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Census reveals more than half of doctors seeing more patients with illness due to avoidable social harms

Doctors have reported a rise in the number of patients they are seeing with ill health due to the wider determinants of health, such as living in mouldy or damp homes, employment, poor air quality or education, a census has revealed - sparking urgent calls for government to address the “avoidable social causes” of ill health.

The latest census from the Federation of the Royal Colleges of Physicians in the UK found that 55% of consultant physicians had seen more patients with ill health over the last three months due to social and economic factors.

Dr Sarah Clarke, president of the Royal College of Physicians, said:

“In the midst of unprecedented demands on the NHS and declining public health, it should be sounding alarm bells in government that so many doctors are seeing more patients with illness related to the wider determinants of health, such as housing or poor air quality. Everything from the food we eat to the air we breathe impacts our health. Good health is an economic asset.

“It is clear that the responsibility for good health lies not solely with the NHS nor the Department for Health and Social Care – all of government must play a role. If we are to reduce these avoidable demands on the NHS, improve general levels of health across the nation, and create a healthier labour market, we must see a comprehensive, cross-government strategy to reduce health inequalities that tackles the things that make us ill in the first place.”

Worryingly, the recent survey also revealed the significant impact people’s living conditions are having on doctors’ caseloads with almost a quarter (24%) of physicians saying more than half or almost all of their workload is due to illnesses or conditions related to the wider determinants of health. This comes after the latest figures show the overall waiting list stands at 7.6m in England.

The three Royal Colleges of Physicians say the wider determinants of ill health, including the ability to heat homes, access to green spaces, transport links and poor air quality, are driving health inequalities, impacting the economy, and placing further demand on the NHS. Data from the Office for Health Improvement and Disparities reveals that those living in the most deprived area of England, Blackpool, have a healthy life expectancy of just 53.9 – more than 17 years less than the least deprived area in the UK, Wokingham.

According to the Office for Budget Responsibility July 2023 fiscal risks and sustainability report, increased labour market inactivity over the past three years, coupled with the increase in ill health among people in work means the government spent £6.8 billion more on welfare payments in the year 2023/24, while the total annual tax loss is estimated to have risen to £8.9bn.

The latest physicians census reveals an overwhelming majority (85%) of physicians say they are concerned about the impact of health inequalities on their patients.

Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh, said:

“The findings from this census present a stark image of public health. Many doctors feel that the National Health Service is actually a national sickness service, dealing with the symptoms and signs of disease and limited in its ability to prevent that disease. That will remain the case for as long as we neglect the root causes of ill health. We must confront these head-on. That means better housing, cleaner air, better nutrition, better education and ensuring equitable access to basic necessities for health living. Our physical and mental health is intrinsically related to our environments. There is no quick fix. It requires bold and transformative action from across government – and the reports we have from our nation’s physicians should be all the impetus we need.”

Mike McKirdy, president of the Royal College of Physicians and Surgeons of Glasgow, said:

“Doctors increasingly find themselves under unprecedented strain, grappling with mounting caseloads of patients whose ailments are directly linked to their living conditions.

“Prevention is better than cure and we must see a concerted effort from across government and wider society to address the underlying socio-economic factors which perpetuate this cycle of illness and increased demand on the NHS.”

Notes to editors

Inequalities in Health Alliance  

The Royal College of Physicians convenes the Inequalities in Health Alliance – a coalition of more than 250 organisations calling for a cross government strategy to reduce health inequalities.   

Healthy Life Expectancy  

Healthy Life Expectancy (HLE) is the average number of years that a person can expect to live in good health. There is significant variation across the country. 

The latest data from the Office for Health Improvement and Disparities revealed:  

Blackpool has the lowest healthy life expectancy of anywhere in the country, at just 53.9 years. This has worsened over the last decade, from 54.1 years in 2009.  

Wokingham has the highest healthy life expectancy of anywhere in the country, at 71.05 years. This has worsened over the last decade, from 71.1 years in 2009.  

Within London, Barking and Dagenham has the lowest healthy life expectancy at just 59.1 years, while Kingston upon Thames has the highest health life expectancy at 69.6.   

There is over a 10-year gap in health life expectancy between the most and the least deprived areas of London.   

There is a 17.6-year gap in healthy life expectancy between the most and least deprived of England.   

The largest gap in HLE between men and women exists in Rutland, where men are expected to live 7.9 years longer than women. The reverse is true of Greenwich where women are expected to outlive men by 7.1 years. Only three areas of the country have an equal HLE for men and women - Bath and North East Somerset, Hertfordshire and Cheshire East.  

The annual census of UK consultant physicians  

The Medical Workforce Unit (MWU) of the Royal College of Physicians (RCP) conducts an annual consultant physician census on behalf of the RCP, the Royal College of Physicians of Edinburgh (RCPE) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG).  

A physician is a medical doctor, normally based in a hospital, who usually focuses on the non-surgical treatment of patients’ conditions, such as outpatient care and diagnostic investigation. A consultant physician is the most senior physician. Physicians are currently at the forefront of bringing down waiting lists, including diagnostic waiting lists. There are over 30 medical physician specialties from cardiology, acute medicine and gastroenterology to infectious disease, palliative medicine and stroke medicine. For further information: https://www.rcplondon.ac.uk/education-practice/advice/what-physician.