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Why we need a cross-government strategy to end inequalities in health

Professor Cheng-Hock Toh, RCP’s Academic Vice-President, contributes to Northern Health Sciences Alliance’s COVID-19 pandemic report, revealing a massive hit to the North of England’s health and economy.

In a Foreword written for a new report from the Northern Health Sciences Alliance (NHSA) on the effect of COVID-19 in the north, RCP academic vice-president Professor Cheng-Hock explains how decades of failing to invest in improving public health and reducing health inequalities laid the bedrock for the disproportionate brunt of the current epidemic experienced across the north.  Tracking from the 1980 Black report through the recent Marmot report to the formation of the new Inequalities in Health Alliance by the RCP, the Foreword is a powerful call to action to protect all UK citizens. As the RCP prepares to open its first ever major office in the north in 2021 in Liverpool, it is committed to using its presence to reduce health inequalities in the UK.

Read the Foreword below:

This report is a spotlight on the disproportionate e­ffect of COVID-19 and the underlying inequality that helps to fuel this disparity of impact. The writing has been on the wall for many years now but it will be for years to come that we are all responsible for. In September 2019, the Office for National Statistics (ONS) revealed that life expectancy in the UK had stopped improving for the first time since records began.

Between 2011 and 2017, improvement was slower in the UK than in the majority of OECD countries. Four months later, Health Equity in England: The Marmot Review 10 Years On was published by the Institute of Health Equity. The RCP, along with 20 other leading health organisations, wrote to the Prime Minister to urge the government to accept Sir Michael Marmot’s recommendations.

Sadly, as this report shows, those with the fewest resources have indeed borne the brunt of the negative impacts of the pandemic on health and the economy.

As Sir Michael tweeted on 12 June in response to ONS data on the rate of deaths involving COVID-19: “Inequalities in mortality from #COVID19 - the social gradient - are similar to inequalities in mortality from all causes, suggesting that the general causes of health inequalities as laid out in #Marmot2020 apply to COVID19 plus some extra in more deprived areas”.

This is not what we should, or do, expect to find in the UK in 2020. Around 20 countries are more populous than ours, yet we have the fifth highest GDP in the world. Why, then, does OECD data show we are only 17th in terms of life expectancy?

The causes, as the ONS said about the slowdown it identified in September last year, “are likely to be complex.” Which reminds me of the foreword to the 1980 report of the working group on inequalities in health, better known as the ‘Black Report’ as the chair of the group was the then president of the Royal College of Physicians (RCP), Sir Douglas Black.

In his foreword, the secretary of state explained why: “It will be seen that the Group has reached the view that the causes of health inequalities are so deep rooted that only a major and wide-ranging programme of public expenditure is capable of altering the pattern. I must make it clear that additional expenditure on the scale which could result from the report’s recommendations – the amount involved could be upwards of £2 billion a year – is quite unrealistic in present or any foreseeable economic circumstances, quite apart from any judgement that may be formed of the e­ffectiveness of such expenditure in dealing with the problems identified. I cannot, therefore, endorse the Group’s recommendations.”

While £2 billion was around a sixth of the health budget at the time, the figures in the report are before you outline the cost of choosing not to ignore the problem. A similar choice faces us today: invest in the health of the nation now or fail to realise our economic and social potential in the future, instead spending money on caring for people who are ill but do not need to be.

This is why the RCP this year convened the Inequalities in Health Alliance (IHA), which has a growing membership of over 100 organisations with an interest in health and care. We are together asking the Prime Minister to develop a cross-government strategy to reduce health inequalities as a matter of urgency - and invite you all to join this call with us.

Because while the pandemic has not created new inequalities, it has exacerbated existing ones. As we said in the letter to the Prime Minister on behalf of the IHA, “COVID-19 has exposed how health inequalities can have an impact not just over a lifetime, but a matter of weeks.”

As such a rich country, we should have all done more to protect all our citizens from the shockwaves of a crisis. But we should not wallow in that shame or blame but act. The impact of the pandemic will be felt for years to come, but we still have time to make sure it is felt equally.

For more information about the Inequalities in Health Alliance click here.

To read the NHSA’s report COVID-19 and the Northern Powerhouse: Tackling inequalities for UK health and productivity, click here.