The price of inequality is far too high. Anna Round argues it is time for tackling it to become a national priority
What does income inequality look like? In the United Kingdom it looks very much like last year, and the year before, and the year before that.
Figures released last week show that in real terms, the average income for Britain’s poorest ten per cent of households was the same last year as it was in 2009. Income equality has not improved since 2011, despite the record high employment rate. In fact, on most measures the gap between people ‘with’ and people ‘without’ has widened.
This isn’t just about money. On Wednesday the Office for National Statistics published data that shows a widening ‘deprivation gap’ in life expectancy. Possible drivers of trends in longevity across the developed world have been the subject of much debate recently, but this time the story is all about inequality.
The link between deprivation and life expectancy is well-established, but in a country that’s serious about social progress it should not be getting stronger. Yet this is exactly what last week’s figures show.
In the least deprived areas of England, men live almost a decade (9.4 years) longer than in the poorest places. Women get 7.4 extra years. And those extra years may well be better ones, at least as far as health is concerned. Total healthy life expectancy is around 19 years longer, for both sexes, in the wealthiest areas than in the poorest ones. That’s a big penalty for poverty – and the gap is growing.
This is most acute for women. In the top ten per cent of affluent areas, average female life expectancy has increased by 84 days in the past few years. Where deprivation is high, though, it has fallen by more than three months. For men, both ends of the deprivation scale are at least moving in the same direction. But the small (and not statistically significant) life expectancy gains in the most deprived areas are outstripped by larger increases in the least deprived half of the country.
By any standards, this is surely the kind of ‘burning injustice’ that Theresa May has promised to tackle? What policies can make a difference?
Our health in older age is the sum of experiences over the course of our life; as in so many things, a good start in life is crucial. Last week’s figures show that the number of children living in poverty has risen, with the greatest increase in the north east of England. Child poverty in working families has also risen. The government has reiterated its commitment to improving the lives of the poorest children, but it’s hard to see how this is cutting through the distractions of Brexit and the ongoing challenges of welfare reform.
More generally, we need the right policies – and investment – to make a real difference to the social determinants of health. Quite rightly, the National Health Service budget is a key issue, but health services alone can only do so much; health is created in the places where we live, work and learn. Factors such as quality of housing, air quality, transport and job quality all contribute towards the quality of a person’s health. In fact, research suggests that only around a fifth of improvements in life expectancy are associated with healthcare; social factors are hugely influential on the need for care in the first place.
If our NHS is to remain sustainable, we need to be serious about investing in policies that support healthy lives.
Some of this investment will come with a ‘health’ label, for example in schemes to reduce smoking or substance abuse or promote exercise. But some – maybe more – of it will come from the smart co-ordination of priorities and targets across budgets, using spending across policy areas to improve health. Planning, transport, justice, education and a host of other agendas are all important. Our everyday lives and in particular our work are vital in shaping our health and wellbeing. The arguments for a health in all policies approach, particularly at the local level, are clear.
Food is one example of an area where greater joining-up could make a huge difference. Obesity rates have plateaued since 2010, and only a minority of the population eat the recommended quantity of fruit and vegetables.
It’s easy to say that this is all about personal responsibility, but personal responsibility happens in a context. In the context of twenty-first century Britain, healthy foods are more expensive than unhealthy ones, and their prices are rising more quickly too. To afford the government’s recommended diet, the poorest ten per cent of households would need to spend three quarters of their disposable income on food. Innovative approaches that bring together policy on agriculture, environment, business and health are essential.
The price of inequality is high. It’s far too high in the years and quality of life lost, but it’s also too high for our economy. Better health isn’t just needed for social justice and lower health spending; it’s an essential input to stronger economies. We need to invest time, ideas and money in better health, not only because it’s the fair thing to do – but because we can’t afford not to.
Anna Round is a Senior Research Fellow at IPPR North. She tweets @annainnewcastle
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