Health inequality

Mortality from heart disease in England is highest in the North West, primary care trust figures indicate.

Richer areas in the south have lower death rates from heart disease than poorer areas in the North.

Yes, OK.

Dr Jessica Allen, of University College London, is one of the authors of a landmark report on health inequalities in England, the Marmot Review.

\”Significant variations in risk of suffering heart disease across England are shocking but sadly not unexpected,\” she said.

\”We know that many health conditions relate to social and economic status and these largely explain the variations in life expectancy and health status that we see across England between regions and within smaller areas.

\”It is still the case in England, as in most other countries, that the richer you are the healthier you are likely to be and the longer you will live.\”

And there is the problem with the Marmot Review, indeed, with just about all research into this area.

People move you tosspots!

So, let\’s start from the beginning.

We have areas of the country that are poorer/richer than other areas. We have people who are poorer/richer than others. We have people who live longer, in better health, that others. We also have a correlation between those longer lived people being the richer people and further, a correlation between there being more of those richer longer lived people in richer areas.

Well, yes, put like that, it\’s obvious, isn\’t it? If wealth leads to a longer life then areas with more wealthy people will have longer average life spans.

Now, if everyone stayed where they were born then we\’d be able to say that this difference in life spans (vide, the oft quoted average life span in the Gorbals is 3 months for men etc) was entirely to do with the vile regional socio-economic gaps in the country.

But people don\’t stay in the same place all their lives. Certainly, someone who gets educated, gets rich, doesn\’t go back to Gorbals, does he? No, he ends up on Morningside. Having that longer life span along with the other rich people.

So that\’s one thing that\’s wrong with the way these statistics are reported geographically. They simply not taking account of the mobility of the population. To take it to extremes, it\’s like saying that the secret of a long life is to be in a care home. Eh? No, wazzock, the people in care homes are in care homes because they\’ve lived lives long enough to become senile. Eastbourne\’s got a very long average lifespan. It\’s a retirement resort you see. Those who die before they\’re 65 don\’t get to move there.

But there\’s another, much worse, problem with the way that the figures are interpreted. I went through the whole Marmot Review once, looking for some discussion of this next point. Couldn\’t find even the mention of it, not even as something considered but rejected.

Let us agree that being poor makes you ill. Being ill kills you. OK, that\’s what everyone is saying and to an extent it\’s true.

Now, can we also consider this: being ill makes you poor?

It\’s a blindingly obvious point: for of course it does. You get hit with some chronic illness (Oooh, I dunno, severe Crohn\’s, heart problems, insulin dependent diabetes, emphesymia, whatever) in your 40s, then you financial prospects are really rather dimmed, aren\’t they?

Yes, sure, there\’s welfare, no one\’s left to die in the streets, but these sorts of severe and chronic diseases are going to lower your earning capacity. Illness will make you poor.

And nowhere in Marmot did I see this. The assumption is that all of the correlation between economic inequality and health inequality flows from the economic to the health. Which is complete friggin\’ nonsense, of course.

Just one final point: yes, the death rates from heart disease are higher in poorer areas. But if we presuppose heart disease, that is, we look at the death rates of those who do already have the affliction, then death rates are higher in richer areas.

To illustrate with some imaginary numbers.

20% of the people in the NW die of heart disease, 15% of people in Croydon do. That\’s the first case.

Of people who have heart attacks, 20% of people in Croydon die of that heart attack while only 15% of people in the NW die of that heart attack.

These numbers are entirely imaginary, as I say, but the underlying reality is not.

What kills is the national wage settlement for nurses, leading to shortages in high wage areas and copious supply in low wage areas.


17 thoughts on “Health inequality”

  1. The Grange, rather than Morningside, I’d have thought; or Inveresk, or Cramond, or Merchiston, or somewhere really lovely in or near Heriot Row, or Anne Street, or …. But, as you say, not the Gorbals. Mind you, a weegie might prefer to lurk in Weegieland.

  2. Come to think of it, do ill people like to flit to be near a big teaching hospital? If so, add Little France to my list.

  3. I say this as a chubby smoker…

    Isn’t self discipline a factor… Succesful people form good habits… and thus are more likely to take care of their diet etc.

    Whereas people who don’t give a shit and wallow in the benefits hammock, might say be more likely to have shitty habits…?

    Just saying…

  4. That’s not the only scandal; no, sir.

    I have read that half of our children are below the median in school achievement. How are we to progress as a civilization if half our children emerge from school so handicapped? I call for immediate government regulation to ensure that all our children achieve above the median level for their age. Nothing less should be acceptable in these modern times.

  5. “I have read that half of our children are below the median in school achievement.”

    Even more a scandal is where 40% of sick days are weekend-extending Mondays or Fridays.

  6. Even worse than that, the average number of legs per citizen in Britain is less than 2. How can we carry on carrying this burden of disability?

  7. Apparently prior to the NHS, hospitals in rich areas paid more so those in poor areas could n’t get staff.
    I should think the determining factor in distribution of nursing staff is cheap housing,negating the no- working-class-person- can-afford-to-live-in-London effect. The Ed Milliband idea of making council-housing a reward for social usefulness seems like a good idea. (My God the lights have gone out; I’ve been struck by lightning!)

  8. How the hell do you decide who is “socially useful”? Is not a shopworker socially useful? A maintenance engineer? A taxi driver? A fisherman? A farmer? A computer manufacturer? A textile worker? An accountant? A pornographic cartoonist?

    Doesn’t Comrade Ed’s “socially useful” actually mean, “special interests on the State payroll”? What’s special about nurses?

  9. If I recall early posts correctly I am sure that there is a correlation between Regional Government spending and health. Gretaer Government largess the poorer the health. If so should we campaign for a Health Warning on Government spending

  10. The labour government introduced a scheme for making mortgages more affordable for essential workers like nurses ( it may only have applied to nurses, I’m hazy about the details ). Does anyone know if it’s still going ?

  11. Surreptitious Evil

    “Key Worker” housing. Part of the “Homebuy” scheme – 50% of the Homebuy properties were reserved for “key workers”. These include nurses, teachers and the police.

    There is a separate scheme for the armed forces.

  12. Surreptitious Evil

    It seems to be a sub-set of “state employee” – whether these are actually the ones who are more valuable to society or just the ones with (more bought pols / better unions / public sympathy / whatever), I won’t even attempt to hazard a guess.

    To be honest, I’m not sure that nurses or teachers in the private sector are not entitled – it will probably depend on the individual housing associations rules.

  13. @ DBC Reed prior to the NHS hospitals in areas with expensive housing had to pay higher wages for nurses in order to cover the cost of fares from areas with lower housing costs. Hospitals in areas with lower housing coasts didn’t have a problem.
    For Pete’s sake, think when you are reading a Labour Party press release (even if it is disguised as an article in the Grauniad/Independent)

  14. Doesn’t smoking make you poorer and unhealthier?
    If we take 2 hypothetical people on average wage.
    They both smoke 40 a day and drink 30 pints a week.
    However at the age of 25 one of them stops doing this and uses the saving to pay his mortgage quicker – won’t the same thing make him healthier and richer?

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