Social class persists as a key determinant for life expectancy and good health
In 1942, two drivers of William Beveridge’s concern for the giant evil of disease were the need to combat life expectancies that saw women, on average, dying in their mid-fifties and men in their early fifties, and the need to improve maternal and infant mortality.
These women and men died mainly of infectious diseases, such as polio, diphtheria, tetanus, whooping cough, pneumonia and tuberculosis. The need for a sufficient and healthy labour force to rebuild the economy necessitated combating the disease that was killing the potential and existing workforce.
Poverty, poor diet and poor living conditions were major contributory factors to the prevalence of disease and infant mortality. However the dual forces of increased political will, which led to the Public Health Act 1936, Factories Act 1937 and Food and Drugs Act 1938, and scientific advances in antibiotics and mass immunisation programs, had begun to significantly impact on mortality caused by these diseases by the time the National Health Service was founded.
Ad hoc healthcare provision had developed to cope with the devastation of these diseases. Bevan centralised the system, nationalising hospital provision and built a NHS on a tripartite structure of hospitals, general practice and community services.
So would a modern Beveridge report include disease as a giant evil? I would say yes – but the nature of disease has changed and so must the policy response.
The top four causes of premature mortality today are cancer, cardiovascular disease, respiratory disease and liver disease. Depending on social class, the biggest contributors to early death and disability are dietary risks, tobacco and obesity. Alcohol and drug misuse and lack of physical activity are also key and we are starting to appreciate the impact of mental health and social isolation on physical health.
Life expectancy has significantly increased, but the prevalence of people living with, one or more, limiting long-term illness or disability has changed the picture of healthcare demand.
In Bristol, women live 64 years in good health on average, but a further 19 years in poor health. For men, the figures are 63 years and 15 years respectively. The average masks a huge range depending on social class. Several areas of my Bristol South constituency are in the lowest five per cent in England for male life expectancy. Michael Marmot’s review of health inequalities estimates between £36bn and £40bn in lost taxes, welfare payments and cost to the NHS of what we now call health inequalities.
Combating disease continues, demonstrated by current vaccination programmes for influenza and meningitis but the prevention of avoidable long-term disorders requires beefed-up public health and community services. They should be assisted by doctors surgeries, with hospitals the place for specialist support, with the taxpayer and patient having a much greater say.
Scientific advance continues to keep us alive for longer, but unless there are accompanying political forces to refocus the system to prevent and manage limiting long-term illness, and to address the silent misery for families coping with this largely social care issue, the evil of disease should continue to dominate the debate.
Karin Smyth is member of parliament for Bristol South