There is a fatalism surrounding the shocking fact that the poor in England die much younger than the better-off. We have become hardened to the awful facts that demonstrate that the ultimate inequality of life and death is bad, and in some aspects getting worse.
Morality demands of us that we ‘should do something about it’ but history teaches us that as every decade passes, the well-off live even longer than poorer people. It’s bad, and it’s getting worse.
Those steeped in the theory of public health know what to do. They identify the economic and social factors that are the ‘social determinates of health’. They ‘do what it says on the tin’ – they determine health. Social determinates are driven by major historical themes concerning economic and social power. Revolutionaries know that these big issues can be challenged and changed, but the problem is that for decade after decade the revolution keeps on not happening – and people keep dying young.
A recent study gives us more hope for immediate action – it provides hard evidence that Governments in general and the NHS in particular can actually do something to turn this history around. With strong focus and consistency we can reduce the gap in life expectancy between the better off and the poor that has been growing for most of the last 50 years.
Excuse me while I jump up and down with glee a bit but it shows that even in the pretty dark times of 2018 that politics work. Not only can we improve people’s lives but we can help them live longer.
The English Health Inequalities Strategy was a cross-government strategy implemented between 1997 and 2010. Over 13 years the New Labour governments of Tony Blair and Gordon Brown kept to the strategy and it was only when the coalition government came to power that government lost focus on the policy – and ‘normal’ times resumed.
This study is the first to analyse the impact of this policy by looking at its data on impact on life expectancy. Its conclusion is,
“The English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. Since the strategy ended, inequalities have started to increase again. The strategy may have reduced geographical health inequalities in life expectancy, and future approaches should learn from this experience.”
(see Conclusion on this page)
Since the authors ask us to learn, what lessons can the new relationship between the NHS and the government draw from this? What could and should go into any contract between the NHS and government?
First, that pragmatic focused intervention works. Focus and targeted medicine can help poorer people live longer and reduce inequalities. Most public health professionals agree that the longer-term issues of jobs and education have a big impact on people’s life expectancy.
This is important work, but it is long term. Help someone get a university degree and in 50 years’ time it is very likely they will live longer than they would have otherwise. But poorer people are dying sooner now. The core of this policy asked local NHS and local government in poorer areas to find out who were dying so much younger than in other locations; find out what they were dying of, and help stop that from happening.
We know that we can find those people who are likely to die in their 50s and help them survive and thrive for a further 15-20 years. This is what makes this policy work.
That may sound very simple – and in many ways it is. We know that in poorer areas stroke and cancer carry people off younger than in better-off areas. The same diseases that kill us all, kill the poor – but do so earlier.
Second, the policy focus was saying “don’t just carry out this task randomly but do so in and with communities”. This policy was organised around what were called 70 spearhead local authorities. These authorities and the 62 Primary Care Trusts that could be mapped on to their boundaries were accountable for implementing the strategy. I remember that as this strategy unfolded that whenever I went into an NHS or a local authority building in Tower Hamlets, they all had the same messages about reducing health inequalities on posters. Local authority buildings advertised both NHS and local government aims to increase life expectancy, and vice versa.
Local accountability for local lives was crucial.
Third it’s important that the Government – a cross-departmental Cabinet committee – gave some clear ideas on what local services could do to help poorer people live longer. There were four issues that the whole NHS knew would work to achieve this:-
Support for people to give up smoking
Control of blood pressure
Control of Cholesterol
Interventions to reduce infant mortality
We know that more poorer than well-off people smoke, have high blood pressure and cholesterol and we know that poorer pregnant women ‘present’ to the NHS later with their births. If we change this we know that people – and their babies – live longer.
To increase life expectancy amongst poorer people we needed a much more active NHS that went out and found people with these characteristics and helped them change their behaviour and their vital signs. People need help to change their lives and this policy gave them that help.
As the authors of the research into the policy say in their conclusions that I quote above “future approaches should learn from this experience”. We now have the opportunity of a new covenant with the NHS to make a pledge about increasing life expectancy in poorer areas. Here we have evidence that a determined focused policy can reduce the inequalities of life expectancy that previously looked inevitable.
It shows that – even on the most entrenched inequalities focused and determined policy and politics works.