Fewer infectious diseases, lower infant mortality, and reductions in degenerative conditions. These are just some of the many benefits of preventative health measures. But some even more startling evidence has recently emerged with regard to life expectancy in England.

Wealth has long been known as a strong predictor of life expectancy. But new findings paint an even starker picture than previously thought. Moreover, they emphasise the difficulties that governments face in trying to improve the situation by highlighting the factors that impede effective policies and confound honourable intentions.

The report, from Britain’s National Audit Office, reveals that the gap in life expectancy between rich and poor citizens is widening, despite the efforts of the previous Labour administration to narrow it. The current difference has grown to 10 years and, although the poor are living longer, the rate of increase for them is lower than for the better off. Men in the Northern town of Blackpool, for example, live just under 10 years less (73.6) than those in the wealthy London borough of Kensington and Chelsea (84.3).

In its defence, the Department of Health says efforts to equalise life expectancy did not become a national priority until 2006 and so it is too soon to judge the effects of its policies. Indeed, the techniques adopted - such as the widespread prescription of drugs to lower blood pressure and cholesterol, weight and diet management, and the encouragement of exercise - have only been extensively deployed for less than four years.

The financial cost of the life expectancy gap is, though, considerable, whether for the individuals who suffer illness and lost income, or for the government which funds the National Health Service that treats them. There is also an important social justice angle: while the age for receiving a state pension (60 for women and 65 for men) is the same for people regardless of their wealth, the better off enjoy 10 more years of state income and other benefits that come later in life, such as free television licences at 75.

Nonetheless, the causes of the differences in life expectancy are complex. Some individuals undoubtedly contribute to their situation by drinking and smoking, and eating the wrong foods to excess. But poor people are also more likely to live in unsuitable housing in polluted areas, be exposed to danger at work and have an inauspicious genetic inheritance. Moreover, they cannot afford to pursue a lifestyle that compensates for these disadvantages.

All of this confirms for the general population the argument made by the late Jerry Morris, the pioneer of preventive medicine in the UK (a discussion to his work was published in Prevention Action on 5 November 2009), with regards to older people: that the benefits of healthy activities are only forthcoming if the participants’ income is well above subsistence levels. Focusing on the lifestyle choices of individuals is, therefore, important, but this has to be complemented by social programmes targeting the wider causes of ill health.

Reference
National Audit Office, Tackling Inequalities in Life Expectancy in Areas with the Worst Health and Deprivation, 2010

www. nao.org.uk/publications