Health Inequalities

Debbie Abrahams Excerpts

Wednesday 20th March 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I congratulate the hon. Member for Telford (Lucy Allan) on securing the debate. She was absolutely right to say that, as important as our NHS is in treating and caring for us when we get ill, reducing health inequalities —in my Oldham East and Saddleworth constituency, there is an 11-year life expectancy gap between rich and poor—goes beyond the NHS and the Government’s 10-year plan.

The term “health inequalities” refers to the increasing mortality and morbidity that occur with declining socioeconomic position. This is the systematic, socially reproduced, differential distribution of power in relation to 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. Those things, rather than biological and behavioural differences, drive these inequalities. No law of nature decrees that the children born to poor families should die at three times the rate of children born to rich families, but that is the reality in 21st-century Britain.

Given that those health inequalities are socially produced, they are not fixed or inevitable. If the Government were committed to tackling these burning injustices—let us face it, what could be more unjust than knowing you are going to die earlier because you are poor?—a starting point would be to tackle their regressive, unfair economic and social policies.

Countries that have a narrow gap between rich and poor have not only higher life expectancy rates, but better educational attainment, social mobility, trust between communities and so on. Fairer, more equal societies benefit everyone. Unfortunately, the concentration of power in tiny elites is happening more than ever in the UK.

Just four weeks ago the Office for National Statistics published data with more evidence that these inequalities are on the increase, with income inequalities increasing in 2018. The average income of the poorest fifth of the population after inflation contracted by 1.6% in the last financial year, while the average income of the richest fifth rose by 4.7%. This followed “fat cat Friday” in January when it was revealed that top executives were earning 133 times more than their average worker—up from 47 times more in 1998.

At the same time we are seeing increases in both infant and child mortality, which—as shown in the latest study, just 10 days ago—correlate with increasing child poverty. These increases, the first in 100 years, mean that four babies in 1,000 will not see their first birthday in the UK, compared with 2.8 in 1,000 in the EU.

Two weeks ago life expectancy estimates were revised downwards by six months by the Institute and Faculty of Actuaries in its latest mortality projections model. The institute now expects men aged 65 to die at 86.9 years, down from its previous estimate of 87.4 years, while women who reach 65 are likely to die at 89.2 years, down from 89.7 years. Public Health England’s investigation into flatlining life expectancy revealed—as many of us, including Sir Michael Marmot, have said for a number of years—that austerity has wrought misery and poverty, and ultimately an early death for too many of our citizens.

As analysis from the Institute for Fiscal Studies and others has shown, since 2015 the lowest income decile has lost proportionately more income than any other group as a consequence of personal taxation and social security measures. Last autumn’s Budget had only marginal impacts on the household income of the poorest, while reducing the number of higher rate taxpayers by 300,000. Last week’s spring statement followed that trend. There was nothing for the 8 million working poor, the 4 million children living in relative poverty or the two thirds in working families, and nothing for the 4 million disabled people living in poverty.

These health inequalities are socially produced, so they are not fixed or inevitable. They can be changed, and that should give us hope.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to respond to the debate. I feel that it is a major challenge and an absolute responsibility for Ministers in the Department to do everything we can to tackle inequalities. Frankly, that is why all of us got involved in politics and stood for public office, because we want to do the best for everyone in our society.

I pay tribute to my hon. Friend the Member for Telford (Lucy Allan) for her very persuasive argument in opening the debate. She has been an absolutely fantastic champion for her constituents, at a time when difficult decisions are being made about how to reconfigure health services in her area. She has not been backward in coming forward to make her case, because this is the second time that I have responded to her on it. I know that she will continue to make her case.

I will just say something about some of the concerns that my hon. Friend has raised. When the NHS makes decisions on how best to deliver health services for a local community, clearly those decisions are made locally and should be locally responsive. However, it is equally the case that the public become very nervous about the potential downside of any decision. It is therefore absolutely crucial that engagement is constructive, with dialogue and transparency, so that the public can have confidence that the right decisions are being made.

My hon. Friend articulated her case with clear reference to inequalities in the area that is served by that configuration. It is important that we have a way of addressing those points, because there is a perception that the pointy-elbowed middle classes are better at fighting for themselves than everyone else is. We all have a duty to ensure that everyone can have confidence in the decisions that are made. I encourage my hon. Friend to continue to give challenge, because it is only when we provide her with answers that she can give her constituents reassurance. I know that she will continue to give that challenge.

On that basis, I would give a gentle prod to some organisations within the NHS. We often find that some areas are better at consultation than others, but we are elected representatives who are here to give challenge on behalf of our constituents, and I would like to send a message that the NHS needs to be more transparent in its decision making throughout.

I thank all Members for their contributions to this debate, and I will try to address most of the points that have been raised. Turning to the legal duties on the Secretary of State, we have regard to the need to reduce health inequalities. That requires concerted effort across all our health services. That is a priority for us, and it is a particular priority for me. Clearly, other factors contribute to poor health outcomes and inequalities, which go beyond the gift of the NHS and the Department of Health and Social Care, meaning that we need to take a cross-Government approach to the problem. Housing is clearly an issue; we know that poor-quality housing can be a driver of ill health and health inequality. We have heard about employment and income, and clearly education is a factor as well. We need to equip everyone with the tools to live a healthy lifestyle and look after themselves well. Equally, this issue is about access to services, and we know that there is much we can do within the NHS and the wider healthcare system.

[Debbie Abrahams]

Is the Minister aware that there was an interdepartmental public health group specifically to look at the wider determinants of health and how each Department could do its bit? Would she consider re-establishing that group to address the important issues that have been raised?

[Jackie Doyle-Price]

We have a number of inter-ministerial groups looking at particular areas of inequality, such as rough sleeping and the first 1,001 days. The hon. Member for Central Ayrshire (Dr Whitford) spoke about the importance of early intervention; if we could get that right, that would be a real way of addressing inequality. My short answer to the question asked by the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) is that we pick up public health in a number of ways, but my priorities are the first 1,001 days and particular pinch points where there are real inequalities. We will continue to look at those areas, not least because supporting those individuals is not just better for them, but makes financial sense. If we can tackle some of these issues earlier, not only do individuals live longer and healthier lives, but there is a reduced cost for the health system.