Christine’s Blog: Health Inequalities

Health Inequalities. Isn’t that a neat little phrase? Of course, those of us working in the Third sector, or in the public sector, have heard these two words many, many times. But does the phrase resonate with most ‘people on the street’? I doubt it. And yet, the fight against health inequalities is one of the longest running battles our country has fought. It emerged strongly after the post-WW2 period. And, whilst, over the following decades, there have been glimmers of hope, it is still an ongoing struggle that Scotland is not winning. So, for many people, from the Baby Boomers to Generation Alpha and beyond, the reality that lies behind that small phrase, will impact them throughout their lives.

Actually, I recall a time when the phrase was a little longer: Health Inequalities Gap. Somewhere along the way, ‘Gap’ has dropped out of the vernacular; but this is all about the Gap – an unseen void that separates some communities from others. Where, on one side, individuals look forward, not just to living a longer life, but also to enjoying years of healthy living; but where, on the other side, life is not so kind.

Health inequalities are determined by many factors – in the conditions in which we live; the support we receive (particularly in our earliest years); through our home and surrounding environment; by easy access to affordable, good food; in the availability of health support; by having wider amenities within our local community; via our education; and beyond that to our employment prospects.

In May 2004, Voluntary Health Scotland was established with the aim of bringing together and amplifying the voices of our voluntary health sector – the hundreds of amazing organisations that work with individuals, with families and with communities every day – in tackling health inequalities.

Just imagine two people born in May 2004. Like VHS, both are now fast approaching their 20^th birthdays. Their young lives should be full of possibilities, excitement and dreams for their future. But the reality is that their postcode, their community –even the street on which they live – can affect that future, in ways over which they have no control. Born into a ‘good’ postcode, a 20-year-old is far less likely to die prematurely (before 75 years). But a 20-year-old from one of the most deprived postcode areas faces a premature mortality rate 4 times higher. That has increased since 2014, when it was holding at 3 times higher.

Realistically, to a 20-year-old, thinking about whether they might reach 75 is probably not going to occupy much of their time. But look at it another way: what about how long they might expect to enjoy good health? Well, here the statistics are startling. In a ‘good’ postcode, the 20-year-old might expect at least another 50 years more of good health. But, in a deprived area, someone at 20 years of age, may be looking ahead to less than 30 further years of healthy living. Even as they blow out the 20 candles on their cake, they may already be seeing the reality of this – since the rates of coronary heart disease, cancer, smoking, obesity, alcohol and drug related illnesses are many times higher in our most deprived areas.

Perhaps our 20-year-old will already be seeing the 40^th or 50^th birthday celebrations of their parents overshadowed by poorer health? What does that do in terms of their mental health and sense of well-being? What trauma is that inflicting on these young people who, after all, did not choose to be born into the wrong postcode? Sadly, far too many in our country still carry the heavy burden of health inequalities. The pandemic has done nothing to help, but it cannot be an excuse. And, as Scotland moves forward with a strengthened, legal commitment to the rights of the child, the closing of the health inequalities gap must be a key priority.

After all, Generation Alpha are already here, and Generation Beta start arriving less than a year from now. How wonderful if most of those young people lived to enjoy blowing out the candles on their 90^th birthday cakes!

Christine Carlin is the Chair of the VHS Board. She was a former senior civil servant and also held two Executive Director posts (HR and Estates Review) in the Scottish Prison Service. Having joined the Third Sector in 2013, Christine has been Scotland Director for two national charities and was Chief Executive of a Scotland-based charity. She is a member of Changing the Chemistry, a charity focused on increasing diversity of thought in the boardroom.