1997 and 2010 there was a comprehensive program to reduce geographical disparities in health. This approach achieved success by addressing broader determinants of health through the introduction of solutions such as a national minimum wage, fiscal reforms aimed at alleviating child poverty, and enhancements to policies pertaining to education, housing, and employment. There were also reallocations of the NHS budget directly into disadvantaged areas. This resulted in a reduction in the geographic health inequalities in life expectancy, reversing the trend at the time. Sadly, since 2010, there has been a regression from these achievements due to policy choices and spending cuts to peripheral services. Combined with a continuous treadmill of short-term quick-fix policies, the NHS is at its knees and one of the first things to deteriorate is the difficulty of implementing services in deprived areas. For example, despite having a greater prevalence of disease, impoverished regions typically have fewer general practitioners per capita than richer regions, meaning that getting a GP appointment for people in more deprived areas can be significantly more difficult.

In this election year, we will soon be seeing ‘big’ changes being pitched from all sides of the political spectrum on ways to cut the waiting lists and improve NHS services. As voters, we must recognise the truth. The UK spends the least amount of money per capita on healthcare for its citizens compared to similar countries, we have the least amount of CT and MRI scanners per million people than comparator countries and one of the lowest rates of doctors and nurses per thousand compared to similar countries. Inequalities in access to healthcare are worsening along with the standard of living which, in turn, is worsening the health of the nation and when people do get ill, they have to access subpar services. In essence, no matter your political allegiance, fixing the health inequality and inequity crisis in the UK requires a multi-pronged approach. Fixing these problems is possible, it has been demonstrated, but it requires political motivation to do so.