Socioeconomic Health Inequalities

This is Article no. 2 in a series on health equalities. Previous article: What are health inequalities? Next article: Ethnic inequalities (coming soon).

Welcome to the second article in a series of articles about health inequalities. This article will look more in detail at what socioeconomic health inequalities are.

Introduction

Socioeconomic factors refer to the circumstances in which people are born, grow, live, work, and age. These conditions are often considered the wider determinants of health, and are a fundamental cause of health inequalities. These inequalities are not accidental; they are the result of underlying structural disparities, occurring as a result of unequal distribution of resources and opportunities in society. Addressing these disparities requires coordinated, cross-government action across a wide range of policy areas, including prevention and focused work on the wider determinants of health.

How income is linked to health

Poverty and financial insecurity have a significant negative impact on health, as living on a low income is a source of stress. It also affects an individual's ability to afford health-improving goods, from nutritious food to gym memberships.

Across the income spectrum, lower incomes are associated with worse self-reported health. Data from the Department for Work and Pensions’ Family Resources Survey 2023/24 shows that 43% of people on the lowest income rate their health as fair, bad or very bad, compared with 31% in the middle (the fifth income decile) and 15% on the highest incomes. The Health Foundation has visualised this in Figure 1.

The impact on health is even greater when low pay persists for generations: children from households in the bottom fifth of income distribution are over 4 times more likely to experience severe mental health issues compared to those in the highest fifth. Furthermore, Black, Asian and Minority Ethnic (BAME) individuals are disproportionately affected and are more likely to live in poverty, have low incomes, and lower levels of wealth compared to White individuals.

How housing links to health

The places where people live and age can significantly influence their health. Affluent areas have more access to green and other public spaces, clean air, and affordable and active travel. In contrast, deprived areas often have less access to green space, higher concentrations of fast-food outlets, and limited availability of affordable and healthy food. Individuals living in deprived areas will most likely have poor-quality and overcrowded housing conditions, associated with an increased risk of cardiovascular and respiratory diseases, depression and anxiety. They may also experience fuel poverty, so they cannot afford to heat their home. BAME households are more likely than White households to live in overcrowded homes and to experience fuel poverty.

Health outcomes and projections

The consequences of socioeconomic inequalities can be seen in differences in health outcomes. People in more deprived areas experience major illness earlier in life and die younger: in England, individuals in the 10% most deprived areas are expected to develop major illness 10 years earlier compared to those in the 10% most affluent areas. They are also over three times more likely to die prematurely before the age of 70. This inequality is projected to continue through to at least 2040, with no expected improvement.

These findings are supported by research which looked at the impact of socioeconomic factors on the COVID-19 pandemic. Results showed that unequal access to healthcare amplified COVID-19 cases. It meant that a significant portion of cases, which could have been prevented through timely diagnosis, treatment, and resource distribution, contributed to an overall case rate that was 6-fold higher than it otherwise might have been.

Additionally, a small group of long-term conditions contributes to most diagnosed health inequalities: chronic pain, chronic obstructive pulmonary disease (COPD), type 2 diabetes, cardiovascular diseases (CVD), and anxiety and depression. The prevalence of these conditions is 1.5 times higher in the 10% most deprived areas compared to the least deprived areas. The Health Foundation has visualised this in Figure 2.

Conclusion

Socioeconomic health inequalities are fundamentally caused by the structural inequalities discussed throughout this article. Actions to address these disparities must be specifically targeted in the most deprived areas, which often see a disproportionate impact on BAME individuals. The next article in this series will look more in detail at ethnic health inequalities, so watch out for that!

Written by Naoshin Haque

Related article: Global Health Injustices (series)