Health Inequalities: Office for Health Improvement and Disparities

Peter Dowd Excerpts

Wednesday 26th January 2022 Westminster Hall

[Derek Twigg (in the Chair)]

Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with the current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test before coming on to the parliamentary estate. Please also give each other and members of staff space when seated and when entering and leaving the room.

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered the Office for Health Improvement and Disparities and health inequalities.

It is a real pleasure to be here under your stewardship this afternoon, Mr Twigg. I thank all those who have come along—all on the Labour side of the House—to debate this important issue, which affects so many of our constituents. I thank the organisations that have provided me with information to help me articulate my points, including the Royal College of Physicians, the Inequalities in Health Alliance, the British Heart Foundation, Cancer Research UK, Maternity Action, the Royal College of Paediatrics and Child Health, the NHS Federation, the UK Vaping Industry Association, Kidney Research UK, the Health Foundation, the Terrence Higgins Trust, Global Blood Therapeutics, the Local Government Association, the Institute of Alcohol Studies, the Children’s Alliance and, as ever, the House of Commons Library, which brings much of this together. I do not believe I have missed any organisation out. If I have, I apologise.

Each organisation made helpful and constructive comments about the matter we are debating today. The extent of health inequalities is remarkably wide—in fact, I felt I understood the extent of such inequalities, but the information from those organisations has widened my knowledge significantly. Each of the organisations had the decency to send me information, so I will read out comments from each of them, if I may.

Alongside its key ask for a cross-governmental strategy to reduce health inequalities, the Inequalities in Health Alliance also asks the Government to

“commence the socio-economic duty, section 1 of the Equality Act 2010”

and to

“adopt a ‘child health in all policies’ approach.”

The Health Foundation notes:

“Public health funding grants to councils have been reduced by £700 million in real terms from 2015/16 to 2019/20. In the Spending Review published in October 2021, the Government said it would maintain the public health grant ‘in real terms’ until 2024/25, but has yet to confirm the amount for 2022/23.”

We are only a couple of months away from the beginning of that financial year. The Terrence Higgins Trust asked me to ask whether the Minister can confirm when local authorities will have their public health grant allocations published. Other organisations also asked that question.

The Institute of Alcohol Studies said:

“People from the most deprived groups in England are 60% more likely to die or be admitted to hospital due to alcohol than those from the least deprived… We believe that for any levelling up agenda to be comprehensively successful, it must address alcohol harm as a top priority.”

The LGA said:

“Councils have seen a significant reduction to their public health budgets in the period between 2015/16 and 2019/20. The recent announcement of a real-terms protection of the public health grant is welcome, but is unlikely to address the impact of the past reductions to funding.”

Cancer Research said that its modelling estimates suggest that

“30,000 extra cases of cancer in the UK each year are attributable to socio-economic deprivation. The two biggest preventable causes of cancer—smoking and overweight and obesity—are more prevalent in deprived groups.”

Kidney Research said:

“Around 3 million people in the UK have kidney disease and every day, 20 people develop kidney failure…. There is also a gender bias associated with kidney disease—women are more likely to be diagnosed with kidney disease and are at higher risk of developing end stage renal failure than men.”

[Judith Cummins (Bradford South) (Lab)]

My hon. Friend is making an excellent speech. On that point, I want to ask him about gender inequality in terms of health. As a member of the all-party parliamentary group on osteoporosis and bone health, he will know that fracture liaison services are key to prompt and timely diagnosis of osteoporosis, but only 51% of NHS trusts in England have an FLS and only 41% of all NHS trusts have permanent and sustainable funding in place for their FLS. That means that every year an estimated 900,000 people miss out on the medication they need to prevent avoidable fractures. Does he agree that this health inequality, or postcode lottery, needs to end?

[Peter Dowd]

My hon. Friend is completely right and she has been a real champion of osteoporosis services, pushing them in her own area and as chair of the APPG. One figure shows that half of women over the age of 50 suffer a broken bone due to osteoporosis. That is the kind of stark figure that we have to face. I thank my hon. Friend for that intervention.

The NHS Confederation has made comments similar to those I have mentioned:

“The number of people waiting for planned NHS care in England has grown to record levels, with more than 5.6 million people currently on the waiting list and over 7 million ‘missing patients’ anticipated to come forward... Inequalities are now becoming evident in the backlog, with evidence suggesting that waiting lists have grown more rapidly in more deprived areas during the pandemic.”

Maternity Action says:

“Vulnerable migrant women face charges of £7,000 or more for… maternity care. Charges are levied on women with insecure immigration status, including destitute asylum seekers whose claim has been refused and who are not in receipt of Home Office support, women whose relationship has broken down and who were dependent on their partner for their immigration status, women on fiancee visas and women who have been unable to afford to renew their visas. This policy disproportionately impacts on minority ethnic women, who make up 85% of women using Maternity Action's Maternity Care Access Advice Service, which advises women”

on such matters.

