If you're reading this, you're likely aware of the profound impact health inequalities have on individuals and communities. Discussions often centre on the quality of healthcare services, but Dame Claire Moriarty, in an NHS blog, underscores that addressing the wider determinants of health is crucial to reducing demand on healthcare systems.
While the quality of healthcare is important, it contributes only 20% to overall health outcomes. Factors like income, employment, and housing—social and economic determinants—account for 50%. Overall, 80% of health determinants lie outside clinical care. Moriarty emphasises:
"Acting on these wider determinants should be much higher up the agenda if we are serious about improving people’s health and quality of life. However, this leads to significant policy changes such as improving social welfare, affordable housing, and access to education."
The landmark "Fair Society, Healthy Lives" Marmot Review (2010) highlighted six policy objectives for reducing health inequalities:
Give every child the best start in life.
Enable all individuals to maximize their capabilities and have control over their lives.
Create fair employment and good work for all.
Ensure a healthy standard of living for all.
Develop healthy and sustainable communities.
Strengthen the role and impact of ill-health prevention.
The review emphasised the influence of socio-economic position on health, noting, “the more favoured people are, socially and economically, the better their health.” It also highlighted that failing to act on these issues has significant economic costs, estimating productivity losses of £31-33 billion per year and additional costs from lost taxes and higher welfare payments.
Since the Marmot Review, life expectancy has stalled, and for the poorest 10% of women, it has declined. Health inequalities have widened, and the time spent in poor health has increased. The "Marmot Review 10 Years On" (2020) found the north-south health gap had increased, with the most deprived areas in the north-east experiencing the largest declines.
Key findings from the 2020 Marmot Review include:
The more deprived the area, the shorter the life expectancy, with a steeper social gradient over the past decade.
Marked regional differences in life expectancy, particularly in deprived areas.
Increasing mortality rates for men and women aged 45-49, potentially linked to 'deaths of despair' (suicide, drugs, alcohol abuse).
Increased child poverty, closure of children’s and youth centers, and reduced funding for education.
A housing crisis, rise in homelessness, insufficient money for a healthy life, and more neglected communities.
Policy change is crucial but challenging. However, action on wider determinants can also be driven by independent third-sector organisations. Kinaraa collaborates with several Black-led organisations working towards holistic health improvements. Despite being underfunded, these organisations are vital to achieving health equity and systems change in Lewisham.