The gap between rich and poor is the root cause of illness, Sir Michael Marmot warns

A stark picture of the impact of poverty and social injustice was drawn by one of the country’s leading experts on public health.

‘We have decided as a society that we will not give people who depend on the state pension enough for a healthy life,’ warned
Professor Sir Michael Marmot, who is leading a strategic review of health inequalities.

And the intellectual ability of children in poorer families was being held back. ‘Those from low social-economic groups saw a decline in their cognitive function’ between age two and 10.

The launch of the Marmot Review was seen as an admission by government that it will miss its own targets on reducing the health gap between rich and poor by 2010, based on indicators such as infant mortality, overall life expectancy, and early deaths from cancer and heart disease.

Giving a preview of his interim report, due out next month, Sir Michael said toddlers from low-earning families whose cognitive development is behind their peers stay behind throughout early childhood.

Yet ‘those who grow up in families with high socio-economic status catch up nearly with those who are at the very highest to begin with’ by the age of nine or ten, he explained.

Even the brightest children from poor families suffer. ‘Those who come from low socio-economic backgrounds experience a decline in their cognitive function.’ While the top scorers at 22 months from families with high socio-economic status stay at the top.

‘Even if you say those cases of low cognitive development at 22 months are to do with factors such as nutrition and genetics, nevertheless the families in which you grow up and their circumstances make an absolutely crucial contribution.’ That was demonstrated by comparison with outcomes at age nine or ten, he said.

In fact, the cognitive development scores at 22 months of age are themselves strongly influenced by social and economic factors.

‘If we want to make a difference we have to start now, we have to start with girls who are going to become women and mothers and boys who will become men and fathers,’ he warned.

The difficulties are no smaller in later life, Sir Michael added. ‘The state pension is about two-thirds of the minimum income needed to live a healthy life.’ The review calculates many elderly people cannot afford a good diet, to stay physically active or to maintain social contact.

‘Health inequality is a marker of how well we are doing as a society,’ Sir Michael told the conference. ‘If we want to get the narrative right, we have to ask the question about what sort of society do we want, not just “can we deliver better services”.’

Smoking, obesity and mental ill health were all strongly related to income, he added. ‘The social gradient in mental health is clear. The lower your income, the higher the risk of mental illness.’ While obesity was rising in all groups, the poorest are the worst affected.

Over the past few decades incomes have been rising generally, but the rate of growth for the poorest in society has been far slower than for the richest. So inequality was growing even during the economic boom.

Now the recession would only drive a deeper wedge between rich and poor, he warned. Economic crises always have more impact on those who have least in the first place.

Universal benefits and social goods, such as the NHS and child benefit, are far more effective than targeting people on low incomes, Sir Michael added. ‘A healthcare system for the poor is a poor healthcare system.’

Injustice was not inevitable. Since the world economic crisis started, $5.2 trillion had been poured into rescuing banks around the world.

Yet it would cost just $100bn to upgrade the world’s slums, according to the World Health Organisation’s Global Commission on Social Determinants of Health, which Sir Michael chaired

Just a fraction of the money used to prop up the banks ‘would ensure everyone in the world could have clean water’.

‘We have the knowledge, we have got the skills – do we have the will?’ he asked.

While he hoped the Marmot Review’s proposals would be adopted across government: ‘the real success would be a world where social justice is taken seriously.’