Deprived are paying with poorer health

People whose annual income is below £10,000 have disability rates four times as high as those whose income is more than £29,000…

People whose annual income is below £10,000 have disability rates four times as high as those whose income is more than £29,000.

The mortality rate of infants of poorer parents is 50 per cent higher than those higher up the socio-economic scale. Ireland has the highest male death rate from heart disease in the EU, at 320 deaths per 100,000. Of these, the death rate is doubled for men who are low-earners and who live in socially deprived areas.

Statistics linking poor health and social deprivation are convincing. While traditional medical care can prolong survival after serious disease, it is social and economic conditions that affect whether people become ill in the first place.

To tackle the causes of ill-health, it is essential to focus on the range of factors that impinge on health. Low income, bad environment, poor housing and community infrastructure, and bad working conditions all affect a person's well-being adversely.

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Education is central to bringing about change, according to Dr Jane Wilde, director of the all-island Institute of Public Health. She believes it builds confidence and opens up employment pathways that in turn lead to the increased income that brings with it better health. It is also crucial in enabling people to access healthcare. A lack of knowledge about services and, in particular, about the value of preventative health undoubtedly affects longevity among the socially deprived.

How do these factors lead to ill health? Take housing. For mothers with young children, a high-rise, dangerous, overcrowded environment with no play space leads to depression and isolation. Because of where they live, the children are more prone to infections and accidents.

The health trust covering south and east Belfast has published a report outlining the impact on health of social and economic deprivation. Its author, Mr Rowan Davison, found east Belfast had significantly higher premature death rates than the North as a whole. There was a strong correlation between increasing levels of deprivation and increasing levels of mortality. Also, the highest infant mortality rates, a particularly sensitive measure of social deprivation, were in the east of the city. "The most common reasons for accessing healthcare is a high level of mental health problems," Mr Davison says. "The use of soft drugs is on the increase also."

What can be done to bring about change? One east Belfast scheme is the IMAGO Project, which trains local people in counselling techniques and befriending. When a GP has a patient who is socially isolated he or she can be referred to the service which aims to integrate the person into cross-community activities.

The South and East Health and Social Services Community Trust is also involved in a SURESTART Programme, a health project giving support to families with children under four to enable them to have a better start in life. For older children, there are plans to reconfigure health services to make them school-based, to ensure adequate nutrition, fluoridation and other preventative measures.

In Dublin, the Healthy Cities Project promotes health and fitness among young people. Senior citizens are encouraged to form a "circle of friends", which helps combat isolation and promotes exercise activities such as dancing and pitch and putt.

If we are to reduce the impact of social deprivation on health we must tackle all-island inequalities in the areas of cancer, circulatory disease, diabetes, immunisation, accidents, infant mortality, nutrition, smoking and alcohol consumption.