MEMORANDUM BY THE DEPARTMENT OF HEALTH PUBLIC
HEALTH (PH1) (contd.)
2. INTRODUCTION
2.1 Health in Britain improved dramatically
during the 20th Century. For example, life expectancy for a baby
girl born in 1900 was 48 years and 44 years for a boy. By the
millennium, life expectancy had increased to 80 years for a girl
and 75 years for a boy.
2.2 But the health of the people of Britain
is not as good as that in many other developed countries. Britain
ranks only 14th in the latest WHO survey of health life expectancy,
behind Spain, Italy and Greece.
2.3 The benefits of improving health have
not been experienced equally across society. Health inequalities
in Britain are wide and growing (see Annex A). For example:
(i) life expectancy at birth for a boy is
over nine years less in the lowest social class compared to the
highest, for a girl over six years less;
(ii) among men of working age, 17,000 premature
deaths would be avoided each year if the death rates of all were
the same as those in professional and managerial jobs;
(iii) coronary heart disease (CHD) death
rates in men under 65 vary between health authorities, with the
highest almost three times that of the lowest;
(iv) infant mortality rates vary between
health authorities - the highest rates are three and half times
that of the lowest rate;
(v) Death rates from coronary heart disease
among first generation South Asians aged 20-69 are about 50 per
cent higher than the England and Wales average;
(vi) Stroke death rates are more than 50
per cent greater among those born in the Caribbean.
2.4 Such marked inequality—such unfairness—is
not inevitable. If other countries such as Sweden can both be
healthier overall and avoid marked health inequalities, then so
should Britain. We can—and should—do better.
Determinants of health
2.5 The determinants of health are well
recognised. Communities with the poorest health tend to have:
(i) greater exposure to the root causes of
disease:
— limited educational opportunities
and attainment;
— high stress social environments (anti-social
behaviour, crime, drug misuse);
— hostile physical environments (homelessness,
or overcrowded, cold, damp homes, lack of safe places for recreation,
and exposure to infections, pollutants etc. (see Annex B);
— social and physical isolation (poor
transport, no local shops);
— limited social support and personal
control.
(ii) high rates of smoking, poor nutrition
and sedentary lives;
(iii) restricted access to and poorer quality
services including poorer access to high quality health care.
2.6 Promoting health, preventing ill health
and tackling ill health requires action on all three fronts.
2.7 This Memorandum sets out how each front
is being tackled. Often it is not the Department of Health or
the NHS whose decisions and actions have the greatest impact on
health. The implication is that co-ordinated action is required
between Government departments, local government, the NHS and
other agencies. In the past, this co-ordination has been difficult
to achieve. Reflecting the remit of the Committee's Inquiry into
Public Health, particular emphasis is placed on what is being
done to improve this co-ordination nationally, regionally and
locally and on the role of key players in delivering effective
public health.
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