Inequalities in Health in Great Britain

The purpose of this report is to discuss and review health inequalities across Great Britain. The report will use extensive research from the Black report, the Whitehead report and the Acheson report to evaluate how different factors of society has been proven to have damaging effects on the public's health. The report will also evaluate Government strategies' and health campaigns like Saving Lives - Our Healthier Nation, Choosing Health and Change4Life that have been instigated to tackle health inequalities and overall improve the public's health since the issues were first documented by Sir Douglas Black in 1980. In order to properly assess the progress made it is important to use historical evidence to understand developments and inequalities throughout the land.

The definition of 'Health' has been confirmed as 'a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity' by the World Health Organisation (WHO) and it has not been amended since 1948. WHO analyses public health reviews and implements practical policies to improve the health of the populations. The author Katherine Mansfield had another idea as to what health means and other holistic concepts of health cover: physical, mental, emotional, social, spiritual and societal health.

Beside discussions as to what is health, there become developing concerns over the differences in health status for different groups of people in the UK and this lead to the 1980 Black Report, named after Sir Douglas Black, at the time of the Thatcher Government. The purpose of the Black Report was to evaluate the public's health across Great Britain, obtain patterns of inequality and suggest strategies for improvements. The report analysed the lifestyles and health records of people from all social classes (based on the Registrar General's categories) and found substantial evidence that connects health inequalities to social class divides. The report suggested that people in upper socio-economic classes had a greater chance of living a healthier life and avoiding illness. Income, education, housing, diet, geographical location, occupation, gender and ethnicity were all recognised factors of poor health and the rising inequalities.

The Black Report acknowledged there had been dramatic improvements regarding infant mortality and life expectancy since the National Health Service was established in 1948. Infant mortality had fallen to six in one thousand, whereas the figures were one in ten during the 1900's. Statistics demonstrate positive differences in life expectancy at birth for both males and females during the twentieth century. Women are now expected to live an average of 80 years compared with 48 years that was recorded in the 1900's and life expectancy for men increased to 75 years, compared to the age of 44 in the 1900's. Mortality and Morbidity rates are crucial to establish the level of health amongst the nation. Morbidity means disease or a state of ill health in a population and mortality refers to the incidence of death and the number of deaths in a population. Child and infant mortality are important indicators of the general well-being of society.

The data table below shows figures of social class and death rate

Table: Social class and health, 1991-1993 and 1993-1995

Social Class Still-birth rate Infant mortality rate Mortality rate

(1-15 years) Standardised mortality ratio (men 20-64 years)

I 4 4 18 66

II 4 5 16 72

IIIN 5 5 16 100

IIIM 5 6 26 117

IV 6 7 22 116

V 8 8 42 189

N=non-manual; M=manual

Still birth rate = number of deaths per 1000 live and death births, 1993-5

Infant mortality rate = number of deaths in the first year of life per 1000 live births, 1993-5

Mortality rate (1-15 years) = number of deaths per 100,000 population aged 1-15 years, 1991-3

Standardised mortality ratio (men 20-64 years) = The ratio of the observed mortality rate in a social class to its expected rate from the total population, multiplied by 100, 1991-3

Source: Bartley and Blane, 2008

The data table shows the variation of life expectancy between the lower social class and higher class citizens.

Mortality rates by sex, UK and constituent countries

The graph above demonstrates health improvements across Great Britain since the Black report but indicates considerable health inequalities exist within gender and geographical location. Similar observations lead to the final review called the Whitehead report in 1987, the Health Divide. The review was commissioned by the Health Education Council (HEC) in order to revise the evidence made since 1980. The report concluded that overall the health in Britain was improving but the rate of improvement was not equal across all social sections of society and inequalities were continuing to grow.

In 1988 Sir Donald Acheson was invited to review and summarise health inequalities in England. Acheson's report is split into two sections. The first part of Acheson's report detected patterns of health inequalities and found that very little had changed. The second part of Acheson's report identified areas of priority and found approximately a quarter of people in the UK were living in poverty. In order to improve the standard of living Acheson recommended many cost effective and affordable interventions to target areas such as education, environment, families and housing to reduce the gap of health inequalities across the UK.

Acheson recommended that schools offer pupils free fresh fruit, entitlement to free school meals and restrictions on providing less healthy foods. Acheson was particularly targeting the less well-off and advised that schools should promote health through the curriculum by teaching children about healthy eating and budgeting methods. Acheson's plans were to reduce risks of obesity and dietary related deceases by improving nutrition in schools.

Statistics show in 1996, 29% of men and 28% of women smoked. Of which it was found only 2% of professional men and 11% of professional women smoked, compared with 41% of unskilled male workers and 36% of unskilled women workers. The report