Inequality in the NHS

Well, yes:

On health inequalities Field is scathing. \”Despite record investment in the NHS over the last 12 years the gap in life expectancy between the richest and poorest has widened. In some areas it\’s become shockingly bad. A woman in north Somerset is likely to live 20 years longer than a man in Blackpool. And this is getting worse. These health inequalities are abhorrent. The fact the gap has widened is inexplicable, really. For an industrialised, rich country in the western world to have such an inequality gap is an absolute disgrace.\”

That\’s a very dodgy number indeed: comparing life expectancy of men with that of women will always (well, now that we\’ve largely conquered the risks of childbirth) give you a longer life for the woman. So confusing the two, income and gender is very naughty. But there\’s obviously a reason for this:

The board will abide by the doctrine of \”proportionate universalism\”, propounded by health inequalities pioneer professor Sir Michael Marmot, that resources are used to benefit everyone\’s health but especially poor and marginalised groups. Field says the interests of social justice and the need to reduce demand on the NHS and boost the economy by tackling illness-induced inability to work mean the cycle of ill health depending on someone\’s postcode, ethnic origin or family background must finally be broken.

Yes, the reason being Marmot.

And we\’ve a large and very serious problem here. Marmot is indeed the go to guy on this. Everyone says and agrees that he\’s the expert. Yet he\’s made a simple and basic mistake in his research. Or at least, he has done in what I\’ve read of it (which isn\’t, of course, quite the same thing). I did actually read through the whole of that Marmot report. And there was something very important lacking from it.

Do income and wealth inequality contribute to health inequality? Sure, yes, they absolutely do. The poor end up living by the busy road junctions for example, have a worse diet, smoke more and so on.

But that does not mean that we can assign all health inequality to income or wealth inequality, which is the assumption that Marmot makes. For it is also obviously true that health inequality leads to income or wealth inequality. Getting hit with some serious and chronic disease in your 40s can happen to absolutely anyone, rich or poor. And having been hit by that you are going to be poorer than if you hadn\’t been hit by it.

It\’s a two way process: and assuming that it\’s only a one way one is simply wrong, an error. But that error is now coded into all of the information that everyone uses to think about and attempt to address this problem.

There\’s another one in the death statistics as well: people move. The generally wealthy old of Eastbourne die much later than the generally poor old of some Glasgow slum. This is entirely true. But those raw numbers don\’t take account of the fact that the long lived wealthy often move in retirement. Including, of course, some of those who started out in some Glasgow slum.

This error is akin to noting that people in old age homes appear to have longer lifespans than the general population. Well, yes, of course they do: for you\’ve got to reach old age before you can be in an old age home. And expected life span at age 75 is higher than expect lifespan at age 40. Obviously it is, for the former already leaves out all those who die between 40 and 75 years of age.

Regular readers will know that I get very het up about people making decisions on incomplete statistics. And I\’m afraid this is one of those areas where everyone, but everyone, is using the wrong numbers.

Some health inequality is undoubtedly caused by income and or wealth inequality. But to work out how much we must correct for population movement and also for the way in which some health inequality will lead to income inequality. And the entire field, everyone in it, does not make those two corrections. Thus we\’re all working from the wrong figures. Which, when we\’ve got the government trying to plan these things isn\’t a good place to start from, is it?

7 thoughts on “Inequality in the NHS”

  1. Couldn’t ill health and poverty be caused by the same thing e.g. smoking.
    If I smoked I would be less healthier and poorer.

  2. If they’re allocating NHS money by life expectancy, that will mean less for women’s health problems and more for men.

    Could get interesting when the poverty campaigners and the women’s libbers clash.

  3. How the hell do you equalise health outcomes for ethnic origin? By definition that includes immigrants. They’ve not been covered by the UK health system & all the things he’s suggesting, so their outcomes will be different.

  4. “bloke in spain // Mar 20, 2013 at 11:37 am

    How the hell do you equalise health outcomes for ethnic origin? By definition that includes immigrants. They

  5. I might once have sneered that people study “health inequality” because they are too dim to study physics. Given the Global Warming scam, and the antics of the Royal Society, I am now denied that simple pleasure.

    On the other hand, I’m pretty confident that very few of the undergraduates whom I’ve taught would have made those mistakes.

  6. So Much for Subtlety

    bloke in spain – “How the hell do you equalise health outcomes for ethnic origin?”

    Well if people of Afro-Caribbean origin live twenty years less than people of Euro-British origin, the solution seems simple – Afro-Caribbeans are about 5% of the population, White British live to be about 80, so …. quick maths …. we would have to smother at birth about 1 in 400 pinkish babies and then life expectancies are equalised.

    I mean, it is a sacrifice, sure, literally, but I am just as sure that the Guardian Tendency would be happy to support it in the name of equality.

  7. i) The growth in inequality of life expectancy is not just due to the worsening of the NHS under New Labour when Brown decided to increase pay for doctors and nurses without increasing the NHS budget and directing doctors to prescribe generic drugs without changing the formula for reimbursing drug companies, so the NHS had to cut down on resources i.e. the number of doctors and nurses and quantity/ quality of drugs prescribed. The billions thrown at the NHS since then have not been enough to fully restore quality because large numbers of nurses made redundant (large lump-sum payments out of said billions) have been working as locums at higher cash pay (NHS pension costs are hidden) plus the fees paid to the recruitment companies and because several £billion has been wasted on incompetent IT systems provided by New Labour’s paymasters or pets.
    ii) Ill-health/disability reduces income: hence the rejoicing in Acts III:8. The left-wing attempt to reverse causality was first drawn to my attention in the late 1970s by my socialist assistant/trainee (his socialism didn’t stop him becoming much higher paid than I after he moved on as he had less scruples/inhibitions than I about financial dealings within the law). There is also a weaker effect for low income to reduce health but I cannot remember the last middle-class guy to become world heavyweight champion (middle-class before not after!).
    There is a third effect that in a bureaucratised system, the better-educated who, as one side-effect are better able to cope with bureaucracy and multi-page forms and other failings of the system will have better survival rates and, on average, higher incomes as another side-effect.

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