A close call on health inequalities

In Glasgow's glittering West End, known as the "G12" after its prestigious postcode, the bars are filled with professional couples and Glaswegian musicians and artists, and celebrity footballers live close by. Outside the gated homes and 4WDs on Princes Gardens, a group of female students emerge from a private cab after a night out. When presented with the fact that they can expect to live more than 20 years longer than their neighbours down the hill merely because of their postcode, the young women's eyes widen. "Really?!" says 21-year-old Amanda Jason. "Bonus!"

New research published by the British Medical Journal shows the north-south health divide is at its widest for 40 years. It follows last week's report by Sir Michael Marmot, a professor at University College London, on how wealth determines health.

Marmot found that far from a simple north-south divide in life expectancy, the reality is a messy patchwork of inequality around the country. Some of the starkest differences occur not between regions but between neighbours.

The research finds that, although Glasgow has the worst longevity in the UK, you're better off living in the city's Jordanhill, where the average life expectancy is 80, than the poorest parts of supposedly affluent areas such as London's Westminster, where men live to just 75; Solihull, where the poorest men live to 74; or Surrey, where those in the most deprived areas live to 77.

Recent data from NHS National Services Scotland shows that Scotland's inequalities are even more pronounced. Men living in Parkhead, just a few miles down the road from Glasgow's Kelvinside and Jordanhill, can expect to live to just 59 – a life expectancy lower than the national average in Yemen, Laos or North Korea.

Although the UK's average life expectancy is high – 78 for men and 82 for women, according to the Office for National Statistics – this masks huge variation between different social groups. Take Wellington Archibold, 67, who lives and works as a cleaner in Kensington and Chelsea, central London, the borough with the highest life expectancy in the UK. In the ward of Courtfield, male residents can expect to live over 85, but the residents in St Charles ward, where Archibold lives, can only expect to live to 73. As he pushes his cleaning trolley around the 15-storey tower blocks, I ask him if he thinks it is fair that he is only expected to live another six years when neighbours of his age up the road can expect to live another 18.

"Seems to me life is just the luck of the draw – your family might live longer than mine and mine might live longer than yours," he says.

Despite being over the pension age, Archibold is still working a 45-hour week, cleaning his estate throughout the freezing winter months and putting his health at risk. But he insists he continues to work because he likes it, and because it helps him to pay his relatively high rent.

Spending all day cleaning, he says, gives him a real insight into the health status of his neighbours: "I pick up needles and the ends of drugs," he says. "The younger ones taking them [drugs] move on, but others take their place. Then there's a lot of takeaways – wrappers for chips and pizza and KFC. There's a lot of mess on the staircases. Seems to me a lot of the young people around here are just following a pattern."

Stereotypes

It's hard to believe that such deprivation can exist in the heart of one of the UK's richest boroughs, but the statistics defy the stereotypes. Data published in July by the Department of Health shows that people in Kensington and Chelsea are more than three times more likely to suffer an early death from cancer, and almost twice as likely to be hospitalised for an alcohol-related condition than residents in Kelvinside and Jordanhill. Although detailed breakdowns per ward are not available for England, rates of heart disease and diabetes in Kensington and Chelsea are higher than in Glasgow's West End.

But how can people living close together have such radically different health profiles? Phil Hanlon, a professor researching the issue at the University of Glasgow, says the answer is multifaceted. "Areas with different life expectancies might be close together, but they tend to be different in every way," he says. "Take Jordanhill and Parkhead in Glasgow. Physically, Parkhead has worse housing, fewer parks and transportation links. In the womb, Parkhead's next generation is more likely to be exposed to smoking, alcohol and a poorer diet, and this gets compounded in early years and adolescence, with people from poorer neighbourhoods being more likely to work in lower-income jobs or suffer unemployment. It's hard to say what matters most; it's the complex interaction of factors rather than any one."

Last November, the coalition government published its first health white paper responding to these challenges. It did not mince its words. The current system, it argued, is "not up to the task" of reducing health inequalities and is in need of a radical overhaul. Professionals need more freedom, communities need more powers and individuals need to take more personal responsibility. The role of the state is to intervene in the "least intrusive" way possible, and individuals should be "nudged" into changing their behaviour by, for example, being given more information.

With so many health reforms, health authorities are now warning that these inequalities could worsen. "Staff are being lost and services reshaped so extensively that just coping with all the change is taking most of their time," says Lindsey Davies, president of the UK Faculty of Public Health. "They don't have the energy left for the public health interventions on the ground they know they should be focusing on … Such a huge reorganisation does pose real risks to life expectancy."

There are also concerns that the cuts themselves could damage life expectancy. People living in economically deprived areas are likely to be affected disproportionately, while proposed health reforms could create a postcode lottery of services that widens existing inequalities.

"I am very worried by the significant reductions of some services," says Davies. "I know the health service is doing everything it can to limit the impact of cuts on patients, but I do worry."

Hanlon also fears that the economic climate could exacerbate matters. "The threat of unemployment and the experience of unemployment has detrimental effects on mental and physical health, including the risk of heart disease," he says. "So the policy perspective that accepts loss of employment as a 'price worth paying' for economic recovery could have a significant impact on inequalities in life expectancy."

Many experts agree with Marmot that central government will have to play a bigger role in improving the nation's health. "Regulation has a role to play," says Davies. "Getting rid of trans fats and reducing salt is important, and so is banning point-of-sale advertising for tobacco. Increasing the unit price of alcohol to 50p would make a big difference. Then there's improving access to good health centres and making sure we support the excellent healthy food campaigns that we've seen and helping kids get plenty of exercise – I don't understand why some of these budgets are being considered for cuts."

Targets

But some projects are managing to sustain themselves through the cuts in funding. One example is the Dalgarno neighbourhood trust's Shout programme, based in St Charles ward, Kensington and Chelsea. Funded by the NHS, more than 100 individuals have benefited in the last financial year. Each person gets a key worker and a healthcheck, and personalised targets are set accordingly. Support workers are on hand to help participants give up smoking, and a choice of exercise classes is on offer every week.

"It's no good just giving them a diet sheet," says the trust's director Vicki Laville-Davies. "Many of the people we see don't have the confidence to take the initiative. Having a group and some mentoring is what's needed."

Such unity is not always possible. Back in Glasgow's G12, Jason continues to live in a separate world from her neighbours with lower life expectancies in the east of the city. "I don't think about how people live down there – I have no reason to see them," she says. "I don't understand why people live less long there. Sure, there might be drugs about, but they don't have to take them. There are plenty of [positive] opportunities for people out there. I don't think life is that unfair."