Health: Women and Low-income Groups

Lord Crisp Excerpts

Thursday 20th March 2014 Grand Committee

[Lord Crisp (CB)]

My Lords, I, too, congratulate the noble Baroness on securing this debate, and on the excellent way in which she laid out the issues at the beginning. These are important themes, which go beyond health and beyond the UK. I will not talk about international development, although I will say in passing that I identify completely with everything my noble friend Lady Hayman said on that issue.

I was interested to note recently that the European Strategy and Policy Analysis System, which advises all the parts of the European Union, has identified inequality as the most significant long-term challenge now facing Europe. As recovery is now under-way, there is what it describes as a “trend break” in inclusive growth; in other words, growth that is taking everyone with us. It is interesting that in our international development world we talk about no one being left behind in health, but we are not doing very well at that ourselves.

That report goes on to talk about the most vulnerable, the growth in unemployed youth and the so-called lost generation, and the impact on the most vulnerable and the ill of the reduction of public services, all of it indicating that we are building up health problems for ourselves for the future.

That theme of inequality is one that we will have to keep coming back to, and it is important that we do so. I absolutely agree with the noble Baroness, Lady Warwick, that we need to increase the volume. Not only does the Department of Health need to do that, but we all need to keep pressing the points that I suspect we all understand very well, and make sure that they are turned into reality.

We in the UK understand those issues better than most. We have had a great tradition of research into and evidence of the relationship between health and income since the Whitehall study, which was begun in 1967. It shows the clear relationship between them; within that, it also notes that while women have longer life expectancy, as we have already heard, low income can affect them worse, and that there is a greater discrepancy in the length of healthy lives. Therefore in a quarter of the boroughs in the UK, men have longer healthy life expectancy than women do. We also know that people from black and minority ethnic communities are particularly affected, because they are overrepresented in low-income groups and face some specific health threats. Therefore we know what the problem is.

The relationship between health and income is complex, and has at least four components, all of which have to be addressed. The first component is simply the material one: whether people are able to buy better health with better food, gym membership and so on. Then there is the psychosocial: we now know the biological mechanisms that show the way in which stress impacts on the body and affects health. We also know that there are links between people in low-income groups and risky life behaviours, as we have already heard from a number of noble Lords. The reverse is also true: poor health can cause low income and reinforce the whole cycle. All these issues affect women, but for women there is a double impact, because many of them are carers or involved in bringing up children, and the health of women affects other people profoundly.

The way to deal with this is equally complex. The WHO study on social determinants, already referred to, stressed the importance of taking a life-course approach to health inequalities, with interventions at every stage from birth to old age, while the study from Europe that I mentioned emphasised investing in citizens and having a focus on promoting well-being.

We have in this country many good specific examples, of which I will name just one: in Lewisham, where they are targeting women’s inequality and picking up across the entire borough the sort of issues that I am talking of. But we need strategic impact, as the noble Baroness, Lady Manzoor, said; she described it in relation to coronary heart disease, drugs and TB. We need a much more strategic and followed-through approach at a higher volume than is the case at the moment.

I would be very interested to hear the Minister’s response to the noble Baroness’s questions. I suspect that she will tell us that the ideas outlined here and in what other people have said are central to the Government’s policies. However, I hope that she will not just spell out the Government’s hopes for their policies but point to particular examples where those policies are in reality reducing inequalities and having a positive impact on health. We all understand that there needs to be a cross-government approach; health by itself cannot achieve many of the things that we are talking about. Could the Minister also therefore give us good examples of where this approach is happening; for example, where education is working with health to develop health literacy among children?

Finally, the reverse of this is also true: some government policies from other departments may have adverse effects on equality and on health. Can the Minister therefore tell us what the health department is doing to assess the impact of policy from other departments on health and reassure us that the Department of Health can intervene, and indeed has intervened, where there is a potentially negative impact?