Healthy inequality

Health is heavily determined by the conditions in which people are born, grow, live, work and age. These, in turn, are shaped by the distribution of money, power, resources and particularly by the power relations that define social structures and pattern oppression, exploitation and exclusion at local, national and global levels. The World Health Organisation (WHO) describes health inequalities as ‘avoidable inequalities in health between groups of people’. But the UK is a long way from avoiding them, and gaps in health outcomes have not been narrowed in recent years.

The 2010 Marmot review revealed that people living in the poorest neighbourhoods in England will on average die seven years earlier than those in the richest. People in these areas will spend around 17 years more than their richer counterparts living with disability. The stress of living in extreme poverty may cause the early onset of age-related diseases and can take years off the lives of the urban poor.

A new study measured telomere length of poor and moderate-income whites, African-Americans, and people of Mexican descent in Detroit neighborhoods to determine the impact of living conditions on health. Telomeres cap the ends of chromosomes to maintain their integrity but shorten each time the cell divides. They have been compared to the plastic tips on the ends of shoelaces, as they protect the chromosomes from falling apart and from sticking to one another.

“Currently, residents of Detroit are struggling—whether they are white, black, or of Mexican descent—in ways that measurably impact their health negatively, including at the cellular level,” says Arline Geronimus, a professor of public health at University of Michigan and a research professor at the Institute for Social Research. “Our findings suggest that any group subject to extremely difficult life conditions and contexts will bear physiological scars. These findings are consistent with the view that social inequality can affect group health by placing members of different groups in more or less adverse economic, political, social psychological, and physical environmental contexts.” 

Professor Paolo Vineis from the School of Public Health at Imperial College London said:

“We know that it's possible to remain healthy into old age, and this is much more likely among people with high socioeconomic status. We want to better understand why, so we can make healthy ageing a reality for everyone, not just the wealthiest parts of society.”

Dr Carolyn Harper, Director of Public Health at Northern Ireland’s Public Health Agency, said: “Society, health and healthcare have developed enormously in recent decades. However, the health and wellbeing enjoyed by some is not enjoyed by all, or even by a majority of the population. Inequalities are a key challenge for our society and there is evidence that the bigger the gap between the most and least deprived, the worse the health of the population as a whole. Inequalities are therefore everyone’s concern.”

"Some people continue to say that when we hit old age, the playing field finally levels out," said University of Arizona researcher Corey M. Abramson, an assistant professor. "It doesn't. It never levels out. Inequalities shape our life until the very end, in ways that reveal a lot about contemporary American society."