Economic context

Socio-economic status

Economic factors are highly correlated with health outcomes. Lower incomes and lower employment are unambiguously bad for health (1), and socio-economic status is a major determinant of both life expectancy and healthy life expectancy (see figure below).


Source: UCL Institute of Health Equity (2012) Strategic Review of Health Equity. A presentation on the main findings of the Marmot Review

What does this figure tell us about health inequalities?

The figure above illuminates many of the key characteristics of importance about health inequalities in England.

The top dotted line is average life expectancy; the bottom dotted line is average disability-free life expectancy. This is plotted against neighbourhood income deprivation for thousands of small areas in England. Therefore, this shows how health varies depending on how poor or disadvantaged the majority of people are in that area. There are some messages we can take from this figure:

  • Although we are living longer, many people are living in poor health; this is shown by the fact that disability-free life expectancy – a measure of years spent in good health with no limiting illness – is much lower than life expectancy for everyone.
  • Inequalities affect us all, however both life expectancy and disability-free life expectancy are higher in those areas with a higher neighbourhood income.

Having said that,

  • the figure above shows that the gap between life expectancy and disability-free life expectancy is larger for poorer people than wealthier people. The more income you have, the more likely you are to live in better health.
  • There is a steeper slope at the very ends of the graphs. This means that the very poor and the very rich have particularly low and high life expectancy and disability-free life expectancy respectively.  Becoming very poor affects your health a lot more than the average relationship between health and income.
  • Despite this overall relationship, there are lots of areas where health is higher (or lower) than expected based on income deprivation alone. This is shown by the scatter of the dots around the lines. If we can better understand what factors explain this we can improve population health and inequalities.


Recessions are particularly linked to risk factors for poor mental health: unemployment, poverty, unanticipated disruptions in income, uncertain and stressful work environments, debt and financial strain. Emerging evidence suggests the recession has led to an increase in suicide rates in Europe (2).

Our path to recovery is deeper and slower than for all previous recessions since the Great Depression of the 1930s (3). Real incomes fell in 2010 for the first time since 1977 and there has been a substantial growth in young people not in education, employment or training (NEET), with a record of 1,163,000 people aged 16–24 NEET at the end of 2011 (4). 

We know from previous recessions that being NEET at a young age for a substantial period reduces future employability and leads to poor long-term health (5).

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  1. Royal College of Psychiatrists, Mental Health Network, NHS Confederation, London School of Economic and Political Science (2009). Report. Mental health and the economic downturn: National priorities and NHS solutions
  2. Stuckler D, Basu S, Suhrcke C, Coutts A, McKee M (2011). Effects of the 2008 recession on health: A first look at European data. The Lancet, Vol 378 Issue 9786, pp 124–125
  3. UK GDP since 1955 (2012). Guardian data blog
  4. BBC News (2011). Article. Young, jobless 'Neets' reach record level. Harrison A, Education Correspondent, 24 November 2011
  5. Audit Commission (2010). Against the odds: Re-engaging young people in education, employment and training