The value of prevention
Last week I attended the launch of Inequalities matter: an investigation into the impact of deprivation on demographic inequalities in adults. Lead researcher was Professor Les Mayhew of Cass Business School, with the research investigating the impact of deprivation on demographic inequalities in England. In brief the study found that while life expectancy is increasing overall and that life expectancies of men and women are converging, any improvements are slower paced in more deprived areas with the net effect that the gap between rich and poor is slowly worsening over time. In England huge inequalities are growing, with bigger inequalities the poorer you are.
No Targets was invited because of our interest in the reasons underpinning the results and to contribute in addressing the challenges of encouraging behavioural change. As Professor Mayhew pointed out, “The causes of ill health are increasingly lifestyle related and rooted in the cultures of different socio-economic groups – think smoking, excessive drinking, obesity, drug abuse and mental illness. Efforts are being made to improve health outcomes in deprived areas, but more resources need to be provided for preventative measures and education.”
Health – a highly visible divider
Health is one of the starkest manifestations of inequality we can experience, and while average life expectancies increased throughout the 20th & 21st Centuries, these improvements have not been shared equally. The report found an 11year lifespan difference between highest and lowest percentiles examined, while more starkly the implications associated with increasing levels of chronic disease at earlier ages were dire. In simple terms, the earlier a chronic disease is acquired the greater the percentage of life will be spent in ill health with personal and societal consequences.
The consequences of chronic disease
The implications for health and quality of life posed by the rise in chronic disease are profound.
- Person A becomes physically disabled as a result of a chronic disease at the age of 40.
- Person B becomes physically disabled at the age of 75.
Person A could expect to die at the age of 70, with 30 years spent in ill health – some 43% of their life. Person B could expect to die at age 86, living another 11 years, but with only 13% of their life in disability, having had almost double the active years of Person A.
Two important strategic messages
- Increases in life expectancy need to be balanced by improvements in disability-free life expectancy because this increases working life expectancy
- Early onset disability is bad for individuals and for society because it shortens life and increases the chances of dependency. It is also largely avoidable.
Bottom line: Avoid chronic disease for as long as possible.
The report concludes, “If the poorest in society could be made healthier through greater redistribution of available health care resources, the negative health and higher rates of mortality which we observe would not exist today, but this is plainly not the case (House of Commons, 2009). This suggests that skewing resources to towards prevention is a better way forward, otherwise inequalities will worsen as this research identifies. Clearly, other policy tools aimed at changing behaviour using monetary incentives including taxes are needed to steer people towards healthy lifestyles, because if they benefit all of society benefits.”
The value of prevention
The challenges posed by deprivation are huge, with districts where low life expectancy is concentrated also having a lower healthy life expectancy such that a greater proportion of years are spent in ill health. Local culture around attitudes to food and exercise can contribute to problems, but factors such as a less safe environment in which to take exercise, a lack of facilities or living in a fresh food ‘desert’ without shops that stock real food clearly impede the efforts of individuals even curious about making better choices. Clearly location can make turning a vicious circle of deprivation into a virtuous circle of healthier eating and exercise habits much more difficult, with inequality and poor health intertwined.
We have been here before with tobacco, and once again Professor Mayhew sees this as offering a model with “more emphasis needed on things that do us harm versus the things that do us good”.
Up to 80% of premature deaths from heart disease and stroke could be prevented by healthier eating and increasing physical activity. Yet inspiring the changes required may be a much greater challenge than was the case with tobacco. After all, we don’t need to smoke, but we all need to eat, so confronting a food addiction is inherently trickier. And because ultra-processed foods have low nutritional quality, the more that’s consumed, the poorer the nutritional quality of the whole diet. As processing strips food of nutrients that the body needs, those mainly filling up on ultra-processed foods leave little room in their diet for healthier options.
Yet it is also clear that the value of prevention would be huge, and as we have learned from lessons in the past, education must inevitably form a major part of any solution, a point that was strongly endorsed by Carol Jagger, AXA Professor of Epidemiology of Ageing at the Newcastle University Institute for Ageing in her response to the report. A good place to start may be simply encouraging a better appreciation that what we eat can have a direct and critical impact on our health.
Bottom line: The true value of prevention is capitalising on your potential
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