Winter is on its way and, as a cardiologist, it’s not just the dropping temperature which sends a chill down my spine. I know that cold snaps exacerbate cardiac-related disease. Every winter, I see an uptick in the number of people requiring urgent care. As we face another winter of people concerned about their heating bills, and an overwhelmed health service, sadly it'll be the most disadvantaged heart patients who bear the brunt of the coming cold months.
Health inequalities – and their root causes – were exposed and exacerbated during the pandemic. Working-age adults in the most deprived areas of England were nearly four times more likely to die from COVID-19 compared to their counterparts in more affluent areas. These disparities in health have persisted and, in some cases, intensified. Such inequalities are present across a wide range of health conditions. For instance, individuals with diabetes in the most deprived areas were nearly three times more likely to die than their counterparts in better-off areas.
Our health is a product of our environment – where we live, our work and how much money we have, the air we breathe, the discrimination and racism we may face, our education, communities and place of birth, and many other factors like access to transport all have an impact.
These health inequalities have profound real-world consequences. Even before the pandemic, the gap in healthy life expectancy between the most and least deprived areas of England was staggering, approaching two decades. Recent data shows that deaths from all causes and most individual conditions were highest among those in deprived areas and among the long-term unemployed or those who had never worked.
With NHS waiting lists reaching record highs, addressing health inequalities is essential not only for the sake of fairness but also for ensuring the sustainability of our healthcare system. Good health is an economic asset. In the long run, a healthier population with less avoidable illness will reduce the demand on our health service, reduce the number of people unable to work because of long-term sickness, and help to build a more prosperous nation.
But looking ahead, the outlook is concerning. Throughout this year we have seen record numbers of people unable to work due to long-term sickness. Rising energy bills are a pressing concern for a significant portion of the population, and the cost of living continues to impact health and quality of life. The number of people reporting multiple long-term health conditions is on the rise, warning of demands on our healthcare service which will dwarf the ones we already face. Projected increases in major illnesses, such as severe cases of cancer, diabetes, and kidney disease, will place additional pressure on an already strained NHS. The Health Foundation’s recent findings indicate that over nine million people will be living with a major illness by 2040.
We know that health and the NHS consistently rank among the top issues among the public. But because the things that make us sick and lead to inequalities in health are caused by a range of factors, addressing them requires a comprehensive strategy from all of government rather than solely the Department of Health and Social Care. The gift is within government to take bold action to tackle the root causes of ill health. Factors such as inadequate housing, educational opportunities, employment, transport, and air quality are all determinants of ill health that must be addressed in a collaborative way across government.
The Inequalities in Health Alliance, now three years old, is convened by the Royal College of Physicians and has amassed support from more than 250 other organisations. Together as we head toward winter and another new year, we are calling again for a cross-government strategy to reduce health inequalities. Every government department needs to get involved and use all available policy tools. A healthy nation and a healthy economy are two sides of the same coin. To be effective, the strategy must have clear and measurable goals, metrics for progress, have accountability to the Prime Minister, and be supported by the necessary funding.
We stand at a critical juncture in pursuit of a fairer and healthier nation. Our call is not just a matter of social justice, but an economic and public health imperative. By addressing the root causes of ill health, we can reduce the avoidable demand on our healthcare services, increase productivity, and improve the overall prosperity of our nation. The prevention of ill health must be at the heart of all government policy.
Read the RCP's updated policy paper reiterating calls for a cross-government strategy to reduce health inequalities.