23.04.18
Are we moving closer to health equality?
Source: PSE April/May 2018
Reporting from the LGA’s Annual Public Health Conference 2018, PSE’s Sacha Rowlands considers the age-old question: are longer lives necessarily better lives, or do we still have some way to go to achieve true health equality?
This year, our treasured NHS celebrates its 70th birthday.
If it was a woman living in the south east of England, it may have just started to see some ill health creep in over the past couple of years and it could expect to enjoy more than another 10 years of life.
On the other hand, if the NHS was a man born in the north east of the country, it would have probably seen its health deteriorate a good 10 years ago, with less than 10 years left on the clock.
Hopefully, despite its ailments, the NHS will plough on for much longer than this. But why is it that in 2018 we still see these health inequalities? Why do some people enjoy a long, healthy life while others are plagued by ill-health?
Depressingly, Professor Tom Kirkwood, professor emeritus at Newcastle University’s Institute for Ageing, told guests at the LGA’s Annual Public Health Conference in March that the ageing process begins before we are even born: from the moment a cell is formed, it’s susceptible to damage.
Undernutrition in the womb can predispose someone to conditions such as chronic heart disease and diabetes later in life, and there is even evidence for “epigenetic reprogramming,” where hunger in early life can have “transgenerational consequences.”
So is it really worth worrying about if our life expectancy is pre-determined by our genetics and our mother’s lifestyle during pregnancy?
Well, yes, apparently it is.
Although our genetics have a large influence on our health in old age, other factors play an important role. Both the quality and quantity of a person’s nutrition impacts on their health, as do lifestyle choices such as exercise or smoking.
Less easily-modified factors, such as education, social networks, socioeconomic status and environment also play an important role.
It’s no secret that as you travel east on the Tube’s Jubilee Line, each stop sees a drop in life expectancy of around a year – findings that other cities across England have replicated on their own transport networks.
But surely the circumstances of someone’s birth should not affect the quality or length of their life?
And yet, speaking at the conference, Baroness Tanni Grey-Thompson, politician and chair of ukactive, said that “there has been too little policy emphasis, and for far too long, on what contributes to the health and happiness of a person, a family, a community.”
“Westminster politics is failing in its duty of care to the British public to support the health of the nation,” she added. “By deferring key decisions and ducking pressing issues around the health inequalities we face, politicians are unwittingly signing the death warrant of millions of Britons.”
We are living longer – but long lives don’t necessarily mean healthy lives. The number of people suffering from chronic illnesses is increasing, and dementia cases are expected to grow to over a million in the next three to five years.
Areas of success
Many conditions are fuelled by lifestyles. But some areas are working to address these inequalities.
Dudley, a typical town with an average life expectancy representative of England, has been trialling a multispecialty community provider model, which includes public health services such as adult wellness services and NHS Health Checks, with a focus on cardiovascular disease (CVD) and stroke.
According to Dr Matt Kearney, national clinical director for cardiovascular disease prevention at NHS England and Public Health England, death from CVD is more than three times higher in the most deprived areas.
And a preventable heart attack has a mean five-year social care cost of over £27,000.
The philosophy behind the Health Checks is that holistic screening presents an opportunity to influence multiple disease risk factors, and therefore multiple conditions, offering immediate referral and ongoing opportunities for outreach to patients identified as having lifestyle risk factors.
However, those who are classified as “most deprived” were also the least likely to have attended their health checks.
Gateshead, ranking as the 73rd most deprived area in England, has a significantly higher incidence of premature death due to CVD than the rest of the country, and a staggering 20,000 people estimated to be living with undiagnosed hypertension.
In order to reach more people, Gateshead Council and the NHS collaborated to introduce a community incentive programme, with community organisations running an NHS Health Check event in exchange for an incentive payment for the time and effort taken to make it a success.
Those behind the scheme say that it seems to reach people who wouldn’t normally accept an invitation for a health check, although they admit that further research needs to be done to establish this.
Mental and physical health
But what about inequalities in mental health, and how does it interact with physical health?
There are complex interactions between mental and physical health and deprivation. In order to reduce mental health inequality, how this complexity is experienced needs to be understood.
In Leeds, a third of people with a common mental health disorder also have a long-term condition; 28% of women and 21% of men accessing substance abuse services in the city have a diagnosed mental health problem.
A “suicide audit” showed that 55% of suicide cases in the city lived in the 40% most deprived areas. Meanwhile, those hailing from a BAME group are twice as likely to be admitted to a mental health acute service through a crisis service.
According to Catherine Ward, health improvement principal for public mental health at Leeds City Council, risk factors for mental health issues include adverse experiences such as trauma or abuse, debt, caring responsibilities, social isolation, long-term health conditions and unemployment.
On the other hand, protective factors against mental ill health include resilience programmes in schools, employment support and anti-poverty programmes, access to green spaces across the whole of the city, and social networks.
The one thing that these projects all have in common is teamwork. Greater collaboration is essential for ensuring the physical, mental, emotional, social and economic health of the population – and only then can there be true equality in health.
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