Wednesday 2 November 2011

Widening health inequalities signal trouble ahead

Last month brought depressing news for political observers of an egalitarian bent. The Office of National Statistics announced that the gap between life expectancy in the poorest and richest communities in the UK had widened, with men in Kensington and Chelsea now living on average 13.5 years longer than men in Glasgow.

This headline measure of health inequality actually masks an even worse story. For in recent years geographic differences in the length of disability-free life have increased more quickly than variations in life expectancy itself. In poorer neighbourhoods people not only tend to die earlier. They live with ill-health for longer as well. And the gap is edging higher.

This matters because health inequality is ultimately the most important dimension of social justice. Not only do most people value long, healthy lives above all else, but variations in health in middle and later life mark the culmination of lifelong inequalities. The overwhelming conclusion of the 2010 Marmot Review on Health Inequalities was that gaps in the incidence of long-term disability and then premature death are the result of enduring inequalities of money, power, educational achievement, employment opportunity, and environment. Stereotypical health-related factors, such as unhealthy lifestyles or industrial accidents, only explain a small part of the variance.

This is just the latest piece of bad news on inequality. Since 2007 income inequality has reached its highest level since records began. This has been caused not just by the well-documented excesses of the super-rich, but also by low income families failing to keep up with the middle. In hindsight, it looks like Labour's anti-poverty agenda before the crash was a heroic effort at running up a down escalator. Income inequality was stabilised through redistribution, but the underlying economic forces driving wider inequality did not go away. Now, with the economy still becalmed and the coalition's priorities elsewhere, the prospects for closing income gaps are gloomy.

Income and health inequalities are very different, however. Income is a snapshot (albeit a very important one) while health inequalities tell us about our whole life-course. In this respect looking at health is more like looking at our lifetime earnings profile. The gaps we see today are a result of the accumulated experiences of decades, not the period of office of the most recent government. Indeed, over the long-term, Labour's time in office may well turn out to have a positive bearing on gaps in lifetime health and wealth, because many of the key childhood inequalities, such as gaps in GSCE attainment, did close modestly. It goes without saying that it will be decades before we know what impact this will have on earnings differences let alone health inequalities.

Meanwhile the widening gaps in life expectancy should be ringing alarm bells within the Department for Work and Pensions (DWP). Ministers are about to consult on rapidly accelerating the planned increases to the state pension age. When you look at the averages, it is hard to quarrel with the proposition that the pension age should rise so that future increases in life expectancy are split fairly between working life and retirement.

But widening health inequalities make the argument far harder to sustain. If men in Glasgow can only expect to live to 73 and the rate at which their life expectancy is improving is not keeping up with the national average, why should their pension come later? The dilemma is then exacerbated by inequalities of disability. In the poorest fifth of English neighbourhoods the average man can expect to become disabled at 55, a figure that is rising gradually but by less than the nationwide figure. Can we really expect these people to wait longer for their pension, or will solutions to such tragic concentrations of ill-health need to come first?

The DWP may not like to hear it but its next wave of reforms will be a non-starter, unless the formula for increasing state pension age is firmly anchored on prior improvements to healthy life expectancy in poor communities. The prospect of savings to the massive pensions bill should be an incentive for all corners of government to work together to prioritise closing the health gap.

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