Opposition Day Debate: Health Inequalities

Bukky Balogun; Elizabeth Rough; Philip Loft; Rachael Harker; Tom Powell

The motion for debate, in the name of the Leader of Opposition and others, is:

That this House notes the publication of Health Equity in England: The Marmot Review 10 Years On; is concerned by its findings that since 2010 improvements to life expectancy have stalled for the first time in more than 100 years and declined for the poorest women in society, that the health gap between wealthy and deprived areas has grown, and that the amount of time people spend in poor health has increased across England; agrees with the review that these avoidable health inequalities have been exacerbated by cuts to public spending and can be reduced with the right policies; and calls on the Government to end austerity, invest in public health, implement the recommendations of the review, publish public health allocations for this April as a matter of urgency, and bring forward a world-leading health inequalities strategy to take action on the social determinants of health.

Marmot Review

To mark the 10 year anniversary of the publication of the 2010 Marmot Review (Fair Society, Healthy Lives) the Health Foundation commissioned Professor Sir Michael Marmot and his team at the UCL Institute of Health Equity to examine progress in addressing health inequalities in England, and to propose recommendations for future action. Health Equity in England: The Marmot Review 10 Years On (25 February 2020) found that while there had been progress in some areas since 2010 there was also evidence of widening health inequalities.

Section 2 of the 2020 Marmot Review describes changes in inequalities in life expectancy and health over the last decade and explores some of the explanations for these changes.

Section 3 of the 2020 Marmot review is concerned with the social determinants of health since 2010 and reviews changes in five of the six priority areas from the original 2010 Marmot Review and makes recommendations for action. The five areas include: giving every child the best start in life; enabling all children, young people and adults to maximise their capabilities and have control over their lives; creating fairer employment and good work for all; ensuring a healthy standard of living for all; and developing healthy and sustainable places and communities. Section 4 describes national, local and community actions on health inequalities and social determinants over the last decade.

The 2020 report concluded that since 2010:

Health is getting worse for people living in more deprived districts and regions, health inequalities are increasing and, for the population as a whole, health is declining. The data that this report brings together also show that for almost of all the recommendations made in the original Marmot Review, the country has been moving in the wrong direction […] Some of these difficulties have been the direct result of government policies, some have resulted from failure to counter adverse trends such as increased economic inequalities or market failures (p.149).

The report’s main recommendation was for the Prime Minister to “initiate an ambitious and world-leading health inequalities strategy and lead a Cabinet-level cross-departmental committee charged with its development and implementation” (p.150). For NHS England and Public Health England, the review recommended greater investment in more deprived areas and the reassessment of resource allocation formulae (p.142), more investment in prevention services (p.143) and for health care organisations to act on the social determinants of health (p. 144).

Life Expectancy

The Marmot review said that life expectancy has a clear relationship with deprivation. The more deprived an area the shorter the life expectancy. This gradient has become steeper over time as inequalities in life expectancy have increased.

Among men, life expectancy in the most deprived 10 per cent of areas (most deprived decile) stalled from 2011-13 onwards at around 74 year, while in the least deprived areas male life expectancy continued to improve. (Note that the life expectancy figures cited here are based on three years of combined data to improve the reliability of the estimates).

Female life expectancy in the most deprived 10 per cent of areas, fell between 2010-12 and 2016-18, from 79.0 years down to 78.6 years. Over the same period life expectancy for women in the least deprived areas increased from 85.7 years to 86.3 years.

The latest data for 2016-18 shows that male life expectancy at birth in the 10 per cent most deprived areas on England is 9.5 years lower than in the 10 per cent least deprived areas. Among women in 2016-18 the equivalent gap is 7.7 years.

There are also regional differences in life expectancy and these are particularly pronounced among those living in more deprived areas. For both men and women, the largest decreases in life expectancy arose in the most deprived 10 per cent of areas in the North East and the largest increases were in the least deprived 10 per cent of areas in London.

All life expectancy data is sourced from Public Health England’s (PHE) Local Authority Health Profiles 2020. These local profiles also include indicators on the wider determinants of health and causes of mortality which can also be examined in relation to deprivation deciles.

