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Health Disparities White Paper must level up heart health

Dr Charmaine Griffiths, Chief Executive | British Heart Foundation

5 min read Partner content

For a child growing up in Blackpool – let’s call her Mia – the barriers to good heart health are set early on.

There’s limited green space for her to enjoy and run around in, and the air on the busy street where she lives is polluted. Her parents, working long hours to afford necessities, often have to turn to cheaper, processed food for their family.

Meanwhile, a child from Wokingham – let’s call him Noah – lives in a quieter neighbourhood where he can play outside and breathe cleaner air. Noah’s parents can afford to get healthy recipe boxes delivered, and he has plenty of fruit and vegetables in his diet.

Given her circumstances, by the age of 11, Mia is more than twice as likely to have an obese weight than Noah. This increases her risk of living with obesity as an adult, making it more likely that she will develop diabetes, which would double her risk of having a heart attack.

Meanwhile, Noah’s environment lays the groundwork for better heart health in adult life, helping to protect him from conditions linked to heart disease like diabetes and high blood pressure.

Who you are, where you live and your family’s income should not determine your heart health for life – and yet, far too often, they do. Today there’s a life expectancy gap of about 8 years between people living in the most and least deprived communities in England – and heart and circulatory diseases are the biggest driver of that difference.

This inequality is not inevitable. The upcoming Health Disparities White Paper is a golden opportunity to close this unjust gap. To level up health across the UK, action on heart disease is critical.

To ensure that the White Paper delivers for all children, including those just like Mia, we have three key tests.

1. Preventing ill-health at population-level

As the Health Secretary said in his recent health reform speech, prevention is central to tackling heart disease. We must address its drivers – like obesity and smoking – at their source. The most effective way to do this is by changing the environment we live in.

To address childhood obesity, we must limit junk food marketing, yet Government has recently delayed the introduction of crucial restrictions. We urge them to reconsider, for the sake of children like Mia.

And to improve everyone’s diet, we need mandatory measures to bring down the salt and sugar content of our everyday foods.

We also want to see a polluter-pays levy on the tobacco industry, as recommended in Javed Khan’s recent review. This would raise funds to invest in tobacco control, and target those who profit from selling harmful products.

2. Funding for vital services

Extra support can help people at risk of heart disease to stay healthier for longer, and local prevention services to help people manage their weight and quit smoking are vital to this. However, they have been substantially reduced in recent years due to cuts to Public Health Grant funding.

But this hasn’t been felt equally – areas already facing more health barriers like Mia’s have seen their public health funding drop six times more than in areas like Noah’s.

Despite people from Mia’s community being more likely to need these services, they are often less able to access them, simply making the health gap worse.

Cutting funding like this is a false economy, creating more problems later down the line. Heart and circulatory diseases cost the NHS £7.4 billion a year and without effective primary prevention, that number is only going to go up, and up.

Restoring the Public Health Grant, on the other hand, might require £1.4 billion per year and could help prevent many cases of heart disease, saving families the heartache of a loved one’s illness or early death as well as making economic sense.

3. Reaching under-served groups

When it comes to reducing people’s risk of heart disease, we already know what works. Managing high blood pressure – which is linked to half of heart attacks and strokes – is crucial.

This condition can usually be safely controlled with medicines and lifestyle changes, but the pandemic has devastated blood pressure management services.

Millions of people are no longer getting the support they need, and it has gotten worse through the pandemic. This is a ticking time bomb, with thousands more heart attacks and strokes likely to devastate people’s lives over the next three years.

For those people living in the most deprived areas, who are 30% more likely to have high blood pressure, this is particularly serious. People like Mia’s parents urgently need support to identify and manage this often-invisible condition before it is too late.

To level up the country’s health, we need to make sure that effective health interventions are reaching everybody that needs them. We’ll be looking for the Health Disparities White Paper to improve access to all forms of heart healthcare, prioritising measures which target the most deprived 20% of the population – like the NHS Core20PLUS5 framework.

Heart disease is at the centre of health inequalities – but the White Paper can help change that. With long-term commitments to prevention, access to vital services and healthy environments, we can make sure that Noah and Mia’s generation and those to follow live longer, better, fairer lives. For the sake of our health and our economy, these are three tests we desperately need to pass.


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Read the most recent article written by Dr Charmaine Griffiths, Chief Executive - Political willpower needed to tackle heart disease crisis