Across society we are rightly concerned with economic inequality, as the gulf between the wealthiest in society and the rest continues to increase and living standards stagnate. I’m proud of the work my Welsh Liberal Democrat colleague Kirsty Williams is doing in the Welsh Government to close the attainment gap and improve social mobility. But whilst we focus on economic inequality, we pay far less attention to another inequality which is just as egregious – health inequalities.
The World Health Organisation (WHO) defines health inequalities as “differences in health status or in the distribution of health determinants between different population groups.” These differences can be social, geographical or biological. In other words, our health, wellbeing and life expectancy is in part determined by our wealth, sex, ethnicity and where we live.
Surely, we don’t think that someone deserves to live longer than a peer because of their ethnicity? Do we think that a wealthier individual should live longer than a poorer person? This is what health inequalities are at their heart, someone having a greater right to a long and healthy life because of their wealth, sex, ethnicity or where they live.
Of course, these differences in health outcomes are not intentional. Whether it’s housing quality, diet, access to green spaces, air quality or the provision of youth and sports clubs, these inequalities are the result of complex issues requiring complex solutions. But the fact this injustice is unintentional does not make it any less of an injustice.
There are substantial differences in life expectancy across Wales. For example, there is a four-year gap in life expectancy at birth between males and females. More concerning are the inequalities between those living in the most and least deprived areas, inequalities that unfortunately are not improving. Men in deprived areas die nine years earlier than their richer peers and have 19 fewer years in good health, whilst women in deprived areas die seven years earlier than women in the least deprived areas and enjoy 18 fewer years in good health.
It is not enough to have a great health and social care system if it is not a great system for all who need it. When Beveridge first conceived of universal healthcare free at the point of use, he recognised the right of everyone to access health services and enjoy good health. Beveridge’s vision was hugely successful in tackling the disease he highlighted in his report, but 75 years later there is much more that needs to be done.
In Beveridge’s day the major health issues were serious, but preventable illnesses. Today, we face the challenge of increasing numbers of patients with multiple chronic conditions. If we want Beveridge’s vision to be real today, we need to ensure everyone across Wales gets the help they need to prevent the development of chronic conditions and the support to manage these conditions when they can’t be avoided.
As the health needs of our population continue to change, our health and social care systems must continue to evolve to meet these needs. These changes must be driven by clinical staff and based on evidence, not political dogma. Whether it’s developing primary care clusters, introducing new models of hospital care or better utilising technology, every change must help us meet our changing health needs and address health inequalities.
We must make tackling health inequalities a focus of every area of health and social care, by putting the patient at the centre of everything we do. The patient after all, is what this is all about. Every medical professional wants to give every patient the highest possible standard of care, regardless of their personal circumstances or background. Health inequalities prevent them doing this. If we can put the patient at the heart of decisions over their own care and make the patient voice heard at every level of decision making, we can ensure every patient gets the same high-quality care to address their specific needs.
Because whether it’s cancer diagnosis, primary care, mental health, social care, hospital waiting times or palliative care, everyone has an equal right to high-quality services. As we work towards equal access to treatment across our health and social care system, we must also improve disease prevention to fight health inequalities. We have to tackle poverty to reduce its impact on health and wellbeing. We need to ensure deprived areas get the quality housing, green spaces, sports clubs, healthy food and support they need to boost prevention and improve public health.
If we want Wales to be a truly fair country, a country of equal opportunity; we must end health inequalities and give everyone across Wales an equal right to live long and healthy lives. We must start now.
All articles published on Click on Wales are subject to IWA’s disclaimer.
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