To improve health, we need a joined-up approach to reduce poverty, says Helen Barnard.
The news is full of stories about health services under pressure and struggling to cope. More than a dozen hospitals have now declared ‘major incidents’ because they cannot meet the demand for their services. Heated debates about the reasons for this are inevitably being entangled in the start of campaigning for the May election.
However, one important factor driving high demand for health services has hardly been mentioned: poverty. The Marmot Review in 2010 found that people living in the poorest areas of England die seven years earlier than people living in the richest areas. The difference in the average ‘disability-free life expectancy’ is 17 years. People living in poverty die sooner than richer people, and spend more time living with a disability. Last year, JRF’s ‘state of the nation’ poverty report also found that people on low incomes are the most dissatisfied with the NHS. Overall satisfaction with the NHS has increased over the last 15 years. In 1998, 36.5% of people were dissatisfied with the NHS.
By 2013 this had fallen to 22.5 per cent. However, people in the lowest income group moved from being the most satisfied to the least (see chart).
Since 2010, dissatisfaction with the NHS has been rising however. Overall, dissatisfaction has risen by 4 per cent since 2010. But among the poorest quarter of people, dissatisfaction has risen 9 percentage points since 2010. It is worth noting that this varies considerably across different parts of the NHS. Social care is the service which people on low incomes are most dissatisfied with, although they are slightly more satisfied with it than richer groups – 32 per cent of the poorest fifth are dissatisfied with social care compared with an average of 35 per cent being dissatisfied with it. In comparison, 22 per cent of the poorest fifth are dissatisfied with NHS dentists, compared with an average of 19 per cent.
Last year, the Scottish Public Health Observatory published a study examining the impact on public health and health inequalities of 11 policies over a 20-year period. They found that the policies which were most effective at reducing health inequalities and improving health were not health or lifestyle interventions. It was in fact policies which improved incomes at the bottom that made the most difference.
So if current and future governments want to improve health we need a joined-up approach working with the NHS, local public health teams, Health and Wellbeing Boards and others to prioritise poverty reduction. That is why we are working on the UK’s first comprehensive anti-poverty strategy. We will be working hard in 2015 and beyond to persuade all parties to put poverty reduction at the heart of their manifestos and policies.