Tackling poverty and its negative effects on health should be as high a priority as addressing the NHS waiting lists, according to a new report by The Kings Fund and the Joseph Rowntree Foundation. 

The report – Illustrating the Relationship Between Poverty and NHS Services – found that despite poverty being very bad for your health those in poverty struggled to access NHS services. 

Sarah Woolnough, chief executive of The King’s Fund, said: 

‘One of the founding principles of the NHS is that it is free at the point of need, yet our analysis shows the cruel irony that many people living in poverty find it harder than others to access the timely care that could help them better manage their health conditions and prevent future illness.

While the NHS can be a force in addressing poverty, as we head towards a general election, widening health inequalities and deepening deprivation must be tackled head-on by government and policy-makers.’

More than one in five people currently live in poverty in the UK and there has been a sharp increase in the number of children living in poverty. The most recent annual poverty figures published on 21 March 2024 show 600,000 more people, half of them children, are living in absolute poverty, the Government’s preferred measure. This has risen for the second year in a row.

It is much harder to live a healthy life when in poverty – with the combined effects of poor living conditions, high-stress levels, and poor diet having both physical and psychological effects. As a result, people in poverty live shorter lives burdened with greater levels of illness than the rest of the population. 

Despite the high need for NHS services for people in poverty, the report found that it is harder for them to access the services that would help them. The report says 30% of people living in the most deprived areas in the UK have turned to 999, 111, A&E, or a walk-in centre because they were unable to access a GP appointment, compared with just 10% of people in the least deprived areas.

Hospital data shows a direct link between higher levels of deprivation and higher emergency admissions, while the increase in length of stay in critical care beds has been greater among more deprived groups.

Between 2017-18 and 2022-23 the average length of stay in critical care increased 27% for people in the most deprived communities but just 13% for the least deprived.

Greater illness and less access to care contribute to worse health outcomes – the mortality rate of the most deprived population is almost double that of the least deprived.

Saoirse Mallorie, a senior analyst at the King’s Fund and senior author of the report, said:

“To improve the nation’s health and use NHS resources in the best way, tackling poverty must be as much of a priority as bringing down waiting lists.

“While the NHS can do more to treat the symptoms of people experiencing poverty, it cannot alone address the root causes. Bolder action from government, economic, and civic society is needed to lift millions of people out of poverty and break this vicious cycle and its impact on poor health.”

This could address poverty, improve health, and reduce pressures and financial implications on the NHS. 

The focus of much media and politician rhetoric is always on the waiting list. Although important, many recent reports highlight that the waiting list is a product of much more than just the Covid pandemic and chronic underfunding of the NHS. 

The pressing need to address the root cause of poverty in this country and the burden it produces on NHS services has been the subject of several recent reports from a combination of charities, think tanks, and royal colleges all with the message that a healthy nation begins with prevention of ill health.

This has been recognised by NHS England as well. Back in 2021, as the country came out of the 2020 pandemic, NHS England was praised for recognising “that inequalities in health and their causes run deep through our society” and for initiating its ‘Core20plus5’ approach to tackling health inequalities. 

There was to be a focus on the 20% of the population in the lowest deprivation quintile and prioritisation of five key clinical areas, i.e., continuity of maternity care for women in the most deprived areas and those from Black, Asian, and minority ethnic groups, annual health checks for those with serious mental illness, chronic obstructive pulmonary disease management (with a focus on Covid-19, flu and pneumonia vaccination uptake), early cancer diagnosis and hypertension case-finding.

However, as this report and several other recent reports have highlighted, the NHS can only do so much – it can not by itself tackle the root causes of poverty and ill health. Without the political will to tackle poverty, the NHS is left just treating the consequences. Furthermore, the NHS’s ability to even attempt to address inequality has been hampered by chronic underfunding.

As Sir Michael Marmot said in January 2024, when the report – Health Inequalities, Lives Cut Short was released: 

“Important as is the NHS – publicly funded and free at the point of use – action is needed on the social determinants of health: the conditions in which people are born, grow, live, work, and age. These social conditions are the main causes of health inequalities.

“I’m saying to party leaders: make this the central plank of the next government – stop policies harming health and widening health inequalities. To MPs: if you care about the health of your constituents, you must be appalled by their deteriorating health.”

The report from the Institute of Health Equity (IHE) at University College London found that more than 1 million people in England died prematurely in the decade following 2011 due to a combination of poverty, austerity policies, and COVID-19.

Other reports that have called for measures to tackle poverty include, from the Association of Directors of Public Health, whose manifesto in late 2023 called for a new Public Health Act, a dedicated health inequalities strategy with clearly defined targets, and a Health in All Policies approach overseen by a cross-government ministerial-level committee to achieve health equity, and a new Child Poverty Act which commits to ending child poverty in all parts of the UK by 2030.

Likewise, in September 2023 the Centre for Mental Health’s report – To a Mentally Healthier Nation – called on politicians to adopt a ten-year, cross-government mental health strategy, including policies to target poverty and discrimination, and environmental factors, including housing and pollution, to improve the nation’s mental health, as well as preventing illness and promoting better health.

Every organisation in the country involved with health and well-being seems to have put their name to a report in recent months that points out to politicians that improving the health of the nation needs concerted action on many fronts, not just a promise of reduced waiting times. 


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