“ Individuals, families and groups in the population can be said to be in poverty when they lack the resources to obtain the types of diets, participate in the activities and have the living conditions and amenities which are customary, or are at least widely encouraged or approved, in the societies to which they belong”
Townsend, P., in Wedderburn, D. (1974) Poverty, Inequality and Class Structure (p15)
Child poverty in Britain Bradshaw J. Child poverty in comparative perspective. In: Gordon D, Townsend P. Breadline Europe: the measurement of poverty. Bristol, The Policy Press, 2000.
“ The prime responsibility for improving the health of the public does not rest with the NHS nor with the Government, but with the public themselves. . .
“ no government or doctor can make a person healthy on their own. Ultimately, that responsibility has to lie with the individual. Only they can make the choice to healthy lives, to change their lives for the benefit of themselves and their families.
John Reid, Secretary of State for Health, 3rd February 2004
One part of the study examined the health of around 700 staff working in a department that was privatised
The study looked at subsequent experiences of long-standing illness and mental health problems among staff who were: (i) in secure employment; (ii) in insecure employment (e.g. temporary contracts); and (iii) unemployed.
Employment changes and health Ferrie JE et al. Employment status and health after privatisation in white collar civil servants: prospective cohort study. British Medical Journal , 2001, 322:647–651.
‘ Evidence from factory closures studies showed that much of the deterioration in health started, not when people actually became unemployed, but before that – when redundancies were first announced. . . It provides powerful evidence that one of the clearest categories of deprivation in modern societies affects health predominantly through psychosocial channels’.
‘ Job insecurity is presumably only one among several other categories of financial or material insecurity’.
Richard Wilkinson (1996) Unhealthy Societies (p178)
‘ This book brings together a growing body of new evidence which shows that life expectancy in different countries is dramatically improved where income differences are smaller and societies are more socially cohesive. The social links between health and inequality draw attention to the fact that social, rather than material, factors are now the limiting component in the quality of life in developed societies.’
“ In areas with most sickness and death, general practitioners have more work, larger lists, less hospital support than in the healthiest areas – the availability of good medical care tends to vary inversely with the need of the population served.” (J. Tudor Hart, ‘The Inverse Care Law’, The Lancet , 1971).
“ despite the egalitarian principles of the NHS, inequality of access has persisted within the NHS” (Secretary of State for Health, 2003)
Inequalities in the use of cardiology services: evidence from Sheffield
Sample of 491 people with angina symptoms in Sheffield
11.2% of the sample in the ten most affluent wards had received an angiography, compared to 4.2% in the ten most deprived wards
Deprived wards had only about half the number of revascularisations per head of population estimated to have angina symptoms than did affluent wards
“ We found that the ratio of rates of coronary artery revascularisation to the prevalence of angina symptom varied substantially across the city and was inversely proportional to deprivation. Thus, use of services was not commensurate with need and seemed to exhibit the inverse care law, even thought the availability of care is the same.” (Payne, N. & Saul, C. 1997 ‘Variations in the use of cardiology services in a health authority’ British Medical Journal , 314.
Social differences in seeking professional help
Study of heart disease in Glasgow, interviewed 30 residents in deprived area and 30 in affluent area
“ People from the deprived area reported greater exposure to ill health, which allowed them to normalise their chest pain, led to confusion with other conditions, and gave rise to a belief that they were overusing medical services . . . Anxiety about presenting among respondents in the deprived area was heightened by self-blame and fear that they would be chastened by their GP for their risk behaviours.” (Richards, H. et al , 2002, ‘Socio-economic variation in responses to chest pain: qualitative study’ British Medical Journal , 324).
“ The target is a 10% reduction in the relative gap (i.e. percentage difference) in life expectancy at birth between the fifth of areas with the worst health and deprivation indicators (the Spearhead Group) and England as a whole.
“ Latest data for 2002-2004 indicate that the relative gap in life expectancy between England and the Spearhead Group is wider than at the baseline (1995-1997) for both males and females. For males the relative gap is 1% wider than at the baseline, for females 8% wider.”
“ The target is a 10% reduction in the relative gap (i.e. percentage difference) in infant mortality rates between “routine and manual” socio-economic groups and England as a whole from the baseline year of 1998 (the average of 1997-99) to the target year 2010 (the average of 2009-2011).
“ Infant mortality rates have declined in the routine and manual group since the baseline period, however, the rate of decline has been faster in other groups. As a result, the trend shows a widening in the relative gap between infant mortality in the routine and manual group and the total population between the target baseline 1997-99 and the latest period 2002-04.”