This piece is part of a series of blog posts by members of the Inequalities in Health Alliance, highlighting the breadth of health inequalities that exist throughout society. #EverythingAffectsHealth
The Centre for Ageing Better’s flagship publication, The state of ageing 2022, is a comprehensive review of data on the health, homes, work and community connections of people in mid- and later life in England today, writes Dr Aideen Young, senior evidence manager at the Centre for Ageing Better.
The picture we paint is one of stark and worsening inequalities across virtually every aspect of our lives ‒ from health behaviours and the quality of our homes and work, to the ways in which we interact with and belong in our communities. As these are among the so-called ‘wider determinants’ of health, it is unsurprising that the inequalities we see in these areas translate into inequality in a host of different measures of our health.
We documented huge variation in the prevalence of common long-term chronic conditions by level of wealth. For example, people in their 50s and 60s who are finding it difficult to get by financially are twice as likely to have arthritis as those living comfortably (36% vs 18%). Shockingly, four in ten women (40%) in the poorest fifth of the population have a health condition that limits their day-to-day activities, compared with just two in ten women (19%) in the wealthiest fifth.
At a time of increasing pensioner poverty and a cost of living crisis that is hitting millions, the clear association between wealth and health bodes ill for the poorest in society.
There is also stark variation by region: men born in Blackpool and women born in Kingston upon Hull have the lowest number of years ‒ just 52.7 and 51.5, respectively ‒ before the onset of illness and disability. This contrasts with almost 70 years for men in Southwark and women in Wandsworth, both among the most affluent areas in the country.
The lowest life expectancy for men and women is also in Blackpool: 74 and 79 years, respectively. For men, the highest life expectancy is 85 years in Westminster, while that for women is 88 years in Kensington and Chelsea. Thus, a person’s birthplace can be the ultimate decider as to who gets an extra decade of life.
Health behaviours such as smoking and physical activity play a significant role in health outcomes. More than a quarter (29%) of men aged 50 and over in the poorest fifth of the population smoke, compared with just 4% in the wealthiest fifth. Inequality exists by region too, with smoking rates ranging from 17% (north-east) to 12% (East Midlands and the south-east) among 55- to 64-year-old men, and from 14% (north-east) to 9% (London) among women of the same age.
Similarly, people aged 55–64 who live in the poorest neighbourhoods are more than twice as likely to be physically inactive as those in the wealthiest.
It’s vital, however, that we don’t consider health behaviours in isolation, because inequalities in these behaviours reflect the wider structural inequalities that produce them. For many, smoking reduces stress, which could be brought on by such things as debt, poorly paid and insecure work, or overcrowded and poor homes. Crime and fear of crime, area degradation, lack of green infrastructure, noise and air pollution, cluttered pavements and non-inclusive design are all known to be barriers to being physically active and will most heavily impact people in the most disadvantaged areas. And there is a clear correlation between the availability of fast food outlets and the level of area deprivation, which undoubtedly contributes to inequalities in healthy eating and in obesity levels.
Inequalities exist between people of any age, but it is worth noting that they become increasingly pronounced as we age. Because just as money begets money, so poverty begets poverty and thus disadvantage and its impact accumulate over time. This research shows that the health status of different ethnic groups begins to diverge at around 30 years of age and that from that age on, the gap in health between ethnic minority and White majority groups gets gradually larger, becoming increasingly more marked in later life.
As expected, the Queen’s speech included a Levelling Up and Regeneration bill aimed at redressing regional disparities. The data in The state of ageing 2022 demonstrate just how pressing an issue this is.
