Healthcare inequality in the UK

By William Ackroyd

This article will seek to provide a brief summary of the extent of healthcare inequality in the UK, while also proposing some potential solutions. This article draws heavily from the research of the King’s Fund and the NHS, its purpose is to provide a general and non-specialist overview of healthcare inequality.

What are healthcare inequalities ?

According to The King’s Fund, an independent charitable organisation that works to improve health in England, “Health inequalities are avoidable, unfair and systematic differences in health between different groups of people.” It continues: "There are many kinds of health inequality, and many ways in which the term is used. This means that when we talk about “health inequality”, it is useful to be clear on which measure is unequally distributed, and between which people.” Healthcare inequalities impact numerous population groups, therefore while many of the statistics presented measure the inequality based on one factor, it is important to remember that each individual is simultaneously part of numerous other demographics, therefore it is helpful to think of health inequality as intersectional. Improvements in the health of UK such as the increase of life expectancy from 79.69 years in 2010 to 81.15 in 2020, belies the extent of the degradation of public health as a result of global events including the COVID-19 pandemic, but also the government’s austerity measures. As the BBC puts it: ’Not all groups across society are benefitting equally from increased life expectancy or improved health. In most but not all cases, the biggest improvement in health and life expectancy has been from the wealthiest groups in the wealthiest areas.

A closer look at different inequalities:

Life expectancy

Life expectancy is closely related to socio-economic circumstances. Indeed, Females living in the least-deprived 10 percent can expect an at-birth life expectancy of 86.4 years, whereas those living in the most deprived 10 percent at birth can expect 78.7 years, a gap of almost 8 years. The same statistic for males stands at 83.5 years in low-deprivation areas and only 74.1 years for males living in high-deprivation areas. This is a 9.4 year difference, almost a whole decade.4 Life expectancy also varies between different population groups. This includes individuals with a learning disability, which according to data from 2018-19, females in this group have a life expectancy at birth of 67 years, a 17 year difference to the general population. For males with learning disabilities life expectancy is 66 years, 14 less than the general population. Life expectancy statistics to compare white British groups and ethnic minority groups are currently insufficient to ascertain if there is an inequality, however ‘experimental’ ONS statistics suggest that life expectancy for white and mixed groups is lower than all other ethnic groups. Another measure of health inequality is ‘healthy life expectancy’- how long people live in good health over the course of their life. This again exposes the extent of health inequality, data for 2017-19 demonstrates that people living in the least deprived areas could expect to live almost two decades longer in good health than those in the most deprived areas. So not only do people in the most deprived areas live a shorter life, they live a greater part of their life in poor health.

Avoidable mortality- a death that could have been averted or delayed through timely, effective healthcare. In 2019 there were almost 140,000 deaths in the UK considered avoidable. Once again, those living in the most deprived areas of the UK were more likely to die from an avoidable cause, with women 3.5 times and men 3.6 more likely.

Prevalence of mental ill-health

Measuring the prevalence of mental illness is a complex task because recognition, reporting and diagnosis vary between social groups. However the available data suggests more deprived communities have a higher demand for mental health services. Current evidence suggests that inequalities in mental ill-health exist across legally protected characteristics such as sexual orientation, disability, sex and ethnicity. LGBT identifying individuals experience higher rates or poor mental health than the non-LGBT population. In addition 19% of women report symptoms of common mental health disorders compared to 12% men. However the difference in sex may be due to continuing social stigmas and personal beliefs. Lastly, the homeless suffer immensely from high rates of mental ill-health, more than 80% of homeless people report having mental health difficulty and were 14 times more likely to die by suicide in 2019 than the general population.

Access to healthcare services

Access to health services: ‘refers to the availability of services that are timely, appropriate, easy to get and use, and sensitive to user choice and need.’ Inequitable access to healthcare occurs when particular groups face obstacles to receiving the appropriate treatment, this impacts asylum seekers and refugees and Gypsy, Roma and Traveller communities the most.

