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Income-based health inequalities are increasing each decade

More effort needed to stop society’s poorest becoming increasingly dependent on healthcare as they age

Louise Prime

Tuesday, 21 January 2020

The gap in self-reported health between the richest and poorest people of the same age in Britain is growing over time and the health of the poor is now worse than it was a century ago, according to research from University College London. The author of the study*, published in the Journal of Epidemiology & Community Health, called for policies that will reduce these inequalities, to avoid greater demands in healthcare from those least able to manage their own health in later age.

He explained that previous research has already shown that later-born English cohorts in the post-war period have better or the same health in relation to limiting long-term illness (LLTI) but worse or the same health in relation to general health; and that health inequalities in Britain by socioeconomic status have widened since the 1970s. But, he said, much of this research has focused on differences between cross-sectional time points or between areas by level of deprivation.

Instead, the researcher investigated differences in health by birth cohort of individuals after considering their age to see whether later- born cohorts had better or worse health compared with older-born cohorts by income – to allow policymakers to see from where future demand for healthcare will be likely to come and so for whom interventions could be prioritised. He analysed data from repeated cross-sections from the British General Household Survey, 1979–2011, for England, Wales and Scotland, to create ‘pseudo birth cohorts’ born 1920–1970. He then estimated age-adjusted limiting illness and self-rated health (SRH) by household income tertiles, and calculated absolute and relative differences between the poorest and richest income groups.

He reported that absolute inequalities in LLTI between the richest and poorest households have doubled in women and increased by one and a half times in men for those born in 1920–1922 compared with those born in 1968–1970. Relative inequalities in limiting illness increased by a half in women and doubled in men. Absolute inequalities in SRH between the richest and poorest households increased by almost half in women and more than half in men; and relative inequalities increased by 18% in women and 14% in men for those born in 1920–1922 compared with those born in 1968–1970.

He commented: “The results presented here show a widening in health inequalities by income in later-born British birth cohorts, 1920–1970. They point to a greater future demand in healthcare from people in society who will be least capable of managing their health as they enter ages when morbidity becomes more common. The poorest among these later-born cohorts are likely to require more healthcare sooner in life.

“In the absence of policy interventions, there is likely to be a growing inequality by income in premature mortality given the strength of the relationship between LLTI and SRH and morbidity and mortality. This is doubly important because of the growing size of later-born post-war baby boom cohorts up to 1972 that will mean that there is likely to be more people in poor health irrespective of relative declines in the prevalence of LLTI in later-born post-war cohorts.

“More effort is, therefore, required to assist the poorest in society from becoming increasingly dependent on healthcare as they become older.”


*Jivraj S. Are self-reported health inequalities widening by income? An analysis of British pseudo birth cohorts born, 1920-1970. Journal of Epidemiology & Community Health Epub ahead of print: 20 January 2020. doi:10.1136/jech-2019-213186

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