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The importance of health inequalities

Summary :: Our health inequalities :: The importance of health inequalities

Inequalities in health exist between individuals or groups due to differences in social, geographical, biological or other factors. These can influence people's behaviours and lifestyle choices, as well as their risk of illness and actions taken to deal with illness when it occurs. Although some factors are fixed, others are avoidable or can be lessened, such as those relating to social, economic or geographical factors; these are known as 'health inequities' (NICE).

The Marmot Review, entitled 'Fair Society, Healthy Lives' (2010), sets out the health inequalities challenges for England and includes priorities for action and evidence about how these could be applied. Importantly the focus is on reducing health inequalities by addressing the social gradient and imbalance in health outcomes; a lower social position equates to poorer health outcomes.

For an overview of and access to the full report, see 'Fair Society Health Lives' (The Marmot Review).

The two key indicators used to monitor health inequalities, are life expectancy (LE) and healthy-life expectancy (HLE). LE is the estimate of how many years a person might be expected to live and HLE, also called disability-free life expectancy (DFLE), is an estimate of how many years that individual might live in a 'healthy' state, defined as time without disability or illness.

Figure 1 shows the relationship between the gradient in neighbourhood income and life expectancy. It shows that people in poorer areas not only die sooner, but also spend more of their lives with a disability (Marmot review, 2010). In England, people living in the poorest areas will, on average, die seven years earlier than people in the richest neighbourhoods and the average difference in healthy-life expectancy is 17 years. The figure highlights the economic issue that a greater proportion of individuals from the more deprived neighbourhoods will be unable to work due to disability prior to the age of retirement.

Figure 1: Life expectancy by income deprivation - national picture (The Marmot Review)
Figure 1: Life expectancy by income deprivation

Social determinants of health

Social determinants of health are the conditions, in which people are born, grow, work, live and age (WHO). They include the forces acting upon people at each of these phases that can shape the conditions of daily life, including education; housing; environment; employment, economic, political and social influences. Evidence suggests that societies with bigger income differences suffer a wider range of health and social problems in each of the following areas: [1]

• Physical health
• Mental health
• Drug abuse
• Education
• Imprisonment
• Obesity
• Social mobility
• Trust and community life
• Violence
• Teenage births
• Child well-being

In order to reduce health inequalities action is required across all social determinants of health, as well as the health and social care services. Working to reduce the health gaps between the richest and the poorest in the population will benefit society in many ways by increasing economic productivity and reducing health care costs.


[1]   Wilkinson R, Pickett K. The Spirit Level 2009;