Covid has exposed the health gaps between rich and poor and across ethnic groups
A UK government advert in Piccadilly Circus in London, encouraging Londoners to stay home | RichardBaker / Alamy Stock Photo
Baroness Young of Old Scone
4 min read
A more equal society will help people to live longer in better health, and reduce pressures on the NHS
The House of Lords Science and Technology Committee was, between you and me, in a bit of a quandary when Covid hit. The committee had been working throughout 2019 and early 2020 on an inquiry into the government’s Ageing Society Grand Challenge, where we came to some rather chilling conclusions about the pursuit of more years of healthy life.
We found that many of the extra years we are now living are being spent in poor health, increasingly with more than one health condition. In fact of even more concern, for women, healthy life expectancy at birth has decreased in the past decade and improvements in healthy ageing have slowed for men.
The challenge we faced was how to talk about these important findings in healthy ageing when all around people, many older and some younger, were losing their lives due to Covid-19. Suddenly the prospect of helping people to live longer in better health looked like a bit of a luxury, if not a rather bad joke.
But the pandemic and the healthy ageing inquiry highlighted the same basic challenge that we ignore at our peril. It is clear that Covid-19 has hit deprived and ethnic minority populations more severely. The mortality rates from Covid-19 in the most deprived areas have been more than double those in the least deprived areas, and death rates are highest among people from Black and Asian ethnic groups.
People from the most deprived groups spend almost 20 years longer in poor health
Likewise, the grittiest finding of the select committee report, shocking though not unexpected, is that there are big differences in healthy life expectancy between ethnic groups, and that deprivation is a key factor.
People from the most deprived groups spend almost 20 years longer in poor health than the least deprived. For the latter, good diet, active lifestyles, avoiding smoking and a healthy social life throughout earlier life mean more resilience into healthier later years.
For people from deprived communities, the future is all too often having multiple morbidities from middle age and spending the later years in poor health. This is made worse by poverty, lack of social support and fragmentation of care.
We know about the lifestyle, environmental and economic factors across the life-course that correlate with good health in older age. The priority for both public health and economic policy interventions needs to be those living in deprivation.
The government’s Ageing Society Grand Challenge, which was to ensure people have five extra years of healthy life by 2035, may look a bit irrelevant right now. It certainly won’t be met. But the underlying message of the select committee report is valid for Covid-19 and post-pandemic, for health service reform, for the demographic timebomb and a host of other challenges.
At the heart of it all is the need for a clear plan to reduce economic, and thereby health, inequalities. We live in a country where the gap between the haves and the have-nots is one of the greatest in Europe, and widening. Real cuts in people’s incomes are damaging the nation’s health for the long term. All communities need support to live more healthily throughout life, alongside a major push on poverty as the key social determinant of health.
We have been warned. Sir Michael Marmot reported on health inequalities in 2010 at government’s request and again 10 years on, this time not commissioned by government. Had we listened and acted, the impact of Covid-19 could have been less devastating. But instead, Public Health England, the national body responsible for the co-ordination of public health effort, has been done away with in favour of a disease control model.
Though understandable in a pandemic mindset, who will be a beacon of leadership in broader public health for the future? Until we tackle the causes of health inequalities head on, our communities, our health status, and our economy will remain at high risk of successive shocks.
Baroness Young of Old Scone is Labour peer and a former chair of the Care Quality Commission
PoliticsHome Newsletters
Get the inside track on what MPs and Peers are talking about. Sign up to The House's morning email for the latest insight and reaction from Parliamentarians, policy-makers and organisations.
