Health: Women and Low-income Groups

Baroness Manzoor Excerpts

Thursday 20th March 2014 Grand Committee

Asked by

[Baroness Manzoor]

To ask Her Majesty’s Government what steps they are taking to reduce inequalities in health affecting women and low-income groups.

[Baroness Manzoor (LD)]

My Lords, I am delighted to have the opportunity to introduce today’s debate. I am also delighted that the subject has attracted such expert speakers and I very much look forward to hearing your Lordships’ contributions.

There have been three key reports on inequalities in health: the Black report back in 1980; the Acheson report in 1998; and, more recently, the Marmot review in 2010. Clearly, health is a key part of social mobility and, although the population has access to the NHS, there is a huge inconsistency in the problems faced by low-income and high-income groups, between men and women, and across ethnic groups. It is often said in international development circles that health is a human right. It is critical to income growth and poverty eradication. That applies just as much in inner-city Birmingham as it does in rural India. Health underpins access to employment, education, engagement with economic activity and quality of life. Low-income groups often report barriers to accessing health services, which drives poor health outcomes. Although life expectancy is going up, so too, unfortunately, is the gap between the rich and poor. The distribution of health and disabling health conditions across the population of England has been shown to follow a sizeable, persistent and incremental pattern: health outcomes generally worsen in line with greater levels of socioeconomic disadvantage.

An analysis by the Equality Trust has found that in the past 20 years alone, the gap in life expectancy for those in different local authority areas has increased by 41% for men and a staggering 73% for women. For example, there is now an 18-year difference in healthy life expectancy between women living in Richmond, where it is 72 years, and Tower Hamlets, where it is 54 years. This has real policy implications for fair and reasonable pensionable ages. Evidence also shows that women suffer more from poverty, gender inequality, gender-based violence and mental health problems.

Investment decisions based on women’s specific health needs are a practical and cost-effective way of delivering the NHS social inclusion agenda. For example, the cost to the NHS of violence against women and girls is estimated to be around £1.2 billion a year. Domestic abuse alone costs a further £176 million a year in mental health services. The return on investment in prevention is therefore significant. I would welcome the Minister supporting investment in the scale-up of dedicated outreach services for marginalised, low-income and hard-to-reach populations in the UK. Charities such as Find and Treat are excellent examples of organisations providing such services.

Reducing health inequalities is one of the NHS’s top five priorities, and rightly so. I welcome health organisations now having a statutory duty to have regard to the need to reduce health inequalities, and congratulate the Government on this. Therefore, health improvement is no longer the only success criterion; reducing differences in health between populations is also a welcome policy objective for NHS England and Public Health England. Not only does economic inequality affect health, but more unequal societies are more likely to experience poorer literacy rates, higher incidence of drug addiction and greater exposure to diseases.

Due to time constraints, I shall briefly touch on three issues: coronary heart disease, drugs and TB. I turn first to coronary heart disease. Collectively, as we know, heart and circulatory diseases cause more than a quarter of all deaths in the UK. Rates of premature death have been declining since the 1970s but this decline has not been reflected equally in all parts of our society. Tackling inequalities in heart disease should be hard-wired into the performance measures of the NHS and explicitly reflected in the quality and outcomes framework and the payment-by-results scheme for GPs, and should highlight gender differences in risk factors, screening and treatment needs. There is not sufficient evidence that this is being done.

Secondly, 1.2 million people are affected by drug addiction in their families, mostly in poor communities. The annual cost to society of drug addiction is £15.4 billion and this does not take into account the huge cost to families and end-users in their personal lives. An estimated 250,000 to 350,000 children who are affected by parental substance abuse face additional risk and harm, including neglect, being taken into care, involvement in drug abuse and poor mental health. Drug prevention can therefore be a mechanism for reducing inequalities and social exclusion. Drug treatment is an essential part of a successful drug policy and of reducing inequalities. However, evidence from the recent European Quality Audit of Opioid Treatment suggests that NICE and Department of Health guidance is not being fully implemented. The survey found that, although patients are ill informed of their treatment options, choice of treatment is often driven by patients. The UK has the second highest reported rate of patient relapse. Anecdotal evidence suggests that many patients may be relapsing and then re-entering the same treatment. Can the Minister say how the Department of Health and NICE guidelines are being implemented and evaluated, and whether that information is being disseminated to clinical commissioning groups?

My third and last area of health inequality is TB, which is a global disease of poverty. TB has killed more people than any other infectious disease in history. It remains the second deadliest infectious disease in the world, claiming 1.3 million lives each year. TB is airborne and infectious; in a world of globalised travel, it is no surprise that nearly every country in the world has TB. London has the highest rates of any capital city in western Europe. In 2012 there were nearly 9,000 cases of TB, nearly 10% of which came from just three London boroughs: Newham, Brent and Ealing. The first two of these are the London boroughs with the worst rates of overcrowded and temporary accommodation. This is not a coincidence. Although the number of cases has stabilised, rates in Indian, Pakistani and Bangladeshi communities are steadily rising. This is not a coincidence either. These groups are often marginalised and report barriers to accessing healthcare. TB in the UK is far from being under control and health inequalities are driving it forward.

Many poor people around the world suffer and die because they cannot afford to buy advanced medicines that are still under patent and often sold at a 50-fold, or even a 100-fold, mark-up. The NHS spends an estimated £8 billion every year on patented drugs. There are merits in other ways of incentivising important pharmaceutical innovations, such as a health impact fund, which Germany is actively considering. Would the Minister consider meeting the architects of the fund to see what benefits the UK could derive from it?

I end with five key points. First, it is time for action. How are the Government implementing the recommendations of the Marmot review? Secondly, there should be a joint narrative between the Department of Health, NHS England and Public Health England on what they are doing together to tackle inequalities and who is accountable for what. Like the King’s Fund, I believe that local authorities have a critical role to play, through their new public health duties, but the reduction in health inequalities cannot be delivered solely by them. Thirdly, Public Health England should show leadership and visibility by showing how it is supporting and, where necessary, challenging other government departments. Fourthly, all new government policies and services should be subject to health equality impact assessments, requiring policymakers and service providers explicitly to take health inequalities into account. Finally, I totally agree with the British Heart Foundation when it states that each of the four Governments in the UK should appoint a senior Minister with cross-cutting responsibility for tackling health inequalities and each government department should have an objective to reduce health and social inequalities.