UK Mortality Rates

Lord Bishop of London Excerpts

Thursday 12th January 2023 Grand Committee

[The Lord Bishop of London]

My Lords, I thank the noble Lord, Lord Sikka, for securing this important debate. I also look forward to hearing from the noble Lord, Lord Evans, in his maiden speech.

The paper at the heart of this debate provides a useful focus, because it highlights one of the worst health outcomes that we have seen in the past 10 years: that of widening inequalities. It is also helpful because, by focusing on the impact of austerity, we begin to see that public health is impacted by many factors besides healthcare access—factors called the social determinants of health. Those include housing, our jobs, our environment, our education and much more. They can be summed up as the opportunities that we have to lead healthy lives. The Heath Foundation noted that 50% of people in the most deprived areas report poor health by the age of 55 to 59, which is more than two decades earlier than in the least deprived areas. It is not just about life expectancy; it is also about healthy life expectancy.

The debate is poignant also because it comes at a time of great strain on the NHS and on social care, and at a time when those other determinants of health are challenging for many of us. We are also at a moment when I hope we are beginning to realise the importance of prevention of ill health, which is essential for the sustainability of our healthcare system.

Over the years, many organisations have agreed on the need for a strategy for health and health equality, but the long-promised and long-awaited health disparities White Paper is nowhere to be seen. Meanwhile, those subject to health inequalities are more likely to be affected by healthcare pressures and to struggle in the coming economic climate. It is in these conditions that inequalities in health can only worsen.

In the absence of a strategy to tackle health inequalities, I propose that recognising and supporting the work of faith groups could be key to a real improvement in both prevention and access to healthcare. Faith groups hold the deep trust of the people they serve, with unrivalled knowledge of their communities. I recently had the opportunity to convene the Health Inequalities Action Group, which brought together faith leaders, healthcare professionals and civil society leaders to explore the intersection of faith, health inequality and health in London. London currently has the biggest gap in life expectancy between its local authorities of any region in England.

Through two townhall sessions, we heard some extraordinary stories of faith groups which had stepped up in the pandemic to advocate for public health and deliver healthcare solutions in, for and with their communities. For example, we learned from a senior leader in the Jewish community in north London who had designed a vaccination service that hosted separate sessions for men and women with the Jewish Hatzola ambulance service. They also made sure that rabbis were vaccinated, because they understood the influence they carried in their communities. Another example was the setting up of a mortuary by a mosque in east London, because many were dying in the pandemic and “there was a lack of cultural knowledge about how a burial for the Muslim community happens, so we did it ourselves”.

Faith groups know well the people who often fall into the “hard to reach” category in public health. They are already serving them, not just with health services but for other needs. It is hard to overstate the value of this relational capital to advocate for good public health. There is a track record of successful partnerships between faith groups, local authorities and healthcare providers. For example, the South London Listens campaign saw community and faith leaders come together with citizens to work with three NHS trusts in south London to improve mental health services there post pandemic. The Faith Covenant, established by the APPG on Faith and Society and FaithAction, also does good work on collaboration and tackling mistrust between faith groups and local authorities.

However, there is still a variation of experience and a lack of literacy among both local authorities and healthcare professionals in how they relate to faith groups and vice versa. There is a lack of systematic recognition of the importance of faith to those who have one, which means that people do not feel that they have access to health services. On top of that, the extent of health inequalities can be misunderstood. There is also a lack of collection of ethno-religious data. As the Marmot Review 10 Years On makes clear, this is needed in the academic analysis of inequalities because, without such information, understanding ethnic inequalities is difficult.

We have had the opportunity to work to reduce health inequalities through both access to healthcare and the social determinants of health for prevention. Faith groups have something to offer here and could be transformational for health. What efforts are the Department of Health and Social Care making to engage with faith groups genuinely to ensure that health provision is being made more accessible? What effort is being made to ensure that effective data is collected so that we might have a clearer picture of local health inequalities?