The health gap between rich and poor is increasing, but why?

9th May 2016 / United Kingdom

By – If you are richer and better educated you’ll live much longer than if you are poorer and less well educated, according to new research published this week.

The links between inequalities and health are already well documented. What’s new is that, for the first time since the 1870s, that gap is widening.

The most striking thing about this report is how it explains the widening gap. Bypassing a huge body of evidence, it focuses on lifestyle and choice.

The research examined the average lifespans of men in England and Wales (discounting those who die before they are 30), and found that the longest-living five per cent of men were living to be 96 years old on average – 33.3 years longer than the shortest-living 10 per cent, who died at an average of just over 62 years.

The report, ‘An Investigation into Inequalities in Adult Lifespan’, attributes the discrepancy to ‘damaging lifestyle choices’, with ‘the poorest groups…more likely to fall victim to the cumulative effects of decades of poor lifestyle’.  It argues that ‘more educated people can process information relevant to their health better than less educated people’.

Attributing health inequalities to lifestyle choices flies in the face of a well-respected international evidence base, which demonstrates that health inequalities are not just the result of genetic makeup, ‘bad’ or unhealthy behaviour, or difficulties in access to medical care, important as those factors may be.

Inequalities in health reflect, and are caused by, inequalities in the conditions in which we are ‘born, grow, live, work and age’ – they’re systemic. They are caused by structural differences between social groups, which lead to richer people having a greater array of choices and more opportunities to lead a flourishing life.

Health-related behaviours may indeed be worse in poor neighbourhoods, but those behaviours are shaped by social, economic and environmental factors, not simply by individual choice.

Material circumstances, such as whether you live in a decent, well-insulated house and have enough money to live healthily, and psychosocial factors, such as whether you have a sense of control and autonomy over your life and adequate support networks, interact in complex ways to affect how life expectancy varies across populations.

In their research into links between politics, power and health, a leading group of academics make this observation:

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“Where ‘negative lifestyles’ exist within these [working class] communities, they are seen as closely connected to broader social and political circumstances.  [An] ex-miner told us how downwardly spiralling morale and behaviours in his community were rooted in changing circumstances: ‘The factories started slimmin doon, cutting workforces. The ability for young people to get into work was becoming limited. We started to see probably drugs in our community for the first time. And probably the excessive drinking was starting to take a hold as well…”.

The authors of this week’s report recognise that ‘personal choice does not exist in a vacuum’. But they conclude that choices are influenced by personal exposure ‘to advertising, communities and peer groups’, rather than by inequalities of income, wealth and power. The answer, they suggest, is new ‘policy tools aimed at changing behaviour … to steer people towards healthy lifestyles.’

The widening health gap is worrying. But no less worrying is the narrative that explains it in terms of lifestyle and choice.

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