For richer, but not for poorer...


For richer, but not for poorer...

The gap between the lifespans of the richest and poorest in the UK seems to be increasing for the first time since the 1870s. How can this worrying trend be reversed?

                Health inequalities are widening at an alarming rate


In 2014, the Office for National Statistics reported that the North East had the highest standardised mortality rate (SMR) in England: 14 per cent above the national level. Middlesbrough’s SMR was 37 percentage points above the national level. At the other extreme, the SMR was lowest in London: 9 percentage points below the national level.

Now, a new report from the Cass Business School and the International Longevity Centre suggests that the 5 per cent of the male population who survive the longest after reaching 30 years of age lived on average to 96.0 years, 33.3 years longer than the lowest 10 per cent. The gap increased by 1.7 years between 1993, when it was at its narrowest, and 2009.

The 5 per cent longest surviving women reach on average 98.2 years, 31.0 years more than the 10 per cent lowest. The gap was narrowest in 2005, then levelled out.

“The widening gap in life expectancy between the richest and poorest in society, which is already over 30 years’ difference, is shocking,” says Merron Simpson, chief executive, New NHS Alliance. “Given that we have been gradually improving population health for the best part of 200 years, this latest retrograde step is unacceptable.”

Unhealthy lifestyles largely underlie these trends, says the report. Between 1870 to 1939, the longevity gap gradually narrowed reflecting public health improvements such as clean drinking water, improved sanitation and mass vaccination. Everyone benefited, but the “improvements were disproportionately shared by the poor relative to the rich.”

Today, changes in mortality in old age (such as age-related chronic diseases) largely determine life expectancy. According to the ONS, potentially avoidable mortality – such as lung cancer and ischaemic heart disease – accounts for about 23 per cent of deaths in England and Wales. Men in lower socio-economic groups are the most likely to make damaging lifestyle choices, the Cass report says.

“The finding that the life expectancy of those in the lowest and the highest socioeconomic groups is diverging for the first time since the 1870s is of concern,” says John Smith, PAGB chief executive.

“Good nutrition is important to support the healthy ageing process but we have known for a number of years that people in lower socio-economic groups tend to have a poorer diet than those who are more affluent. People who do not meet the Government’s recommendations for a healthy diet are missing out on important vitamins and minerals and it is these dietary deficits that can fuel an epidemic of ill health.”

Creating wellness

If we are to truly address the issue, it will be important to look at what lies behind the choices people make, rather than to blame them for making the choices they do, says Merron Simpson.

“While it is critical to work with people to tackle today’s lifestyle issues, we need to recognise the complex realities of people’s lives, particularly those who are struggling the most. We know there are ways in which health inequalities can be reduced through healthcreating practices, but they require a very different approach from the one the NHS is used to. Both the NHS and public health services need a change of mindset, from treating illness to creating wellness.”

Community pharmacists can provide local leadership in areas of deprivation, says Sandra Gidley, chair of the RPS English Pharmacy Board, but funding cuts are a concern to the provision of these services in the long-term.

The widening gap in life expectancy between the richest and poorest in society is shocking

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