Health inequalities

Health inequalities are avoidable health differences across populations and between different groups within societies. The causes of health inequalities are multifaceted and due to the effects of social and economic conditions that determine people’s risks of illness and preventatives and or curative actions they can take. They can involve differences in health status (for example life expectancy and prevalence of health conditions), access to and quality of care, behavioural risks and wider determinants such as housing and employment.

Differences in health status can be due to a range of factors such as socio-economic, geography, sex, gender, ethnicity, disability and those that are considered socially excluded (for example those experiencing homelessness). Inequalities exist between countries and within countries. For example, life expectancy ranges from 34 years in Sierra Leone to 81.9 years in Japan. The infant mortality rate is 2 per 1000 live births in Iceland and over 120 per 1000 live births in Mozambique and the lifetime risk of maternal death during or shortly after pregnancy is only 1 in 17 400 in Sweden but it is 1 in 8 in Afghanistan. In England, people living in the most deprived areas had life expectancy 19 years shorter than those living in the most affluent areas in 2014–2016. The infant mortality rate ranged from 2.8 per 1,000 live births in the least deprived areas to 5.9 in the most deprived areas in the same year. a

Health inequality research has led to many questions, definitions, strategies and finings as well as certain solutions in improving health outcomes both nationally in the UK and globally. The Marmot Review, Fair Society Healthy Lives 2010, was a review of health inequality in England. The review stressed that reducing health inequality is a matter of fairness and social justice, as health inequality stems from social inequality. Marmot highlighted a social gradient within society — essentially the lower a person’s social status, the worse their health is. Focusing solely on the most disadvantaged within society will not do much in reducing health inequalities. Universal action with a scale and intensity that is equivalent to the level of disadvantage was stated to reduce the steepness of the social gradient in health Marmot proposed required action on six policy objectives:

  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure a healthy standard of living for all
  • Create and develop healthy and sustainable places and communities
  • Strengthen the role and impact of ill-health prevention

Health inequalities not only reduce an individual’s quality of life but can also give rise to avoidable mortality. Covid-19 has shown a harsh on the stark health inequalities that persist in our society. like nearly every health condition, COVID has had a disproportionate impact on people working lower-paid jobs, black and ethnic minorities and people living in poorer areas. The inequalities highlighted by COVID-19 are not new to public health researchers but what they highlight is that little effort has been done to address the inequalities and ultimately improve people’s health. The issue here is not that the virus has disproportionally affected certain groups within society, but that it has taken a global pandemic to start a conversation on health inequalities.