June 20, 2024

The recent spell of cold weather led to a health alert from the UK Health Security Agency as many of us prepared for more people turning up at hospital. As a Consultant Cardiologist working at the Royal Papworth hospital, I am well aware that cold weather puts pressure on the cardiovascular system and can increase the risk of heart attacks and strokes. The ongoing cost-of-living crisis, among other factors, continues to make it increasingly difficult for people to heat their homes, risking an even greater impact of the cold on people’s health.

The cold weather we’ve seen over recent weeks demonstrates how people’s environments and contexts can play a detrimental role in their health. It’s not just the cold that drives people to become unwell. Factors such as poor housing, air pollution or employment can play a part in people becoming ill. That is why we welcomed the government’s commitment to legislate for a smokefree generation. Our members have seen this directly. An RCP member survey published last year found that just under a third of you had seen more patients with illness due to their living conditions. The impact of our environments is significant: for many, it will determine their life expectancy and how many years they can expect to live in good health. Michael Marmot’s recent report on health inequalities finds that more than one million people in 90% of areas in England lived shorter lives than they should in the decade from 2011.

As the Chief Medical Officer set out in his evidence to the Health and Social Care Select Committee:

‘the bad side of things going badly for public health ends up in Health, but the cost of solving it is in a different Department… At the end of the day, only the Treasury and No. 10 can say, “This is a whole-of-Government problem, and we need to bring that together.”’ Professor Sir Chris Whitty, Chief Medical Officer for England  

The Health and Social Care committee report of the prevention inquiry published last week explicitly recognises that tackling the problems caused by ‘unhealthy places’ will require ‘long-term thinking’ and ‘whole-government solutions, including commitment, leadership and co-ordination from the very top.’

Health inequalities cannot only be a matter for the NHS because so many of the factors that cause illness sit beyond their remit. The RCP has long been calling for a cross-government strategy to reduce health inequalities. And we are not alone. Over 250 members of the Inequalities in Health Alliance, convened by the RCP, back this call. Only by applying a prevention first approach can we address the root causes of illness that are growing in our population.

Over the last year, increasing ill health has led to an uptick in economic inactivity – latest figures show that 2.6 million people were out of work due to long-term sickness. The OBR estimates that the increase in inactivity in the labour market over the past three years, coupled with the increase of ill health among those in work, means that the government spent £6.8 billion more on welfare payments in 2023-4.

The link between poor health and the social, physical and economic environments people live in is clearer than ever. Without bold action across the whole of government, we risk further entrenching existing health inequalities. Acting on the wider determinants of health is vital to ensuring that efforts to help people live longer, healthier lives succeed. 

This is an issue that requires a holistic, joined-up strategy that spans every government department and uses every policy lever available to reduce health inequalities and tackle what makes us ill in the first place. The government’s Major Conditions Strategy, due to report in full this year, recognised in its interim report the impact of the wider determinants of health in contributing to serious health conditions. The final report is a vital opportunity to offer a prevention-first solution and commit to such a strategy.

A final note – there are things that we as clinicians can and should do on health inequalities. The impacts of the recent cold spell will be most acutely seen among the most vulnerable in society including those who are experiencing homelessness – there is some very good information about our ‘duty to refer’ as clinicians under the Homelessness Reduction Act from the homeless healthcare charity Pathway. And if you want to learn about health inequalities more generally, then the RCP has produced an e-learning resource for clinicians.


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