Pathways to health inequalities

Behavioural risk factors

Areas of deprivation often see higher rates of harmful behaviours, these include smoking, alcohol and drug use, a sedentary lifestyle and a poor diet. The King’s Fund argues that more often than not in areas of high deprivation, negative behaviours combine to produce pronounced health impacts. For example in 2017, ‘the proportion of adults with three of more behavioural risk factors was 27% in the most deprived fifth, compared with 14% in the least deprived fifth.’ Several factors compound these behaviours. In order to follow government advice on a healthy diet, the poorest 10% of UK households would have to spend 74% of their post-housing cost income on food, an unrealistic burden on households. The environment in which the poorest 10% live makes behaviour changes exceedingly difficult, for example the number of fast food outlets correlates with an increase in deprivation.

Public Health England has observed that ‘the prevalence of overweight and obesity also raised with deprivation and fruit and vegetable consumption falls with deprivation.’

Income

As mentioned earlier in this article, those on the lowest incomes in the UK would have to spend almost three quarters of their post-housing costs income to adhere to government advice on healthy eating. Similarly, those with less disposable income are understandably less able to buy health-enhancing goods and services such as gym memberships.The mental strain of living on a low income also has been associated with health disparities, this added stress for individuals can negatively affect their decisions on behavioural risk factors such as smoking and alcohol consumption.

Housing

Housing has long been recognised to be important to health, and once again this factor is tied to income but also ethnicity, as a 2017 Ministry of Housing Communities and Local Government report found that people from ethnic minorities were more likely to live in overcrowded homes and to experience fuel poverty. Private renters were found to be more likely to occupy homes with damp issues or even worse- live in a ‘non-decent’ home. ‘Non-decent’ is defined by the UK government, as one that does not meet basic legal health and safety standards, is an unreasonable state of repair, lacks modern facilities or has ineffective heating and insulation. According to the King’s Fund: ‘poor housing and overcrowding are associated with increased risk of cardiovascular and respiratory diseases, depression and anxiety.’

What is the current approach to reducing healthcare inequalities ?

NHS policy ‘Core20Plus5’

Closing remarks

If the UK government wishes to return to stable economic growth and reduce inflation, then investing in equalising health will result in a more productive population. An economically productive population will become ever more important as our ageing population requires ever greater welfare spending. Therefore it is in the government’s interest to prolong the working life of adults, meaning a more equal national healthy-life expectancy is highly desirable. The coming election should be a time for political parties to take the leap and make radical reform of the health system a campaign pledge. While the reform should be radical, it does not have to be idealistic, rather as the King’s Fund and others suggest, it should be informed by the successes and failures of local authorities in levelling health inequalities. Based upon the experience of previous attempts to reduce health inequality, local authorities have demonstrated the most promising innovation. Good health is fundamental to all other aspects of an individual’s life, without an equally healthy population we cannot expect those who live under-privileged areas, belong to an ethnic minority, or identity with a LGBTQ sexuality to be able to compete fairly in a meritocratic society. Finally, we should not neglect the fact that male health inequality is by a significant margin wider than between women.

References

BBC Bitesize, ‘Nature of social inequality: Health’, National 5 Modern Studies, accessed 10 October 2023

Department for Levelling Up, Housing and Communities, ‘People without decent homes’, (8 October 2020), accessed 14 October

Ethan Williams, David Buck, Gbemi Babalola and David Maguire, ‘What are health inequalities ?’, The King’s Fund, (published online 17 June 2022), accessed 12 October 2023.

Friends of the Earth, ‘England’s green space gap: How to end green space deprivation in England, (September 2020), p.40

Hull City Council, ‘Briefing Report: Public Health Sciences and Insight Team: English Indices of Deprivation 2019.’, p.1 (accessed 12 October 2023)

Public Health England, ‘Obesity and the environment’, 31/12/2017 (accessed 12 October 2023)

Public Health Scotland, ‘Health inequalities-fundamental causes- income inequality’, (updated 24 December 2021), accessed 14 October 2023

Statista, ‘Life expectancy (from birth) in the United Kingdom from 1765 to 2020’, accessed 12 October 2023

Stefano Mirabello, ‘UK Smoking report’, Nowpatient website, (published 27 February 2023), accessed 12 October 2023