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Times are changing. Our population is growing and living longer. Our healthcare system, as is stands, is not expected to keep up. The Health Inequalities in 2040 report, published in April 2024, brings to light inequalities prevalent in England and how they are projected to persist in the next two decades, and the impact these inequalities will have on society.
Background
The report by the Health Foundation’s Research and Economic Analysis for the Long term (REAL) Centre tracks the inequality experienced across England and highlights how patterns of ill health among the adult population vary with socioeconomic deprivation. Going further, the report looks at how the working-age portion of the population (from around 20-years-old to 69-years-old) are affected by these inequalities and the significance of this on the country’s labour supply, economic growth and regional inequalities. In 2019, there were 3.6 million people aged 70 years and older living with a diagnosed major illness. By 2040, this is projected to increase to 5.5 million. The number of working-age people living with major illness is also expected to increase, from three million people in 2019 to 3.7 million in 2040 – with 80 per cent of this increase being concentrated in more deprived areas.
By looking at patient records which show age, type of illness and deprivation level of an individual combined with the Cambridge Multimorbidity Score (CMS), the authors were able to compare the average level of illness across England. “We used patient-level healthcare data that combined primary care and secondary care records with mortality data. This was then linked by the data provider to geographical data to estimate the difference in diagnosed illness by level of deprivation in England in 2019,” the report stated. The report also looks at what age people can expect to be diagnosed, how long they may live with the major illness, and average life expectancy based on level of deprivation.
Key findings
“Our report shows that there are large inequalities in diagnosed illness across socioeconomic deprivation in England: the gap in major illness-free life expectancy between the 10 per cent most and least deprived areas is around a decade,” said Ann Raymond, economist and lead author on the report. “We also project that these health inequalities will stubbornly persist into 2040 if current trends in risk factors such as obesity, smoking [and] alcohol consumption continue as is. This shows that we need bold and decisive population-wide prevention policies addressing the biggest risk factors that shape health outcomes. But this should be accompanied by a concerted focus on the building blocks of good health such as poverty, quality of work and housing.” A small number of long-term conditions were found to contribute to the greatest discrepancies in England’s health, namely chronic pain, chronic obstructive pulmonary disease (COPD), type 2 diabetes, cardiovascular diseases and anxiety and depression – conditions which are typically managed in primary care. Chronic pain, type 2 diabetes and anxiety and depression are projected to be the most rampant in both the 10 per cent least and 10 per cent most deprived areas. “Since our findings are based on illness recorded in healthcare data, they pertain to inequalities in diagnosed illness and will not capture any instances of unmet need,” Ann commented. “In our analysis, the inequality in illness is due to differences in the exposures to different risk factors and potentially, the wider determinants of health. But there is also well-established evidence of inequalities in access to healthcare which means that the extent of inequality that we find could be an underestimate.” The report also found that people of working age are more likely to live in more deprived areas, allowing the conclusion to be made that England’s working-age population will be concentrated in the more deprived areas.
“Tackling health inequality cannot wait until we have economic prosperity”
What if the working-age can’t work?
“As of January 2024, 2.7 million working-age people were out of the workforce – neither working nor seeking work – due to a long-term health condition or disability,” the report noted. There are many alarm bells which should be sounding after the publishing of this report, but one of the most worrying is the impact of having a large proportion of the working-age population suffering from a major illness. “One of our key results is the unequal increase in working-age ill health. The number of working-age people with major illness is projected to increase by 700,000 by 2040. But 80 per cent of this increase will be in the more deprived 50 per cent of areas,” said Ann. “Inequalities in the health of the working-age population pose a challenge to labour supply and worker productivity and represents a massive lost opportunity hampering economic recovery and growth. It also exacerbates existing economic inequalities and has considerable implications for local and regional economies.” In areas of high deprivation, there are already different economic and employment opportunities, as well as differences in access to education and high education. In turn, this leads to the physical and social infrastructure of society reflecting this – as skills and opportunities reflect the deprivation present. The wider determinants of health like poverty, poor housing and quality of work become difficult to escape, creating perfect conditions for health inequalities to persist.
Without their health, a population cannot be expected to achieve or even contribute to economic prosperity, which is key in maintaining living standards and a multitude of services. The concentration of working-age individuals expected to be living with major illness will not only mean the country will lose out on what should be able, competent citizens who are actively contributing to economic, social and civil society, but it also means that a large portion of the population will spend much of their lives living with an illness that would affect their quality of life, daily. As the report states: “The circumstances in which we live will have a greater role in shaping our health.”
Who has the shortest lives in England?
While the age structure of England’s population is expected to change due to people living longer, this expectation is not the same across the country. Depending on one’s level of deprivation, there is a 10-year difference in life expectancy between the least and most deprived areas. “Women and men in the most deprived areas of England die, on average, 7.6 years and 9.4 years earlier than their counterparts in the least deprived areas,” the report found. “The number of years people live in good health varies too: 60-year-old women residing within the 10 per cent most deprived areas are likely to have a similar level of ill health as 76-year-old women within the 10 per cent least deprived areas.” And the inequalities only worsen as people age – that is to say, the margin of inequality widens as people age. For example, 2019 research showed that in the most deprived areas of England, 10 per cent of people have diagnosed major illness in their 40s, compared to 38 per cent of people in their 60s. By contrast, in the least deprived areas, four per cent of people in their 40s are diagnosed with major illness, rising to 18 per cent in their 60s. “People in the most deprived areas die earlier and spend more time living with major illness,” the report states as one of its key findings. “Men in the most deprived areas have the shortest lives on average, while women in the most deprived areas spend the longest time living with major illness.”
Pharmacy has a role to play
Where policy may be slow to act, pharmacy teams are able to take action immediately, as most of the conditions considered in the report are managed in primary care. “With the projected growth in conditions such as chronic pain, type 2 diabetes and anxiety and depression, primary prevention, early intervention and condition management will be key to supporting people’s wellbeing,” says Ann. Pharmacy teams can be well prepared to spot and caution red flags, and before that, be the first place people look to for prevention advice. Ann continued, saying: “Community pharmacies have an important role to play through public health interventions such as smoking cessation advice, weight management and alcohol advice, health checks and supporting people to self-manage their conditions appropriately as highlighted by recent research by the Nuffield Trust and the King’s Fund.”
Swift Government action needs to be focused on policies that address these inequalities. On a basic level, primary care in the most deprived areas needs to be improved, while national and regional policy is needed to curb bigger catalysts of poor health like smoking, alcohol consumption and diet. “Based on current trends, our predictions indicate that health inequality will remain stubbornly persistent,” states the report. And if this is the case, then England is setting itself up for an exacerbation of socioeconomic inequality. “Tackling health inequality cannot wait until we have economic prosperity; it is one of the key areas of national and local policy focus on which prosperity depends.”
Rewarding Health Equality
The Health Equality category at the Recognition of Excellence Awards aims to recognise a community pharmacy team member who has identified and tackled health inequalities for their patients and communities. Health inequalities include those relating to race, gender, socioeconomics, age, sexuality or living circumstances. Previous winners have helped minority communities like the homeless, refugee or asylum seekers or the deaf community. Every little step towards bridging the gap in the healthcare received across the UK makes a difference. If this sounds like something you or your colleague(s) are adept at, we encourage you to enter the awards in 2025. You can register your interest for when entries open at roeawards.co.uk/register-your-interest-for-2025.
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