At the root of our health crisis is poverty

23 Mar 2023 Nick Garbutt    Last updated: 23 Mar 2023

Pic: Unsplash

Health inequality lies at the heart of the crisis in care we are living through. Yet few members of the public know what it means, or what needs to be done about it.

It would appear that most politicians are oblivious too – at least that would be the kindest way to explain why they seem either unable or unwilling to address the root problem.

And for all of us there is a need to accept that better health for all requires action far beyond hospital beds, white coats and stethoscopes. It requires joined up, mature politics that recognises the health consequences of policies.

It also necessitates a simple choice: are we prepared to pay the financial cost and accept the moral consequences any longer for policies we pursue?

First let’s deal with some facts. The link between how much money people have and their mental and physical health is very well established. Poverty, and especially persistent poverty is associated with worse health. So much so that health think tank The Health Foundation is able to estimate that an increase in household income of £1,000 is associated with a 0.7-year increase in female healthy life expectancy.

Furthermore 31% of people on the lowest incomes report ‘less than good’ health. In middling incomes this figure is 22% and for people on the highest incomes the figure is 12%.

And to put these figures into context 13.6 million across the UK live in poverty, one fifth of the population.

Single parents with children, people with disabilities and those from ethnic minorities are the most likely to be affected.

Poverty may well be a cause, and is sometimes a consequence of ill-health, but it is not inevitable. So clearly, if we want to address health and reduce the stress on an overburdened system we have to address poverty.

The UK currently has a government that has overseen a period where the poverty gap has widened. Meanwhile, in Northern Ireland we are unable to do anything to ameliorate the effect this have because we have no government. And we have no government because one of our parties objects to the fine print of our Brexit deal.

There are many policies that would help people escape poverty. One of the more obvious would be increasing the stock of available affordable housing. Currently 29% of people in the private rented sector are spending more than a third of their income on housing costs, compared with 10% of social renters and 3% of owner-occupiers.

Whilst affordability has got worse for those who rent privately, it has decreased for home owners.

Private renters also face the consequences of inadequate legislation which can mean serious problems with homes being unaddressed, inefficient heating and precarity of tenure.

Food poverty has become an increasingly serious problem thanks to the war in Ukraine.

But even before then it was responsible for multiple deaths. Around 3.26 million people were in fuel poverty last year, according to the government. In addition there were 178,000 excess winter deaths over the last five years. Almost 17,000 of those people are estimated to have died as a direct result of fuel poverty and a further 36,000 deaths are attributable to conditions relating to living in a cold home.

It’s not just the fact of poverty that’s a problem, the prospect of it too can do damage. A lot of research points to the cumulative impact of economic hardship and strains over prolonged periods.

Heightened stress and anxiety caused by poverty can have a really damaging effect on both mental and physical health if experienced over a long period.

One of the most harmful factors that can affect people is a prolonged period of poverty when they are children.

Not only does that make it more likely they will: die in the first year of life; be born small; be bottle fed; breathe second-hand smoke; become overweight; suffer from asthma; have tooth decay; perform poorly at school or die in an accident it also has been shown to makes a significant difference to their outcomes later in life: poorer children have worse cognitive, social-behavioural and health outcomes.

There’s more as well. People with a low income are more likely on average to engage in unhealthy behaviours, such as smoking, high alcohol consumption, inactivity, high calorie intake and not taking advantage of preventive health services.

Low income produces stress – and many turn to drink and or drugs as a means of coping and of escaping from the misery of their lives of struggle.

Quite apart from that people in poverty tend not to be able to afford healthy diets.

Mental health problems are today widely acknowledged as forming the greatest public health challenge of our time, and that the poor bear the greatest burden of mental illness.

Once again one important driver of the mental health crisis is poverty. Poverty is both a cause of mental health problems and a consequence. Poverty in childhood and among adults can cause poor mental health through social stresses, stigma and trauma.

Mental health problems can also lead to loss of employment or fragmentation of social relationships. The reality is, for many people with mental health problems, that they will live in and out of poverty, living precarious lives.

A study in Scotland showed the clear link between poverty and deprivation in childhood and adult mental health.

In 2018, 23% of men and 26% of women living in the most deprived areas of Scotland reported levels of mental distress indicative of a possible psychiatric disorder, compared with 12 and 16% of men and women living in the least deprived areas.

Suicide is also three times more likely in the most than in the least deprived areas.

What seems particularly striking – and disturbing is that, just like in physical health, inequalities in mental health emerge early in life and become more pronounced throughout childhood. In one cohort study, again in Scotland, 7.3% of 4-year-olds in the most deprived areas of Glasgow were rated by their teacher as displaying ‘abnormal’ social, behavioural and emotional difficulties, compared with only 4.1% in the least deprived areas. By age 7, the gap between these groups had widened substantially: 14.7% of children in the most deprived areas were rated as having ‘abnormal’ difficulties, compared with 3.6% of children in the least deprived.

It is time that we renewed focus on the social causes and consequences of mental health problems especially given recent increases in social inequalities and people working in the field need the support to advocate for the sort of progressive public policies required to reduce poverty and its impact.

In doing so they would not be doing anything radical. In the nineteenth century the linkages between poverty and ill-health were widely acknowledged, and alleviating the impacts of poverty were regarded as a necessity.

There was also explicit recognition of the requirement to spend in non-clinical areas to improve health – on sewage, sanitation and air pollution for example.

If we are to improve health for all we need to acknowledge that and to accept that the best way to start addressing that is to reduce poverty, which lies at the root of so much that ails us.

This will inevitably bring those who want to make our health better into politics. That can’t be helped because to pretend that the two are not connected and that policies that make the poor poorer do not have consequences for their health would be to perpetuate a lie and mislead the public.

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