As the focus on levelling-up grows, our Senior Policy Officer, Debbie Horne, explains why addressing the social determinants of health (non-medical factors like environment or employment that affect your health status) must be an essential part of the agenda. And discusses the actions we need to see to prevent increasing type 2 diabetes diagnoses and enable everyone with diabetes to live well.
Every day at Diabetes UK we work to create a world where diabetes can do no harm. Over the past 15 years the prevalence of diagnosed diabetes has almost doubled, and the numbers are expected to continue rising.
This increase in diabetes cases will not be shared equally among society and neither will the impact. People living in poverty will be two and a half times more likely to be diagnosed with type 2 diabetes compared to the average earning person, and then twice as likely to face serious complications.
It’s not just diabetes cases that poverty drives up. It’s a common theme running through the prevalence rates of most conditions – from type 2 diabetes to mental health problems and heart conditions – that the less money someone has the more likely they are to become ill in the first place and to go on to experience poorer health outcomes. It’s the so-called social gradient.
Sir Michael Marmot, who coined the term the ‘social gradient’ also said ‘why treat people and send them back to the conditions that made them sick in the first place?’ We need to start to think about the health impacts of the conditions in which we are born, live, work and grow. And how improving these conditions will help reduce the rates of health problems, like type 2 diabetes.
Our health, including our risk of developing type 2 diabetes, is determined by several factors often out with our control. Where you were born, how much money you have, your housing conditions. All these things directly impact on health – most clearly seen in the almost 19-year life expectancy gap between the richest and poorest. Poverty restricts people’s options and when your options are restricted your health suffers.
For people with diabetes, it’s a relentless condition that requires careful monitoring. This is far less easy to do if you’re juggling insecure work, food insecurity, caring responsibilities or money worries.
Take, for example, the money worries caused by low-incomes, wages and the social security system. Currently, it’s estimated that a family in the lowest income bracket would have to spend 75% of their disposable income to meet the UK Government’s own Eat Well Guide. If the government are to take prevention of health conditions like type 2 diabetes seriously, they need to take a more rounded view on the importance of ensuring everyone has for the income required for a decent standard of living.
Tackling inequalities
At Diabetes UK we’re members of the Inequality in Health Alliance (IHA). This is a group of over 180 organisations united by the goal of ending health inequalities. In a recent briefing produced a member of the Alliance, one case featured a man who due to living in overcrowded accommodation with no kitchen was unable to cook and eat healthy food for himself. This was having serious complications for his diabetes. Unfortunately, his GP was unable to prescribe adequate housing and kitchen facilities to enable him to eat the diet needed to be healthy.
It’s why so many of the Inequality in Health Alliance members are medical bodies representing clinicians. Clinicians who every day see the consequences of inadequate income, housing, or other environmental and structural factors that have created ill-health. And clinicians who know the real measures that are needed to improve health so often lie out with the health system and out with what they can prescribe or do.
We recognise the importance of talking about the social determinants of health. Not just talking but calling for real action. As one of the fastest growing and potentially devastating health issues we face, we say the recovery from COVID-19 must focus on real change for everyone at risk of and living with diabetes.
Our strategy sets out the need to tackle health inequalities and to address the social determinants of health if we are to prevent the thousands of type 2 cases of diabetes diagnosed every week that could be prevented. We have also started to expand our team to grow our expertise this area including a newly created Senior Policy Officer role, focused on poverty and social justice.
But health organisations and health bodies cannot do this work alone, when we know health is often determined by factors that sit outside the traditional health remit – the economy, the housing system, the environments we live in. That’s why we need cross-government action that is bold and ambitious.
A plan to level up health. A plan to make sure the building blocks of good health are under the feet of everyone.
The recent Cabinet Reshuffle created the new Department for Levelling Up, Housing and Communities. It’s a step in the right direction, but now needs to be followed by a cross-government strategy and implemented actions to address the social determinants of health, if the government are to succeed in levelling-up.
The economic system we have currently was designed, and it can be redesigned to work for everyone. So that people no matter where they are born in the country or how much they earn can all experience the right to good health.
As part of the Inequality in Health Alliance we’ve written to the Prime Minister calling for an explicit plan. Creating a cross-government strategy to address health inequalities is the first step required on the road to levelling up health, and towards ending the harm caused by millions of cases of preventable conditions, including diabetes. We’re waiting for the Prime Minister’s response and are hopeful for a commitment to an explicit strategy to level up health as part of the recovery from COVID-19.
Surely, we can all agree, in a society that believes in fairness – it’s the right thing to do. And in a wealthy and resourceful country it is more than possible.
