“Health divides: where you live can kill you”: it’s an arresting title, which was fitting for a lecture delivered with the exact same sense of urgency and passion. Part of the Insights series, Clare Bambra – professor of Public Health at Newcastle University, and former lecturer in Health Geography at Durham – gave a talk on 13th November about the relationship between place and health, or how one’s location can affect things like obesity and life expectancy.
Bambra’s research is thorough, and damning: she points to novels written as far back as the 19th century, such as North & South by Elizabeth Gaskell and Charles Dickens’s Hard Times, to suggest that the ‘north-south divide’ has existed for hundreds of years. She then links this to Edwin Chadwick’s 1842 report to show that such a divide has long since extended to life expectancy, when it was found that southerners and those living in rural areas could expect to live longer than northerners and city-dwellers, even when controlling for profession (the divide was present amongst the gentry and professionals, tradesmen and labourers). Today, those living in the north-west, north-east and Yorkshire and the Humber all experience “worse than England average” health outcomes, while southerners enjoy above average health standards.
Such ‘health inequality’ is not just visible on a national scale; Bambra’s analysis of Newcastle showed several years’ difference in life expectancy depending on which Metro station you lived closest to. Those lucky enough to live near the airport can expect to live to around 74.8 years old, far older than the average Fawdon resident, who will die at 66.1 years, nearly nine years younger, despite living just five miles away. Even more extreme is the case of Stockton Town Centre and Hartbum, which, despite being two miles away from each other, have a difference in life expectancy of 15 years. Across the Atlantic, the story is not much better: once “the tallest and the healthiest”, Americans now have one of the highest levels of obesity in the OECD.
The reasons Bambra offers for poor health and health inequality are myriad. She explains that traditional explanations for a location’s healthiness focus either on composition or on context. Composition is influenced by the population of the location; a high drinking or smoking rate will naturally lead to a place being deemed less healthy. Context is determined by features of the location itself, like socioeconomic position, that are largely outside the wider population’s control; a polluted city is a less healthy one, for example, while parents living in an area that isn’t safe aren’t going to let their children play outside, perhaps contributing to their poor health. However, more recently, scholars have tried to offer up explanations that incorporate both composition and context; in America, Bambra points out, the average citizen eats 20% more calories than in Sweden (an issue of composition, or the habits of the population), but poverty (an issue of context) is also an issue, cutting off low-income Americans from affordable, nutritious food, leaving them marooned in ‘food deserts’. Even something as trivial as poor-quality pavements can reduce the ‘walkability’ of an area, making driving the less healthy but more popular mode of transport. As for the north-south divide, Bambra points to higher poverty rates in the north and a larger area of ‘brownfield land’, which is previously developed but now vacant (and often derelict) turf, as explanations for lower health standards.
The final part of her lecture focusses on the political causes of health inequality. Bambra makes no secret of her own political views, happily calling David Cameron a “plonker”, and referring slightly more seriously to austerity, the name given to the series of cuts pursued by the Conservative Party since 2010 as a “project to take from the poor”. She points out that America was left less scarred by WWII than Europe, and so never set up as large a welfare state as many of its western European cousins; as a result, 30 million Americans now live without health insurance, with another 100 million ‘underinsured’. America also has significantly less red tape, a term often used to describe regulation derisively, but Bambra puts up a strong case for it; she explains that red tape can refer to public healthcare rules that stop cigarettes being advertised to minors or protection for workers’ rights – including holiday time, sick leave and maternity leave, all areas in which America lags behind Europe.
Indeed, for all her talk of inequality, Bambra is far from a doomsayer; she talks excitably about how the seemingly insurmountable gap in life expectancy between East and West Germany in 1990 (four years for both men and women, when the two countries were reunified in 1990) was eliminated in just two decades (the difference stood at just six months for men, and was practically closed for women, in 2010). She is willing to ruffle Old Labour feathers and praise Tony Blair’s Health Inequality Policy, which decreased the gap in the Infant Mortality Rate between the most deprived local authorities and the more affluent majority. In short, she has seen change before and seems convinced it can happen again; in talking with her after the lecture, she already has ideas. The scrapping of the Health and Social Care Act 2012, which many feared would open the NHS up to privatisation, is top of her priorities, followed closely by an increase in healthcare spending in poorer and northern areas. After the lecture, she signed books, and after hearing her talk so enthusiastically and articulately, it was plain to see that her loyal following was well-earned.
Last modified: 26th November 2018