Health linked to people's wealth, study on ageing finds

Those in the poorest fifth of the population are 10 times more likely to die in their 50s than those in the richest fifth - and five times more likely to die between the age of 60 and 74.

The striking inequalities shown by the English Longitudinal Study of Ageing [ELSA] are not due to unequal access to healthcare.

"We were pleased to find that the National Health Service is delivering equally good care across the socio-economic spectrum, regardless of wealth," said Professor Sir Michael Marmot [UCL Epidemiology & Public Health], the study leader who launched the findings at a conference in London yesterday.

Sir Michael … said a complex range of lifestyle, social and psychological factors were responsible for the fact that almost every significant disease occurred more frequently among poorer people as they become older.

Although some direct causes of ill health, such as smoking and obesity, were more common in less wealthy groups, these did not come close to explaining the disparities discovered. "The place to start looking for explanations is earlier in life," Sir Michael said.

"The relationship between health and wealth is affected by childhood conditions, education, what happens to you in employment and whether you feel secure and in control of your life." …

Previous research by Sir Michael has shown that hierarchical societies inevitably have health inequalities, because those at the bottom suffer psychological stress even if their physical needs are met in full. "The real interest of ELSA is the finding that this continues into old age. Some people had speculated that the weaker members of the lower economic groups would die off and the survivors might not show the effect," he said.

Even so, Sir Michael said policymakers should not take a fatalistic view of the findings or conclude that nothing could be done, short of a wholesale redistribution of wealth. "Raiding the bank accounts of the rich and giving the money to the poor is not a viable option," he said. "The challenge is not to abolish hierarchies but to understand better what links your position in the hierarchy to your health and then to do something about it." …

Clive Cookson, 'Financial Times'