An exclusive focus on helping the very poorest in society will fail far larger numbers of people who are at risk of ill health and an early death. That is the view of Professor Sir Michael Marmot, one of the UK’s leading public health academics.
Marmot, who led a commission on the social inequalities that lead to ill health for the World Health Organisation and then, this year, a review specifically for England, warned today that action was needed to help a large tranche of the population whose prospects are weak.
His work has shown a social gradient from the poorest to the most affluent – as people’s wealth, education and prospects improve, so does their health and their life expectancy.
Public health, he says, must be about improving housing, education and the environment, as well as diet and addiction.
At a discussion hosted by the British Medical Association, where Marmot shared the platform with the health secretary, Andrew Lansley, he warned that if the retirement age is set at 68 in years to come, as is planned, 75% of the population will still be prevented from working or curtailed in what they can do by ill health.
“The effect would be to shift people off pension on to disability benefits – a dubious social advance that would save no money,” said Marmot.
If everyone in England had the same health prospects as those who go to university, he said, “each year we would prevent 202,000 people aged 30 plus from dying prematurely – that’s 40% of deaths”.
In monetary terms, the benefits were enormous, he said, adding: “The cost of doing nothing is gigantic.” It equated to productivity losses of between £31bn and £33bn a year.
The cost of lost taxes and higher welfare payments amounted to another £20bn-£32bn and the additional NHS healthcare costs came to £5.5bn.
Speaking afterwards, Marmot said he was in favour of universal policies, such as child benefit.
“The British social policy has been we must spend the money where it will do the most good. It is common sense – but so are universal benefits,” he said.
“More of the inequalities in health come from the people who are not at the very bottom. There are just more of them.
“A concern about the decision on child benefit was about the erosion of universality. We shouldn’t close down perfectly good things just because the rich benefit from them.”
He also pointed to the substantial numbers of low achievers who were not in the bottom tier. Around 40% of young people in the third decile (bottom 20-30% in family income) do not achieve at least five C grades at GCSE. They do not go to university but may be among the 31% of 16- to 19-year-olds who are unemployed. Unless their prospects improve, they are already destined for worse health than their more affluent and better educated peers.
What are commonly considered public health issues – smoking, alcohol, poor diet and a sedentary lifestyle – may be the outcomes of social inequalities, which need to be tackled in every aspect of national and local government policy, Marmot believes.
Lansley reiterated his commitment to public health – on which there will be a white paper later this year.
“Our task is to improve the health of the public and improve the health of the poorest fastest,” he said. “The extent of inequalities and their persistent tendency to widen is a scar on society.”
But he stressed that better health could not be imposed on people. “We live in a free society. We can’t move to an unfree society to make this happen.”
The Guardian UK