Poverty is bad for you

Men in the most deprived areas of Northern Ireland live, on average, over seven years less than those in the richest parts of our wee country.

Male life expectancy in the 20% of poorest areas is 74.2 years - 7.1 years less than the 81.3 years seen in the most affluent 20% of areas.

For women, the gap in life expectancy between most and least deprived is not as large but still significant. In the 20% most deprived areas it is 79.6 years while in the least deprived it is 84.1 years – a difference of 4.5 years.

These figures are from the Department of Health, which published Health Inequalities – Life Expectancy Decomposition last week.

Several factors contribute to these differences. A multi-faceted approach is needed to try and close the gaps.

The pursuit of such approaches should not be taken for granted. The sugar tax came into effect last April and represents an attempt to improve the population’s diet – and thus its long-term health – and there are currently plans to extend this legislation.

However, new Prime Minister Boris Johnson has already spoken out against so-called sin taxes, calling them “nanny state” and pointing out they “clobber those who can least afford it” - which is one interpretation of a tax designed to encourage better health.

Deprivation gap analysis

To see why this is important, look more closely at the Department of Health’s life expectancy figures – and, in particular, its deprivation gap analysis for the period 2015-17.

It divides the population up into different age groups that roughly correspond with decades of life: 0-9, 10-19 and so on, until we get to 90+.

When looking at males, nearly all of these age brackets contributed to the life expectancy gap. The exception is in the 90+ bracket, which researchers believe is “likely due to a larger proportion of the population in the least deprived areas surviving into the 90+ age group.”

Per the report: “In 2015-17, almost a quarter (1.6 years) of the life expectancy deprivation gap was due to cancer related mortality with almost half (0.7 years) being attributable to lung cancer. 

“Of the 1.4 years that circulatory disease contributed to the life expectancy deprivation gap, more than two-thirds (1.0 years) were attributable to CHD.

“Suicide was the third highest contributor to the deprivation gap, after cancer and circulatory diseases, contributing 1.2 years of the total. Of this, three-quarters (0.8 years) was attributable to males between the ages of 20 and 39 years.”

The burden placed on tobacco firms, both in terms of taxes and also clear displays of the potential consequences of smoking, is large. This is because of the dangers to health.

Circulatory disease is second only to cancer. Sugar contributes to this. That’s the rationale for all sin taxes.

More stat analysis

When it comes to females, the deprivation gap analysis follows a similar pattern. Again, the 90+ age group is the only one where those in the most deprived 20% of NI areas see a life-expectancy gain compared with those in the least deprived 20%.

“Across the majority of age groups, females living in the most deprived areas experienced higher mortality rates compared with those living in the least deprived areas. Females aged between 60 and 79 years contributed over half of the total life expectancy deprivation gap. Over a third of the gap was attributable to those aged 20-59 years with suicide being the highest contributing cause in females aged 20-59 years.

“In 2015-17, greater mortality in the most deprived areas resulted in a 4.5 year deprivation gap for females. The difference in cancer mortality, mainly due to lung cancer, was the largest cause of the female life expectancy deprivation gap.

“Additionally, 0.9 years and 0.8 years were attributable to mortality from circulatory and respiratory diseases respectively. Of all respiratory diseases, chronic lower respiratory diseases were the largest contributor to the gap, mainly due to mortality among females aged 50-79 years.”

The future

Dr Alan Stout, chair of the NI British Medical Association GP committee, told the Belfast Telegraph these latest statistics “sadly show no reversal” of the deprivation gap here.

He said lifestyles are a factor while “complex and multi-layered issues” mean that those in social and economic deprivation are “still disadvantaged in terms of health outcomes”.

“There needs to be a multi-agency approach to addressing these issues as factors like employment, education and housing play a significant role in health outcomes.”

Alliance Party MLA Paula Bradshaw said: “The latest life expectancy figures for Northern Ireland show a mixed picture. Life expectancy is still rising, which is not the case in some neighbouring countries, and the gap between males and females is closing…

“Secondly, the gap between male and female life expectancy is accounted for almost entirely by deaths resulting from cancer or circulatory disease, roughly equally. These also account for half the life expectancy gap between the poorest and richest areas.

“This reinforces the need for a cancer strategy and implementation of the Bengoa principles around identifying and treating cancers earlier, and also the need to take circulatory disease far more seriously, as there is too little focus on it.”

Ms Bradshaw is not wrong but Dr Stout is perhaps more right. Better curative care is no cure all.

Closing the gap

The life expectancy gap can be shrunk in several ways. First of all, by closing the health gap between people who are better off and those who are not so well off.

But how far that can go? It is fair to wonder if we might need to close the wealth gap, per se, to improve these figures past a certain point.

Poverty is bad for you. Some of its negative consequences might be innate – and, if so, tackling the wealth gap itself is essential for tackling the consequences of that gap (this is not limited to health).

It is too early to say whether or not the sugar tax has been a success. It has barely been in place for a year. However, a changing approach to tobacco – taken over many decades – is generally well thought of.

Calling something “nanny state” is just rhetoric. Reality is a question of whether something works, whether it has unintended consequences, and whether the picture taken as a whole is a good one.

One thing is for certain – NI’s life expectancy gap between rich and poor is massive. It is hard to see how it can be considered acceptable. Therefore, something has to change.