On 12th January 2022, the House of Lords debated changing mortality rates in the UK in Grand Committee. The Bishop of London spoke in the debate, advocating for greater inclusion of faith groups to aid in tackling health inequalities:
The Lord Bishop of London: My Lords, I thank the noble Lord, Lord Sikka, for securing this important debate. I also look forward to hearing from the noble Lord, Lord Evans, in his maiden speech.
The paper at the heart of this debate provides a useful focus, because it highlights one of the worst health outcomes that we have seen in the past 10 years: that of widening inequalities. It is also helpful because, by focusing on the impact of austerity, we begin to see that public health is impacted by many factors besides healthcare access—factors called the social determinants of health. Those include housing, our jobs, our environment, our education and much more. They can be summed up as the opportunities that we have to lead healthy lives. The Heath Foundation noted that 50% of people in the most deprived areas report poor health by the age of 55 to 59, which is more than two decades earlier than in the least deprived areas. It is not just about life expectancy; it is also about healthy life expectancy.
The debate is poignant also because it comes at a time of great strain on the NHS and on social care, and at a time when those other determinants of health are challenging for many of us. We are also at a moment when I hope we are beginning to realise the importance of prevention of ill health, which is essential for the sustainability of our healthcare system.
Over the years, many organisations have agreed on the need for a strategy for health and health equality, but the long-promised and long-awaited health disparities White Paper is nowhere to be seen. Meanwhile, those subject to health inequalities are more likely to be affected by healthcare pressures and to struggle in the coming economic climate. It is in these conditions that inequalities in health can only worsen.
In the absence of a strategy to tackle health inequalities, I propose that recognising and supporting the work of faith groups could be key to a real improvement in both prevention and access to healthcare. Faith groups hold the deep trust of the people they serve, with unrivalled knowledge of their communities. I recently had the opportunity to convene the Health Inequalities Action Group, which brought together faith leaders, healthcare professionals and civil society leaders to explore the intersection of faith, health inequality and health in London. London currently has the biggest gap in life expectancy between its local authorities of any region in England.
Through two townhall sessions, we heard some extraordinary stories of faith groups which had stepped up in the pandemic to advocate for public health and deliver healthcare solutions in, for and with their communities. For example, we learned from a senior leader in the Jewish community in north London who had designed a vaccination service that hosted separate sessions for men and women with the Jewish Hatzola ambulance service. They also made sure that rabbis were vaccinated, because they understood the influence they carried in their communities. Another example was the setting up of a mortuary by a mosque in east London, because many were dying in the pandemic and “there was a lack of cultural knowledge about how a burial for the Muslim community happens, so we did it ourselves”.
Faith groups know well the people who often fall into the “hard to reach” category in public health. They are already serving them, not just with health services but for other needs. It is hard to overstate the value of this relational capital to advocate for good public health. There is a track record of successful partnerships between faith groups, local authorities and healthcare providers. For example, the South London Listens campaign saw community and faith leaders come together with citizens to work with three NHS trusts in south London to improve mental health services there post pandemic. The Faith Covenant, established by the APPG on Faith and Society and FaithAction, also does good work on collaboration and tackling mistrust between faith groups and local authorities.
However, there is still a variation of experience and a lack of literacy among both local authorities and healthcare professionals in how they relate to faith groups and vice versa. There is a lack of systematic recognition of the importance of faith to those who have one, which means that people do not feel that they have access to health services. On top of that, the extent of health inequalities can be misunderstood. There is also a lack of collection of ethno-religious data. As the Marmot Review 10 Years On makes clear, this is needed in the academic analysis of inequalities because, without such information, understanding ethnic inequalities is difficult.
We have had the opportunity to work to reduce health inequalities through both access to healthcare and the social determinants of health for prevention. Faith groups have something to offer here and could be transformational for health. What efforts are the Department of Health and Social Care making to engage with faith groups genuinely to ensure that health provision is being made more accessible? What effort is being made to ensure that effective data is collected so that we might have a clearer picture of local health inequalities?
Extracts from the speeches that followed:
Lord Patel (CB): The subject of today’s debate is austerity and its subsequent effect on health inequalities, including mortality. I will focus more on the latter—the health inequalities—but I accept the conclusions of the observational study reported on the subject in the Journal of Epidemiology and Community Health.
