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November 26, 2014

Health inequalities kill

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Dara Gantly says the debate on health inequalities needs headline coverage.

In last week’s post-IMO AGM editorial, I mentioned how the kind of compelling research and statistics that were presented during the scientific session on health inequalities in Killarney seldom makes headlines. So I decided to do something about it (see headline above).

Perhaps part of the apathy around the subject lies in the fact that not many would disagree that health inequalities are a bad thing: a case of motherhood, apple pie and a multi-use games area (MUGA) pitch on every street corner — but more of that later.

However, the debate around health inequalities goes to the very heart of what type of society we are trying to create and the health service we want to provide. ‘Quality & Fairness’ — remember that?

Commenting on the most recent evidence from the Central Statistics Office (CSO) of the stark differences found in life expectancy in Ireland, Owen Metcalfe, Director of the Institute of Public Health, pointed out that if one took the least-deprived Irish female (first quintile, 82.7 years) and the most-deprived male (fifth quintile, 73.7 years), there was a life expectancy gap of almost 10 years. It’s even worse for homeless men, who are unlikely to reach their 45th birthday.

“Is that fair? Is that just? Is that right?” asked Metcalfe of the 10-year gap. Quoting a comment from leading expert in the field Sir Michael Marmot, Metcalfe added: “Addressing health inequalities is not an economic argument, it is a moral argument.”

Of course, there are economic arguments too. Granted, most of the statistics relate to the UK, but some are available for Ireland, including €2.7 billion as the cost of obesity (Task Force on Obesity, 2005), and €3.7 billion in 2007 for problematic alcohol use (Byrne S, 2010). What is more difficult to calculate is the economic cost of all those life years lost due to ill health attributed to health inequalities, or the reduction in life expectancy in good health, which can affect productivity, labour supply, savings levels, et cetera.

As Dr Paul McKeown, newly-elected IMO President and public health specialist, pointed out at the AGM, health inequalities reach into almost every aspect of our lives.

Referencing the ground-breaking Whitehall studies of British civil servants in the 1960s and ’70s, where ‘control’, or lack of it, was found to be a major factor in ill-health, Dr McKeown pointed to evidence that showed those who had job security were much more secure in themselves and reported better mental health and objectively had less mental health issues. Lower socio-economic standing could even impact on lung function, according to Dr McKeown, who pointed to studies showing the effects on values for FVC, FEV1 and FEV 25-75 from air pollution, occupational exposure, tobacco smoke exposure, heating or cooking with biomass fuels, housing conditions, childhood respiratory tract infections and prenatal exposures — all of which are socially determined. Indeed, such factors could account for a 14 per cent reduction in lung function, he said.

The Gini coefficient — which I soon discovered had nothing to do with famine ships or magic lamps — is actually a number between 0 and 1, where 0 corresponds with perfect equality (where everyone has the same income) and 1 corresponds with perfect inequality (where one person has all the income — and everyone else has zero income). The EU average is 0.3, while in Ireland it is 0.33 — a 2010 figure — and probably rising.

Dr McKeown explained how 5,700 deaths could be saved simply by having the same degree of inequality that Europe enjoys on average, spread across the EU as a whole.

So inequalities are definitely killing people.

The next question is, what can be done, apart from trying to rebalance such income inequalities? Well, public health experts think we need to build a healthcare system that is based on the principles of equity, disease prevention and health promotion and place the responsibility for action on health equity at the highest level of Government. I agree.

But what was that about MUGA pitches? Well, Owen Metcalfe suggested these outdoor, urban play areas — one of which is located near his Institute and which is used “morning ‘til night”, he says — should be placed on every street corner in Dublin and in other built-up cities.

You know it makes sense on so many levels; and I bet you haven’t even thought of the impact it could have on the World Cup after next, or the Olympics in Rio, in terms of encouraging new talent. But the benefits in terms of health 10, 20, 30 and even 50 years down the line could be dramatic and would be a more important ‘gold’ for which to aim.

So here’s another headline for you: ‘MUGA pitch needed on every street corner’. Let’s see who’s reading.