Skip to main content

Deprived Areas

Volume 813: debated on Thursday 1 July 2021

Private Notice Question

Asked by

To ask Her Majesty’s Government, further to the report by the Institute of Health Equity Build Back Fairer in Greater Manchester: Health Equity and Dignified Lives, published on 30 June, what steps they are taking to address the (1) disparities in life-expectancy, and (2) social conditions, in England’s most deprived areas compared to the rest of the population.

My Lords, the Government welcome Professor Marmot’s report and his insights into this important area. Reducing health inequalities is a core aim of the new office for health promotion. Under the Chief Medical Officer, the OHP will work with partners across government, the NHS, business and society to systemically tackle preventable risk factors, improve the nation’s health and narrow health inequalities.

I thank the Minister for her Answer. The main findings of the Marmot report about gross and growing inequalities in life expectancy are sobering. What makes the situation even worse is that awareness of this was heightened by research and documentation more than 20 years ago. In what way do the policies of the present Government differ from the failed policies of previous Governments over the last decades?

My Lords, the Government have put a renewed emphasis on prevention in their approach to tackling health inequalities. That is taking place over a number of areas—for example, in the new obesity strategy and the smoking cessation strategy—that will help us close this gap, which is too wide and something we should all be concerned about.

My Lords, deepening inequality and poverty, especially child poverty, are key social determinants of the worsening health inequalities identified by Sir Michael Marmot, who argues that they must be central to the Government’s levelling-up agenda. How exactly does that agenda address the poverty and inequality that the report shows are damaging health and well-being so badly?

My Lords, the levelling-up agenda will be about improving life chances across the UK, and the Government’s proposals in that area will be set out in a White Paper later this year. The noble Baroness has given me the opportunity to expand on some of the other important government policies that the noble and right reverend Lord asked about, so I say that introducing the national living wage and the pupil premium has focused support on those most in need.

My Lords, yesterday’s report highlights the need for an ambitious new framework to reduce health inequalities, focusing far more sharply on the wider social determinants of health to make a reality of building back fairer from Covid, which has cruelly exposed and amplified inequalities in life expectancy. Given that mental health problems are the number one cause of death for men under 50, and the leading cause of maternal death in the UK, what immediate steps are the Government taking to improve the mental health of at-risk groups living in deprived areas?

My Lords, absolutely: as part of the NHS long-term plan, the Government have committed to improving mental health services and increasing the funding that goes to those services, as a proportion of overall funding, in every year of that plan.

My Lords, inequalities in healthcare have long plagued the NHS. Inequalities exist not only in years spent in ill health and shorter life expectancy but in referrals of care, leading to poor health outcomes for people from deprived communities. With waiting lists running into the millions, dealing with this effectively is a priority. To this end, does the Minister think that NHS plans for clinical validation as a way of tackling waiting lists are likely to worsen inequalities in access to treatments?

My Lords, clinical validation is, at its heart, about adapting to the need to manage larger and longer waiting lists and tackle those. Patients will be treated in order of clinical priority and then by length of wait to reduce the harm by waiting. But I reassure the noble Lord that his point is very well made and that, in the NHS recovery plan, there are eight actions to reduce inequalities in the restoration of services, including reporting on providing services to the poorest 20% of neighbourhoods and black and Asian patients.

Was my noble friend rather surprised that she had to get to page 94 of the summary before there was any mention of obesity as a cause of inequalities in health, given that it is one of the major things that both undermines health over time and has exacerbated susceptibility to mortality from Covid?

My Lords, being somewhat familiar with Professor Marmot’s work, I know it is incredibly wide-ranging and looks at a huge number of the determinants of health. But my noble friend is absolutely right that obesity is a big part of our health agenda, which is why the Government have set out a number of areas where we will take further action to support people to reduce levels of obesity across the country.

In the light of Sir Michael Marmot’s report, will the Minister commit to providing an early opportunity for this House to debate the impact of Covid-19 on Her Majesty’s Government’s much-advertised agenda for levelling up, particularly relating to children and young people in those regions with the greatest level of deprivation?

My Lords, I had the pleasure of sitting in on an excellent debate on a similar subject last week. Unfortunately I do not lead the House’s timetable, but I will make the submission on behalf of the right reverend Prelate.