The British Heart Foundation said:

“The prevalence of heart failure, stroke, and mini stroke in adults with learning disabilities in England is higher than the general population, and circulatory diseases are one of the main causes of death in people with learning disabilities. For the most part, this can be attributed to differences in the social determinants of health.”

The Royal College of Paediatrics and Child Health said:

“Child health outcomes in England are some of the worst in Europe… Our State of Child Health 2020 report reveals a widening gap between health outcomes across nearly 30 indicators. It shows that children living in more deprived areas have worse health outcomes than their peers living in less deprived areas… The COVID-19 pandemic has also highlighted and accelerated the devastating impact of health inequalities.”

[Apsana Begum (Poplar and Limehouse) (Lab)]

My hon. Friend is making an excellent speech. Does he agree that, given that the largest number of covid-related deaths have been experienced by ethnic minority communities, it is imperative that the Minister provides clarity on whether the Office for Health Improvement and Disparities and the Health Promotion Taskforce will be given a remit outside the Department for Health and Social Care?

[Peter Dowd]

I am pleased that my hon. Friend asked that question, because it is one that has been asked many times, and I am sure the Minister will cover it—it is one of the questions I have as well.

The UK vaping industry said:

“It is absolutely critical that the new Office for Health Improvement and Disparities continues the pragmatic approach of Public Health England in recognising the role of vaping in tackling inequalities. It is essential that the institutional knowledge of PHE is not lost in the establishment of the OHID”

It is important that that is factored into these debates.

The House of Commons Library referred to the debate on health inequalities versus disparities. Jabeer Butt of the Race Equalities Foundation has welcomed the institution of the OHID and the possibility of working alongside it, but he said:

“With the establishment of OHID, we can’t help but wonder why the language used by the Health and Social Care Secretary talks about ‘health disparities’, compared to Professor Chris Whitty, who describes ‘health inequalities in the Government announcement.”

This is not just about semantics. It is important that we recognise that it is about not just disparities but health inequalities as well.

[Marsha De Cordova (Battersea) (Lab)]

I commend my hon. Friend on his speech. He touched on a really important point: that the Government talk about disparities when they should talk about inequalities. To truly tackle health inequalities, we need to look at social factors, such as housing, racism and air pollution, and socioeconomic factors. Does he agree that, to tackle all of those inequalities, the OHID will need to look in the round at all those issues and seek a cross-governmental role to deliver on the Department of Health and Social Care’s aims?

[Peter Dowd]

My hon. Friend is spot on. That is a key point that we want to tease out today: cross-departmental working.

As with many other health issues, the devil is in the detail. Only by looking into the granularity of the issues can a real understanding of the levels of inequality and disparity be established. I do not have time for more significant references to the organisations concerned, but it really was important for me to get down to the detail of the information that they provided. I will give the documents to the Minister for her perusal in due course.

Before the pandemic, growth in life expectancy had stalled for the most deprived in England. Between 2014 and 2019, people in the least deprived areas saw their life expectancy grow significantly, but there were no significant changes for people in the most deprived areas. For women in the most deprived areas of England, life expectancy fell between 2010 and 2019—a stark fact. The pandemic unambiguously exposed and exacerbated inequalities that have existed in our society for far too long, as many hon. Members will have seen first hand in their constituencies. The pandemic has widened gaps that were already too big to begin with, and once again it is the most vulnerable who have borne the brunt.

We know from the Sir Michael Marmot’s “Build Back Fairer” report that mortality rates for covid in the first wave mirrored mortality rates for other causes. In order words, the causes of health inequalities more widely were similar to the underlying drivers of covid-19 deaths among certain groups. It has been estimated that working-age adults in England’s poorest areas were almost four times more likely to die from covid than those in the wealthiest areas—another stark figure. Now, with the backlog, analysis of waiting list data shows that people living in the most deprived areas are nearly twice as likely to wait more than a year for treatment compared to those living in the least deprived areas. That cannot be right.

Before the pandemic, through the pandemic and now as we emerge, we hope, from the worst of the omicron variant—it is clear that there is a deep-rooted inequality in our society that causes huge inequality in health. The gap in life expectancy is startling. People in my constituency live on average 12 years less than people in Southport—just at the other end of the borough. Those are stark differences in healthy life expectancy—how many years a person spends in good health. Before covid, it was estimated that people in the richest communities in England could expect to live in good health for up to two decades more than the poorest. In Bootle, according to Nomis at the Office for National Statistics, 42% of people who are economically inactive are long-term sick, compared to the national average of 24%.

However, statistics get us only so far. A recent paper from the Royal College of Physicians brings to life the reality of health inequalities. One hospital clinician saw a patient who was extremely malnourished and dehydrated. The patient had been regularly missing meals so she could feed her teenage son. When she first became unwell, she did not call the GP, because she was unable to afford to pay someone to look after her son, and was frightened that he would be taken into care if she had to go to hospital for a long time. She was eventually admitted to hospital with sepsis. There are other stories in the paper of people who missed hospital appointments because they could not afford public transport, people who do not have the kitchen facilities to cook food and someone who was hospitalised because their asthma was aggravated by mould in their flat that the landlord refused to fix.

