How poverty affects health and life expectancy
Poverty is one of the leading causes of poor health and early death in the UK. Over the last decade, the gap in life expectancy has continued to widen as income equality has worsened. The facts are stark – if you are born in Blackpool, you are likely to die seven to eight years sooner than a contemporary born in Chelsea, as well as living more years of your life in poor health. [Reference – https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-england].
Health inequalities are already a major driver for healthcare policy in England, as well as the source of much debate about their causes and potential solutions. A key challenge with this issue comes down to measurement of impact from the myriad changes that are implemented. Personally, I believe that reducing the geographical variation in life expectancy should be a key metric by which we judge the long-term success of government health policy, and its implementation by both the NHS and Local Authorities.
Measuring life expectancy
Life expectancy is a straightforward and uncomplicated measure. It is easier to measure than almost any other population health outcome and its interpretation does not fall foul of the challenges of hidden groups or poor measurement techniques. It appears on the face of it to be an obvious quantitative measure that we should certainly be focussing on in healthcare quality improvement.
However, from discussions with colleagues and clients, I often hear the argument that the ultimate goal isn’t just about length of life – the quality of those years lived is paramount. This may be true, but who decides what ‘quality’ living looks like? In all likelihood, quality of life means something different to each individual, and your perception of this is age and context dependent. I believe that this is a situation where instead of ‘either/or’, we should be striving for ‘yes/and’ – both to improve life expectancy and number of years lived in good health – and this can prove to be the optimal situation.
The cost of living longer lives
The other argument against increasing life expectancy I commonly hear relates to cost – an ageing population is a more expensive burden to health and social services. You can argue on the one hand that this is true – an ageing population in poor health does currently require more money and resources to reactively support and treat. To follow this line of thought often leads to discussions around rationing treatments – although this evokes fear of distributive justice and equity amongst decision makers as well as furore about the ‘postcode lottery’ amongst service users.
Contrary to this argument, it’s important to shift the paradigm towards a future where a proactive focus on health and wellbeing throughout life can reduce the burden of long-term conditions in middle and older age, hence reducing the reactive healthcare spending in the long run. For example, reducing childhood obesity today will reduce the prevalence of type 2 diabetes and associated morbidities in 40 years’ time – but this requires us to holistically address the determinants of childhood obesity, which costs money now.
Improving life expectancy
Improving life expectancy is a long-term project that we should be proud to invest in. As with so many things in healthcare, solutions lie far beyond the entrance to the GP surgery or hospital, and crossover into areas such as employment, housing, education, social policy, and public health.
It’s easy for us to label this as a wicked problem and feel overwhelmed, but if we break it down and focus on multiple small, targeted improvements rather than overarching solutions, then we can take steps to close the gap.
In order to improve life expectancy, quality of life, and reduce the cost of reactive healthcare we need to focus on improving the wider determinants of health throughout a person’s life. We must begin with urgent, short and medium-term actions – the first of which is to recognise life expectancy as a key health outcome measure in its own right.
Written by Tom Sheppard, Managing Director, and Alison Sheppard, HealthBid Associate