How Inequality Hurts

Why Health Care Matters Less than We Think

The British already have universal health care. So why do average life expectancies in the UK vary so dramatically by neighborhood? A new UK blue-ribbon commission has some answers to questions that Americans ought to be asking.

A review of Fair Society, Healthy Lives, the Marmot Commission Strategic Review of Health Inequalities in England Post-2010. London, February 2010.

By Sam Pizzigati

Policy makers in the United States spent last year talking about health care. In the UK, policy makers are talking about health.

The British already have universal health care. Nobody goes without medical attention in the UK because they can’t afford it. Yet staggering health inequalities remain. People in the UK’s richest locales live, on average, 17 more disability-free years than people in the poorest.

But British health inequalities go far beyond this contrast between rich and poor. The rich live longer and healthier lives than the near rich, the near rich longer and healthier than the middle-income. Health in the UK follows, in other words,  a “social gradient.” The lower a person’s social status, the worse a person’s health.

Marmot ReviewTwo years ago, the UK secretary for health asked Sir Michael Marmot, one of the world’s most distinguished health analysts, to chair a commission that would “propose the most effective strategies for reducing health inequalities in England.”

That commission’s end product — Fair Society, Healthy Lives, or, as better known, the “Marmot Review” — last week went public, with hundreds of pages full of charts and graphs, a veritable epidemiological treasure chest. Amid all the data, a simple message: We can prevent health inequalities.

But to do that preventing we need to understand why we have these inequalities in the first place. And today we don’t.

We typically blame poor health on unhealthy behaviors. Or bad genes. Or a lack of access to health care. None of these factors, as important as they may be, turn out to statistically explain why some among us live lives so much longer and healthier than others. What does?

Says the Marmot Review: “Social and economic differences in health status reflect, and are caused by, social and economic inequalities in society.”

If we truly want to tackle health inequalities, advises the Marmot commission, we need to address “inequalities in the conditions of daily life and the fundamental drivers that give rise to them: inequities in power, money, and resources.”

Societies that have done a better job narrowing these inequities than Britain — or the United States — have people who live longer and healthier lives.

The new Marmot Review comes complete with recommendations for countering inequalities in everything from early childhood development to “the freedom to participate equally in the benefits of society.”

Behind all these recommendations sits an optimistic vision — and a warning. The vision: Our current economic crisis offers us an opportunity “to do things differently.” The warning: If we don’t do things differently, if we simply endeavor to restore the economic growth we had pre-meltdown, we doom millions to an ill-health they should not suffer.

signup“Economic growth without reducing relative inequality will not reduce health inequalities,” the Marmot commission cautions. “The economic growth of the last 30 years has not narrowed income inequalities.”

And those inequalities — not just poverty — drive ill-health.

Poor English neighborhoods, explains the commission, display little of the sheer material deprivation — the lack of access to clean water, sanitation, and shelter — that plagues the developing world. Yet life expectancies in these neighborhoods run no higher than life expectancies in nations like Egypt, Ecuador, and Belize, “all countries that have a lower Gross Domestic Product.”

The ailments that are shortening UK lives — heart disease, drugs, alcohol, smoking, poor nutrition and obesity, accidental and violent deaths, mental illness — don’t emerge out of sheer destitution. They emerge from the stresses and strains of daily life in a society growing ever more unequal.

If this inequality reversed, the Marmot Review posits, if the daily conditions of life became “more equitably distributed,” ill-health in England would begin to fade.

Britain’s health secretary, Andy Burnham, has hailed the new Marmot commission report as a giant step toward a “historic achievement.” Said Burnham last week: “Everyone should have an equal chance at good health.”

Everyone would have that chance — in a UK, or a United States, more equal.

Sam Pizzigati edits Too Much, the online weekly on excess and inequality published by the Washington, D.C.-based Institute for Policy Studies.

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