As we all know, 40 years ago, Sir Douglas Black, a former president of the Royal College of Physicians, was asked by the Department of Health and Social Security to lead an expert committee looking into health and inequality. That now famous Black report was unequivocal and said that while overall health had improved since the introduction of the welfare state, there were widespread health inequalities, the main cause of which were economic inequalities.

In his foreword to the report, the then Secretary of State said:

“the influences at work in explaining the relative health experience of different parts of our society are many and interrelated.”

That is as true today as it was then. It might seem that health inequality is a matter for the Department of Health and Social Care and the NHS but, as other hon. Members have said, health and social care services can only try to cure the ailments created by the environments people live in.

Research by the University of York linked austerity measures with the deaths of almost 60,000 more people than would be expected in the four years following their introduction. The money a person has will change the decisions they make about their health. It is the difference between having a healthy meal and having a meal at all, or between choosing to pay for the journey to the GP for an ongoing cough or choosing not to.

Housing affects health too. Last year, Shelter found that poor housing was harming the health of a fifth of renters. Our society benefits some people and deprives others, and those structural inequalities drive many of the health inequalities in black, Asian and other minority ethnic groups. We have to address that if we want to tackle this issue.

If we are to prevent ill health in the first place, we need to take action on issues such as how much money people have, poor housing, food quality, communities, place, employment, racism and discrimination, transport, and air pollution. That is why many organisations and coalitions, including the 200 members of the Inequalities in Health Alliance, which is convened by the Royal College of Physicians, have made calls for a cross-Government strategy to reduce health inequalities.

Tackling health inequality requires a considered and co-ordinated approach across myriad factors. Last year, the Government signalled that they recognise the need to look beyond the Department of Health and Social Care and the NHS and to take action on the issues that cause ill health. When the Secretary of State announced the Office for Health Improvement and Disparities in October last year, we were promised a new cross-Government agenda that would look to track the wider determinants of health and reduce disparities. The Health Promotion Taskforce was established.

These are potentially encouraging signs, but I am concerned that we are yet to hear the detail of what the OHID will do to reduce health inequalities. Will the Health Promotion Taskforce have a remit to take action outside the Department of Health and Social Care? When will we see a strategy on reducing health inequalities, so that we know what the Government’s ambition is in this area and we can track progress? Will the Government commit to developing a cross-Government strategy to reduce health inequalities?

Will the Minister set out how the Office for Health Improvement and Disparities will reduce health inequalities? Will he tell us about the work of the Health Promotion Taskforce and how often it meets? What engagement has the OHID had with Government Departments to date, since it was formally established on 1 October 2021? Importantly, will the Minister set out how the OHID will work with integrated care systems and support them to address health inequalities in their areas? I hope he can answer some of those questions.

When the Labour Government first asked Professor Marmot to review health inequalities in 2008, Gordon Brown said:

“The health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health. They also limit the development and the prosperity of communities, whole nations and even continents.”

He was absolutely right.

This Government were elected on a platform of levelling up, but while covid-19 caused a decrease in life expectancies for most countries between 2019 and 2020, the UK’s life expectancy has fallen below where it was in 2010. The UK was one of only two countries where that happened, the other being the United States.

In 1980, the Government responded to the Black report by saying:

“you might be right about the solution, but it’s going to cost too much.”

After two years of living with the pandemic, which, of course, has hit the most deprived the hardest, it is clear that the real cost lies in not supporting those who need that support most. Only Government can create the conditions for better health by improving the factors that lead to ill health in the first place. I hope the Minister can set out what the Office for Health Improvement and Disparities can do to achieve the aim of reducing inequality, and can confirm that the Government intend to tackle the wider determinants of health, which drive so much of the health inequality that we see.

[Derek Twigg (in the Chair)]

A good number of Members want to speak today. I do not intend to impose a time limit, but it would helpful if you could keep your speeches to around six minutes. That will ensure that everybody gets in. I intend to call the Front Benchers at no later than 3.40 pm.

--- Later in debate ---

[Peter Dowd]

I appreciate the fact that so many colleagues have come here to discuss this matter today, because it really goes to the heart of the needs of our communities.

We need a seismic shift—a paradigm shift—to tackle health inequalities and inequalities more generally. If we can guarantee £1.3 trillion to support a few institutions because of the banking crisis and £400 billion in relation to the pandemic, surely we can afford in the longer term to tackle health inequalities that affect the lives of millions of our constituents—many of whose lives are, to quote Thomas Hobbes’s “Leviathan”, “nasty, brutish, and short”.

Question put and agreed to.

Resolved,

That this House has considered the Office for Health Improvement and Disparities and health inequalities.