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There aren’t many reports that merit reading several times over, but Health Inequalities in 2040 is certainly one of them. The salience of the findings make it required reading for anyone wanting a fairer and more equal Britain. The depth and richness of its analysis is thought provoking and needs time to fully absorb the full implications. And while some of its findings are hard hitting, its insight provides cause for hopefulness.  

The forerunner in this series was our Health in 2040 report which projected an increase of 2.6m people living in England with major illness by 2040. Mostly because we are an ageing society, and with older age comes greater illness. This latest report digs into this headline figure to explore what it means for inequalities and working age health. It paints a stark and concerning picture for any government wanting to improve prosperity and reduce the wide geographical inequalities we see across the UK.  

Some startling findings

Two main findings stand out. First that the working-age population living with major illness is projected to increase by nearly a quarter. Second, that this increase doesn’t fall equally. Of the 700,000 additional working-age people living in England with major illness in 2040, 80% fall within the most deprived half of the population.

The report starts by setting out the most detailed analysis to date of the patterns of disease that shape health inequalities in England. Rather than viewing health inequalities in terms of life expectancy or healthy life expectancy, the report takes a novel approach based on diagnosed major illness to understand trends and differences. In doing so, it lifts the lid on a complex issue and helps us to better understand the problem as well as point to some of the solutions.  

The first part of the report takes the reader through an analysis of current patterns of inequalities in diagnosed health conditions by age and deprivation. It shows that there is a ten year difference in the age at which people in the most deprived areas are diagnosed with major illness compared to those living in the least deprived areas. So, whereas over 70% of people living in the least deprived parts of the country can expect to reach the age of 70 without major illness, in the most deprived areas, over half of people will have major illness by the age of 70 – or indeed will have died.  

The implications are profound

The consequences this has for those individuals and their families are profound. Lives cut short, more time spent caring for elderly relatives, children growing up without grandparents, communities without the social capital of their elders. But the implications go wider. With the burden of illness falling disproportionately on people living in more deprived areas, this has implications for people’s ability to work. In the most deprived areas, twice as many working-age people have major illness compared to the least deprived areas. Our Commission for Healthier Working Lives analysis shows how this same patterning is visible in the prevalence of work limiting conditions.  

The report then looks ahead, and shows that the unequal distribution of major illness is set to continue with 80% of the growth in working age ill health falling on the more deprived half of the country. Three conditions – chronic pain, depression and anxiety, and type 2 diabetes – lie behind this, and are projected to increase at a faster rate in the most deprived areas – amply illustrating that what makes us ill is shaped by where we live.

The consequences of increasing major illness in the working age population at the same time as the population ages has significant consequences. At a time when the country will need more tax revenue to fund and maintain services, the healthy, productive workforce will be being squeezed. This will lead to growing competition between the needs of the public sector to deliver services, and the needs of the wider economy to fuel growth.  

A need for urgent action

Yet, the report offers some hope. The conditions driving the growing burden of working age ill health are largely preventable and amenable to effective management. Chronic pain, anxiety and depression, and type 2 diabetes can often be prevented with the right interventions, and can largely be managed in primary care. Achieving this will need the cracks in primary care services to be mended and investment in more equitable access so that people who are already facing early diagnosis can get the support they need. The role of support schemes, such as Workwell, that can help people get back to work after periods of illness are also critical.  

But the need for action doesn’t stop there. As well as looking at what is needed in the short term, employers need to ensure that they can help existing employees stay well for longer and stay in work. Whether through addressing factors in the workplace that contribute to these conditions – poor quality work, lack of autonomy, poor working conditions – or providing the flexibility needed for someone with a health condition to stay in work longer.  

Ultimately, government needs to take a long-term approach to preventing ill health. The past few years have underlined that health is our most precious asset. But improving health requires the whole of government to work together – and differently – to ensure all areas of policy work towards giving people access to the building blocks of health. Whether that’s legislating to control known risk factors such as tobacco, and aspects of the food and drink industry that fuel obesity, or addressing poverty, poor quality housing and loneliness.  

This can’t simply be seen as a top-down exercise – investment is needed in local government and public services so they can adapt to local needs. And all parts of society – including businesses and the voluntary sector – have a role to play.  

What this report tells us first and foremost is that we can’t afford to wait for greater economic prosperity to solve entrenched inequalities – rather that tackling inequalities is an essential step on the path to future prosperity.

Jo Bibby (@JoBibbyTHF) is Director of Health at the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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