I am a doctor, not an economist, but like many of my colleagues I know what price patients pay for a cost-of-living crisis.
Research has clearly demonstrated the link between poverty and ill-health. In England, the life-expectancy gap between the most- and least-deprived areas was eight years for women and 10 years for men between 2018-20.
Health inequalities between the rich and poor also lead to gaps when it comes to infant mortality, long-term health conditions, avoidable illness, and mental health.
Many families and individuals were already struggling financially as they entered 2022, having felt the impact of austerity politics, COVID-19, and Brexit. At the beginning of the year, the JRF (Joseph Rowntree Foundation) was reporting poverty rates of 22% in England, and 27% in Wales. Things have not improved since then. Instead, we are now facing double-digit inflation and a cold winter ahead.
Those without economic security will be forced to make a series of Hobson’s choices. Like whether to eat, or heat their home. In June, the JRF reported that seven million low-income households had 'either gone without enough food in the previous 30 days, or gone without at least one essential such as a warm enough home or basic toiletries…since the start of 2022'. In August this year, I treated an older patient with hypothermia. It was a hot summer. As we move to Autumn, I have seen many more. I dread to think what the winter will bring.
If you can’t afford to meet your basic needs, you can’t reliably preserve your physical or mental wellbeing. The NHS confederation wrote earlier this year about the manifold ways cold, damp homes can impact patients’ health – from leading to an increase of heart attacks and strokes, to raising the risk of falls in the older population and the development of respiratory conditions in children, to the five-fold likelihood of adolescents in cold housing developing multiple health problems compared to their peers.
The confederation also spoke about the revolving door nature of the issue. Doctors can treat a chest infection produced by a mouldy bedroom, but they ultimately send their patients back to biohazards.
There’s a limit to our prescription pad. I can talk about the importance of good nutrition to manage diabetes or recover after a stroke, but it’s of little use if my patient can’t afford to eat. Ultimately, the cost-of-living crisis is a health crisis, but not one doctors can cure alone.
That is why the BMA has joined the JRF and many other organisations to ask the new prime minister to bring the uprating of benefits – that is, an inflationary uplift – forward, and provide patients with a bit more resource to face the season ahead. The very poor can’t wait until April in the hopes of an uprating: they need to survive the winter.
It is why we have also added our support to the Big Issue’s Big Futures campaign, which demands long-term solutions to break the cycle of poverty. It demands the Government:
- Create decent and affordable homes for all
- End the low-wage economy and invest in young people
- Build a greener, sustainable future and create millions of well-paid green jobs.
There is much to be done to reverse the health impact of recent and long-standing economic trends, but adopting JRF’s measure will provide some relief to those most at risk, while answering Big Future’s demands will help pave a healthier future.
If 'protecting the vulnerable' is, as the chancellor recently said, 'at the forefront' of the Government’s mind, we ask him to prove it by agreeing to these asks.
If the UK can avoid death, illness, and further strain to an already over-stretched health service, it must do so. Those unmoved by ethical arguments might consider the economic one: at the beginning of the year, the Northern Science Health Alliance predicted endemic ill-health in 'left-behind' neighbourhoods cost the economy £30bn, far higher than the £7bn cost of uprating benefits by inflation rather than earnings.
Surely if we were to invest to prevent such dramatic health disparities in the UK, the net effect would be not only a prevention of the economic loss, but potential contribution to the wealth of the nation. To prevent such dramatic health disparities in the UK, the net effect would be not only a prevention of the economic loss, but potential contribution to the wealth of the nation.
As the adage goes: an ounce of prevention is worth a pound of cure. Preventable ill-health should not be seen as 'acceptable losses', but something we simply can’t afford.
David Strain is chair of the BMA board of science