Reducing Health Inequality

Debate between Sarah Wollaston and Peter Bottomley

Thursday 24th November 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House calls on the Government to introduce and support effective policy measures to reduce health inequality.

In her first speech at Downing Street, the Prime Minister referred to the “burning injustice” of the difference in life expectancy between the richest and poorest in our society, and to her determination to tackle it. The purpose of this debate is to try to assist the Government in making that a reality, but I also urge her to look at the gap in healthy life expectancy. Based on Office for National Statistics data from 2012-13, the healthy, disability-free life expectancy of a woman born in Tower Hamlets is 52.7 years of age, while that for a woman born in Richmond upon Thames is 72.1 years of age. That is a gap of about 20 years. The social gradient for disability-free life expectancy is even greater than that for mortality. I ask the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), to consider the issue not only as one of social justice, but as one that adds hugely to NHS costs and to economic costs more widely. There is a compelling economic and social justice case for tackling it.

What should the Minister do? In a nutshell, she should follow the evidence and start immediately, beginning with the very youngest in society—in fact, she should start with them even before they are born—and take a whole life course approach, following all the wider determinants of health. She should also take a cross-Government approach, with leadership at the highest level of the Cabinet. She needs to take the long view—many of the benefits will become evident in 20 or 30 years’ time—while not ignoring the fact that there will also be quick wins. She needs to look at everything that needs to be done to tackle the situation.

I hope that this will be a consensual debate. I congratulate the Labour Government on the work that they did to tackle health inequalities, which is starting to pay dividends. I also pay tribute to Sir Michael Marmot for his groundbreaking work; the blueprint that he set out in 2010 holds true today and it should be the basis of everything that we do. It is about giving every child the best possible start in life and allowing people of all ages to maximise their capabilities and exercise control over their lives. It is also about fair employment and good work, healthy environments and communities, standards of living and housing.

It is about preventing ill-health as well, and that is what I want to address, because I know that many Members across the House will speak with great expertise about the wider determinants of health. Tackling the issue starts long before people come into contact with health services, but that is still an enormously important part of tackling health inequalities. As Chair of the Health Committee, I will focus on those aspects.

On preventing early deaths, we need to look at lifestyle issues, including smoking and obesity, and at preventing suicide, which is the greatest single cause of death in men under the age of 49. Public health plays a critical role. The “Five Year Forward View” called for a radical upgrade in prevention in public health. Cuts to public health budgets are disappointing and will severely impact on the Government’s ability to tackle health inequalities. The Association of Directors of Public Health surveyed its members in February and found that the cuts to the public health budget were affecting issues such as weight management, drugs, smoking cessation and alcohol, which are key determinants that we need to tackle. In my own area, part of which covers Torbay, cuts of about £345,000 to council public health budgets will result in the decommissioning of healthy lifestyle services. Those budgets affect education and active intervention, and support a network of fantastic volunteers. I regret that those cuts to public health are going ahead, and call on the Government to stop them.

I want to tackle a few key areas. First, smoking is still the biggest cause of preventable death in the United Kingdom. Every year, 100,000 people die prematurely as a result of smoking. In her closing remarks, I hope that the Minister will update the House on the tobacco control plan.

[Sir Peter Bottomley (Worthing West) (Con)]

About 25 years ago I took an interest in how many death certificates mentioned smoking, and the answer was four. The figure may be larger now, but we should encourage medical practitioners to say that the person had been an active smoker, even if it was not the primary cause of death, so that at least people can become more aware of the issue.

While I am talking about this, I will mention two other things, which my hon. Friend may be going to cover. One is nutrition at the time of conception, and the second is that we should learn the lessons of how we cut the drink-driving deaths, which was not by public programmes, but by people doing the things that actually made a difference—that cut down the incidence and cut down the consequences and cut down the deaths.

[Dr Wollaston]

Those are extremely important points. The Government can introduce policies and make sure that there are levers and incentives in the system to make that happen. The drink-drive limit is a very important example.

We are not likely to make a difference to the gap in disability-free life expectancy without tackling smoking, which is a key driver for health inequality and accounts for more than half of the difference in premature deaths between the highest and the lowest socioeconomic groups. Without tackling it, we will not make inroads.

I would like briefly to touch on obesity and on the Government’s obesity strategy, which the Health Committee has looked at. To put the matter in context, the most recent child measurement programme data show us that 26% of the most disadvantaged children leave year 6 not just overweight but obese, as do 11.7% of the least deprived children. Overall, of all children leaving year 6, one in three is now obese or overweight. The situation is storing up catastrophic lifetime problems for them, and we cannot continue to ignore that.

In our report, the Committee called for “brave and bold action”. Although I really welcome many aspects of the childhood obesity plan—such as the sugary drinks levy, which is already having an impact in terms of reformulation—it has been widely acknowledged that there were glaring deficiencies and missed opportunities in the plan.

I would like to have seen far greater emphasis on tackling marketing and promotion. Some 40% of food and drink bought to consume at home is bought under deep discounting and promotion, and that is one of the potential quick wins that I referred to. We often focus in this debate on what people should not do, and this is an opportunity to look at what they should do. Shifting the balance in promotions to healthy food and drink would have been a huge opportunity for a quick win, because one of the key drivers of this aspect of health inequality is the affordability of good, nutritious food. This would have been an opportunity to tackle marketing and promotion, and I urge the Minister to bring that back into the strategy. I also urge the Government to extend the sugary drinks levy to other drinks, including those in which sugar is added to milky products, because there is no reason why it should be necessary to add sugar to such drinks.

I also welcome the mention in the plan of the daily mile, which has been an extraordinary project. I have met Elaine Wyllie, who is one of the most inspirational headteachers one could meet, and she talked about the strategy and about how leadership from directors of public health makes a real difference. I hope that the Minister will update the House on how that will be taken forward. We should think not just about obesity, but about physical activity and health promotion, and about the benefits that they could bring to all our schoolchildren.

The Health Committee stressed in our report the importance of making health a material consideration in planning matters when money is so restricted. I do not think that to do so would be a brake on growth; it would be a brake on unhealthy growth, and it would give local authorities the levers of power when they are making licensing decisions and planning decisions for their communities. That is something that Government could do at no cost, but with enormous benefit.

The Health Committee is actively considering how we reduce the toll of deaths from suicide. The Samaritans have identified that men living in the most deprived areas are 10 times more likely to end their life by suicide than are those in the most affluent areas. Many factors contribute to this—economic recessions, debt and unemployment—but when we try to tackle health inequality, we will not make the inroads that we need to make unless we look at the inequality in suicide, particularly as it affects men. Three quarters of those who die by suicide are men. I hope that the Minister will look carefully at the emerging evidence from our inquiry as the Government actively consider the refresh to the strategy, and that they will do so at every point when they look at how to tackle health inequality.

I would like the Minister to look at the impact of drugs and alcohol on health inequality. The fact that there are 700,000 children in the United Kingdom living with an alcohol-dependent parent is a staggering cause of health inequality, which has huge implications for those children’s life chances and for the individuals involved. Again, alcohol has a deprivation gradient; the two are closely linked.

There is evidence about what works, and we have had encouraging news from Scotland. The Scottish courts, I am pleased to say, have ruled that minimum pricing is legal, although I am disappointed that the Scotch Whisky Association has yet again taken the matter to a further stage of appeal. As soon as those hurdles are cleared, I think it would be a great shame if England undermined the potentially groundbreaking work being done in Scotland by failing to follow suit and introduce minimum pricing at the earliest possible opportunity; if we failed to do so, people would be able to buy alcohol across the border.