Health and Care Services

The rich are getting healthier, the poor are not?

24 November 2016

Article by Sarah Hatherley, National Assembly for Wales Research Service

Darllenwch yr erthygl yma yn Gymraeg | View this post in Welsh

Too many Welsh people still die prematurely, is the message from Wales’ Chief Medical Officer’s Annual Report. 

Wales’ new Chief Medical Officer (CMO) has used his first annual report to focus on health inequalities. Dr Frank Atherton says that the overall health of the Welsh population is continuing to improve, along with a decline in the death rate. However, the gaps between those with the best and worst health and wellbeing still persist and in some cases are widening.

Where you live, what you earn and how long you stay in education may all affect your health. For example, men living in the poorest parts of Wales will on average die 9 years earlier than men living in the richest communities.


The CMO describes health inequalities as unfair, avoidable and something which we should no longer be prepared to accept or tolerate.

Health inequalities

Health inequalities are the avoidable differences in people’s health across social groups and between different population groups.  They are most commonly associated with socio-economic inequalitiesHealth inequalities do not occur randomly or by chance, but are socially determined by circumstances largely beyond an individual’s control. These circumstances disadvantage people and limit their chance to live a longer, healthier life.

The CMO’s Annual Report, ‘Rebalancing healthcare. Working in partnership to reduce social inequity’. 

The key messages from this year’s annual report are:

Child health gaps are unacceptable 

The CMO’s annual report focuses on tackling inequality, particularly in the early years. Simply by growing up in a poor area in Wales, a child is more likely to have poorer health that will impact of the rest of their lives. It is vital children have the best possible start to their lives, says the CMO. His report focuses on the first 1,000 days of a child’s life, highlighting the importance of a healthy mother, a healthy pregnancy and a healthy early childhood. The report draws particular attention to infant mortality rates, which are highest in the most deprived areas of the country. Similarly, the report uses the examples of childhood obesity, childhood injuries and tooth decay to illustrate the impact of poverty on children’s health.

Maximising the impact of the NHS in tackling health inequalities

The CMO insists that the NHS can do more to tackle health inequalities; to ensure services reach the most deprived people and to lessen the overall demand on services. He says that healthcare services can contribute through prevention of poor health for those most at risk and by promoting equality of access to and outcomes from service provision. The CMO wants to prompt the NHS in Wales to look seriously at what it can and should do in terms of planning, partnership, use of resources and interaction with local communities in order to address these problems.

Good health depends on much more than the provision of a good health service

The CMO’s annual report also makes clear that public services need to work together to better target people who are disadvantaged. The report emphasises that public sector bodies need to work together to target resources at health inequalities and monitor their collective performance. It is not clear how much money Health Boards and councils spend in this area, or what it is spent on.

A strong message from the report is that taking collective action across services and organisations is vital to deliver fairer and better health outcomes. The CMO’s annual report makes specific reference to the Future Generations (Wales) Act 2015 and the Social Services and Well-being (Wales) Act 2014, which provide a framework for creating an environment for better health in Wales.

Stakeholder views 

The focus on health inequalities has been welcomed by many stakeholders in Wales, including the British Medical Association (BMA) Cymru, the Royal College of Paediatrics and Child Health (RCPCH), and the Welsh Local Government Association (WLGA), who all agree that more needs to be done to reduce the health divide between rich and poor.

The newly appointed CMO is well regarded among health professionals; he is recognised as someone who can work effectively with clinicians and the public to help tackle the challenges to the NHS in Wales. However, shaping the environment so that people in Wales can be as healthy as they possibly can be is not an easy task. The CMO’s annual report recognises that tackling inequalities is not straightforward, and that NHS Wales’ function will have limited impact in isolation.

Dr Frank Atherton was appointed Wales’ new Chief Medical Officer on 27 April 2016. He is responsible for providing independent professional advice to the Welsh Government. His annual report was published on 11 November 2016. It will be debated in Plenary on 29 November 2016.

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