Health Inequalities: Office for Health Improvement and Disparities

Debbie Abrahams Excerpts

Wednesday 26th January 2022 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I will keep my mask on because I have a wound, unfortunately, which I need to keep covered. It is an absolute pleasure to serve under your chairmanship, Mr Twigg. I remember that we served on the 2012 Health and Social Care Bill Committee together, so this is bringing back memories.

I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on his excellent speech, and particularly on his focus on the wider health determinants and the need for an intergovernmental strategy and co-ordination. He is absolutely right.

I sought to become an MP because of my work on health inequalities. I was at the University of Liverpool for 10 years. Prior to that, I was a jobbing public health consultant. My hon. Friend mentioned the Black report. We must not forget that Margaret Whitehead at Liverpool was the first person to identify the health divide between the north and south. I am grateful to her. I learned so much under her and my other colleagues at Liverpool.

In the time that you have made available to me, Mr Twigg, I want to make three points. First, health inequalities are not inevitable. We hear “Oh, it’s always been there; it’s never going to change”. They are not inevitable but a consequence of political choices. As my hon. Friend said, those choices relate to whether or not we want socioeconomic inequalities to continue. It is also about—and this is rarely talked about—inequalities in power. We must ensure that that is addressed and brought into the debate.

Secondly, the structural inequalities across our country have been exposed and exacerbated by covid, resulting in, as Professor Sir Michael Marmot has said,

“the high and unequal death toll from COVID-19”,

which was one of the highest in the world. Thirdly, tackling health inequalities involves every single Government Department, not just the Department of Health and Social Care.

The term “health inequalities” refers to the increasing mortality and morbidity that occurs with declining socioeconomic conditions. In my Oldham East and Saddleworth constituency, the health inequality gap is more than 12 years. Those health inequalities are systematic and socially produced, and are a result of the differential distribution of income, wealth, knowledge, social status and connections. There is overwhelming evidence that those factors are the key determinants of health inequalities, influenced by written and unwritten rules and laws across our society, rather than biological and behavioural differences. I have always been disappointed by the focus always being on the individual: “It’s your fault if you get ill; it’s your fault if you get a disease. It’s your lifestyle choices.” It is not. There is overwhelming evidence on that.

There is no law of nature that decrees that the risk of a baby dying is 94% higher for children born into poor families than for those born into rich families, but that is the reality. We know that infant mortality, which had been declining for nearly a century, has started to rise again. As my hon. Friend has said, there are consequences to inequality and the austerity that has been imposed on so many families.

To my first point, given that health inequalities are socially produced, there is hope because that means that they are not fixed or inevitable—we can do something about them. If the Government are committed to levelling up, will the Minister comment on why the Gini coefficient has increased over the past few years? As my dear friend Frank Dobson famously said, nothing could be more unjust than someone knowing that they are going to die sooner because they are poor. Will the Minister comment on the socioeconomic factors that are driving health inequalities? Why they have they got worse over the past two years?

On my second point, Sir Michael Marmot was very clear in his analysis of the covid death rate that there have been four drivers of the high and unequal death toll in the UK: the governance and political culture detrimentally affecting social cohesion and inclusivity; the widening inequalities in power, money and resources; the regressive austerity policies over the past decade; and the declining healthy life expectancy of the poorest, particularly women, which is among the worst of all comparable economies. Deprived communities have also been hit particularly hard in that regard.

On my third point, as important our NHS is in treating and caring for us when we get ill, reducing inequalities must involve all Government Departments, as my hon. Friend has said. That was reflected in Sir Michael’s recommendations to address those inequalities. He said that we must build back fairer from the pandemic, with multi-sector action from all levels of Government, and increase investment in public health. Since 2015, there has been a 24% cut in public health budgets.

One thing we know about the NHS and its impact on inequalities relates to the privatisation and marketisation of health services. We know that that helps to reduce access to health services for those on lower socioeconomic groups. On top of that, there is the inequality in health outcomes. I fear that the 2021 Health and Care Bill will make a bad situation even worse, adding to the issues resulting from the Health and Social Care Act 2012.

Not only do countries in which there is a narrow gap between rich and poor have high life expectancy; they also have better educational attainment, social mobility and trust, lower crime and a fairer society as a whole. I appreciate that I have gone over time and apologise for that.

--- Later in debate ---

[Debbie Abrahams]

I refer back to my point about not victim blaming, but in relation to the NHS resource allocation formula, can I ask the Minister whether the Government will be reinstating the health inequalities weighting that the previous Administration scrapped?

[Maggie Throup]

If I may, I will write to the hon. Lady on that so I can make sure that my facts are completely clear, rather than giving her an answer that may not be quite accurate.

In recognition of the strong relationship between work and health, the joint work and health unit was established in 2015. It has invested in a programme of trials and tests to identify effective models of health and employment support, and it is now using that learning to develop and/or roll out services to support disabled people and people with long-term health conditions to enter and stay in employment. The 2021 spending review confirmed that the public health grant will be maintained in real terms for the spending review period, so local councils can continue to invest in prevention and essential public health services. The distribution of that grant is heavily weighted towards the areas that face the greatest population health challenges, with per capita funding almost 2.5 times greater for the most deprived authorities than for the least deprived. The allocation at local authority level will be announced shortly.

The role that local authorities play in improving public health is far broader than simply the important services and interventions funded through the public health grant. That grant is part of a wider package of targeted investment in improving the public’s health over the spending review period, including £300 million to tackle obesity; £170 million to improve the “best start in life” offer available to families, including breastfeeding advice and parent-infant mental health support; and an additional £560 million to support improvements in the quality and capacity of drug and alcohol treatment, which was announced as part of the drugs strategy. In addition, we have made over £12 billion available to local councils since the start of the pandemic to address the costs and impacts of covid-19. Of this money, £6 billion was non-ringfenced, because we recognise that local authorities are best placed to decide how to manage the major covid-19 pressures in their local areas.