Editorial: A fair society is better for all of us
THAT a lack of wealth all too often translates into poor health may seem painfully obvious. But now a of health inequalities in England reveals that such disparities don鈥檛 just disadvantage the least well-off. The review also suggests some strategies to tackle the inequalities. These remedies should apply the world over, including in the US, where health and wealth inequalities can be especially stark.
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Commissioned by the UK government, the review was headed by of University College London, who most famously showed that British civil servants at the bottom of the organisational pile were much more likely to suffer coronary heart disease than those at the very top. In his latest work, Marmot uses census data from across England to show that these health inequalities don鈥檛 just exist between the richest and the poorest.
For example, even if you exclude the richest and poorest 5 per cent of people in England, the richest remainder can expect to live 6 years longer than the poorest, and enjoy an extra 13 years free of disability. Marmot says action to reduce health inequalities should take place right across society, not focus solely on the poor. 鈥淚t鈥檚 not rich versus poor, because it鈥檚 a social gradient,鈥� he says.
What鈥檚 more, the most productive time to intervene to create a healthier society is childhood, Marmot says. That children who start out with well-off, well-educated parents are likely to be healthier would seem to be something of a no-brainer. But the fates of 17,200 UK babies monitored since they were born in the same week in April 1970, and highlighted in Marmot鈥檚 review, make compelling evidence.
It turns out that babies who had low IQs at 22 months and were born to richer, better educated parents caught up by the age of 6 with children who started with high IQs but whose parents were poorer and less educated. By age 10, the children in the higher socio-economic group were forging ahead on intelligence tests while those in the lower socio-economic group fell further and further behind (see diagram). 鈥淚t shows that the social is trumping the biological,鈥� says Marmot. 鈥淲e can change that, and that鈥檚 why I鈥檓 optimistic.鈥�
He also finds that children in poorer families miss out on pre-school reading, socialising and physical exercise (see diagram). This disadvantage leaves them trailing far behind when they start school (see diagram) and they seldom recover (see diagram).
Diagrams: Being behind can lead to behavioural and emotional problems. What鈥檚 more, the UK spends less on children during early childhood than at any other stage of their education
Such inequalities are not confined to the UK. A by the US-based Robert Wood Johnson Foundation concluded that interventions most likely to improve the health of all Americans were 鈥減rograms that promote early childhood development and that support children and families鈥�. A recommended prioritising 鈥渁ctions related to health promotion of children and adolescents鈥�.
鈥淲e look forward to assessing how to adapt the policy recommendations for England to the rest of the world,鈥� says R眉diger Krech, director of the WHO鈥檚 department of ethics, equity, trade and human rights. He agrees that giving every child the best start in life 鈥渋s critical in setting the foundation for a lifetime of health and successful contribution to society鈥�.
What can be done to ensure this? One option is to extend maternity or paternity leave, suggests Marmot. Another is to help struggling parents by providing extra services and information.
Editorial: A fair society is better for all of us
