A Tipping Point in Health Inequality?

By Hannah Comiskey

The premise of free healthcare throughout the UK has created the widespread illusion that access to good health is independent of the balance in your bank account, the postcode of your home or the job title which you hold. Britons pride themselves in living in a country which offers free health care built on the fundamental value that everybody matters, irrespective of background or economic circumstances.

And looking at the health figures within the UK, this idea that ‘everybody matters’, that you are not fundamentally disadvantaged by health or by systematic barriers within society holds true – that is, assuming you are white, middle-class, geographically privileged and a British born member of society. Take away your middle-class status and change your postcode to the rougher end of the city and watch your years of expected good health fall to nearly 20 years fewer than your counterparts living on the nicer side of town. Peck yourself down a few pegs on the socio-economic scale and watch your life expectancy drop by up to 10 years. Or walk in the shoes of a BAME individual within modern day Britain and watch your vulnerability to heart disease, diabetes or just having a significantly more unpleasant experience as a hospital patient sky-rocket relative to the general population.

Across neighbourhoods within and between cities, the UK has seen a widening in the health gaps between the most and least deprived members of our society in the last 10 years, gaps which have been cracked wide open and put in the spotlight during the Coronavirus pandemic. With the UK suffering a death toll devastatingly higher than our international neighbours, we have to ask ourselves whether there is more to these figures than the poor handling from the UK Government of lockdown measures. Perhaps the UK’s high death rate points to problems more deeply entrenched in our society.

Existing health inequalities identified at the beginning of 2020 have been exposed, mirrored and in many cases intensified by the impact of COVID-19. Put yourself back in the shoes of someone living in poverty and feel the stress of the knowledge that you, your neighbours down the hall or your family members who are also trapped below the poverty line, are twice as likely to die from COVID-19 than a Briton not living in poverty. Just being a woman living in one of Britain’s most deprived areas makes you 133% more likely to die from coronavirus than a woman living in one of the least deprived areas. Death rates from COVID-19 have also been revealed to be highest among people of Black and Asian ethnic groups, with a disproportionate number of COVID-19 patients in intensive care being black or from another minority ethnic background.

Higher rates of underlying health conditions, overcrowded living conditions and the high proportion of essential workers within these communities all contribute to such figures. But while the coronavirus pandemic may be new, for the most deprived in the UK, the pandemic has merely shone a spotlight on pre-existing issues which have been lying in the shadows of our Governments priority for years. The statistics are harrowing, but the years and generations of being overlooked and ignored as a group within society is all the more devastating.

The scandal therefore lies not in the disproportionate impact of COVID-19, but on the disproportionate efforts of the UK Government in the past decade to address health inequalities and improve the health of those in the most deprived and vulnerable areas of the UK population. It has taken a global pandemic to bring into sharp focus the health inequalities within our society. While the country leaned on those essential workers in the peak of lockdown to keep our shelves stocked, our hospitals staffed and our public transport mobile, the government has simultaneously failed the disproportionate amount of front-line workers coming from deprived or ethnic minority communities who have been most hard hit by the pandemic.

Even now, it is clear that improving the health of those most vulnerable in deprived communities is not at the heart of the Government’s priorities. The ‘Eat out to Help Out’ scheme, while quite ironic given the almost simultaneously delivered lecture on the importance of cutting obesity levels, is exclusive in its decisive target of aiding only those who can afford to ‘eat out’. Surely a better use of Government investment would be targeted towards aiding those who never mind being able to afford to ‘eat out’, can barely afford to eat in with foods conducive to good health.

Disappointingly, the Government seems more interested in preserving its inclusive efforts exclusively towards food groups, extending the enticing 50% food discount to everything on the menu from salads, to pizzas to deep-fried, heart disease inducing chicken nuggets at KFC. Choosing to subsidise only healthy options on the restaurant menus, discounting vegetables in the store or giving away free gym memberships in deprived areas as facilities start to re-open would have felt more appropriate given the desperate push in public health the UK needs.

Yet while the message that we must deal with our obesity crisis has been promoted loud and clear, only whispers surround the strong links between obesity and poverty – with the most deprived areas of the UK correlating with where obesity levels are highest. Black Britons are also reported to have the highest percentage of obese or overweight adults and also the highest rate of income poverty, compared to any other ethnic group in the UK. Associated with fewer years in good health and increased vulnerability to coronavirus, obesity is arguably at the heart of the health inequality crisis within the UK with deep roots in prolonged poverty and deprivation.

Although our PM may be able to afford a personal trainer to help him lose weight and improve his health, those struggling in the depths of poverty are trapped into unhealthy lifestyle habits by a lack of education, a lack of funds and the strain of living in deprivation. With this in mind, it is a time that the burden of obesity and the poor health of the most deprived within the UK is shifted from being entirely on the individuals themselves. We must move instead towards an effective government strategy tackling the well-established relationship between obesity and poverty.

In neglecting to address the rising vulnerability of those from deprived and ethnic minority groups to underlying health conditions, the UK has sleep-walked into the current crisis we find ourselves in with the coronavirus pandemic. The consequences of our complacency towards widening health inequalities are materialising in the disproportionately high death rates among these communities.

Within BAME groups specifically, a lack of robust ethnic data has contributed to the lack of accountability in addressing the higher likelihood of long-standing illness and poorer health than the general population. With no evidence to suggest that genetics explain the high susceptibility or death rate of BAME groups from COVID-19, as a society we must not abdicate responsibility. Instead, we must commit to confronting the systematic barriers and discrimination faced by the individuals within these ethnic groups which have created such long standing health inequities, now put in the headlines by the coronavirus pandemic.

Failure to make public health an urgent priority risks leaving the most deprived and disadvantaged members of society to carry the greatest burden of the pandemic. But more than that, failure to recognise how out of control health inequalities are within the UK, is a failure to recognise how socially and economically vulnerable the UK is. Both to future spikes in COVID-19 but also to new pandemics, given how at risk huge proportions of our population are to current and future health threats.

With this in mind, COVID-19 has acted only as a catalyst for the incredibly desperate position we now find ourselves in. For while health inequalities have driven the course of COVID-19 across the UK, the impact of COVID-19 is simultaneously driving these same inequalities into socially unacceptable levels. Where the health of our population risks becoming polarised based on which side of the socio-economic, postcode lottery or ethnicity scale you reside.

We have reached a tipping point which requires ambitious, forward-thinking and targeted intervention to address the root cause of our health inequality crisis. Funding to decrease the number of people falling into long-term poverty and tangible efforts generated from the official enquiry into the disproportionate impact of COVID-19 on BAME individuals are absolutely vital. While lockdown continues to be a necessary measure to prevent the immediate spread of virus outbreaks, narrowing the health gap offers a solution which is not only more sustainable, but fundamental if we wish to transform the current illusion of equal health opportunities in the UK into a reality which we can be proud of.

The views expressed in this article are the author’s own, and may not reflect the opinions of The St Andrews Economist.

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