Since 1945 the Welfare State was established by Attlee’s Labour government to provide care from ‘the cradle to the grave’. The National Health Service, the ‘jewel in the crown of the welfare state’ remains a popular universal service, free at the point of delivery, meeting the needs of all regardless of income or background.
Yet, despite significant advances in medicine and the quality of health care, a stubborn health divide persists in the North East of England. Now a controversial proposal by Tyneside health bosses, the Clinical Commissioning Group, to withdraw family doctors from the Ponteland Road Health, has been met with opposition from both residents and Labour councillors. The loss of GPs from Cowgate, the most deprived neighbourhood in the city and the 10th most deprived in the North East, could deepen this divide.
Despite Newcastle having the best hospitals outside London, massive inequalities in health remain both in the city and the region. Nearly every illness is linked to social class. Poverty is a key driver of ill-health, and poorer residents tend to get sick more often, to be ill for longer and to die younger than the well-to-do. Those who die youngest tend to live on benefits or low wages, work in unhealthy places and too often eat cheap, unhealthy food.
The Marmot Review in 2010, commissioned by the Brown administration, noted that if everyone were as healthy as middle class university graduates, with everyone without a degree having their death rate lowered to that of people with degrees, there would be 202,000 fewer early deaths each year among those under 30!
Marmot’s report, Fair Society, healthy Lives, showed that the death rate amongst unskilled manual workers is about twice that of professionals. A person born into the middle class lives on average, about seven years longer than someone from the working class. In Newcastle, according to the think tank, Policy North, it’s wider. You are more likely to live to 82 or more if you live in leafy Parklands than if you live in Byker or Cowgate. Life expectancy in both communities is 66.
Cancer of the lung and stomach occurs twice as often among men in blue-collar jobs as among men in managerial jobs. The death rates from heart disease and cancer – the two biggest cases of premature death – are twice as high for those from working class manual backgrounds. Four times as many women die of cervical cancer in the lower class than the higher class.
Alarmingly, the mortality rate for all causes of death in Cowgate (798 per 100 000) is more than double that of the city (380 per 100 000). Even after taking deprivation into account north Cowgate has a very high death rate in relation to all causes of death and for cancers. Over a fifth of Blakelaw and Kenton residents have a long-term disability affecting daily activities. A quarter have mental health related issues.
In short patterns of ill-health and sickness provide strong evidence that it’s the make- up of society that shapes health rather than simply biological factors. How do we make sense of these disparities and what can be done about it.
In 1978 the well- known GP Tudor-Hart coined the idea of the ‘’inverse care law’. This suggests that health care money tends to be spread out in inverse proportion to need. This means that those whose need is least get the most funding, while those in greatest need get the least.
Why is this? Poorer areas have fewer GP practices – so there are fewer doctors for those who are more likely to sick. Poorer people therefore get less time with their doctors and poorer neighbourhoods tend to have the most overcrowded facilities in the NHS. Likewise poorer residents are more likely to be dependent on buses, and so spend more time travelling to hospitals and GP surgeries. In Cowgate and nearby Blakelaw over 4,000 residents were registered with over 68 doctors! The harsh reality is that some doctors simply don’t want to work in poorer areas!
In contrast, those in the middle class are more clued up about ill-health and how to prevent it. They are better informed and more assertive in getting their health needs met and are less likely to be fobbed off.
It is for this reason that Newcastle city Council, with Labour government funding, were pledged to reduce inequalities in access to health services by setting up a new health centre on Ponteland Road in 2009 as part of the successful Cowgate regeneration strategy.
Access to services is a key determinant that contributes to good health. Primary health care is tailored to meet local need. Disadvantaged patients have real choice with long-term health conditions managed. And GPs working in primary care teams including nurses, alongside a 365 open all hours nearby multi-purpose pharmacy, are supporting people to make healthy life style choices to improve physical, sexual and mental health and well-being which in turn helps to reduce health iniquities.
Of-course tackling material deprivation and cultural factors, which lie behind a lot of illness, is important. But removing doctor surgeries in the well-used Ponteland Road Heath Centre makes no sense. A health centre without GPs is like a fire station without firefighters.
Removing the doctors will simply end real choice for the disabled and long-term sick. It will deepen class and gender inequalities in access to primary care. We know from experience and research evidence that seeing a doctor is a pivotal factor to good health and well-being. It was Nye Bevan – the architect of the NHS’s dream in 1946 that every community should a have health centre with doctors at their core. The Clinical Commissioning Group must listen to local patients and think again.