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Choose equality
As the UK Public Health Association opens its annual forum today its chief executive, Angela Mawle, says we must do more to tackle the widening health gap between classes
Tuesday March 14 2006
The Guardian


Health inequalities is one of the major issues of our time. Daily we hear about the lurching crises of the NHS financial support system, the apparent failure to achieve the holy grail of zero-rated waiting lists and a limitless supply of life-saving drugs. Daily we are deflected from the major underlying malaise by a society and media which view health in terms of the absence of disease made possible by the presence of a technologically driven system that addresses symptoms and dispense cures, the all powerful National Health Service

Derek Wanless, in his report Securing Good Health for the Whole Population, acknowledged that we do in fact have a National Sickness Service, hardly geared to prevention at all. Astounded by his own findings, in his earlier report, that the cost of the NHS in 2022 prices would be nearly £200bn a year if we carry on as we are now, he focused on the urgent need to reduce the accelerating growth of chronic diseases and conditions which accompany our modern lifestyles. He predicted a difference in spending of £30bn pounds in 2022 NHS spending if society could become "fully engaged" in working towards a healthier future.

And yet the chronic diseases and conditions which are placing such a burden on the NHS and on society as a whole - cardio-vascular diseases, diabetes, some cancers - are falling disproportionately on those least able to bear them. For example death rates from ischaemic heart disease in men and women aged 35-64 years in 1997-99 were nearly double for men in social classes IV and V compared to those in classes I and II, and more than double for women in those same groupings.

The shocking 10-year gap in life expectancy between a male child born in Dorset and one born in Manchester was identified in the government's own report, Tackling Health Inequalities: a Programme for Action, in 2003 where it set itself a target by 2010 to reduce inequalities in health outcomes by 10% as measured by infant mortality and life expectancy as measured at birth.

Little progress

By 2005, however, little progress had been made. Prof Sir Michael Marmot, chairman of the Scientific Reference Group of Health Inequalities, found that the gap in life expectancy between the bottom fifth and the population as a whole had widened by 2% for males and 5% for females.

As long ago as 1980 the Black Report alerted us to the health inequalities which refuse to lessen in our society. Sir Donald Acheson, in the halcyon first years of the New Labour government, spelled out these persistent and increasing inequalities and urged action to address them. Like Black before him he concluded that: "Poverty, low wages and occupational stress, poor housing, environmental pollution, poor education limited access to transport and shops, crime and disorder and a lack of recreational facilities all have an impact on people's health."

So how can lifestyle choice so beloved of the current genre of politicians, counter the overwhelming influence of all of the above? Can we in fact have choice in public health at all? I acknowledge that we can make choices about which GP, nurse or even hospital that we might wish to seek help from when we are sick, but what of our choice to remain healthy? How if we are poor do we achieve decent housing, buy fresh healthy food, have long healthy walks or cycle rides when confined to dense, tense and degraded urban environments?

Olympic debate,br>

At the UKPHA [UK Public Health Association] 14th annual public health forum, these are just the issues which will be concentrating our attention. Identifying and acknowledging the causes of health inequalities is a central theme of the whole conference. The great Olympic debate will be focusing upon how we as the public health community and the nation as a whole can ensure that the health benefits which should be the natural consequence of London 2012 will be experienced by communities across the UK and not just become the preserve of the privileged few or the chattering classes.

Fiona Adshead, the deputy chief medical officer, will be championing the natural and built environment sessions where we will be looking at the need to create communities where health is planned into the very essence of the infrastructure and where the natural environment is valued as a physical spiritual and psychological resource.

Other debates will focus on the inequitable burden of environmental pollution and how we can promote environmental justice. We will also be looking at how we can address health inequalities by maximising the partnership between community pharmacists, the neighbourhoods that they serve and the public health workforce as a whole.

And of course we will be looking at the roots causes of obesity. The fact that the poorest in our society have to get their calories where they can in the cheapest way possible. And when they do attempt to make a stand their children are subjected to the onslaught of advertising and promotion of fat-dense, high sugar and high salt processed foods.

The YWCA found that in 16 to 24-year-old young women 28% were obese in social class V and 14% in social class I. Healthcare charity the King's Fund estimated in 2005 that 30% of women in the poorest fifth of households are obese compared to 17% in the richest fifth.

So the UKPHA will continue to fight for the recognition by government that health is not solely the province of the Department of Health but that the responsibility cuts across all government departments. Sir Donald Acheson defined public health as: "The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society." What more do I need to say??

· Angela Mawle is chief executive officer of the UK Public Health Association

Copyright Guardian Newspapers Limited

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