What are health inequalities?

This is Article 1 in a series on health inequalities. Next article: Socioeconomic health equalities (coming soon).

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

Introduction

Imagine that you lived in Blackpool, and that your friends or family lived in Kensington. Your life expectancy would be 76 years, while theirs would be 86 years, a full decade of difference! Or consider the fact that even though men have shorter life-spans compared to women, women spend longer living with ill health or major illnesses.

These are some examples of health inequalities, which are health differences between different groups of people. They aren’t just random variations in health outcomes between different groups or people: instead, they’re systematic and avoidable.

What groups are affected by health inequalities?

Health inequalities can be seen across various populations. A person’s health can be impacted by socioeconomic factors, like income or wealth, and geographic factors, like where they live. Other characteristics affecting health include ethnicity or gender.

These factors don’t act in isolation. For individuals who experience multiple levels of disadvantage, the effects of inequalities are worsened. For example, ethnic minority groups who live in deprived areas, or socioeconomically disadvantaged women, experience even worse health outcomes. This interconnectedness means that understanding health inequalities and addressing them requires a holistic approach.

Health status and health inequalities

Differences in health outcomes can manifest in different ways. One indicator is health status, which includes overall life expectancy and healthy life expectancy, which is the time people live in good health. In England, there’s an almost 10-year gap in life expectancy between the most and least deprived areas, shown by the example above, where the life expectancy is 76 years in Blackpool and 86 years in Kensington. Differences in healthy life expectancy between the most and least deprived areas are even more pronounced. Healthy life expectancy is more than 18 years lower for the most deprived areas compared to the least deprived areas, as shown in Figure 1. Males living in the most deprived areas can expect to live 52.3 years in good health, while for males living in the least deprived areas, this number increases to 70.5 years. For females, it’s 51.9 years in the most deprived areas, compared to 70.7 years in the least deprived.

The impact of the COVID-19 pandemic on health inequalities

The COVID-19 pandemic has exacerbated health inequalities, with those living in the most deprived areas and people from ethnic minority backgrounds being the worst impacted. For example, as the pandemic strained healthcare services, more deprived areas had longer waiting lists, highlighting issues of unequal access and quality of care. In addition, death rates in the most deprived areas were higher compared to the least deprived areas: at a deprivation level of 1 (most deprived), deaths from COVID-19 were 566.2 per 100,000, with this number decreasing to 228.7 deaths per 100,000 at a deprivation level of 10 (least deprived), as seen in Figure 2.

The economic impact of health inequalities

Health inequalities can have economic impacts as a result of the added costs needed to address them. The persistence of health inequalities, particularly among the working-age population, is a challenge to economic growth, as increasing levels of ill health can lead to economic inactivity. For example, data from before COVID-19 suggests that health inequalities cost the UK £31bn to £33bn per year in lost productivity, £20bn to £32bn per year in lost tax revenue and higher benefits payments and £4.8bn of the NHS budget. This is equivalent to almost a fifth of the NHS budget.

As the pandemic exacerbated inequalities, these numbers have only increased: for example, the long-term impacts of COVID-19 have varied between demographics. Given that at least 2.5 million working-age adults are unable to work due to long-term sickness, as per the Office for National Statistics estimates, this is a significant economic challenge for the country, as well as a health issue.

Conclusion

Health inequalities have been shown to affect different groups disproportionately, with deprivation, ethnicity, socioeconomic status and other social factors having compounding effects, resulting in poorer health and shorter healthy lives. The COVID-19 pandemic further exacerbated these inequalities, with the most marginalised communities being the most affected. Failure to address these differences has resulted in not only human costs but also billions in lost productivity and increased burdens on health services.

Socioeconomic status is one specific factor that influences health outcomes: as mentioned above, people in the most deprived areas face a gap of approximately ten years in life expectancy compared to the least deprived, seen when comparing life expectancy in Blackpool and Kensington. The next article in this series will look more in detail at socioeconomic inequalities, so watch out for that!

Written by Naoshin Haque

Related article: Global Health Injustices (series)