Our health is determined by a complex mix of factors including income, housing and employment, lifestyles and access to health care and other services. There are significant inequalities in health between individuals and different groups in society.
These inequalities are not random. In particular, there is a ‘social gradient’ in health; neighbourhood areas with higher levels of income deprivation typically have lower life expectancy and disability-free life expectancy. This relationship (known as the ‘Marmot curve’) formed an important part of the independent and influential report on health inequalities, Fair society, healthy lives (the Marmot Review).
Inequalities in life expectancy assesses how the Marmot curve has changed over time and what that tells us about the success or otherwise of government policy on inequalities in health over the period 1999–2003 to 2006–10. This study brings together, for the first time at a small area level, data on a wide array of variables for 6,700 areas of England on wider determinants, lifestyles, demographics and public service variables widely thought to be significant in determining health and health inequalities.
The Marmot curve for life expectancy got flatter between 1999–2003 and 2006–10, which implies that the relationship between income deprivation and life expectancy got weaker over that period.
Other factors, in particular employment, housing deprivation, and income deprivation among older people and some lifestyle factors such as binge drinking and fruit and vegetable consumption are the most important in explaining differences in life expectancy between areas in 2006-10.
Low employment, housing deprivation and smoking are among the factors that distinguish areas with persistently low life expectancy over time.
‘Place’ remains important over and above these general findings and relationships.
There needs to be a much more nuanced and integrated policy response to inequalities in health. There are some early signs of this integrated approach, but beyond this, we argue for a more coherent approach to inequalities in health delivered through population health systems that more strongly integrate NHS services with other public services and approaches to public health.
Austerity, and, as importantly, the policy reaction to it, will have consequences for health inequalities. NHS and wider government policy needs to refocus on inequalities in health, if some of the positive findings that happened over the 2000s are not to be lost.
Some places and parts of the country seem to do better or worse than our general analysis predicts. How policies are translated at area and community level needs to take into account the local knowledge, history and experience that no high-level analysis can provide.