The Health Gap
22 September 2015

Why is it difficult to lose weight? Why does it feel like pushing water uphill? Because our society bombards us with marketing to 'take it easy', 'eat, drink and be merry' and 'enjoy life, because you only live once'. Our (in)ability to lose weight is inextricably linked to our society. And our society is set up in a way that promotes ill health and unhealthy behaviours.

Most people understand that there are dramatic differences in health between different countries and even within countries. But there are also stark differences within the same communities. Nottinghamshire for example. People in the wealthiest areas of our city can expect to live 20 years longer than those in the poorest. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The man in India is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. The higher the social status of individuals the better is their health.

Conventional approaches to improving health emphasise access to treatments – improved medical care and control of risk factors – smoking, drinking and obesity. But as good as they are these approaches only go so far. Creating the conditions for people to have control over their own lives, empowering individuals and communities, is the key to reducing health inequalities, right here, in Nottinghamshire. And part of that empowerment is paying people a real living wage with which to provide for their families. And so I welcomed the former Lib-Dem leader Nick Clegg’s comments this week, highlighting that recent changes to tax-credits in the Budget in July means hundreds of thousands of hard-working families, earning between £15,000 and 20,000 a year will be up to £2000 worse off. Worse off, and as we now understand, at greater risk of poor health. Yet again the poorest are being asked to take the hit for financial decisions made by the rich elite.

In addition to income your position in the social hierarchy also directly affects your health. The lower you are on the social scale, the shorter you will live and the worse your health will be. Who but the most heartless can think this to be acceptable? Prof Sir Michael Marmot, in his new book, The Health Gap, sets out clearly how, and why, this “health gap” is unjust, avoidable, and changeable. Instead of spending all their energy on trying to restrict access to medical treatments maybe Clinical Commissioning Groups (CCG’s) who control the NHS budgets locally should focus more on preventing ill health in the first place, by improving the conditions in which everyone in our community, at all levels in the social spectrum, is born, grows and flourishes.