PHE also have a general Health Inequalities Dashboard for England. This presents measures of inequality for 18 key indicators, each drawn from the Public Health Outcomes Framework. The dashboard measures trends in each indicator since a baseline period, with longer term data provided where these are available. Inequalities are considered across a range of dimensions, including deprivation, ethnic group, sexual orientation and employment status.

In addition, PHE’s Segment Tool provides information on the causes of death and age groups that are driving inequalities in life expectancy at local area level. The tool provides data tables and charts showing the breakdown of the life expectancy gap in 2015-17 for two comparisons:

England – The gap between each local area as a whole and England as a whole.
Within area – The gap between the most deprived quintile of each area and the least deprived quintile of the area.

It is hoped that targeting the causes of death and age groups which contribute most to the life expectancy gap should have the biggest impact on reducing inequalities.

UK Government Policies on Health Inequalities

continuing to target a higher share of funding towards geographies with high health inequalities than would have been allocated using solely the core needs formulae (2.25);
setting out “specific, measurable goals for narrowing inequalities, including those relating to poverty” (2.26);
for maternity services, implementing a targeted continuity of carer model to improve outcomes for the most vulnerable mothers and babies (2.28) and specialist smoking cessation support for pregnant women living in the most deprived communities (2.29);
increase the number of physical health checks by 110,000 to 390,000 by 2023/24 for people living with severe mental health problems, as set out separately in the Five Year Forward View for Mental Health (2016) (2.30);
doing more across the NHS to provide timely support for people with a learning disability, autism, or both (2.31);
investing £30 million to meet the needs of rough sleepers, and ensuring specialist NHS mental health support, integrated with existing outreach services, is available to the most impacted parts of England (2.32);
greater support for carers, including the development of quality marks for carer-friendly GP practices (2.33-2.35);
supporting people with severe mental health illness to seek and retain employment (2.38).

As part of the NHS Long Term Plan process all local health systems in England have been asked, as part of their overall delivery plans, to set out how they will specifically reduce health inequalities by 2023/24 and by 2028/29 and their plans are expected be published shortly. Further information on work to support local delivery plans can be found on the NHS England website.

In addition, the UK Government’s Green Paper, Advancing our Health: Prevention in the 2020s (July 2019), set out proposals to achieve “5 more years of healthy, independent life by 2035 while reducing the gap between richest and poorest”. A consultation on the Paper closed in October 2019 and is currently awaiting a response.

Public Health England’s Strategy 2020 to 2025 (September 2019) commits it to “work to narrow the health gap”. The Strategy includes ambitions to:

reduce the overall rates of smoking and inequalities affecting lower socio-economic groups and vulnerable communities;
advise and influence decision-makers on the effectiveness of actions to promote healthy indoor and outdoor environments (including their ability to reduce inequalities);
reduce inequalities in premature mortality for people with long-term and severe mental health problems;
reduce inequalities across key markers of maternal and child health;
develop new indicators to improve the monitoring of outcomes and inequalities in the early years and facilitate evaluations of early years services; and
enhance insights into the population’s health and health inequalities.

Further background on public health policy and funding can be found in a Commons Library briefing prepared ahead of an Opposition Day debate on public health funding in May 2019.

UK Parliament Proceedings

HC Deb, Health, vol 660, cc 146-198, 14 May 2019

HC Deb, Women’s Life Expectancy, vol 658, cc 869-870, 25 April 2019

HC Deb, Health Inequalities: Life Expectancy, vol 657, c 162, 26 March 2019

HC Deb, Health inequalities, vol 656, cc 410-426WH, 20 March 2019

HC Deb, Health Inequalities (England), vol 650, cc 140-141, 27 November 2018

UK Parliamentary Questions

PQ 20572 Health: Disadvantaged, 25 February 2020

Asked by: Carla Lockhart | Answering Member: [Awaiting Answer]

PQ HL101 Alcoholic Drinks: Misuse, 15 October 2019

Asked by: Baroness Hayter of Kentish Town | Answering Member: Baroness Blackwood of North Oxford