Breaking the dependency cycle

Introduction

Vulnerable families face significant health inequalities, despite rising life expectancy across Western Europe. While access to good healthcare is important, it only accounts for 15-25% of health inequalities. A range of social determinants crucially drive trends around mortality and ill-health, including quality of education, housing, employment, working conditions and welfare.

These are among the findings of a new Deloitte Centre for Health Solutions report – Breaking the Dependency Cycle: Tackling Health Inequalities of Vulnerable Families – which warns of the damaging consequences of health inequality.

Our study reveals how health inequalities hold back all generations, from early childhood to old age. Offering a host of case studies, it recommends a life-cycle approach to vulnerable families – with governments and providers urged to break down organisational barriers and collectively face up to challenges.

Read our full report.

Health inequality across the generations

Health inequalities have a substantial economic impact, hitting labour productivity and accounting for an estimated 20% of European healthcare costs. But they also take a social toll, with negative socioeconomic circumstances having a cumulative effect throughout a person’s life. Unemployment and financial disadvantages pass between generations, as vulnerable children become vulnerable adults.

Health inequality threatens people across all life stages, including:

• Maternity and infancy
  Infants require effective maternity care and well-educated mothers to maximise their chances of enjoying a healthy life. But wide gaps remain, and infants in lower socioeconomic groups have benefited less from falling mortality and morbidity rates.
• Childhood and education
  Children who engage with society, stay active and eat well are significantly more likely to become productive, socially-included adults. Yet children brought up in stressful environments have fewer opportunities to exercise and eat healthily, facing a greater risk of obesity, drug abuse, and emotional and behavioural problems.
  
• Adulthood and employment
  Working conditions, social opportunities and the built environment can influence people’s vulnerability to disease and death during adulthood. Workers in low-paid jobs are more exposed to health risks, while deprived environments with limited green space hinder healthy behaviours.
  
• Elderhood
  Older adults in lower socioeconomic groups are 30-65% likelier to face chronic disease, while they’re also at risk of depression, housing deprivation and weak digital engagement. Poverty, social isolation and ill health perpetuate each other.

Bridging the health gap: Key actions for stakeholders

A whole-system, whole-life approach is urgently needed to tackle health inequalities. Governments, providers, academics and businesses must integrate their services, working across institutional boundaries instead of in silos. We recommend that:

• policymakers combine and align policies across people’s life-spans to reduce inequality, using a single-citizen identifier, and deliver adequate health and social care funding which includes new models of integrated funding

• public service providers integrate health promotion and prevention across their workforce, and adopt a key-worker approach to help families

• academics develop tools to boost health economics research and make effective use of population data – measuring the return on investment offered by interventions

• charities and companies promote sustainable practices, improve workplace safety and engage in public-private interventions

• citizens improve their health literacy and actively contribute to the design of local and national programmes

• all stakeholders embrace analytics and digital technology to provide more efficient and cost-effective support.