Health: Women and Low-income Groups

Baroness Warwick of Undercliffe Excerpts

Thursday 20th March 2014 Grand Committee

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I thank the noble Baroness, Lady Manzoor, for introducing this debate on this challenging issue. We know from the NHS, the Office for National Statistics and elsewhere that poorer people live shorter lives and that they live more of their lives with limiting illnesses. The Marmot review in 2010 highlighted the seven-year gap in life expectancy and the 17-year gap in disability-free life expectancy between those on the lowest incomes and those on the highest.

We also know that there is a significant difference in rate of diagnosis, treatment and outcomes for the five biggest killers depending on where you live. Last month, the ONS published its analysis of the health deprivation divide using the 2011 census and found that men and women aged 40 to 44 living in the most deprived areas are about four times more likely to have “not good” health compared to their equivalent in the least deprived areas.

In terms of gender, the most recent ONS figures, published at the weekend, show that women in the most advantaged areas can expect to live 20 years longer in good health than those in the least advantaged areas. Poor women spend only 66% of their lives in good health, compared to 83% of the richest. The richest women live nearly seven years longer than the poorest. Although women have historically enjoyed longer life expectancy and more prolonged health than men, that gender advantage is almost entirely eroded by social inequalities.

The Marmot review, Fair Society, Healthy Lives, made the simple point that reducing health inequalities is a matter of fairness and social justice, but tackling those inequalities and injustices is neither simple nor straightforward. Health inequalities result from social inequalities, so any action on health inequalities requires action across all the social determinants of health.

The Marmot review’s first and highest priority for action was giving every child the best start in life. I have spoken on this before, but it is a subject that I feel very strongly about. The evidence is overwhelming that investing in the pre-school years pays most dividends for health and well-being in later life. What happens during early years, starting even in the womb, has lifelong effects on everything from obesity, heart disease and mental health to educational achievement and economic status. That is why it is so important that we provide more parenting support programmes and that we have a well-trained early years workforce and high-quality early years care.

I will not dwell on that point but want instead to look at where we are four years on from the Marmot review. The Health and Social Care Act 2012 places a duty on the Secretary of State, NHS England and clinical commissioning groups to have due regard to reducing inequalities, and there have been some successes. The widespread adoption of high-impact interventions, such as prescribing cholesterol-reducing drugs and drugs to control blood pressure, and increases in stop-smoking services, have all shown an impact.

However, this sort of success has been uneven. A King’s Fund report tells us that the overall proportion of the population that engages in three or four of the four main areas of unhealthy behaviour has declined significantly, from around 33% of the population in 2003 to around 25% by 2008. However, people with no qualifications were more than five times as likely as those with higher education to engage in all four poor behaviours in 2008, compared with being only three times as likely in 2003.

So far, policy has focused on tackling individual lifestyle risks one at a time but this ignores the distribution of these behaviours. We need a more holistic approach to policy and practice that addresses the lifestyles of people showing multiple unhealthy behaviours. When your future prospects look hopeless and your life is lonely and miserable, there is little reason to make changes to your behaviour now in order to add years later. Will the Minister tell us what is being done to ensure a more integrated approach to behaviour change, which links to inequalities policy and focuses more directly on the Government’s stated goal to,

“improve the health of the poorest, fastest”?

Michael Marmot recently returned to the fray: last month he alerted us that the ONS plans to reduce the amount of data it collects which highlight the differences within local authority areas. My borough of Kensington and Chelsea has the highest average life expectancy in the country but there are pockets of extreme deprivation. One ward has a life expectancy of 71 years, whereas it is 92 in Knightsbridge. These are the data that should inform the commissioning of services. I hope that the Minister can reassure the House that these data will continue to be collected.

I welcome the recent launch by Public Health England of a national conversation on health inequalities. However, this conversation needs to take place at rather a higher volume than it appears to have done so far. Like the noble Baroness, Lady Manzoor, I ask the Minister what the Department of Health, NHS England and Public Health England are doing together to tackle inequalities. They need to be heard telling us how they will use their powers, not just calling the rest of us to action. We need a joint commitment. As NHS England is now the monopoly buyer of primary care, it needs to use that power to reduce health inequalities. Public Health England should share its expertise in health impact assessment with other departments so that they are able to take into account the health inequalities impacts of one potential decision versus another.

The task of reducing health inequalities cannot be left to local authorities to deliver solely through their new public health duties. We need to ensure that local authorities invest money and expertise to ensure long-term reductions in health inequalities. One of the values at the heart of the NHS constitution is that “everyone counts”. Our resources must be maximised for the benefit of the whole community and we must make sure that nobody is left behind.

--- Later in debate ---

[Baroness Jolly]

I understand that. I am sure that there are adult education programmes across the country. The noble Baroness shakes her head. Perhaps we can have a conversation about that outside the debate.

We have focused on outcomes rather than on targets to promote action and measure progress, including through the public health outcomes framework, in line with the Marmot review proposal for a national framework of indicators for local areas to draw on to meet their own needs. This strategic approach to reducing health inequalities will help guide local action that is practical, joined up across the causes of ill health, and delivered at a scale to make a difference and improve health outcomes for all our people.

In what time I have, I shall run through points that noble Lords have raised that I have not covered. The noble Baroness, Lady Manzoor, asked about cardiovascular disease, which we know affects millions of people and is one of the largest causes of death and disability in this country. The previous Government made huge strides in this area which this Government have carried on. During the past decade, there has been a 40% reduction in under-75 mortality rates, with a narrowing in the difference between the most deprived and the least deprived areas of England.

Domestic violence is one aspect of violence against women and girls; others include sexual violence, abuse and gang violence. We also heard today at Question Time about FGM, and the Government are working on that issue.

On international health inequalities, raised by the noble Baroness, Lady Hayman, the approach to tackling health inequalities in England is recognised internationally as leading edge. Professor Sir Michael Marmot has chaired the World Health Organisation’s commission on the social determinants of health. Based on the interim analyses of the first phase of this programme, it is estimated that, during the lifetime of the project, more than 9,500 maternal lives will be saved, more than 190,000 maternal disabilities will be avoided, nearly 10,500 new-borns will be saved and more than 12,500 stillbirths will be averted.

The noble Baroness, Lady Warwick, asked about the gap of 20 years in healthy life expectancy. I mentioned earlier that local authorities have been given a £5.4 billion budget to press on that.

I have been informed that I am out of time. I am sorry. I flagged up that I doubted that I would get through all your Lordships’ points during the debate, but I will certainly write to you and answer any outstanding queries.

[Baroness Warwick of Undercliffe]

Before the Minister sits down, it would just be quite nice to have a reassurance about the data.

[Baroness Jolly]

Yes.