Poorest in England 'live seven years less on average'
By Jane Dreaper
Health Correspondent, BBC News
Every child should be nurtured at an early stage, report says
People in England's poorest areas live an average of seven years less than those in the richest ones, says a major report on health inequalities.
Epidemiologist Sir Michael Marmot, says the NHS must spend much more on preventing illness.
And he calls for an increase in the minimum wage to allow everyone to have a healthy lifestyle.
Health Secretary Andy Burnham has welcomed the government-commissioned report and said more work was needed.
The Marmot Review shows that although life expectancy has risen in poor and rich areas, inequalities persist.
People in the poorest neighbourhoods will also spend a greater proportion of those shorter lives unwell.
There must be a real political commitment at all levels, because a fairer society will benefit all
Professor David Hunter, Durham University
The report estimates up to 202,000 early deaths could be avoided, if everyone in the population enjoyed the same health as university graduates.
Doing nothing to tackle these inequalities would cost the economy more, according to the review, which says inequality in illness accounts for £33bn of lost productivity every year.
The report says "action is essential" because more than three-quarters of the population experience significant illness by the age of 68 - which will by 2046 be the pensionable age for men and women in England.
And there's a call for NHS spending on preventing illness to be much higher than the current 4%, with more money going to initiatives such as providing statins and helping people to stop smoking.
The authors feel their most important recommendation is giving every child the best start in life.
Women from less well-off families are less likely to see cuddling and talking to a child as important
Sir Michael Marmot, from University College London, said: "Every child needs to be nurtured at an early stage.
"In one study, mothers were asked whether it was important to cuddle and talk to a child.
"I would have thought every mother would have said yes to that - but not all of them did.
"That made my hair stand on end.
"And it follows the social gradient - women from less well-off families are less likely to see this as important.
"But then by the age of three, these children had more behavioural problems and worse cognitive skills.
"Then they have less readiness to learn, and the problems continue."
The review also says the current minimum wage of £5.80 an hour is below the level needed for a healthy life.
Sir Michael Marmot: "Children who are nurtured, flourish"
It cites the higher pay levels recommended by the London Living Wage Unit - set up by then mayor Ken Livingstone and continued by Boris Johnson.
This calculated that Londoners need an hourly wage 16% higher than the national minimum rate to lift them above poverty.
The report says a minimum income should allow people to consume a healthy diet, take exercise and have technology such as broadband, that enables them to maintain social networks.
Sir Michael says he has been given a sympathetic hearing when presenting his findings to politicians from all main parties.
The health secretary, Andy Burnham, said: "It's not right that where we live can dictate the state of our health.
"The report shows us there is still much to do - so we are looking to all corners of the community to work together."
In a commentary in Thursday's British Medical Journal, Professor David Hunter, an expert in health management at Durham University, said: "There are few votes in health inequalities.
"As politicians of all hues become increasingly preoccupied with securing electoral advantage, it is questionable whether this important report will receive the careful and considered attention it deserves.
"There must be a real political commitment at all levels, because a fairer society will benefit all."
Professor Mike Kelly, of the National Institute for health and Clinical Excellence (NICE) said: "Public health interventions are extremely good value when compared with the costs of clinical interventions.
"We need to shift the emphasis away from medical interventions that treat existing illnesses to interventions to prevent those illnesses developing in the first place, but it needs political support and system change to make this happen.
Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, said: "This report is not just about fairness and opportunity - essential though these things are.
"It is also about hard-nosed investment in preventive strategies that really pay off.
"It is about seeing people's health and wellbeing as real assets, especially in these tough economic times."
Steve Field, chairman of the Royal College of General Practitioners, said health inequality was not an issue solely for the health service to address: "Health Inequality can be best challenged by focusing not only on health, but also on the wider socioeconomic factors that contribute to it.
"Children must be given the best possible start in life but, beyond this, increased work opportunities, improved standards of living, and the development of healthy and sustainable communities are paramount to combating health inequality."
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