Chronic health inequalities in south west London set backdrop to Covid-19 crisis

Anna Cooban
July 30 2020, 7.35

Men in Richmond upon Thames are expected to live 11 years longer in good health than men in nearby Lambeth, according to data published by Public Health England (PHE).

Data shows healthy life expectancy at birth – the number of years a person can expect to live in full health – is 72 for males in the riverside borough while, just 10 miles away, men can expect to live to 61.

For women, the disparity is seven years; those in Richmond are expected to live to 70 without debilitating illnesses or injuries whereas for Lambeth women it is 63.

Covid-19’s differential impact on communities has thrown into sharp focus longer-standing inequalities in health between regions, causing us to consider their origins.

Dr Emily Murray is a research fellow at UCL’s Department of Epidemiology and Public Health and is unsurprised by the data.

“The disparity between Richmond and Lambeth is actually quite small – between the most and least deprived London boroughs there’s a 20-year difference in life expectancy,” she said.

“Even when you account for income and educational level, those who live in less well-off neighbourhoods do worse in their health outcomes.”

So what underlies this stark relationship?

Sir Michael Marmot is Director of the UCL Institute of Health Equity and former President of the World Medical Association. His landmark review, Fair Society, Healthy Lives, published in 2010 defined how politicians and policy-makers approached public health for the next decade.  

The Marmot Review laid out six domains across which a person’s health is influenced – early childhood, education, employment, income, community environment and behaviours.

However, in a follow-up paper released in February, Sir Marmot emphasised a widening gap in life expectancy across the country, with the largest decreases experienced in the north east.

“In most of those domains, it has gotten worse in the past 10 years,” said Sir Michael.

“For instance, child poverty – the Prime Minister has said it has declined, but it has actually gone up. Over the long-term, this will impact on health inequalities. Children growing up in poverty are less likely to do well in school, get good qualifications, good jobs, higher incomes and live in better conditions.”

The interaction of the different domains has a compounding effect on an individual’s health over their lifetime. And, in the context of Covid-19, pre-existing health problems such as diabetes and chronic lung diseases dramatically increase the risk of mortality.

ONS data published last month showed a link between deprivation and Covid-19 mortality rates, with people living in the poorest areas of England and Wales more than twice as likely to die from the disease compared to those in more affluent areas.

The figures revealed that people living in the poorest 10% of England died at a rate of 128.3 per 100,000 relative to 58.8 per 100,000 residing in the wealthiest 10% of the country.

Healthy life expectancy at birth for south west London boroughs, 2016-18 (Public Health England)

In the London borough of Brent – where one third of the residents live in poverty – 36 residents died of the virus in a single housing estate.

And it is not only across neighbourhoods that differences in mortality rates are experienced.

A PHE report last month confirmed the Covid-19 mortality rate was between 10 and 50% higher in BAME groups compared with their white counterparts, with those of Bangladeshi origin at most risk.

Policy executive at the Royal Society for Public Health Louisa Mason said: “The health burden of Coronavirus is shouldered disproportionately by those already at the sharp end of the UK’s deeply entrenched inequalities in health outcomes.”

Ms Mason said that one of reasons behind the disparity is the relatively high proportion of BAME workers in key occupations requiring them to work outside the home, resulting in a higher risk of exposure to the virus.

“Until we narrow the deprivation gap, health inequalities will continue to widen. Public health and local authorities have been severely underfunded in recent years and funding needs to be re-instated to provide the adequate services.”

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