Fenland Sunset Fellside sunset (Rosie Jennings, age 4)

As George Osborne promises fresh hardship for the working poor, Prof Michael Marmot and Dr Angela Donkin look at the impact of growing inequality on child health

Clare Sambrook writes: Yesterday, speaking at his party’s conference, Chancellor George Osborne harked back to the Steam Age, the “golden age of Boulton, Murdoch and Watt, “when the spirit of invention was alive and the marriage of business and science made everything possible.” Osborne said: “I want us to be that Britain. Let’s raise the ambition of the nation so that everyone has the chance to succeed.” Then he promised that a future Conservative government would freeze benefits to people of working age, squeezing the already stressed working poor. Over to Prof Sir Michael Marmot and Dr Angela Donkin:

Persisting social inequalities in early child development and an alarming increase in poverty were among figures we (the UCL Institute of Health Equity) published last week. We have been monitoring trends in health inequalities and their causes since the publication in 2010 of Fair Society, Healthy Lives: the Marmot Review.

The findings show a worrying picture. Inequalities in life expectancy and healthy life expectancy persist. The difference between life expectancy at birth between the most and least deprived areas of the country is eight years for women, and nine point two years for men.

There is an even higher level of inequalities in healthy life expectancy – that is the length of time someone can expect to live in good health.  For example if you are a man, you can expect to live 55 years in good health in Manchester, compared to 70.3 years in Richmond upon Thames.

We have shown, previously, that the majority of the variation in health can be explained by inequalities in the conditions in which we are born, grow, live, work and age. To address these inequalities in the life course Fair Society, Healthy Lives set out its policy recommendations, in six domains: To ensure every child has the best start in life,

1Enable all children, young people and adults to maximise their capabilities and have control over their lives,

2Create fair employment and good work for all,

3Ensure a healthy standard of living for all,

4Create and develop healthy and sustainable places and communities,

5Strengthen the role and impact of ill-health prevention.

The Government white paper that followed Fair Society, Healthy Lives (Healthy Lives, Healthy People: Our strategy for public health in England) accepted all but one of the recommendations (the recommendation for a minimum income for healthy living). Encouragingly as well, alongside a general acceptance of the need for action, there has been significant support from the Department for Health, with for instance, the introduction of the Public Health Outcomes Framework (PHOF) within England. PHOF is a monitoring system with the ultimate aim of reducing health inequalities. 

However the results regarding trends in the causes of health inequalities are discouraging.  More needs to be done across all government departments, and the approach needs to be joined up.

A key focus should be early child development.  Good early development is a predictor of better health outcomes in later life. 

The Department for Education’s own figures sadly show only 52 per cent of children achieved a good level of development at the end of reception class. For those on free school meals this drops to a heart sinking 36 per cent. It isn’t as simple as being poor = bad health and being rich = good health. There is a gradient. For each step up the social ladder, for each increase in income decile, our health and the social determinants (the conditions in which we are born, grow, live, work and age) improve.

If we compare ourselves to other countries, then we don’t perform as well as we ought to on measures of child well-being. A Unicef report last year placed the UK in 16th place in the OECD, below Slovenia, the Czech Republic and Portugal. 

We know that the Department for Education have expanded provision of childcare places to those who are disadvantaged, however this is at a time when there are increasing numbers of families not reaching an acceptable standard of living. Those Departments responsible for benefits, wages and economic policy need to be involved if we are to make headway on inequalities.

On a brighter note, there have been improvements in GCSE attainment and unemployment is down after growing sharply after the financial crisis of 2008. However better grades, and being in work need to be aligned with better prospects for the future. But they are not. We have seen a serious and far reaching squeeze on living standards. 

Figures from the Joseph Rowntree Foundation, which we have made available at a regional level, illustrate that the number of households who do not have enough money to live a healthy life has increased by a fifth, between 2008/9 and 2011/12: from 3.8 million to 4.7 million. Currently, 23 per cent of households, fall below this poverty threshold. 

In London, where costs are higher, more than one in four households (29.4 per cent) did not receive enough income to live a healthy life.  It is a disgrace that in this country nearly a million people will need to use food banks by the end of the year, according to estimates by the Trussell Trust.

If incomes are insufficient, it is more difficult to have adequately sized housing, free from damp, and adequately heated. It is more difficult to buy a nutritious diet, with fruits, vegetables and lean meat, leaving people to buy cheaper filling food, full of processed carbohydrates and fats.  

Families with children will struggle to provide them with the opportunities for enrichment that other families do, they will avoid having birthday parties and friends round to play, they will struggle to buy birthday presents, sports equipment and warm clothes. Parents will be stressed, and less able to respond to children positively, which we know is important for their development.

Thomas Piketty, in his book Capital in the Twenty-First Century, captured attention by pointing to dramatic increases in the concentration of income and wealth – we are heading back to 19th Century levels. This increasing concentration of capital and income is not good for our society. 

If we want a healthy economy, a healthy population, a fair society, a population with lower crime, we ought to be very concerned.

It is now the case in England that a majority of people below the poverty line are in households where at least one adult is in work. Whatever one’s political leaning, a failure to reward people adequately for hard work, cannot surely be the basis of a civilised society.

We need to ensure that work creates the opportunity for a healthy life, that the jobs created provide sufficient income and a healthy working environment. 

We must do more to tackle health inequalities, starting from birth.  If we need a motivation beyond our ethical responsibilities, then we would do well to remember that health inequalities come at a huge cost. 

More children reaching a good level of development means less financial burdens on the NHS in later life. Lower unemployment means less economic inactivity.  Better working conditions mean less money lost to sick pay and less cost to the NHS. Tackling these issues has the potential to save many billions in future years.

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