Kayte McCann on health inequalities

Kayte McCannIf I were to ask you what the primary care trusts of Gateshead, Lambeth, Rotherham, Liverpool and Tower Hamlets had in common, what would you say?

Would you realise that they make up a selection of the 62 spearhead PCTs that were identified in 2006? Because until very recently, neither would I. In fact I wouldn’t have been able to tell you what a spearhead PCT was until I attended a press conference about health inequalities at the National Audit Office (NAO). The story is now live at BMJ.com

It turns out that the spearhead group is a list of 70 local authorities, containing 62 PCTs that are in the bottom quintile nationally and tick 3 out of 5 boxes for health and deprivation markers.

The press conference was about a report by the NAO comptroller and auditor general, indicating that the target to reduce health inequalities was failing. The plan in 2002 was to reduce the health inequalities gap by 10% within 8 years. It was a wonderful idea; the gap in life expectancy between the richest and the poorest would not be such a gaping chasm of doom. Meaning that by now the problem would be improved – but sadly it hasn’t worked quite so well. Ironically, instead of getting smaller, the gap is increasing. Since the spearheads were identified the gap in life expectancy from birth has increased by 7% in men and 14% in women.

It might not seem like such a big issue. The rich live longer and the poor die younger – it would be almost expected. But then you see the figures…

According to the press release: “If everyone in England had the same death rates as the most advantaged, people who are currently dying prematurely as a result of health inequalities would, in total, have enjoyed between 1.3 and 2.5 million extra years of life.” Simply unfathomable. But it echoes the Marmot review earlier this year. Fair Society, Healthy Lives was published in February 2010 and was commissioned to provide an evidence base to reduce health inequalities: “There is a social gradient in health – the lower a person’s social position, the worse his or her health.”

I’m sure there would be some economic spin about how many working days this means we have lost as a country, and how much damage this does to the workforce and so on, but on the bare face of it, if you’re poor you are more likely to die approximately 10 years younger than a wealthy counterpart.

I don’t know what I’m more shocked by – these figures, or the fact that I didn’t know about any of this? I’d always known that being from a lower socioeconomic background predisposed you to poorer health, but I hadn’t realised the massive impact on life expectancy. And why didn’t I know of spearhead groups? Perhaps it’s because I’m not a resident anywhere near one. I’m going to admit a little ignorance on my part.

But maybe the solution would be easier to understand: increase prescribing of lipid-regulating drugs, anti-hypertensives and increase capacity of smoking cessation services. According to the National Audit Office this change would cost around £24 million per year to implement – a snip when you compare it to the £3.9 billion that spearhead PCTs spend each year on cardiovascular and respiratory illnesses.

Saving money and improving life expectancy? If it sounds too good to be true then why haven’t we tried it before…

Kayte McCann is a final year medical student at the University of East Anglia