Speaking at the RCGP annual conference in London, held in association with the World Organisation of Family Doctors Europe (WONCA Europe), Professor Sir Michael Marmot said rising inequality in the UK over the past decade had left the country 'ill prepared' for the arrival of a pandemic.
Professor Sir Michael pointed to the findings of his 2020 'Marmot review: 10 years on' report - which found that life expectancy had stalled, patients were living longer in ill health and health inequality had risen after a decade of austerity.
And he told the conference: 'Then came COVID-19. You remember the fiction at the beginning of COVID-19, that it will affect prince and pauper alike? The great leveller?
Health inequality
'Garbage. It was utterly predictable, and so it turned out, that COVID-19 exposed and amplified the underlying inequalities in society.'
Figures early in the pandemic from the Office for National Statistics showed that people living in the most deprived areas of England and Wales were roughly twice as likely to die after contracting COVID-19 - with 3.1 deaths per 100,000 population in July 2020 in the most deprived areas compared with 1.4 per 100,000 in the least deprived areas.
Professor Sir Michael - a professor of epidemiology at University College London and director of the UCL Institute of Health Equity - said data on dental caries in children, as well as data on child obesity closely matched the social gradient seen in the impact of COVID-19, with children in the most deprived areas facing the highest levels of ill health.
He told the conference that tacking specific diseases was vital, but would only work alongside steps to address 'the social determinants of health that give rise to avoidable inequalities in health - hence promoting health equity'.
Low-income households
To follow healthy eating guidance, he said, households with income in the lowest decile would have to spend 75% of their income on food.
'Don't blame the poor, blame their poverty,' he said. He pointed to an argument set out in his landmark 2010 Marmot report that government interventions should be 'universal, but with an intensity and a scale that is proportional to the level of disadvantage'.
However, he argued that since 2010 government policy had been effectively to 'make the poor poorer', citing changes to the tax and benefits system that had led to a 20% drop in income for the poorest people, while incomes in the highest decile were not affected in the same way.
He said the government's levelling up fund allocation was worth £32 per person - but that over the past decade the reduction in council funding per person had been more than 10 times this amount.
Professor Sir Michael said he believed this reduction in spending - which had been most acute in areas with the highest levels of deprivation - had contributed to rising health inequality and the slowdown in life expectancy.
He warned: 'Primary care is absolutely vital in society, but we need to address the conditions that make people sick.' He said, however, it was possible for primary care to become more involved in tackling social inequality that leads to ill health - citing the example of a rise in social prescribing.
But he said tackling health inequality required a change in approach from government. 'If I had to recommend one thing - put equity at the heart of all government action.'
