There are substantial health inequalities across the UK. These are caused by the social and economic inequalities that shape the environment in which individuals are born, grow, live, work and age.
This does not just affect the most disadvantaged groups. There is a social gradient in health where the lower a person’s social position, the worse their health.
The cost of this inequality is substantial, both in years of life lost and costs to the economy. It is also a significant challenge to healthcare.
The BMA strongly supports the comprehensive approach to tackling health inequalities set out in the 2010 Marmot Review. In 2011, it developed a guide for how doctors can take action.
Health at a price - reducing the impact of poverty
Doctors have expressed significant concern about poverty and social inequality, and the negative effect this can have on physical health, mental health, and life expectancy.
Our briefing 'Health at a price - reducing the impact of poverty' outlines the different ways poverty can impact on people’s physical and mental health, and explores actions that can be taken to prevent and mitigate this.
It suggests a range of recommendations for policymakers, as well as ways for doctors to act as advocates for patients facing the harmful effects of poverty.
Read the report
Read doctors' views on how poverty impacts their patients
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- Poverty is a widespread issue. It affects an estimated one in three people in the UK.
- Poverty affects the health of people of all ages. For example, children living in poverty are more likely to suffer from chronic diseases and diet-related problems; most individual long-term conditions are more than twice as common in adults from lower socio-economic groups; and mental health problems are much more prevalent.
There is debate about the relationship between poverty and health. Some of the factors which may contribute to poor health include food poverty, types of employment and unemployment associated with poverty, fuel poverty and overcrowded homes, having no qualifications, poor health behaviours and mental health. There can be a negative cycle between poverty and health; unemployment and poverty contribute to poor mental and physical health, which in turn makes it more difficult to find work.
- The BMA supports action on the social determinants of health - as set out in the Marmot review. We also support a ‘health in all policies’ approach, where health is explicitly considered in all government policy-making.
- With increased investment, the NHS can play a stronger role in tackling poverty. For example, it could spend more on prevention and provide greater support for its own employees. The NHS should also ensure it is fully engaged with other sectors outside of the health system in relation to tackling poverty.
Doctors as advocates
Doctors can have a strong voice in advocating for the health needs of their patients and the wider population.
For example, they can raise awareness of the negative effects of poverty on health by writing to their local councillor or MP, or by joining professional and health organisations, community projects or school boards.
They can also support their patients directly - for example, by focusing on their health literacy, considering social prescribing, or by signposting patients at risk of poverty to non-medical support services.
This is not intended to be prescriptive about what should be done, but to provide examples of the type of activities doctors can undertake.
Case study: General Practice at the Deep End Yorkshire and Humber
GPs Dr Ben Jackson, Dr Dom Patterson, Dr Tom Ratcliffe and Dr Liz Walton have been involved with an initiative to support the health of those living in the most deprived areas of Yorkshire and Humber.
'General Practice at the Deep End Yorkshire and Humber brings together healthcare professionals working in the region’s most socio-economically deprived areas to tackle stark and growing health inequity.
Established in 2015 inspired by Glasgow University's 'GPs at the Deep End,' project, it has links with academia, public health, the voluntary and social care sectors and groups working with poor or vulnerable people.
We started out by identifying the 100 practices with the highest deprivation scores in Yorkshire and Humber and inviting them to meet. This lead to a symposium of 65 frontline GPs, professors, directors of public health and commissioners.
At a time when the future can feel bleak and uncertain, our meetings have provided an atmosphere of hope and optimism for the committed healthcare professionals trying to help people living in poverty.
We have set up regular CPD events covering topics such as managing chronic pain, 'respectful curiousity' when working with diversity, GP advocacy, immigrant health and understanding the benefits system.
Our work has led to increased funding for developing training capacity in 'Deep End' GP practices, regional workshops on deprivation medicine for GP trainers and specialist trainees, sharing of good practice, improved links with research networks, and closer working with GPs across the North of England, who are developing community based healthcare interventions and social prescribing focused on helping those most in need.'
Read more about General Practice at the Deep End Yorkshire and Humber
Health in all policies: health, austerity and welfare reform
Our 2016 briefing, 'Health in all policies: health, austerity and welfare reform,' aims to support doctors’ advocacy role in protecting health during times of austerity, setting out the potential harms to health of austerity and the action needed to prevent them occurring.
Read the briefing
'Who pays the price?' - read our feature on austerity