Calls for a greater focus on the prevention of ill health in England have intensified following a review that estimated the cost of health inequalities to be between £31 and £33 billion a year.

In addition, health inequalities in England are generating lost taxes and higher welfare payouts of £20 billion - £32 billion a year and extra annual costs to the NHS of more than £5.5 billion, highlighting the urgent need – from an economic point of view - to address issue.

Fair Society, Healthy Lives, a government commissioned report by Sir Michael Marmot, from the department of Epidemiology and Public Health at University College London, has also revealed the true scale of health inequalities across the country, which it says are “unfair and unjust”.

For instance, it found that while health inequalities are generally assumed to affect primarily the poorest classes in society, premature illness and death actually affects everyone who is not part of the wealthiest strand of the population.

But the differences between the lowest and highest ends of the social spectrum are the greatest, with those living in the poorest areas of the country not only dieing, on average, seven years earlier than those in the most affluent areas, but also spending a much greater proportion of their lives in ill health.

To better balance the scales the review says that the issue of health inequalities must be given the same priority as tackling climate change in the drive to create a sustainable future, and it makes six key recommendations to help foster a more equal health climate across the country.

For one, it says there must be a greater focus on ill-health prevention and ensuring a healthy standard for living for everyone. In addition, it has stressed the importance of giving every child the best possible start in life, as well as enabling everyone “to maximise their capabilities and have control over their lives”. Also important, the review says, is ensuring that good work/employment is available for all and that sustainable communities are developed.

“There will be those who say that our recommendations cannot be afforded, particularly in the current economic climate,” said report author Professor Marmot, but added: “We say that it is inaction that cannot be afforded, the economic and more importantly human costs are simply too high”.

“The health and wellbeing of today’s children, and of those children when they become adults, depend on us having the courage and imagination to do things differently, to put sustainability and well-being before a narrow focus on economic growth and bring about a more equal and fair society,” he stressed.

Commenting on the report, Health Secretary Andy Burnham said its recommendations will help the government implement a strategy to continue tackling health inequalities over the next decade.

Equal chance for everyone
“It is not right that where we live can dictate the state of our health. Everyone should have an equal chance at good health. I am passionate about getting to the heart of this issue and ensuring that young people can look forward to the same life expectancy regardless of where they are born,” he said, adding that the report “will help us make that historic achievement”.

The NHS Alliance published a report back in August warning that health inequalities are likely to worsen because there is not enough emphasis in this country on encouraging people to take care of their own well being. It claims that “a lack of engagement from frontline clinicians in community health, little or no funding, and an NHS that is risk adverse and fails to inspire the local population and its professionals” means that far from improving health inequalities the divide will only deepen.

But over the years there have been significant improvements, and work by the National Institute for Health and Clinical Excellence in particular has, through its programme of public health, played a major role in improving life expectancy rates across the country.

Speaking at the launch of Marmot’s review in London, Professor Ian Diamond, chief executive of the Economic and Social Research Council and a commissioner of the review, said the Institute “has done an enormous amount of work in terms of identifying strategies like smoking cessation and the use of statins that can help to reduce inequalities”, and said NICE will continue to play a major role in building on these “great foundations” and achieving the report’s recommendations.