I am very pleased to hear that the Government have noted the report, but I would like the Minister to confirm whether the Government have actually consulted or used Sir Michael Marmot, who is the UK’s foremost academic in the field of health equity or lack of it. His research is being used, so I would like to know: when did the Government, or representatives of the Government or the Minister’s department, meet Sir Michael Marmot and his team? Are the findings of this research and the research from last year being taken into account with the levelling-up plans?

My Lords, on the specifics of any meetings, I am happy to write to the noble Baroness. I point to the creation of the new office for health promotion and the fact that the guiding mantra that sits behind it is very much aligned with the agenda Sir Michael Marmot has set out. I know that is a key priority for the Chief Medical Officer as we come out of the pandemic and take this work forwards.

My Lords, only 5% of total health expenditure is on preventive measures, which has declined in real terms since 2015. How does that help narrow health inequalities?

My Lords, as part of the Government’s long-term plan for the NHS, we want to increase the focus on prevention and, as part of the new office for health promotion, a cross-ministerial board will look not just at the measures within health but at those wider determinants and the government policies on them, which all contribute to narrowing those inequalities in health outcomes.

My Lords, many of Sir Michael’s recommendations, such as on local government finance, housing and universal credit, fall outwith my noble friend’s department, and I hope that there will be a comprehensive government response to those. But the recommendations on public health, which has been disproportionately disadvantaged recently, falls within it. In the forthcoming spending review, will the department press for the 0.5% of GDP on public health, as recommended in the report, to address the inequalities that it has identified?

I hope that my noble friend will forgive me and be understanding from his time in government that I am not in a position to comment on the spending review process. He might take heart from the recent government announcement, or that of a few years ago, of the funding for the National Health Service overall and the accompanying long-term plan. As part of that long-term plan and as a condition of receiving that funding, all major national programmes and every local area across England is required to set out specific measurable goals and mechanisms, by which they will contribute to a narrowing of health inequalities over the next five and 10 years.

Michael Marmot has demonstrated once again the totally unacceptable chasm in healthy life expectancy in different parts of the country. I welcome the Government’s commitment to the obesity strategy, even if it is five years late, and to the smoking cessation strategy. What are the Government’s plans to improve physical activity, which is such a vital part of the public health agenda? Will they accept the recommendations of Sir Muir Gray and Sport England?

My noble friend is absolutely right to highlight the importance of physical activity. That is why the proceeds of the sugar tax went into promoting school sports. It is just one of a number of actions that we are taking to promote physical activity among young people.

My Lords, one cause of the poverty and inequality that led to the health inequities so eloquently revealed in the report is low wages. In Manchester each year between 2010 and 2016, wages dropped by 1.1%. Does the Minister agree with the ILO, the OECD and President Biden that the best way to increase wages and diminish inequality is to extend the coverage of collective bargaining, which in this country fell from around 85% of workers between 1945 and 1979 to a mere 25% today? New Zealand is introducing legislation for sectoral bargaining; should not we?

This Government’s approach to reducing low wages is the introduction of the national living wage. We have also extended the national living wage to apply to younger cohorts of people, and we have a longer-term commitment on the level of that national living wage to try to eliminate low pay altogether.

My Lords, what are the Government doing to address the lower rates of testing and vaccination among underserved communities at the risk of Covid?

My noble friend raises an important point. On testing, we have been piloting alternative delivery models based on identifying the trusted individual for people in underserved communities and enabling them to encourage their members or service users to start testing; that has been incredibly effective. For vaccines, we have a community champion scheme which applies a similar logic, and we are taking vaccinations to places and sites where people will access them and improve take-up rates.

My Lords, the Minister has on two or three occasions just now referred to the importance of tackling obesity as a way of evening up inequalities in healthcare and life attainment. Does she agree that local authorities ought to have and are bound to have a key part in tackling those inequalities, whether based on obesity or other matters? How can they do this when they have been subjected to serious cuts in expenditure? Is not the real answer that what we want to tackle these inequalities is more devolution of power from Whitehall to the regions?

My Lords, a key focus of the Government’s and the NHS’s plans for reform on health is the introduction of integrated care systems, which will work by putting providers and local authorities in the position where they can join up care and focus on population health and prevention. That will be an incredibly effective way in which to address some of these public health measures, which is why we look forward to introducing our NHS Bill later this year.