Disparities in health widen between rich and poor in England

BMJ 2005; 331 doi: (Published 18 August 2005) Cite this as: BMJ 2005;331:419
  1. Owen Dyer
  1. London

    Social disparities in health outcomes in England have been widening, not narrowing, in the early years of the government's drive to reduce class inequalities in health by 2010, says a status report commissioned by the Department of Health.

    In 2002 the government set a target to reduce by 10% the degree to which the fifth of local authorities with the worst figures in infant mortality and life expectancy fall below the national average, compared with a 1997-9 baseline figure.

    But the class gap in health has actually been growing, the statistics show. In 2001-3 infant mortality among the families of “routine and manual” workers was 19% higher—at six deaths in every 1000 live births—than the national average. In 1997-9 infant mortality in this social group had been 13% higher than the national average and in 1999-2001 it had been 17% higher. Infant mortality in this group in 2001-3 was 69% higher than that in the “managerial and professional” group.

    The difference in life expectancy between the most deprived areas and the national average also grew in these years. In 2001-3 the average life expectancy in the fifth of local authorities with the worst figures was 74.17 years for men, 2.07 years less than the English average for men of 76.24, and 79.09 for women, 1.63 years less than the English average of 80.72. The differences at baseline were 2.00 years for men 1.54 years for women.

    Rod Griffiths, president of the Faculty of Public Health at the Royal College of Physicians, said the efforts undertaken so far showed that “the government's heart is in the right place on this issue.”

    “But,” he continued, “the task is a monumental one, and there's no certainty that they can turn around a longstanding social trend. This gap has been growing for at least 50 years.

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    Health outcomes-like cash flow-are still relatively poor in England's deprived areas


    “The government is trying to move the things that need to be moved, in my opinion. But in other areas they are working against these ends. All of this spending on shortening waiting lists is effectively shovelling money to the middle classes, who tend to be over-represented on waiting lists for elective surgery.”

    Michael Marmot, chairman of the scientific research group that authored the report, said that the absolute difference between social classes in outcomes in circulatory diseases had already narrowed somewhat but that cancer has a longer lead time between exposure and effect.

    The report's findings on life expectancy came as no surprise to Professor Marmot's group, but they did note social changes that might be expected to have an effect on health in years to come, of which the biggest was a dramatic reduction in the number of children in poverty.

    The report reviews 12 such “headline indicators” of long term change. Others include smoking cessation, educational attainment, flu vaccination, consumption of fruit and vegetables, and exercise in school.

    Rates of smoking have declined in all social classes, but the proportion of smokers is higher in manual workers than in other groups. The “five a day” programme to encourage consumption of fruit and vegetables has had no apparent effect.

    The government announced last week that it will deploy “health trainers” to 12 deprived areas to counsel people on healthy lifestyles. The minister for public health, Caroline Flint, said their tasks “might include giving a pregnant woman information about her local stop smoking services or accompanying a woman to a breast screening appointment.”

    Efforts to encourage healthy lifestyles have been slow to get off the ground, said Professor Griffiths, because changing social culture is much harder than improving health services. “Improving medical knowledge actually tends to widen health disparities,” he said, “because the middle classes are amazingly adept at pouncing on every new snippet of information about healthy lifestyles and incorporating it into their daily activities.”

    Life expectancy (years) at birth in England and in the fifth of local authority areas with the lowest life expectancy

    View this table:

    The 12 areas to receive health trainers are Bradford, Tameside and Glossop, South East London, Manchester, Gateshead, Hull, Kirklees, Bristol, Birmingham and the Black Country, County Durham and Tees Valley, Derbyshire, and Tyne and Wear.


    • Tackling Health Inequalities: Status Report on the Programme for Action is accessible via the search engine at

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