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A reflection on health inequalities

Last week the Academy of Medical Sciences published a report, Improving the health of the public in 2040’ Dr Vittal Katikireddi is an NHS Research Scotland Senior Clinical Research Fellow in the MRC/CSO Social and Public Health Sciences Unit and was a member of the working group. He explains how a healthier society can only be achieved by making society fairer – and why the solution goes beyond anything medicine can do on its own.

Slow progress

Despite advances in medical technologies treatments and public health measures, we’ve made no progress in addressing health inequalities in the UK. For example, a boy born today in one of the most deprived areas of Glasgow can expect to live around 15 years less than someone born in one of the richest parts of the city.

The reasons for health inequality are complex. Growing up in a deprived area means that boy is less likely to have a safe place to play. That puts him at greater risk of accidents and injuries. He is also more likely to live in damp housing which increases his chances of developing breathing problems. He’s likely to be exposed to more road traffic and therefore air pollution – even though his family is less likely to drive.

The big picture

Health has a complex recipe, and we do not know how all the ingredients mix together. We need to know more about how and why all the different factors interact with each other to affect our health. That means looking at everything from basic biological processes to the places where we live.

This is the rationale behind the Academy’s new report, for which I sat on the working group. It calls for collective action to find and fund the best research to understand what factors determine health, how they are connected and how we can intervene to support the health of the public.

Many of these factors are outside of the medical sphere, so research must be a collaborative effort with areas inside and outside of medical science. We need to include disciplines such as economics, education, engineering and design.

Every stage of life

Let’s go back to that boy in Glasgow. As he grows up, he is less likely to receive the highest quality education available. He is more likely to experience unemployment or zero-hours contracts. Poor working conditions could cause him to have poor mental health. That could lead to him having to stop work before he would like to.

By 2040, that boy may be thinking about having his own children, but unfortunately, health inequalities could be even worse by then. The adverse impacts of climate change on health – such as heatwaves and infectious diseases – are likely to affect those most vulnerable in society.

Questions to answer

This is of course a pessimistic scenario, but it is useful to show how many non-medical factors determine our health. To prevent the health inequalities it illustrates, we need answers to certain questions. What is the best way to create healthy environments for our children? How do non-conventional working patterns affect health? Is unemployment related to mental health? How do all these things link together?

Once we have the research to explain this, we’ll be able to put health at the heart of government policy. Then we can embed it in every intervention, reduce these inequalities and improve people’s lives.

A more equal 2040 means starting today

We need to start now, by identifying the right research, by funding the right projects, by training a new breed of researchers that will be able to work at the interface of all relevant disciplines, and to make sure this knowledge is passed on to practitioners and policymakers.

We need the knowledge and tools to meet the grand challenge of tackling health inequalities. That way, in 2040, everyone has the best chance of living a healthy life.

Dr Vittal Katikireddi

The ‘Improving the health of the public in 2040 project was funded by the MRC and the Wellcome Trust

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