Speech on Health Inequalities in the North East (Long Version)
Blog / January 25, 2012 (4 weeks ago) / Comment now
NHS reforms contained in the Health & Social Care Bill are only one aspect of how government policies are going to increase health inequalities.
Across every government department, Coalition policies will also exacerbate socioeconomic inequalities, and ultimately health inequalities as indicated by Marmot.
Chronic Obstructive Pulmonary Disease (COPD) is linked to smoking, occupational dust and pollution, and is particularly prevalent in the North East of England.
COPD disease costs the NHS an estimated £491 million every year and mortality rates in the North East are higher than in England (accounting for 6% of all deaths), and the inequality gap appears to be increasing.
Smoking kills over 1,700 people every year in the North East before they reach the age of 70, accounting for 29% of premature deaths in the region compared with 26% of all premature deaths in England.
The latest Regional Health Profile (November 2010) from the Public Health Observatories shows Female life expectancy in the North East is distinctly under the European median and is one of the lowest in UK.
The obesity and overweight rates are one of the highest in Europe. The percentage of regular daily smokers is very close to the European median and one of the highest of UK.
MP Grahame Morris (right) receives a petition about privatisation of the NHS from Stephen Barry and Ellin Hare at the Glebe Centre offices in Murton.
There are two significant issues in their debate: inequalities in access to health services and the broader problem of health inequalities produced by deep-seated differences of social class.
In the late 1970s the chief scientific adviser to the Department of Health, Sir Douglas Black, produced a report on the extent of health inequalities in the UK and acknowledged that the NHS could do much more, alongside other improvements across government through child benefit; maternity allowances; pre-school education; an expansion in child care and better housing.
The Conservative Government which came to power in 1979 published the report on a bank holiday to avoid public scrutiny. However, these findings have been refined and supported by subsequent research by Professor Townsend and Sir Derek Wanless, and recently by Professor Marmot.
There is a stark danger of a downturn in the progress made in addressing health inequalities due to decisions being taken elsewhere in government and severe cuts to services for the most vulnerable.
This makes the focus of the NHS on health inequalities all the more important.
In June 2008 the then Health Secretary, Alan Johnson, made a speech on health inequalities in which he said: “It is inconceivable today that any Secretary of State could be so dismissive of an issue so critical to the life chances of so many.”
Remarkably, health reforms look set to weaken accountability and the national infrastructure necessary to tackle health inequalities in the NHS.
The has been good progress under a Labour government on health inequalities.
By the measure of Infant Mortality Ratio the absolute gap has reduced by 0.9 to 0.5 by we can see by the tripling of investment in our NHS how access to healthcare improved dramatically.
And the affect of this on long-term health inequalities is probably yet to be determined.
The Health and Social Care Bill changes the fundamentals of the National Health Service. The fragmentation of the NHS; with privately-led commissioning groups; the reintroduction of the postcode lottery; an uncoordinated health system and greater competition… risks making inequality, in terms of access to health services and outcomes, entrenched.
I sat on the Health and Social Care Bill Committee, and expert witnesses raised concern after concern.
Stephen Thornton, Chief Executive of the Health Foundation, talking about health inequalities, said that a duty: “needs to be placed on the national commissioning board and [commissioning groups] to embed shared decision making in all care and treatment”.
Only by reinforcing the duty on the commissioners themselves to reduce inequalities is there any chance of achieving it.
And when Dr. Hamish Meldrum of the British Medical Association was asked about equitable access to health services, he said it would be:
“the articulate, the new-media savvy, who will do well. Those who are less like that will not. It is not so much what is in the Bill or not in the Bill, but what is happening elsewhere and how much the Bill will help to address that—and I do not think it will be very much.”
Finally, I want to return to the issue of socio-economic factors on health inequalities. Labour commissioned the 2008 Marmot report, which reinforced that we cannot simply focus on lifestyle issues (telling people to lose weight or give up smoking) but instead we must tackle the root causes which are economic and social.
The cuts that are falling across every government department are hitting the poorest hardest.
The Association of North East Councils has shown that the North East will be worst affected by local government cuts between now and 2013.
Child poverty is rising in my constituency of Easington, and stands at 29% – eight points higher than the national average.
And TUC figures from November 2011 shows the North East has the highest ratio of jobseekers per vacancy in the UK. An average of 7.5 jobseekers per vacancy – however it is as high as 23.7 jobseekers per vacancy in some areas (Hartlepool).
In one year from September 2010 to 2011, Youth unemployment rose 20% in County Durham.
This Coalition government has no intention of reducing health inequalities. It knows its policies can only worsen the situation.
The Labour Government introduced the first ever targets to reduce health inequalities in the population, and the poorest were healthier when we left Government than the population average in 1997.
The Marmot review called for these targets to be continued so why does the Health and Social Care Bill only aim to reduce inequalities in healthcare?
This government has given up on cross-departmental action to reduce inequalities in life expectancy and health.
And whilst the Secretary of State for Health says he backs the Marmot report, he will not accept its recommendations in full and he has chosen to ignore another warning by Prof Sir Michael Marmot….
His open letter co-signed by hundreds of public health professionals rejects the Health and Social Care Bill because it will “do irreparable harm to the NHS, to individual patients and to society as a whole” and will “widen health inequalities”.
