Medact Student Blog: Inequality and Health


In the first event of the Global Health Justice series, Medact and QMUL hosted a talk titled ‘Global Health Justice: Harnessing academia to inform policy’. This was attended by Global health students and health professionals.

Dr. McCoy, director of Medact, introduced the series by citing the need for engagement of the professional healthcare community with issues surrounding governance, politics and economics of global and local health. He also highlighted that Medact’s goals towards achieving this include choosing to focus one of Medacts four streams of action on Economic Justice.

The Social Determinants of Health

Matilda Allen, who works for the UCL Institute of Health Equity, gave the first talk on the social determinants of health. She began with recalling the impact of the UCL Institute‘s own Michael Marmot and the work he has done on social determinants of health for both the UK government and the WHO. In the UK for example, his work shows that life expectancy has an obvious social gradient affecting not only the most deprived, but also the middle class. This gradient can also be observed when looking at mortality rates by job type.

Policy recommendations from these reports include ensuring best start to life for children, maximising control of individuals over their lives, raising standards of living, fair employment, creating sustainable and healthy communities and strengthening measures of prevention of ill health.

Allen argued that, while tackling inequalities in health is primarily an issue of social justice, it is also economically wise when you consider the Marmot review had found the social gradient of illness accounted for up to 33 billion in annual productivity losses and cost the NHS 5.5 billion annually; Allen agues that, “We are unlikely to eradicate health inequalities, but reducing them is a financial necessity as well as a demand of social justice.”

The UCL Institute works with the Health Sector and professional membership bodies on incorporating commitments made to social determinants of health in areas such as undergraduate training, guidelines for professionals and even clinically by engaging effectively with social care services. She emphasised that partnership and research collaborations between different entities tackling illness and inequalities in health was key. A good example of this was collaborative research done to show the health impact of fuel poverty on children.

NHS trusts have a big role to play both as organisations accessed by the majority of the population annually, but also as major employers. Allen suggests NHS trusts can foster a culture of fairness by using their purchasing powers to the advantage of local communities as well as weaving strategies to tackle health inequalities at every level of the organisation.

The unit continues to advise trusts and professional bodies on the implementation of commitments made to reducing health inequalities.

Austerity and Health

The next speaker, Aaron Reeves, is a sociologist working at Oxford University with David Stuckler on Austerity issues. He began by posing the question: Does Austerity Harm Health?

Reeves humanised the topic early on by citing two recent news stories about individuals he says were harmed by austerity. First was case of the joint suicide of an Italian senior couple due to crippling debt, and secondly, the death of a teenager in Greece due to fume inhalation from a makeshift stove made by her mother in a desperate attempt to compensate for lack of electricity. He argued that both these stories are the faces of the health effects of austerity.

We were then guided through European patterns of reacting to the recent economic crisis by either increasing government spending or cutting it. It was clear that spending cuts were not the only viable options to deal with the crisis.

In terms of cuts to healthcare, Greece stood out in severity and the health impacts of this are beginning to emerge. Reeves cited analysis done by his team this year estimating half of Greece’s population (and 67% of their elderly) had unmet medical needs due to unaffordability of care as well as cost and distance of travel.  Another worrying impact was a significant rise in HIV infection in drug users due to cutting of needle programmes.

On cuts to social protection, the UK data showed a clear rise in material deprivation, homelessness, fuel poverty and inability to “make ends meet” since the implementation of austerity measures in 2009.

More generally, their research showed that recession had impacted health by increasing suicide rates across Europe, resulting in an excess of 8,000 deaths.

He concluded by emphasising the point that austerity was a choice and not an inevitable reactive policy to the recession. He argued this by citing evidence from countries that have had faster economic recoveries by adopting increased spending policies (including stimulus) instead. Indeed, even the IMF having advocated austerity previously is now stating that it had underestimated its negative impacts. Cuts to healthcare spending and social protections were the most harmful of austerity measures and have hurt the most vulnerable.

Dr McCoy then led discussion by posing a question to the audience on whether health professionals feel they are confident in discussing economic issues with their MPs. Audience members acknowledged a need for these issues to be discussed with MPs, but also amongst the wider health community. Some felt that health professional lack time to engage with health economics to the point of arguing confidently with economists or politicians due to the busy pace of clinical Medicine. Two audience members with GP background highlighted the particular relevance of issues around social determinants of health to the communities they have served and the increasingly important role of GP’s in CCG’s. It was suggested that GP’s would especially benefit from education in this topic as it would prepare them for making better decisions to tackle health inequalities.The next Global Health Justice Lecture takes place on the 29th of Oct and it will look at Nutrition, Climate and Public Health

By Sarah Alhulail