It is 60 years since the Black report highlighted the association of deprivation and ill health. The Marmot reviews of 2010 and 2020, already mentioned by the right reverend Prelate the Bishop of London, spelled out in detail the health inequalities related to deprivation. Apart from the years from 1999 to 2009, no Government have tried to put in place policies to reduce health inequalities.
As already mentioned, deprived populations have lower life expectancies, spend many more years in ill-health, fewer years in good health, have a high incidence of long-term health conditions including cancers, and poor outlooks, not to mention an increased number of stillbirths and infant deaths. Health inequality means that the most deprived spend a significant part of their lives in misery. Government policies and major health events may exacerbate the situation, as I have no doubt that the current cost of living and NHS crisis will, but the root cause of health inequalities is social deprivation.
Lord Allan of Hallam (LD): While the paper looked at lifespan, with its focus on mortality rates, I want to mention the importance of looking at health span, defined as the period of life we spend in good health, free from chronic conditions and the disabilities of ageing. This builds on the comments made by both the right reverend Prelate the Bishop of London and the noble Lord, Lord Patel.
Health span is also likely to be affected by spending squeezes, especially if there are reductions in preventive health measures and delays in the treatments necessary to restore someone’s health. We can look at examples such as a delay in getting surgery to replace a hip or knee. That may not itself change your lifespan, but it certainly means more time spent living a life restricted by the health condition. This is the real cost of the increased waiting times we are seeing for elective surgery at present, which many people are sadly paying today: their health span has been reduced because they are unable to access surgery or other treatments that would enable them to live a fully healthy life again.
Similarly, a failure to provide timely advice and support to somebody who is at risk of developing type 2 diabetes may lead to them facing health problems that could have been avoided, or at least mitigated, with the provision of the right public health services. Again, any impact on their lifespan may be years down the line, but their health span is more quickly and immediately shortened. I hope the Minister’s response covers points related to health inequalities, as well as those related to mortality.
Reflecting on some of the points made by other noble Lords, the right reverend Prelate the Bishop of London rightly drew our attention to the multifactorial nature of the determinants of health. We certainly need to look at issues such as housing, as well as more obvious issues related to health treatment. The noble Lord, Lord Davies of Brixton, helped us to understand how we should look at the mortality figures. In the debate yesterday, I learned a lot about how actuaries think, and the noble Lord is providing an incredible resource for all of us in understanding how to look at the data.
I close by again looking forward to hearing the Minister’s response. I congratulate him on his arrival to the Front Bench, and I hope he will be equally supportive of encouraging and—dare I say it?—funding more research into the kinds of projects and questions looked at in this paper. It is essential from the public interest point of view that we do not shy away from difficult questions about the effect of policies on people out there, in the real world, that we and this Parliament have decided on.
Baroness Wheeler (Lab): As noble Lords have said, this debate is timely, especially in view of the shocking figures from the ONS, which were discussed in your Lordships’ House earlier this week and were the subject of a brutal analysis on the front page of yesterday’s Times. Some 50,000 more people than normal died over the past 12 months and there were 1,600 more deaths during Christmas week, as the long wait for ambulances, cold weather and surging flu infections took their toll. Excluding the two pandemic years, 2022 was one of the worst years on record, despite the Government continuing to cite the pandemic as the main source and cause of the dire problems we face. I understand that, today, the Office for Health Improvement and Disparities is publishing its excess death report on the causes that have contributed to these deaths. Can the Minister update the Committee on this and provide further insight to help us understand the extent of the crisis and the actions the Government need to take?
The study ranges across key community care and health inequalities, which have been ably covered by other speakers in this short debate. I look forward to the Minister’s response to the thoughtful and expert questions that have been raised. The study shows the adverse changes in mortality rates in the UK from the early 2010s onwards, with increasing death rates among more deprived areas, which the right reverend Prelate the Bishop of London and other noble Lords spoke very forcefully about, particularly in relation to the work of the Black and Marmot reviews.
Lord Evans of Rainow (Con): The right reverend Prelate the Bishop of London asked about health equality in the White Paper. The Government are committed to supporting individuals to live healthier lives and at the heart of this is improving access to and levelling up healthcare across the country. No decisions have been taken in relation to the White Paper, but we will publish further information on addressing health disparities in due course. I congratulate the right reverend Prelate on the faith work that she has done. I too do that in my own parish of Rainow, walking from church to church, but there are a lot of hills and valleys in the way and you have to be committed to do it.